Issue Position: Health Care

Issue Position

Health coverage in Connecticut is phenomenally expensive. We spend more per person than all but five states, and the average family premium for employer-based insurance now surpasses $13,000. Health care costs are breaking the bank for small businesses, families, and state government-$7 billion of our $19 billion budget goes to health care.

Despite such spending, most of us know firsthand the problems of our health care system: eye-watering paperwork, long waits, disparities in access, and inconvenient office hours. And those with insurance are the lucky ones-over 400,000 Connecticut residents-1 in 7-lack coverage at all. We need to spend less and get more.

Connecticut families and businesses can neither afford nor accept the status quo. As governor, I will lead bold, sweeping reform of our health care system, building on federal legislation and the state's own efforts. With reform, we can save Connecticut families more than $30 billion over the next decade.

* I will use the state's $7 billion in purchasing power to spread consistent health information technology statewide. Different local systems should be able to talk with one another so that critical medical records are available when needed, wherever the patient may be.

* I will work to provide patients more information. The price and quality of a given treatment can vary dramatically from hospital to hospital; by letting people comparison-shop, we can bring down costs and raise up quality.

* I will leverage the state's purchasing power to phase in payment reform over time. Rather than a "fee for service" model that rewards providers for the volume of tests and services they perform, we should pay based on how patients fare.

* I will require providers serving state populations to report quality and safety metrics such as readmissions and hospital-acquired infections. I will provide enhanced reimbursement to the top third of providers to start a race to the top.

* I will establish "medical homes" for groups covered by the state, paying providers to work together with patients to personalize care, provide round-the-clock access, and make certain that no one is lost in the system.

* I will reward state employees who take care of themselves. We'll reduce co-pays or give rewards, like a $50 savings bond for expecting mothers who go to all of their prenatal care visits.

* I will make Connecticut's schools the healthiest in America. They will have salad bars, limits on junk food, and full-time PE. Most of our schools are already moving in this direction; I want to make it 100%.

* I will appoint a long-term care czar who will ensure adequate long-term care capacity and give people more choice to age at home, rather than in a nursing home.

* I will work with providers to make community-based mental health care a better option for more adults and children. For instance, we will preserve families by keeping children at home whenever possible.

Our families, businesses, and budget are desperate for relief, and our future prosperity is on the line. With the right leadership, Connecticut can lead the nation in health care innovation. Our entrepreneurs can market their innovations to other states, creating jobs and giving our citizens the health care system they deserve. But we can just as easily miss this opportunity. We will either lead or lose-and I am ready to lead.

Ned's Plan for Affordable, Accessible Health Care
Introduction

Health coverage in Connecticut is phenomenally expensive. We spend more per person than all but five states,1 and the average family premium for employer-based insurance now surpasses $13,000.2 Health care costs are breaking the bank for small businesses, families, and state government-$7 billion of our $19 billion budget goes to health care.3

Despite such spending, most of us know firsthand the problems of our health care system: eye-watering paperwork, long waits, disparities in access, and inconvenient office hours. And those with insurance are the lucky ones-over 400,000 Connecticut residents-1 in 7-lack coverage at all. 4 We need to spend less and get more.

Connecticut families and businesses can neither afford nor accept the status quo. As governor, I will lead bold, sweeping reform of our health care system, building on federal legislation and the state's own efforts. Although it won't all happen overnight, I will implement state-of-the-art health IT, change how we deliver care, promote healthy lifestyles, treat mental health at parity with physical health, and make sure those who need long-term care can choose to stay in their homes if possible.

With these reforms, Connecticut and its entrepreneurs can lead the way in health care innovation-what we pioneer here can spread nationwide. We can also save money. We can save Connecticut families more than $30 billion over the next decade, and shave $900 million/year off projected state Medicaid spending by 2025.

What we need is leadership. In 2006, I stood up to the political establishment, and I will stand up again, to all those who say reform is just too hard. Together, we can provide better care to more people at lower cost. It is a moral imperative-and an economic necessity-to reform health care in Connecticut, and I have a plan to do just that.
Where Does the Money Go and What Can We Do?

Throughout our health care system, for people of all ages, we have a problem-waste, inefficiency, and unnecessary care. We must improve the management and practice of health care to reduce cost, while assuring quality is not compromised.
1. Health Information Technology (HIT)

We use shockingly little 21st century IT in health care. Not long ago, a report found Medicaid applications being filed, then couriered to the DSS Central Office, where they were then sorted and sent to district offices for processing.5 At best, it took four employees and days. It could have been one employee and seconds.

We need automated systems that provide the right information to everyone, so that one doctor knows what tests another performed, so the ER nurse knows what medications you're on, so patients can see the cost of care and quality of providers. We all make better choices when we are well informed.
Staggering costs stem from inconsistent treatments and medications. Patients with multiple diseases, the elderly in particular, can't be expected to remember every medication and diagnosis from a half dozen doctors. Electronic health records are critical. As governor, I will wire Connecticut's hospitals and doctor's offices like I wired college campuses across the United States.

