Pennsylvania to Consider Healthcare Transformation Recommendations

Jan. 16, 2021
Panel’s reform ideas include exploring global budget models and creating Regional Accountable Health Councils to prioritize health equity

A Commonwealth of Pennsylvania panel has developed recommendations for reducing healthcare costs and disparities, including establishing and monitoring payer and provider performance toward a cost-growth benchmark.

Fifty percent of Pennsylvanians find it hard to pay their medical bills, and the commonwealth’s healthcare costs have been growing annually at a rate significantly above the annual statewide growth in gross domestic product. The Interagency Health Reform Council (IHRC) was created by an executive order that Gov. Tom Wolf signed on Oct. 2, 2020, to address whole-person health reform.

Among the IHRC’s reform recommendations include legislation to create a commission establishing and monitoring payer and provider performance toward a cost-growth benchmark. Exceeding the benchmark would require an improvement plan towards more accountability.  Spending targets would also be developed to support primary care, behavioral health and value-based payments Such a commission could provide up to $6.4 billion in savings for Pennsylvania businesses and consumers between 2022 and 2026, the IHRC projected.

The council recommends that Commonwealth agencies explore a global budgets model with the Center for Medicare and Medicaid Innovation, payers, and providers that would extend to urban and suburban settings. “If there are barriers to a statewide model, a more limited global budget pilot program could be pursued in Medical Assistance alone,” their report said. “This proposal could truly transform the way that care is delivered, and is particularly strategic because many of the health systems in urban and suburban settings are better positioned to switch from predominantly fee-for-service payments to a global budget model, because these hospitals are generally larger, and have more personnel and data infrastructure to manage the population that they serve. In turn, a global budget model would incentivize the provision of better care and improve health outcomes for Pennsylvanians statewide, and foster innovation approaches to addressing health equity and social determinants of health.”

The IHRC also recommends creating Regional Accountable Health Councils as forums for strategic health planning across payers, providers, and community-based organizations that will make health equity a first priority. These councils would help identify areas of profound inequities, called health equity zones. Grants and incentives to reduce disparities are part of the plan.

In another recommendation to address social determinants of health, the plan suggests using the recently procured RISE PA platform, a statewide resource and referral tool based on Aunt Bertha that when implemented will identify individuals with unmet social needs and connect them with community resources.

The recommendations include measuring quality, including in opioid use disorder treatment, long-term services and supports, and aligning physical and behavioral health measures across state agencies. In addition, the IHRC suggests  aligning terminology, reporting and value-based payment models across payers such as maternity care bundled payments to lower maternal mortality rates and costs, and ensuring access to data to allow providers to manage population health.

In regard to health information exchange, the IHRC recommends determining a solution for data sharing between agencies and increasing provider participation requirements in a health information exchange, as well as an exchange alerting when services are occurring across states. The report notes that “while we have made great advances in getting hospitals to join the Pennsylvania Patient and Provider Network (P3N) health information organizations (HIOs), some general acute care hospitals and many specialty hospitals are not connected to P3N HIOs. Additionally, less than a third of nursing facilities are connected to P3N HIOs.”

The report suggests expanding the P3N Admission Discharge Transfer (ADT) Service to out-of-state HIEs that share patients with Pennsylvania. “The Chesapeake Regional Information System for our Patients (CRISP), the Delaware Health Information Network (DHIN), and West Virginia’s Health Information Exchange (WVHIN) are in active discussions with PA eHealth to participate in the P3N ADT Service. CRISP has proposed a simple Health Information Exchange Agreement and an Exchange of ADT Feeds Use Case Addendum for our consideration.”

The IHRC’s next steps are to identify a timeline for implementation of recommendations and to work with the Legislature on areas that require legislative action

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