Five principles recommended by Iowa Committee for high-value health care

The Concord CoalitionOct 13 2009

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."

Creating a culture of wellness and prevention is important to Iowa businesses. One in particular revamped its benefits program to reward healthy behavior and ensure coverage of those medicines and services most appropriate to help employees manage common chronic conditions. Initiatives such as "Lighten Up Iowa" have helped to combat obesity.

Principle No. 5: Promote individual involvement in obtaining high-value care. The committee determined that reform initiatives should engage all of the individuals who use health care, and specifically encourage individuals to choose high-value care. Accordingly, reform efforts should increase health literacy and provide usable information to them about costs, risks, benefits and outcomes of interventions. Reform efforts also should encourage healthy behaviors. Value increases as individuals increase their involvement in health promotion and prevention and take greater responsibility for managing their own treatment plans.

In Iowa, our public and private health sectors are committed to creating such a culture of individual involvement in health care. One indication of Iowans' level of involvement in their own care is demonstrated by the state's individual health insurance coverage rates, which are among the highest in the country. Targeted educational opportunities exist to help seniors as well as children and their families improve their health literacy and provide them tools for coordinated care, community resources, and lifestyle management.

The committee's report is being transmitted today to President Obama, members of the Iowa congressional delegation, and other key policymakers as they continue to discuss directions for reform. The principles can serve as guidelines for an improved national health care system that promotes long-term sustainability.

"The report released today by the Iowa Committee for Value in Healthcare provides ample evidence of how the nation's health care system can be improved," said Sara Imhof, The Concord Coalition's midwest regional director and a member of the Iowa committee. "The cost growth rate in the American health system is fiscally unsustainable. By focusing on the value equation as is done in Iowa, quality outcomes and cost control are addressed in meaningful and lasting ways. The five principles and Iowa's examples deserve careful consideration in the discussions over national reform legislation."

The Iowa Committee for Value in Healthcare is part of The Concord Coalition's Fiscal Stewardship Project, which encourages regional advisory councils across the country to offer proposals for addressing the nation's long-term fiscal challenges.