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IN THE STATES: Vermont Pushes for Lower Cost, Quality Care
Long before the federal government began its big push to reform the U.S. health care system, states were feeling the strain of rising health care costs and increasing numbers of uninsured. Many states decided to take a crack at health reform in their own way. We've heard a lot about reforms in Massachusetts, but other states have also made progress.
One such state is Vermont. USA Today highlights some of the quality innovations in Vermont that have helped the state save money and improve efficiency. Rather than start with the goal of universal coverage like Massachusetts, Vermont started working towards two other aspects of health reform: lowering cost and improving quality of care. (It already had a -- relatively -- low rate of uninsured residents, and including when Howard Dean was governor, the state had taken steps to cover most children and pregnant women, and as we'll see in a moment, it is also working on covering more adults.)
Among other cost saving measures, Vermont has made good use of health information technology and programs that encourage disease prevention and management. For example, using health IT, doctors can see (if patients consent, of course) whether or not patients filled their prescriptions on time. Helping patients adhere to treatment recommendations such as taking their medications correctly and consistently improves health outcomes and in the long run lowers costs, because patients don't seek as much emergency treatment for serious conditions, relapses and complications.
The state's Blueprint for Health helps patients manage costly chronic conditions such as diabetes through a team-based approach to care, reports USA Today. Primary care doctors work with community health specialists such as nutritionists and social workers to coordinate care for each patient. The pilot program includes approximately 60,000 people.
Vermont even offers a plan for low income residents to acquire health insurance, Catamount Health. The program is priced on a sliding scale and contains all the benefits mandated by the state, including hospitalization and drug coverage, doctor visits for primary and specialty care, and mental health and substance abuse treatment. Vermont set the goal of near universal coverage by 2010. They're not there yet, but they've managed to reduce their uninsured population from 9.8 to 7.6 percent over the past couple of years.
Financing for the Vermont reforms comes from contributions by hospitals and insurers, an 80 cent tax on cigarettes and a penalty of $365 for each employee for businesses that do not offer health insurance, says USA Today. The federal government also allowed Vermont a little more flexibility in Medicaid spending.
Though the program is too new to have data on definite cost savings, reformers are optimistic. According to USA Today, Vermont has already seen a 30 percent drop in emergency room utilization. Savings from increasing the quality and efficiency of care aren't immediate (and sometimes they are difficult to score), but they are there -- and they're vital to creating an affordable, sustainable health system in the long run.
Higher quality care and lower costs are part of the goal for health reform, but they don't complete the package. When we have truly meaningful health reform, we will have coverage for all Americans, better care, and lower costs in a stable, sustainable health system.
In Connecicut. progressive reformers have already won
Vermont is moving in one direction.
But Connecticut is only moving forward.
On July 20th, our state House and Senate successfully overrode Republican Governor Rell's veto of the SustiNet health care reform plan - one of the most ambitious plans for universal health care anywhere. The SustiNet law mandates the creation of a nine member committee to be known as the SustiNet Board. The board, co-chaired by State comptroller Nancy Wyman and State Healthcare Advocate Kevin Lembo, will lay out the steps for implementing a plan to provide health insurance to the state's 325,000 uninsured and to broaden the range of insurance options available to employers.
The centerpiece of SustiNet involves making the state employees plan self-insured, then opening it up (with quality care and sliding-scale affordable rates) to: the uninsured; Medicaid recipients; small business employees; nonprofit employees; municipalities; and individuals who have unaffordable or inadequate employee –sponsored plans.
According to health economists Jonathan Gruber of MIT and Stan Dorn of the Urban Institute, SustiNet will return $2.80 to employers and employees for every dollar invested by the state.
In the insurance capital of the country, with a Republican Governor, a broad-based coalition of small business owners, providers, faith leaders, union leaders, health care advocates and other stake holders beat the odds.
If we can do it here, you can do it there.
More about SustiNet is at: www.healthcare4every1.org.
A strong public plan option IS winnable
Vermont may be going one way.
In Connecticut, we are only moving forward.
The most important part of health care reform is winning - without giving away the store, the farm, the house, the goat, and three of the four kids. And with a strong public plan option.
We just did it in Connecticut. So it can be done.
On July 20th, our state House and Senate successfully overrode Republican Governor Rell's veto of the SustiNet health care reform plan - one of the most ambitious plans for universal health care anywhere. The SustiNet law mandates the creation of a nine member committee to be known as the SustiNet Board. The board, co-chaired by the State Comptroller and the State Healthcare Advocate, will lay out the steps for implementing a plan to provide health insurance to the state's 325,000 uninsured and to broaden the range of insurance options available to employers.
The centerpiece of SustiNet involves making the state employees plan self-insured, then opening it up (with quality care and affordable rates) to: the uninsured; Medicaid recipients; small business employees; nonprofit employees; municipalities; and individuals who have unaffordable or inadequate employee–sponsored plans.
According to health economists Jonathan Gruber of MIT and Stan Dorn of the Urban Institute, SustiNet will return at least $2.50 to employers and employees for every dollar invested by the state.
In the insurance capital of the country, with a Republican governor, a broad-based coalition of small business owners, providers, faith leaders, union leaders, health care advocates and other stake holders beat the odds.
If we can do it here, you can do it there.
More about SustiNet is at: www.healthcare4every1.org.
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