The Iowa Committee for Value in Healthcare today issued a report on five key principles for high-value, fiscally responsible health care that Congress and the Obama administration should consider as they continue discussions over national reform.
The committee found that Iowa, nationally recognized for high-value care, offered many examples of the principles for value-based reform. Health care providers, purchasers, payers, patient advocates and policy analysts advised the committee this year. The committee was formed by The Concord Coalition in partnership with the University of Iowa College of Public Health and the Iowa Healthcare Collaborative.
The five principles:
Principle No. 1: Achieve fiscal sustainability through high-value care. The continued rise in the costs of health care makes the current U.S. system fiscally unsustainable. Without explicitly addressing how to lower costs and increase value in the system, reform proposals will be useless as health care consumes ever more resources in our nation's economy. Continuing to provide insurance coverage to those who have it, let alone all Americans, will necessitate new ways of managing resources so that costs are controlled and value maximized. To that end, the committee believes that specific policy changes to control costs over the long term are necessary to improve value, and that such changes would need to be continually revisited to evaluate their impact.
Iowa makes good use of limited resources by continuous system evaluation. Providers publicly report data and use it to develop initiatives to improve quality, patient safety and cost effectiveness. Hospitals and other health care institutions are encouraged to use "lean" performance improvement models that have traditionally been used in other fields. More than half of Iowa's hospitals currently use lean techniques.
Principle No. 2: Innovate through collaboration. The future of health care will rely more than ever on innovation. In Iowa, innovation is routinely achieved through formal and informal collaborations among key stakeholders: patients, providers, government and private organizations that finance health care. Such collaboration exists in part because Iowa's system delivers care across a large rural landscape with few specialty providers. Per capita reimbursement rates among the lowest in the country have also led to collaboration among patients and providers. This collaboration has become an engine for innovation.
For instance, the Iowa Chronic Care Consortium -- a partnership of the Iowa Farm Bureau, the Iowa United Auto Workers, and two large hospital networks -- established an outreach program to help diabetic and congestive heart failure patients manage their diseases and access the most appropriate level of care. This program reduced costs, hospitalizations and emergency room visits.
Principle No. 3: Expand the role of primary care. This can provide comprehensive well-care and offer prevention programs to individual patients. It also should support health management so individuals can increase the value they receive from acute-care specialty services and long-term care services. In particular, primary care should ensure that more intensive sub-acute specialty services or long-term care services are provided to those who need them.
Iowa's policy landscape has emphasized primary care for some time. The Iowa Medical Home System Advisory Council has created an extensive public health infrastructure including strong links between the public health community, payers, patients and providers with an emphasis on attending to chronic care management in the community setting. Additionally, the Iowa Safety Net Collaborative Network has expanded primary care services to those for whom it is often most inaccessible -- the poor, the uninsured and those living in federally designated primary care shortage areas.
Principle No. 4: Increase wellness and prevention. The committee maintains that wellness and prevention efforts are critical ingredients in a high-value health care system, particularly with respect to chronic conditions. Over the long term, targeted wellness and prevention activities may offer a better use of limited financial resources, in addition to improving health status. Specifically, wellness and prevention are important so that individuals require less access to a "sick care system" and increasingly rely on a "health system."