Policy
We must address the underlying drivers of cost and quality of health care to achieve meaningful access to affordable health care for Minnesotans. The business community supports initiatives that ensure a functioning, responsive and competitive health care marketplace that 1) maximizes better health outcomes, 2) reduces the cost of health care, and 3) reduces the rate of future cost increases.
In 2008, a significant state health care reform bill passed that addressed many of the following recommendations. The reforms will take several years to implement. Accordingly, a focus of this policy will be working with the Departments of Health, Human Services and Commerce as they continue to implement state health care reforms.
Understandable & Comparable Standards for Provider Pricing and Quality Measures
In order to make value-based decisions for health care, we need a more meaningful approach to pricing that allows patients to be informed about the actual cost of service.
Standard quality measurements must be available and presented to consumers in an accessible, easy to understand and comparable format.
The Minnesota Chamber supports:
- Transparent pricing including packages of care and individual pricing when appropriate.
- Enhanced quality and outcomes measures and reporting
Reward Outcomes, Not Volume
Under a system reformed to reward outcomes and value, not volume, we can achieve efficiencies and cost-savings through improved and coordinated care delivery. In addition, we should seek to improve the quality of health care, including ensuring appropriate use of care. Financial incentives for both small and large providers should be based on outcomes, not just volume of patients served and their ability to negotiate with health plans.
The Minnesota Chamber supports:
- Health plan payments and benefits designs that reward optimal care. Potential ways to accomplish this include applying a care management fee to targeted conditions that is based on results and measures and developing a medical home model or other forms of care coordination.
- Payment system reform should be based on provider results and patient outcomes, not just processes. Payment reform initiatives need to be structured in a way that reallocates current resources and not just adding more money into the system. Health care dollars need to be allocated in a manner that promotes cost-effective care, delivers results, discourages inappropriate use of services, and removes financial incentives for unnecessary services.
- Provider contracts that pay for superior results. Health plans should contract with providers based on their results and outcomes, driving value for purchasers. Consumers should be given the tools to make informed health care decisions. It is critical that consumers have access to meaningful information to empower them to become responsible consumers. This will better enable consumers to maximize the value of their health care dollar in a manner that best meets their needs.
- Initiatives that will advance delivery system change.
- The state should review the current license and scope of practice laws and encourage providers to practice to the top of their licenses.
- Support public policies that will discourage and minimize medical mistakes and other avoidable events that add to the cost of care.
- Ensure that payment reform also leads to a right-sizing of health care infrastructure.
- Efforts that will lead to greater value through increased efficiencies. Health care providers should incorporate proven business practices to foster greater efficiencies, not only in the care they deliver, but also in the management of their business.
Understandable & Comparable Standards for Health Plan Pricing and Quality Measures
Seek rates that are more predictable and stable to protect employers susceptible to double-digit premium increases.
The Minnesota Chamber supports:
- Transparent pricing related to all parts of the health care system that would inform purchasers, including small and self-funded, about the underlying cost-drivers in the health care system, including but not limited to advertising, loss claim ratio and claims paid.
- Comparable insurance coverage and tax fairness for individuals and those covered in the group market.
- Mandatory quality reporting by health plans using a common tool. In addition to quality reporting by providers, it is important for purchasers to have uniform, comparable quality information on health plans to facilitate purchasing on value.
- Reforming medical malpractice laws.
- Identifying and prioritizing opportunities to eliminate inefficient administrative functions that add costs but do not support competition.
- Eliminating regulatory requirements that discourage insurance product innovation and delivery.
- If federal law is fully implemented, Minnesota Comprehensive Health Association (MCHA), the state’s high-risk pool, may cease to be necessary. Based on MCHA’s current structure, the following is recommended:
- Itemizing the amount of premium in dollars attributed to the MCHA assessment and the premium tax on the health insurance monthly statement and yearly medical statement for those insured in the fully insured market.
- Not allowing terminated employees to qualify for MCHA simply because they cannot afford continuation or coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
- Ensuring MCHA rates do not compete and in no case are lower than rates in the private market. Premium rate increases for MCHA enrollees should be consistent with rate increases seen in the private sector based on comparable plan design.
- Explore possible alternative uses of MCHA for possible reinsurance mechanisms for high-risk individuals in order to guarantee Minnesotans their right to choose a health plan without risk of being denied coverage.
- A broader-based funding source for MCHA. In 2010, the MCHA assessment accounted for more than 2 percent of premium for the fully insured market. The fully insured market is mainly made up of small- and medium-size employers and individuals.
Reward Health and Promote Wellness
In order to lower health care cost trends, we support the use of proven primary and preventive care.
The Minnesota Chamber supports:
- Supporting and promoting effective primary and preventive care including appropriate incentives for individuals, both in public and private plans, to use primary and preventive services.
- Measuring long- and short-term returns on investment (ROI) of wellness programs and educating employers and others of the potential savings.
- Supporting wellness programs and financial incentives to encourage employers and employees to improve personal health.
- Reducing the regulatory burden on employers that choose to implement wellness programs
Health IT
Information technology (IT) presents an enormous opportunity for improving care for patients and potentially lowering the cost of care. We support infrastructure improvements that allow information to be efficiently and securely shared to improve quality; reduce medical errors; decrease costs by improving efficiencies; improve care coordination; and improve both provider and patient decision-making.
Therefore, the Minnesota Chamber supports:
- Development and implementation of a statewide IT protocol for electronic information sharing that aligns with national standards.
- Improved incentives that encourage adoption and meaningful use of health IT, which recognizes the expense and challenges faced by both hospitals and smaller independent clinics in implementing health IT.
- Making Personal Health Records portable and available for all Minnesotans.
Business Impact
Minnesota is a national leader in health care. We have one of the lowest uninsured rates in the nation (9.1 percent), a high rate of employers offering insurance (63 percent), high scores for health care quality while providing some of the nation’s lowest cost care, and a relatively healthy population. Minnesota employers also have proven themselves to be leaders engaged in health plan redesign and innovative new strategies. As we watch other states’ health care reform efforts, they are often just beginning to catch up to Minnesota.
However, Minnesota must continue to strive for more value for our health care dollars. The way in which health care services and plans are provided and priced may be challenging for consumers. This prevents cost and quality comparisons in a meaningful manner. Consumers remain divorced from the cost of health care, mainly insulated by third-party payers.
The Minnesota Chamber believes that improvements are needed in our market-based system. These improvements should: engage consumers; align purchasers; and reorient providers and insurers to find and deliver market-driven efficiencies and permanent health care savings to create a sustainable system that provides higher quality care at a lower cost. Such improvements will benefit employers through a healthier workforce with a lower costing health care system.
