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POLICY RECOMMENDATIONS Human Health
Policy Recommendation 3:
States may consider ways health systems can leverage advancing technology by updating service delivery and payment models.
The Human Health Subcommittee approved this recommendation citing a desire to update service delivery and payment models in health systems. The subcommittee finds that this can be achieved through leveraging advancing technology, and it recommends states consider doing so as a solution-oriented approach to service delivery and payment challenges.
more modern forms of payment such as electronic. Better payment options may allow for better communication throughout the medical system.
States may also find it useful to consider the work of private sector partners. For example, in recent years CVS Caremark began providing real-time visibility to member-specific medication costs and available lower-cost therapeutic alternatives at the point of prescribing and at the pharmacy.4 This enhanced visibility across all points of care can help eliminate potential dispensing delays, improve patient outcomes through increased medication adherence, and lower costs for members and payors. Additionally, an initiative launched by America’s Health Insurance Plans (AHIP) studied the benefits of creating a Fast Prior Authorization Pathway — or Fast PATH — to better understand how electronic prior authorization (ePA) could impact the process for patients and providers. The study found that 71% of experienced providers who implemented ePA reported faster time to patient care. In addition, ePA reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
State Examples
In Rhode Island, the creation of the Office of the Health Insurance Commissioner has helped improve quality health care by holding health care providers accountable for updating systems.5 This helped decrease premiums along with moderating prices and improved quality measures.
The standard fee-for-service approach to health care creates large inequities in access for people at different income levels. State policymakers and health care administrators could consider alternative payment models that incentivize payment for quality community health outcomes.1 Health access also can be improved by broadening state definitions of acceptable service delivery models to include telehealth services. In July 2020, the Commonwealth Fund reported 33 states required Medicaid plans to cover telemental health services through emergency orders and 21 states required private insurers to cover telemental health services.2
In a time when technology is continuously innovating, states may consider whether their current health systems are outdated and how they can be improved. The health sector is one of the most targeted areas for hackers and ransomware attacks, so updated and secure payment methods are a necessity. The Center for Health Care Strategies created a brief focusing on California and the role of community-based organizations play in helping to improve efficiency when contracting with health care organizations.3
The modes through which many health-related payments are processed, billed and categorized are challenging to access and understand for patients, creating service inefficiencies. Some ways to improve these advancing technologies are through moving towards
In Oregon, The Oregon Health Authority works to lower and contain costs while improving the quality and accessibility of services as well as care coordination for medical patients.6
Additional Resources
The Council of State Governments State Leader Policy Brief: Human Health (2022) — https://web.csg.org/csghealthystates/ wp-content/uploads/sites/23/2022/05/Healthy-States-National-TaskForce-Policy-Brief-Strategies-for-Improving-Health-Equity.pdf
Payment and Deliver Models Within the Medical Sector — https://www.ama-assn.org/practice-management/payment-delivery-models
