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Driving Value into Rhode Island’s Health Care Coverage and Delivery System

HealthRIght’s Strategy June 2014- June 2015

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Call to Action: Health Care Reform in Rhode Island

Why do we need more health care reform?• Health care costs are unaffordable, and getting worse. What value do we get?

• By 2037, the average cost of family health insurance premiums will be higher than median household income.1

• The cost of health insurance premiums has increased by 119% since 2001, far-outpacing inflation which increased 29%.2

• The RI General Assembly has less than 1 staff on each side that works on health policy; legislators have limited time to study reform proposals. They need the community to lead them.

• Many Rhode Island groups—public and private—are working on improving health care in our state, but there is limited unity to their work.

• The largest interests in health care- hospitals, providers, insurers and government- repeatedly fail to include consumers and advocates at the decision-making table.

How can we collaborate to make meaningful change?

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Health Care Authority Bill Overview

Why do we need the Health Care Authority Legislation?• By 2037, the average cost of family health insurance premiums will

be higher than median household income.*

What is RI doing about driving value into our system?• Health care costs are the largest single line item in the RI state

budget. How can we be sure that federal health care reform achieves

the high quality health care system that Rhode Islanders deserve and can afford?

• Many Rhode Island groups—public and private—are working on improving health care in our state. How can we collaborate to make meaningful change?

*Young, DeVoe. Ann Fam Med 2012;10:156-162.

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Health Care Authority Bill Overview

What does S2533/H7819 do? Establishes Unified Vision: Sets a vision for true health care reform,

establishes a commission with the necessary authority to design the pathway to achieve it.

Drives Value: Establishes proven mechanisms for cost containment: global budgeting, aggregated purchasing dollar while preserving quality.

Creates a Predictable Playing Field: Establishes effective and rational collaborative planning, creates a robust mechanism for enforcing cost control, streamlines government processes, allows coverage regardless of employment status.

Builds on work already done: Enables RI to apply for the State Innovation Waiver, which releases restrictions on millions of dollars in federal funds as long as we achieve health care benchmarks.

Senate sponsors: Goldin, Nesselbush, Cool Rumsey, Conley and MillerHouse sponsors: Ferri, Coderre, Cimini, Naughton, McNamara

Catch Up: Findings from Spring 20141. What we learned this legislative session

a. ACA: Few legislators understand the benefits of the ACA and why it is essential that we embrace and enable its different components The 2015 legislative session will focus on HSRI’s sustainability

b. HealthRIght’s Reform Goals: Senate was interested in S2533, but no update as of now; hoping House Finance will hear H7819, still waiting. The 2015 legislative session is an opportunity for HealthRIght to pass meaningful reform-

but how? In parts, or whole? What groundwork do we need to do starting this summer?

2. Why we need HealthRIghta. Success in other states had: unity of vision, tight coordination of advocacy and

allied faith groups, astute legislative strategy, funding, data and—gubernatorial leadership. Models: “Collective Impact” (FSG/Stanford) and “Systems of Action” (Community Catalyst)

b. Other health care reform groups are engaged in direct implementation of the ACA and service: HealthRIght is the only independent organization that can look at the big picture

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THEORY OF CHANGE: ACTIONSHealthRIght’s Platform for Change 2014-2015

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Theory of Change: Goals

Identify and pursue the pathway from our current health care system one that is affordable, accessible and high-quality:1. Coordinate communications to consumers and among consumer-service group;

2. Guide Rhode Island policy makers to use the tools presented in the Patient-Protection and Affordable Care Act (ACA) to accomplish reform in RI:

1. HealthSourceRI- the health benefits exchange2. State Innovation Model Testing- federal funds to fund delivery systems reform3. Existing health policy bodies: HCPAAC, HIAC, ECHCRC4. Existing public and private reform efforts: CSI-RI, Coastal, etc.

3. Enable RI to win the 2017 State Innovation Waiver* so that the state can use federal funds to implement a better system.

