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December 22, 2010 Published in From Richmond, Health & Fitness

Governor McDonnell Receives Report From Virginia Health Reform Initiative Advisory Council

Yesterday, Governor Bob McDonnell received the final report and recommendations of the Virginia Health Reform Initiative Advisory Council from Secretary of Health and Human Resources Dr. Bill Hazel. In August, the Governor created the Advisory Council to provide recommendations towards a comprehensive strategy for implementing health reform specific to the needs of Virginia. He charged the Advisory Council with identifying policies to create an improved health system that is an economic driver for Virginia while allowing for more effective and efficient delivery of high quality care, at lower cost.

Among their findings, the Advisory Council recommended that Virginia expand Medicaid Care Coordination across additional geographic areas, clients, and services, including but not limited to behavioral health and long term care services. Also, the Advisory Council put forward a recommendation to develop a comprehensive eligibility determination and electronic case management system that crosses the span of health and human resources. In order for Virginia to provide comprehensive care to individuals who receive care from a local and or state agency, a technology platform is needed. This technology is a necessary vehicle that will facilitate communication and shared information among providers and agencies who serve the same client.  In addition, a ‘team’ model for care will enhance the collaboration and effective care of patients throughout all of his or her doctors and physicians.

Speaking about the report and recommendations, the Governor remarked, “These leaders have come together and worked diligently to find better ways to deliver high quality health care at an affordable cost to the citizens of Virginia. I look forward to reviewing the recommendations they have provided and finding solutions that benefit our citizens and our Commonwealth. I will work with Secretary Hazel to ensure that Virginia continues to move forward with efforts that are beneficial to Virginians and provide opportunities for collaboration between the public and private sectors. All Virginians deserve access to high quality and dependable health care, delivered in a cost-effective and sustainable manner.”

Secretary Hazel added, “I have had the privilege of serving as the chairman of the Virginia Health Reform Initiative Advisory Council and we are indebted to the work of the members. They brought forward a tremendous amount of information and insight which directly informed the recommendations of the Council. I look forward to working with the Advisory Council over the next year as we work to implement this vision for Virginia health reform.”

Vision: Virginia should aspire to have the healthiest individuals, the healthiest communities, the best health care system and the strongest economy in the nation.

*Among the recommendations, the Virginia Health Reform Initiative Advisory Council found:

·         Virginia should create and operate its own Health Benefits Exchange to preserve and enhance competition.

·         The Secretary should work with business leaders, researchers and private foundations to commission and conduct a representative sampling of Virginia employer opinions about what features they want in a Health Benefits Exchange and what they want from health reform generally.

·         The Medicaid Task Force supports funding and implementation of the Virginia Gateway project, which is the automation of an eligibility system across health and human services agencies and provides the platform for future needs, including the Health Benefit Exchange. This project is led by the Office of the Secretary for Health and Human Resources.

·         The Commonwealth should continue to pursue additional care coordination models for additional geographic areas, clients, and services, including but not limited to behavioral health and long term care services.

·         The Secretary of Health and Human Resources should work with private and public organizations to commission and fund multi-dimensional studies of the highly promising collaborative “team” concept of care delivery for primary care for the purpose of informing future legislative considerations.  Teams could include physicians, nurses, physicians’ assistants, pharmacists, dentists, dental hygienists, mental health professionals, case managers, family care givers and others.

·         The Commonwealth should convene multiple stakeholders in collaborative efforts to identify, pilot test, and spread effective models of delivery and payment reform.  The state should clarify that system-wide costs, not the costs of a particular segment, are the proper cost-metric for evaluation.  The Commonwealth should also ensure that the same performance metrics be used to evaluate all models, including the status quo.

·         The Commonwealth should articulate a vision for excellence in health, health care and economic strength for all Virginians. The vision should be inclusive of service delivery and payment models.

Among the six taskforces, there are central themes surrounding the proposed recommendations:

Service Delivery and Payment Reform- Virginia should define its vision surrounding service delivery and payment reform models; convene stakeholders, leverage its purchasing power, and implement promising new models of care delivery and system transformation while protecting safety net providers. Additionally, Virginia should work to leverage funding to advance Virginia’s goals regarding health system performance.

Technology- Virginia should become a demonstration site for the use of telemedicine in areas where there are underserved populations; consider the future application of an all payer claims data base; promote the growth of access to broadband and telemedicine services; and help small primary care practices acquire small business loans to invest in new technologies.

Capacity- Virginia must acknowledge the health workforce capacity issues facing the Commonwealth today. There are four avenues of increasing capacity: 1) re-organizing care delivery practice into “teams” that can leverage scarce physician capacity by more extensive use of non-physicians in ways that are more consistent with their education and training than many current practices permit; 2) changing scope of practice laws to permit more health professionals to practice up to the evidence-based limit of their training; 3) expanding the use of information technologies, like telemedicine, electronic health records and health information exchanges to extend the geographic reach of existing health professionals; and 4) increasing the supply of health professionals. Additionally, specific recommendations are include: increasing clinical training slots and re-activating loan forgiveness and other programs that will increase retention of health professionals educated in Virginia.

Medicaid- Virginia should consider additional care coordination models; work with nursing facilities, hospitals, and physicians on strategies for caring for nursing facility residents; evaluate and pursue potential federal reforms for chronic disease management; require providers to submit claims and receive payments electronically; and explore cost sharing opportunities for the current and expanded Medicaid population.  In addition, the Task Force supported the funding and implementation of a streamlined eligibility system across all publicly funded health and human services.

Insurance Reform – Virginia should create and operate its own Health Benefit Exchange to preserve and enhance market place competition.  The Governor and legislature should work together to create a process to work through the various issues in detail, with broad stakeholder input.  Additionally, the legislature should provide the Bureau of Insurance the authority to ensure their ability to implement and enforce areas of necessary change.

Purchaser Perspective – Secretary of Health and Human Resources work with business leaders, researchers and private foundations to commission and conduct a representative survey of Virginia employer opinions about what features they want in a Health Benefits Exchange and what they want from health reform generally.  Much of the point and focus of reform is to make health insurance and health care more affordable for small employers and their workers and their families.