What is the Biggest Health Care Cost Driver
and What Can States Do About It?
EXCHANGES, REGULATIONS POSSIBLE
President and CEO
The Henry J. Kaiser Family Foundation
“States don’t control the biggest health care cost drivers, like advances in medical technologies. … The big levers for states to control health care spending right now are, first of all, Medicaid programs. States are doing pretty much what they can to control Medicaid costs. … States, if they choose to, can use (health insurance) exchanges to set up active purchasing, which means … they will only allow plans to compete for people’s business in exchange for meeting certain criteria, like they will not allow plans to compete … that hit people with very large premium increases. … The third level some states use but many do not, is the ability states have to regulate insurance premiums. States do that to varying degrees.”
REWARD PATIENT OUTCOMES
Senior Vice President, Office of Policy and Representation
Blue Cross and Blue Shield Association
“Reining in health care costs requires a shift from a system that rewards volume of care to one that rewards better patient outcomes. With the largest networks of alternative payment and delivery models like patient-centered medical homes and accountable care organizations in the country, the Blues® are leading efforts to transform the way care is managed, financed and delivered in nearly every state. By rewarding quality, enhancing coordination and encouraging more informed patient decisions, these innovative models are yielding healthier patients and lower costs. States are vital partners in these reform efforts and we must continue to work together to advance initiatives that promote better, more cost-effective health care for patients.”
LEGISLATORS PLAY A KEY ROLE
ANDREW HYMAN, J.D.
Coverage Team Director and Senior Program Officer
Robert Wood Johnson Foundation
"The key drivers of health spending growth are interconnected and include how health care is organized, delivered and paid for. Similarly, the solutions are multi-faceted and inexorably linked. What’s more is that many of the drivers and the solutions are local; therefore, states (and state leaders) not only can make a difference, they must, using their influence as the most reliable convener of all stakeholders, and their power as a major purchaser of health care (Medicaid and state employees). And then they promote experimentation with every credible innovation in health care delivery and financing. Evaluate, implement, spread, convene and repeat.”
EMERGENCY COSTS INCREASING
JOHN ZERWAS, M.D.
Texas State Representative
“As the un- and underinsured population grows, emergency rooms shoulder increased costs, particularly from those who have not been able to afford primary and preventive care. These uncompensated costs to hospitals are eventually shifted to the state, privately paying patients and those with insurance. With the highest rate of uninsured in the nation and a population growing twice as fast as the national average, Texas can no longer avoid this issue. Uncompensated care in our state is already unsustainable and is expected to increase drastically over the next 10 years. The time is ripe for our state to develop, negotiate and implement a Texas-shaped solution that benefits patients, providers, our economy and taxpayers.”
BETTER COORDINATION NEEDED
J. MARIO MOLINA, M.D.
President and CEO
“We believe that excessive utilization of services is the main cause of higher health care costs. Excessive utilization is mostly due to duplication of services or unnecessary services because no one is helping patients and doctors to coordinate care. In fee-for-service Medicaid programs, health care services are fragmented and coordination of care is lacking. This creates a particularly challenging situation for Medicaid patients who suffer from behavioral health issues, language barriers and lack of transportation. States can lower costs and ensure better care and outcomes by enrolling these patients in care management programs.”