Designing the Future State of U.S. Health Care

Note from the Director:

DESIGNING THE FUTURE STATE OF U.S. HEALTH CARE

Summer greetings to all! I hope you are having a great start to your summer, which is finally upon us. We also have the early stages of the 2020 elections emerging. Issues like “Medicare for All” loom in the public imaginations.

For those of us in the business of government health care programs, it is evident that population health needs to be incorporated into whatever the design may be for the future state of U.S. health care. With the social determinants of health (SDoH) as an emerging theme, for example, we are aware that perhaps 80 percent of the spend on health care is affected by SDoH factors. If we are ever going to bend the curve of spending in this country, we must come up with successful ways to incorporate strategies that get at the root causes that drive spending and impact population cohorts within our membership.

If we need these sophisticated tools for population health management, then a simplistic health policy that implements an old-style indemnity model insurance coverage is a 1960s cure that will fail the 21st century realities. Just having insurance is no guarantee that high-quality care will be provided nor that the underlying causes of disease and health care spending will be addressed. The

administrative knowhow and capabilities of our industry are indispensable. Our drive toward constant improvement, value-driven performance, transparency, and public accountability is what characterizes our brand of health care financing and delivery.

As an example of this, a recent study comparing the quality of care of dually eligible populations under a Dual Eligible Special Needs Plan (SNP) versus a traditional fee-forservice setting demonstrate that the SNP programs available to these populations deliver better quality care. The data used to better understand their needs translates into better care quality delivery.

It is not going to be easy, as you already know. That is because it is already our job to figure out how to do it better, based upon our experiences already in risk adjustment, HEDIS ®, stars, and population health management.

In a recent RISE risk adjustment policy committee meeting, we had a long conversation about the challenges of data collection to drive our health care management programs, such as Medicare stars and population health, particularly given the emerging importance of SDoH. It is difficult enough now to collect comprehensive, robust, and accurate diagnostic data to drive these programs that further

improve our insights into population health status, enabling us to better stratify and manage cohorts of patient populations without placing additional administrative burdens on the physician practices. We must envision better methods of gathering information to help inform us about SDoH issues without further abrasion at the physician and point-of-care level.

The RISE Association is keenly interested in supporting the industry by identifying best practice ideas and disseminating the shared knowledge. We will conduct studies among our community stakeholders to discover ways in which better data collection techniques can be discovered and rapidly deployed as widely as possible. We invite you to submit suggestions about ways you think RISE could help. Please reach out to me directly: kmowll@risehealth.org. I look forward to hearing from you.

Kevin Mowll

Kevin Mowll

Executive Director, The RISE Association