*The state innovation waiver is a provision of the ACA that would allow states to apply to use federal funds for health insurance coverage to run a different type of system that still meets the goals of the ACA.

RI has done well with expanding insurance coverage. But we are not done with reform.

By 2038, average household income > average house hold health care costs.

What are we going to do about it?

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Affordability

Coverage for EVERYONE

Delivery System Reform

Mechanisms for Containing Costs

Coordinated Health Planning

Models of Health Care Coverage and Delivery System Reform

ACA

Active Purchaser

Single Payer

All of these models need the same basic components in place in order to successfully deliver high quality, affordable care to all consumers. They differ in the degree to which they accomplish affordability and coverage.

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Taking action where there is agreement moves us in the right direction

Everyone should have coverage

Delivery system needs improvement and

efficiency

Coordinated health planning promotes

efficiency and better regulation

Population Health focus drives quality

Rhode Islanders agree that…

Active Purchaser

Single Payer

Successful ACA Implementation

Regardless of the ultimate model:

How do we move these pieces forward?

We need all of these components for an

affordable/accessible/quality system.

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How do we use the ACA and other RI-based efforts to drive towards a better health care system?

ACA mechanism

HealthRIghtPolicy

Actions Allies

?5 Principles for Pop. Health

Represent principles in state-level reform efforts

Dept. of Health, CSI-RI, PPSNE, RIPIN, RI Kids Count, RIHCA, RIHCP, RIQI (?)

HSRI provides leverage for consumers to demand coordination

Health Policy Office legislation: streamline reg. processes

• HCPAAC membership

• Legislation proposed

RIBHG, Small Employer TF

State Innovation Model & Waiver

9 Principles for Delivery System Reform

• Support/guide SIM/SHIP

• Legislation for RI to pursue Waiver

Dept. of Health, CSI-RI, RIPCPC, labor (?)

HSRI expands coverage to individual, small group and Medicaid

Ultimate expansion of HSRI as *the* marketplace for insurance purchases

• Support legislation to protect and expand HSRI

• Support RIHCP

Full list

Everyone should have coverage

Delivery system needs improvement

and efficiency

Coordinated health planning promotes

efficiency and better regulation

Population Health focus drives quality

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How do we work collaboratively to achieve an affordable, accessible, high-quality health care system?

Action Model: Community Catalyst’s “System of Advocacy”

• Who plays which role in RI? • What functions are missing? • How do we articulate a shared goal? • How do we pursue it?

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Non-Government Organizations Concerned with Health Care in Rhode Island

• Chronic Care Sustainability Initiative (CSI) of Rhode Island• Economic Progress Institute (EPI)• Planned Parenthood of Southern New England (PPSNE)• Small Employer Health Insurance Task Force (at Providence Plan)• Rhode Island AFL-CIO• Rhode Island Federation of Teachers and Health Professionals (RIFTHP)• Rhode Island Health Care Association (RIHCA)• Rhode Island Health Coverage Project (RIHCP)• Rhode Island Kids Count (RIKC)• Rhode Island Parent Information Network (RIPIN)• RI Medical Society• RI Primary Care Physicians Corporation (RIPCPC)• Service Employees International Union (SEIU) RI• United Nurses and Allied Professionals (UNAP)

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System of Advocacy: RI Health Care Reform*…DRAFT…

Role Responsibility Orgs W/Capacity

Policy Analysis and Advocacy

Analyze complex data, legal and policy issues to develop winnable policy alternatives

HealthRIght, EPI

Resource Development

Generate resources: Services for pay, Foundations, Donors

All have to do this: some thought on larger coalition support

Grassroots Organizing

Build an active grassroots network Small Employer Health Insurance Task Force, RIHCP, Labor (UNAP, SEIU, AFLCIO)

Campaign Development

Develop and implement health policy campaigns

HealthRIght, Labor groups (UNAP, AFL-CIO, SEIU, Laborer’s); PPSNE,

Coalition & Stakeholder Alliances

Build and maintain strong broad-based coalition and stakeholder alliances

HealthRIght, MHARI, NHPRI, RIMS, RIBGH, RIHCP, Small Employer Health Insurance Task Force

Communications Design and implement communications strategies

Not currently coordinated

• Thanks to Community Catalyst for this framework.• Areas in *red* are somewhat weak right now.

