The National Governors Association (NGA), meeting in Washington this past weekend, took an inward and instructive look at how healthcare reform actions worked—and sometimes failed to work—in their states. But one underlying idea threaded through their comments: Healthcare costs need to be controlled.
"There's a lot of debate in Washington and the state capitals about how we structure paying for healthcare in American—whether it's publicly funded plans or a privately funded system," said NGA Chairman James Douglas (R-VT) on Sunday. "But in the end, I'm not sure that matters, because if we don't get costs under control and we don't bend that curve that's rising in multiples of inflation every year, we're going to be broke either way."
Several years ago, Vermont implemented its "Blueprint for Health" with an emphasis on better chronic disease management and preventive care. Even with one of the nation's largest Medicaid populations (rising from 26% this year to 28% next year), the state, which received federal waivers, has been able to save about a quarter of a billion dollars over the past five years, said Douglas.
"It's not something that happens overnight. It's about bending the curve and making progress over time," Douglas said.
Tennessee, though, ended up facing painful choices with its TennCare program, which first only covered Medicaid patients in 1994. With costs spiraling out of control—at one point the state was spending more under the Medicaid pharmacy benefit than for higher education—Gov. Phil Bredesen (D-TN) said the state had to make many cuts.
The lesson from this experience, Bredesen said, is to consider moving "one step at a time instead of just leaping of the end of the dock on these issues."
Gov. Deval Patrick (D-MA) noted that nearly 98% of his state's population is now insured. However, one issue that remains a continual nagging problem is healthcare cost containment. To better address this area, focus needs to placed on prevention, Patrick said.
"There is a responsibility that individuals and families must take around wellness so that we can move to a 'health' care system, as opposed to a 'sick' care system that we have today," he added. "We have some ideas around cost control, particularly around payment reform, that we are looking to implement right now. But it cannot be understated the importance of each of us doing what we can to look over our own health and our own healthy choices."
Governors pointed to their states as role models for federal health reform.
"We need to recognize that the states are a big part of the solution," said Gov. Haley Barbour (R-MS). He added that annual increases in Medicaid spending in his state have dropped from 20% to 2% because of initiatives, such as using preferred drug lists, increasing emphasis on generic drugs, and using face-to-face determination for eligibility.
"There are common sense ideas everywhere that can cut costs," said Gov. Ed Rendell (D-PA).
Federal efforts have fallen short, he said, on emphasizing cost cutting—while many examples are emerging on how that can be done. In Pennsylvania, one of those ideas taking shape is requiring all emergency room to create a non-urgent facility to care for patients 24/7.
"People go to an emergency room because we designed a delivery system that's open only 8 in the morning to 4:30 in the afternoon Monday through Friday. Anytime outside of that time you go to an emergency room," he said.
With this new facility, nurse practitioners or physician assistants can provide service more quickly and at a lower cost. "Non-urgent, 24/7 rooms can be an big answer to the overload costs of emergency care," he added.
In Washington State, meanwhile, a panel of experts is looking at common diagnoses and what are the most effective treatments—exclusive of costs, said Gov. Christine Gregoire (D-WA). One example is back pain where providers might call for surgery, when physical therapy might provide greater benefit to an individual patient.
"When we talk about what Congress is doing versus what we are seeing, the frustration we share is we want real healthcare reform—not about health insurance reform," she said. "Things like better quality care at reduced costs to patients is really where we think we ought to be headed."
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.