* I will use the state's $7 billion in health care purchasing power to drive change. I will encourage a basic level of HIT and offer incentives to providers going the extra mile.
* I will aggressively support Connecticut providers in their pursuit of federal funding for HIT and work closely with eHealthConnecticut to guide providers in its implementation.
* I will encourage consistent HIT standards across the state. Different local systems should be able to talk with one another so that critical medical records are available when needed, wherever the patient may be.
* I will work to provide patients with more information. The price and quality of a given treatment can vary dramatically from hospital to hospital; by letting people comparison-shop, we can bring down costs and raise up quality.

A well-regarded study by Rand found HIT-related savings could reach $12 billion over the next 10 years in Massachusetts. Adjusting for population, Connecticut could save $6.5 billion over a decade.6
2. Health Care Delivery

We must begin reengineering how health care is delivered, producing better outcomes at lower cost. As governor, I will implement proven models from around the country, starting with those groups the state covers, from state employees to HUSKY enrollees. If we support innovation like this, Connecticut and our entrepreneurs can lead the nation.

Pay for results, not activity. Today the most common health care payment method is fee-for-service, which rewards providers for the volume of tests and services they perform rather than for how their patients fare. Instead, we should pay providers one "bundled" payment for all care related to a particular condition, like cataract surgery or congestive heart failure.

The Geisinger Clinic in Pennsylvania does this to great effect. Not only does Geisinger charge a flat rate for coronary bypass surgery and all the testing and care that go with it, they issue a guarantee. If you have to go back in because of a preventable complication, it's on Geisinger. They've seen a 45% decrease in readmission.

Given the incentive to get things right the first time, Geisinger relies on best practices known as "evidence-based medicine." Under these guidelines, Geisinger has seen a 60% drop in neurologic complications for coronary bypass.7

It can be done here too. Payment reform, together with better HIT, will encourage innovation throughout our state's doctor's offices, clinics, and hospitals.

* I will use the state's $7 billion in purchasing power to phase in payment reform over time, starting with the costliest procedures. With $7 billion in the balance, it will make sense for providers to commit to this change.
* I will take advantage of all federal support available for payment reform, making sure we draft first-rate applications for grants coming from the Center for Medicare and Medicaid Innovation.
* I will require providers serving state populations to report quality and safety metrics such as readmissions and hospital-acquired infections. I will provide enhanced reimbursement to the top third of providers to start a race to the top.

Rand has estimated Massachusetts could save up to $39 billion over 10 years by bundling payment of medical services. Adjusting for population, Connecticut could save up to $21 billion over a decade by paying for results, not activity.8

Drive primary care coordination and expansion. Every patient deserves an informed caregiver who can quarterback his care-whether in a private office or federally qualified health center.

The key is providing everyone a "medical home," paying providers to work together with patients to personalize care, provide round-the-clock access, and make certain that no one is lost in the system. Coordination leads to better care at lower cost.

Many practices in Connecticut are in the process of developing medical home programs. For instance, ProHealth Physicians will serve more than 100,000 patients using this model. Patients with multiple conditions benefit especially from medical homes; although they account for a small part of the population, they generate half of all medical costs.

Federal reform offers considerable support for primary care providers, but we must make sure they have the capacity to handle the coming surge of newly insured. Already, too many people use the emergency room for non-urgent care. Many have insurance but go because their doctor's offices aren't open after work.9 This is not acceptable. We must make primary care available where and when people need it.

* I will push for medical homes for groups covered by the state, and make every effort to participate in federal pilot programs and receive grants for medical homes.
* I will encourage employer-based clinics, so care is available when and where employees need it, and I will support expansion of federally qualified health centers.
* I will work to have all clinical professionals, like physician assistants, working at the "top of their licenses"-we will need all their help to deal with the wave of new primary care patients.
* I will provide loan repayment for students at our state colleges and universities who train for and practice primary care in state after graduation.

Based on Rand's study of Massachusetts, Connecticut could save $3 billion over the next 10 years by moving to the medical home model.10

Encourage patients to make better health choices. Billions of dollars are wasted because patients don't follow through on their treatments. This means dollars spent on medicine not taken, and on more expensive treatments when conditions worsen as a result. We need to encourage patients to be more engaged in and accountable for their own health.

Consumer-driven health plans and value-based benefit design are two ways to encourage people to follow the doctor's orders, rewarding them for taking better care of themselves. Companies with these plans, like Pitney Bowes, have given money freed from health care back to employees in the form of lower insurance premiums and bigger 401(k) contributions.

* I will create a program to reward state employees who take care of themselves. We'll reduce co-pays or give rewards, like a $50 savings bond for expecting mothers who go to all of their prenatal care visits.
* I will bring together employers with and without consumer-driven health plans and value-based benefit designs so they can share cutting-edge practices.

