In Blog

Ohio is Reshaping Health Care – With or Without Consumer Input

By Cathy Levine, Executive Director, UHCAN Ohio

Ohio is leading the way when it comes to implementing policies that get Ohioans better care at lower costs. Thanks to the Ohio Office of Health Transformation (OHT), Ohio is moving forward with many initiatives to reshape health care as we know it. On November 18, OHT announced that it had submitted to the federal government its State Health Care Innovation Plan, described by OHT as “the final step in the design process and first step toward testing new payment models.” Check it out here.

Why Should We Consumers Care?

Ohio is paying way too much for health care, with poor results.  Ohioans spend more per person on health care than residents in 32 other states, yet 36 states have healthier populations (State Innovation plan, at 2). Doctors and hospitals are generally paid to deliver more services, instead of being paid for better outcomes. Should the hospitals and doctors make money  from treating an infection they gave you? Yet that’s what happens in today’s system.  Too many people experience unnecessary tests and procedures, avoidable hospitalizations and complications, and other harm because of how we pay for health care.

Employers, insurers, providers and consumers claim to agree with OHT that we need to pay for better care at lower costs. But, reducing spending means hospitals, providers, andr insurers will lose revenues. So, the devil is in the details.

Insurers, large employers, and providers are working closely with the state. But few consumers and advocates are following the complex activities of OHT and few are in the critical meetings (I’m there but I can’t begin to  speak for all of our state’s 11 million Ohioans and their diverse  needs).  Don’t you think there should be more consumers with diverse needs involved in these discussions to make sure the health care system works for more people? We do too!

State Innovation Plan: Promising Step Forward – But Not Without Consumer Voice

Ohio’s Innovation plan lays out a set of strategies for moving 80% of Ohioans into patient-centered, coordinated primary care (“patient centered medical homes” or “PCMH”) in the next five years. The PCMH model promises consumers personalized care that coordinates all their health care needs, helps them manage health conditions and improve their health. The plan will also develop a method for insurers to pay for “episodes of care,” in order to incentivize better quality and more standardized prices for common treatments such as hip or knee replacements (the most famous example is the media-dubbed “surgery with a warranty” from Geisinger Health System, in which they cover all costs for treating any complication occurring within 90 days). These are both promising strategies to improve care and lower costs.

However, the Innovation Plan was developed without any public watchdog or consumer stakeholder input, and it lacks strategies for building consumer involvement, on all  levels. Yet we  need to adopt methods to get  consumers/patients involved in their own care, in designing and monitoring PCMH plans and initiatives, and in overall implementation and monitoring of the State Improvement Plan. Consumers provide a valuable perspective – should we tolerate being 42 out of 50 states in hospital readmissions and 47 out of 50 in infant mortality? Do we trust insurers and providers to look out for consumer interests  and decide for us what we want from the health care system?

UHCAN Ohio is drafting a plan for consumer engagement in Ohio’s Innovation Plan, but we need consumers willing to get involved: to join our learning community on payment and delivery reform and figure out how we can present a unified consumer voice that speak for the diverse interests of Ohio consumers – young and old, various health conditions, private, public coverage and no coverage. 

The SIM plan is available here.

Do you want to help protect the interests of consumers in OHT’s work? Contact Cathy Levine, [email protected], or 614-456-0060.

Click here to sign up to stay informed of OHT activities.