CT can be U.S. leader in curbing healthcare costs

BY Eric Galvin and Jess Kupec

Health care is expensive in the Nutmeg State.

The reasons are plentiful, but a more informed and better coordinated utilization of our current system could help lower healthcare costs and improve outcomes, making it more affordable for everyone.

Connecticut is home to industry-leading healthcare resources, services and expertise, but the costs of using our world-class healthcare ecosystem are unsustainable under our current fee-for-service payment formula.

We can do better.

Access to quality, affordable health care is attainable and is being modeled in an industry collaboration currently underway in our state.

The search for a better approach started a couple of years ago when the leadership of ConnectiCare and St. Francis Healthcare Partners began taking a closer look at the payer-provider relationship. We quickly identified some significant (and frustrating) challenges for consumers. The industry as a whole mainly operates on a fee-for-service model; you visit your doctor and you pay for the visit.

Seems simple.

However, this relatively simple arrangement too often sets in motion a confusing array of prescribed, but uncoordinated, interactions with providers of supporting products, services and payments. This leaves the consumer to integrate each of these pieces into a coherent outcome.

It is not surprising that the process often leads to duplicative or unnecessary procedures with lower quality outcomes and higher costs.

We saw a window of opportunity to test a better approach to the way payers work with providers; one that is collaborative, reduces inefficiencies and duplication of activities, shifts the focus to the value of care, and enhances the patient experience.

Along with ConnectiCare, St. Francis Healthcare Partners and other industry participants, the Connecticut Health Council recently formed the Value Based Relationships work group. The group consists of health plan representatives and provider systems, doctors, pharmaceutical companies, consumer advocates, insurance brokers, various social-services providers and others.

Working together and leveraging our collective expertise, we can establish integrated models of care based on comprehensive metrics and quality outcomes, rather than continue to rely on the inefficient, disintegrated fee-per-healthcare transaction model.

Our goal is to allow the healthcare consumer to pay for the quality of outcomes rather than the number of individual services a system provides them.

Our pilot project is currently focusing on Type 2 diabetes, and how each group member is involved with the care process for treating that disease. Whether a group member is a primary care physician, health plan, endocrinologist, or an employer of a potential patient, we each have roles, responsibilities, products and services that can be analyzed for impacts and efficiencies.

By beginning with this single disease focus, the work group is able to approach the best outcome creatively and as an integrated system rather than as individual stakeholders. This collaboration allows us to test various approaches in improving how and where care is delivered.

So far, we are encouraged by the level of interest and cooperation of industry partners. ConnectiCare and St.Francis Healthcare Partners could have chosen to address this challenge alone, but the better solution for Connecticut is to make this approach scalable for all healthcare providers across the state.

We need other health insurance carriers and healthcare providers to join us, to help us demonstrate why this model is good for consumers and businesses alike, and to show the country that there is a different way. A better way.

The more voices and collaboration we can enlist, the better our chance of success for controlling costs and improving outcomes for patients.

We urge all interested parties to join the effort.

Eric Galvin, president of health insurer ConnectiCare, and Jess Kupec, president and CEO of St. Francis Healthcare Partners, co-chair the Connecticut Health Council's Value Based Relationships work group.