3. Healthy Lifestyles

Where else does the money go? It pays for conditions like heart disease that crop up when people don't have healthy eating habits. Our children are particularly at risk. They belong to the first generation that may live shorter lives than their parents, a sad reality driven by obesity and diabetes.11 In Connecticut, obesity costs the state over $400 million per year in the Medicaid program alone.12

As the CEO of a small business, I believe that markets work, that if good food is available at fair prices, people will buy it. As governor:

* I will eliminate "food deserts," figuring out ways to get healthy and affordable food to areas without it. Regular Fresh Direct or Peapod deliveries to churches and community centers could go a long way.
* I will make Connecticut's schools the healthiest in America. They will have salad bars, limits on junk food, and full-time PE. Most of our schools are already moving in this direction; I want to make it 100%.
* I will lead state government towards better eating. I will limit junk food in vending machines and cafeterias in state facilities and encourage state employees to embrace healthier lifestyles.

4. Nursing Home Care

Nursing home costs can be overwhelming for the average family, and they're swamping our state budget as well. In 2009, the state spent $1.6 billion on institutional care for 19,000 people under Medicaid. And the problem will only get worse: by 2025, Connecticut will have 40% more people over 65, and long-term care spending will more than double.13

Traditionally, Medicaid paid only for institutional long-term care. As a result, many people who could have been cared for in the community have gone to nursing homes instead.

Across the country, states have moved from costly nursing homes to more affordable, more popular community-based care. States like New Mexico and Oregon spend markedly less and report much higher satisfaction. People prefer to age at home.14

However, in 2008 Connecticut only spent 36% of its Medicaid long-term care dollars on home and community-based care-the rest went to institutions. New Mexico, on the other hand, spent 73%.15 Connecticut is behind: only two states have a higher percentage of seniors in nursing homes.16 There has been a profound lack of leadership, and we are wasting hundreds of millions in taxpayer dollars each year.

Focus long-term care leadership. The state's current goal is to increase the percentage of people receiving home and community-based care from 53% to 75% by 2025. That would mean savings of $900 million in 2025.17 Why wait until then? If New Mexico can do it, so can Connecticut.

* I will appoint a long-term care czar who will give people more choice and ensure long-term care capacity and quality. Our seniors deserve excellent nursing homes and community-based care.
* I will integrate the many different long-term care programs and agencies-we must fix and focus today's fragmented system.

Reform long-term care payment and simplify access. I will work within the new national health law to develop a long-term care system that pays for the care people need, in the setting best for them. The system will be flexible, allow patient choice, and focus on patients' level of need without regard to age or type of disability.

Our current system is confusing and upsetting to many of our most frail citizens. We must treat our elderly and disabled with more respect and get them the services they deserve more efficiently.

* I will work with the federal government to allow home and community-based providers to receive Medicaid reimbursement for the services they provide, so that people can be cared for at home if they choose, depending on their level of need.
* I will speed development of four PACE (Program of All-Inclusive Care for the Elderly) sites, which specialize in keeping people with a high level of need in the community. These programs could be particularly effective in our cities.

5. Mental Health Care

The same leadership void that affects long-term care plagues mental health care in Connecticut. During any given year, 1 in 4 adults suffer from mental disorder.18 Yet, care is too often fragmented and insurance coverage inadequate-despite a parade of commissions and studies over the years.
As governor, I will act. We cannot afford for so many people, from veterans to children, to fall through the cracks: it is neither humane nor cost-effective. Early intervention can prevent more serious conditions later, just as preventative efforts do in traditional medicine.

* I will fix the gridlock between state and local agencies and link their data systems to allow effective communication between mental health professionals.
* I will provide better public education to reduce the stigma associated with mental illness and encourage people to seek help when needed. Stigma is real, and it impedes access, treatment, and recovery.
* I will work alongside providers to make community-based care a better option for more adults and children. For instance, we will preserve families by keeping children at home whenever possible.

Conclusion

We live in a unique time for health care. We face great challenges: a severe recession is taking its toll on our pocketbooks and on our health-we all know economic worries fuel unhealthy stress. Yet we have new opportunities. Last year, we passed Sustinet, a health plan that will encompass people currently covered by the state. Under my watch, it will also allow small businesses and municipalities and those without employer health insurance to buy into the same pool as state workers, relieving some of the burden of insurance premiums.

Sustinet is an opportunity for real change. As governor, I will appoint a strong health care executive who implements best practices from across the nation. GE has been a pioneer in using its $2.5 billion in purchasing power to drive change in the quality and cost of its care. Good health is good business-healthy workers are more productive. Imagine what we can do with more purchasing power than GE.
Connecticut needs a governor who will capitalize on this opportunity, who will fix what is broken and build on what works. Our families, businesses, and budget are desperate for relief, and our future prosperity is on the line. With the right leadership, Connecticut can lead the nation in health care innovation. Our entrepreneurs can market their innovations to other states, creating jobs and giving our citizens the health care system they deserve. But we can just as easily miss this opportunity. We will either lead or lose-and I am ready to lead.

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