U.S. Health Care Expenditures: Costs, Lessons, and Opportunities Proceedings of a Workshop (2023) / Chapter Skim
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3 Innovation to Bend the Spending Curve
3 Innovation to Bend the Spending Curve
Pages 21-36
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From page 21... ...
• A partnership led by United Way of Greater Cleveland uses the Collabora tive Approach to Public Goods Investment model to facilitate cross-sector co-investment in social services to improve health outcomes and decrease health expenditures. (Miladin)
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From page 22... ...
This strategy resulted from the state's efforts to expand health care coverage to its entire population and to make the system affordable, both for the state and for participants in the system. Legislation was passed that set the growth target, then the Health Policy Commission was created to evaluate factors driving health care cost growth in Massachusetts by using a global health spending perspective.
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From page 23... ...
MMF is exploring the extent to which having a cost growth target in place contributes to curbing spending growth. Rhode Island, Delaware, Connecticut, and Oregon have issued executive orders or enacted legislation to establish efforts focused on elucidating total health care spending and addressing factors driving health care cost growth.
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The process of holding public dialogues, summits, and advisory council meetings increased support from legislators, and in November 2018, Governor John Carney issued an executive order establishing a framework and process for setting quality benchmarks and for reviewing annual health care cost targets.2 The executive order set the 2019 spending growth benchmark at 3.8 percent and then decreased it annually until 2022, at which point the benchmark will be a 3 percent growth rate. Established with public input, Delaware's benchmark is equal to the potential gross state product (GSP)
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. CMS launched the AHC model to determine whether linking Medicare and Medicaid recipients with community social services can improve health outcomes and reduce health care costs.5 CMS 4 https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_ 1332_State_Innovation_Waivers- (accessed September 22, 2021)
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From page 26... ...
However, if all insurers and health providers are collaboratively investing in the same service, it can alleviate concerns about individuals who move from provider to provider or insurer to insurer, thus increasing the security of investing upstream. Miladin noted that emerging evidence indicates that social services can lead to health savings.
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From page 27... ...
In service-based fee structures, hospitals may lose revenue if upstream efforts result in decreased services that are traditional high-revenue generators such as intensive care unit and ED visits. In capitated payment models such as managed care, the hospitals have a stronger financial incentive to lower the total cost of care.
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Miladin acknowledged that a substantial challenge to CAPGI implementation is a fear of data breaches associated with sharing data with social service providers. Generally, hospitals do not want to administer social services programs directly, preferring to partner with experts in the field to deliver these programs.
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This can enable hospitals to allocate resources toward keeping people healthier. In the Geo model, CMMI provides additional flexibility to providers that accept capitation to enable investment in population health activities, care management tools, and technologies.
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State health policy innovations tend to emerge in those states; when evidence on the impact of those policies becomes available, it is used by other states as they determine whether they have the political and technical wherewithal for implementation. For example, Block said, Massachusetts independently created an elegant design for health care cost growth targets that MMF borrowed from in developing designs for other states.
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Health Care and Social Services Quality Measures Lee asked Walker about quality measure selection and data collection in Delaware's initiative. She replied that health care providers and specialists were solicited for input about investing in population health.
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Carrucciu said that CMMI is continuing to innovate about beneficiary engagement incentives to include in models, which can serve as a mechanism for exploring additional flexibility needs. Data Capability and Determining Return on Investment Given the complicated nature of projecting a return on investment in social services for health systems, Lee asked how the entities approach bid calculation in the CAPGI process.
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From page 33... ...
Lee asked about optimal methods of state entities and social service organizations partnering to build data systems. Miladin replied that a convening organization like United Way or a health collaborative can be central to these efforts, sparing hospitals from carry ing out simultaneous data collection efforts with multiple social service organizations.
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Patient Role in Health Spending Lee asked about the role of patient care expectations and the perception that more care equates to better care in addressing rising health costs. Block suggested that relying on individual decisions is less likely to be effective than a coordinated strategy that enables all participants in the health care system to work together toward collective goals.
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From page 35... ...
Walker said that leadership is needed to direct greater investment in the health and social services sectors and to possibly combine these sectors. Investments made in infants and toddlers can require a 10-year timeframe to show results, yet managed care contracts operate on 1- to 3-year cycles that are too short to allow for the full ROI of a public good to emerge.
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