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HealthRIght’s Actions 2014-2015

AMPLIFY public debate

CATALYZE Legislative

Action

ENGAGE new coalition members

DRIVE State-Lead Health Care Reform

Efforts

•Outreach to legislators to explain how HC reform tools can benefit RI

• Work with legislators to guide reform towards affordability, quality and accessibility

•3 Public forums, each with different target audience•Expand monthly meetings •Media: publications, social media, radio/TV•Educate policy-makers

•Target providers, entrepreneurial

community, families, graduate students

(med, nursing, policy, public health)

S.2533H.7819

2 Fall Events

•HCPAAC/other councils

•Large representation at state meetings

•Active engagement before/after meetings with leadership

• Partner w/ other coalitions (Small Employer TF, RIHCP, UHCAN, other NE states

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HealthRIght’s Strategic Plan June 2014-June 2015Objective Action When How You Can Help

Amplify public debate concerning reform

• Outreach to policy makers• HC Costs Forum @RIF• Gubernatorial Candidates

Forum on Health @Brown• Engage media• Public poll on HC costs

SummerSept.Oct.ongoing

• Content Committees for 2 Forums• Help design public poll on HC

costs• Email Betsy news and research

articles to post• Write for us: blogs, tweets

Drive state-wide health care reform efforts towards a unified vision

• HCPAAC/other councils• Large representation at state

meetings• Active engagement

before/after meetings with leadership

Ongoing • State that you are a member of HealthRIght at public meetings

• Tell Betsy when you’re going so we can coordinate messages

• Meet with leadership, bring HRT materials

Catalyze legislative action

• Outreach to legislators to explain how HC reform tools can benefit RI

• Work with legislators to guide reform towards affordability, quality and accessibility

Summer-Fall

• Help Betsy map identify potential allies (who will be present in 2015)

• Meet w/all potential allied policymakers using HRT materials

• Help Betsy meet w/all gubernatorial candidates

Engage new coalition members

• Target new members: providers, entrepreneurs, families, grad students…

• Partner w/other coalitions locally, regionally, nationally

Ongoing • Bring people to HRT meetings• Talk about HRT to your

friends/colleagues

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Don’t get overwhelmed. Here’s what you say about what HealthRIght is doing:

• Much of this work has already been happening; HealthRIght is trying to coordinate and amplify everyone’s efforts.

• For this year, groups and individuals supporting HC reform will be more successful if we can agree on overarching goals. Those could be:– Defend HealthSource RI– Win the State Innovation Model grant– Support coordinated health planning– Sign on to HealthRIght’s reform principles

• For Population Health Promotion• For Delivery System Reform

• Individuals: to say you are a “member of HealthRIght” would expressly mean that you support the above action plan.

• Organizations: With those goals in mind, each group keeps doing their work, but we support each other when needed:– For outreach to policy-makers, – Media messaging– Participating in statewide reform efforts.

• Future HealthRIght meetings become coordination and communication meetings

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HealthRIght Model for Health Care ReformOverview

Goal: Cost Containment and Active Purchaser Coverage Model

Aggregates all health care insurance dollars (from individuals, public and private employers, and state/federal programs) into a Health Care Trust Fund used to purchase health care services;

Allows individuals access to a choice of plans that pay providers high-value care, innovation and improved outcomes.

Leverages community expertise to govern use of health care resources;

Implements global health care cost inflation benchmark; and

Champions a robust coordinated health planning process