Universal Health Care Action Network of Ohio
370 S. 5th St., Suite G3
Columbus, OH 43215
www.uhcanohio.org
O. 614-456-0060
F. 614-456-0059
Testimony to the Ohio House Healthcare Efficiencies Study Committee, the
Honorable Stephen Huffman, Chair, from UHCAN Ohio and Ohio Consumers for
Health Coverage
September 22, 2015
Representative Huffman, members of the committee: My name is Cathy Levine. I am the
Executive Director of UHCAN Ohio, a nonprofit, non-partisan, advocacy organization that is
building the voice of Ohio consumers in health care reform and advocating for policies that
address the needs of consumers. I also co-chair Ohio Consumers for Health Coverage, which
unites diverse consumer constituencies1 to speak with one voice as consumers – meaning those
people whose main relationship to health care is as users of services. From that perspective, I
am pleased to have the opportunity to speak briefly today about opportunities for innovative
medical savings and population health.
Consumers and their advocates strongly support efforts to improve value in health care, often
expressed as the so-called “Triple Aim” of health care transformation: Better patient
experience, better patient health, and containing spending. I’d like to make five points today:
First, Ohioans have a huge stake in achieving better care and improved population health
and, therefore, structured involvement of consumers is critical to the success of improvement
efforts. Health care spending in the US is around $2.9 trillion annually, more per capita than
any other western democracy, and we’re not getting good value for our money. Our health
outcomes are among the worst, especially in Ohio.2 Many health care users suffer poor health
and death from substandard care3 High cost keeps consumers from receiving timely,
appropriate care and drives down wage growth. Medical debt contribute to financial, housing
and food insecurity.4
1
Our members include American Cancer Society (Ohio Division), National Multiple Sclerosis Society (Ohio chapter),
Alliance of Retired Americans (Ohio), National Alliance for Mental Illness (NAMI) Ohio, Ohio Council of Churches,
2
See HPIO Value Dashboard, at http://www.healthpolicyohio.org/2014-health-value-dashboard/
3
Examples of suboptimal care include: lack of care coordination for complex patients being treated by multiple
doctors in different settings; preventable hospitalizations, medical errors, infections, readmissions, failure to
receive recommended care, etc.
4
Medical debt is the biggest driver of personal bankruptcy in the US, with 2/3 of those filing having had insurance
at the time they became ill or injured.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Universal Health Care Action Network of Ohio
370 S. 5th St., Suite G3
Columbus, OH 43215
www.uhcanohio.org
O. 614-456-0060
F. 614-456-0059
The consumers of health care have a different set of interests from providers and payers, many
of whom reap large financial rewards in the current set-up. Excessive health care spending
represents revenue for every stakeholder but the consumer. Thus, along with providers,
insurers, and employers, consumers must have an organized, structured, ongoing voice in
Ohio’s health care reform efforts at the state policy, health systems, and personal level.5
Second, avoid “innovations” that put more obstacles in the way of patients obtaining the
right care at the right time and place. The biggest innovation we need in Ohio and the US is to
center our health care system on robust, team-based primary care – such as the Patient
Centered Medical Home (PCMH) model of care.6 In this model, the team partners with patients
to teach and support patients in improving their health. High deductible plans and cost-sharing
create barriers keeping patients from receiving timely, efficient, cost-effective care in the
primary care setting -- instead of delaying until conditions are more expensive to treat. Primary
care must be more accessible and welcoming to all patients. Every individual patient needs to
be treated with dignity and respect for that individual’s values, life experiences, level of
confidence about managing their health, fears and preferences – which is not the norm today,
especially for people with low-incomes, people of color, people with disabilities and older
adults. This innovation requires modernization of our health care work force, including changes
in scope of practice laws. Not only do we need more primary care physicians, but we need to
train and support a more diverse work force for team-based, patient-centered care that
includes care coordinators, community health workers, and mental health counselors able to
work at the top of their license, training, and expertise.
Third, all stakeholders must understand the actual causes of health system dysfunction in
order to develop effective innovative medical savings. Many people speculate about what is
driving health care inflation. According to an extensive review of the literature, there are four
major drivers of excessive health care spending in the US:
1. The excessive unit price of health care – how much we pay for each test or procedure.
Prices7 vary widely among providers, with no correlation between price and quality. Greater
5
For more on multi-level patient engagement, see Levine, Cathy, “OCHC Recommendations on Consumer
Engagement in Ohio’s SIM Initiative,”
http://uhcanohio.org/sites/default/files/OCHC%20Recommendation%20on%20Consumer%20Engagement%20in%
20Ohio%20SIM%20FINAL%203-28-14.pdf
6
PCMH is one of two innovative payment models being spread in Ohio’s State Innovation Model (SIM) Testing
Grant
7
Price, or the amount charged, varies, with insurers receiving different negotiated discounts not available to selfpaying consumers. And the amount charge often bears no relationship to the actual cost of the service or product.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Universal Health Care Action Network of Ohio
370 S. 5th St., Suite G3
Columbus, OH 43215
www.uhcanohio.org
O. 614-456-0060
F. 614-456-0059
2. price and quality transparency would increase competition to
perform better and begin driving the market to pay for better quality at lower cost. More
importantly, it will allow us to develop targeted savings.8
3. Quality – the Institution of Medicine of the National Academy of Science, after an
exhaustive literature review of peer-reviewed studied, concluded that up to 30% of
health care spending produces either no value or negative value (meaning harm).9 We
are paying for tests and procedures that are not warranted based on medical literature
and nationally recognized standards of care, while failing to deliver nationally
recommended tests and treatments. These facts have led to some initiatives10, but not a
systemic move to eradicate the causes of these problems. Gawande (supra) points to a
tested effective solution: “that the primary-care physician and patient should become
the hub of the entire health care-delivery system.” The primary care provider should
coordinate care for patients so that they get the right care and not the wrong care and
partner with patients to make decisions based on full information.
4. Administrative Waste – many private and public payers require different paperwork,
reporting, measures, at great cost. The “Healthy Ohio” Medicaid waiver proposed in the
recent budget, if approved by CMS, would generate significant new administrative
spending without clear benefit, except causing people to lose Medicaid eligibility,
further eroding population health.
5. Poor population health. More on this below.
OCHC has a set of recommendations that we have revised periodically since these
conversations began during the Strickland administration.11 Many states are ahead of Ohio in
introducing innovations to drive savings in all four categories. One “low-hanging fruit”12 which
can producing medical savings quickly, is to adjust reimbursement rates to providers for higher
than expected rates of hospital readmissions, medical errors, and other potentially preventable
harm. Medicare is already seeing reductions in costly hospital readmissions since instituting this
8
Bundling payment for episodes – an innovation being tested by Ohio’s SIM initiative- is a positive example here.
See Gawande, Atul, “Overkill,” New Yorker Magazine, May 11, 2015.
9
10
“Choosing Wisely” is an initiative created by several national medical societies, joined by Consumer Reports, to
provide materials to doctors and patients about recommended treatments for common conditions. But doctors
need to use them regularly.
11
http://uhcanohio.org/sites/default/files/OCHC%20Delivery%20Reform%20Proposals%202015%20Formatted%20
9-30-14.pdf
12
Reducing preventable readmissions and other provider-caused harm was first raised by us in 2008 or so.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Universal Health Care Action Network of Ohio
370 S. 5th St., Suite G3
Columbus, OH 43215
www.uhcanohio.org
O. 614-456-0060
F. 614-456-0059
recently. Ohio Medicaid may be starting it on a limited basis. It needs
to happen across payers, because providers need their payers aligned on incentives in order to
change their practices.
Fourth, Ohio needs to increase greatly its investment in population health. We in the US have
an unusually unhealthy culture, leading to high rates of obesity and other costly chronic
conditions. According to the HPIO Dashboard13 from the Health Policy Institute of Ohio, our
state ranks among the lowest on population health measures. Poor population tracks to
poverty and its partners – lack of access to fresh food, lack of education about how to eat
healthy, high levels of stress, unhealthy environment, etc. Ohio has a chronic under-investment
in public health as compared to other US states and our population health reflects it.
Improving population health requires a major culture change within the health care sector
(providers, payers, consumers) from a “sick care” system to a “health care system,” based on
enhanced primary care teams that work with patients to connect them with resources to
improve their health. We need an even larger culture change in Ohio as a whole, creating what
the Robert Wood Johnson Foundation calls a “Culture of Health.” Changes need to happen at
the policy, community and personal levels, as has happened to reduce tobacco use. This
requires shifting health care spending into prevention and evidence-based population health
strategies, at the policy, public education, and neighborhood/personal level.
As stated above, high rates of chronic conditions drive up health care spending. Not only does
our health care system need to shift toward better management of chronic health conditions in
the primary care setting, but we need to invest more in non-medical strategies to improve the
health of our population. A few short term opportunities:
1. Raise the cigarette tax by $1.00 at one time. That’s what it takes to keep kids from
starting and cause more smokers to quit. Invest the revenues in Center for Disease
Control- recommended strategies.
2. Promote greater collaboration between hospital systems and local/regional health
departments to target hospitals’ Community Benefit obligation toward improving
population health. An OHT proposal to do this was rejected in the state budget.
3. Use Ohio’s public health community to develop recommendations. HPIO has already
been convening experts and started developing recommendations for improving
population health. We need public investment.
13
See footnote 1, supra.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Universal Health Care Action Network of Ohio
370 S. 5th St., Suite G3
Columbus, OH 43215
www.uhcanohio.org
O. 614-456-0060
F. 614-456-0059
Thank you for listening to my testimony. I’m happy to answer any
questions you have and OCHC is happy to provide you with whatever we can to support your
effort to improve health efficiency.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.