Guest blogger: Jodi Mitchell

Jodi Mitchell is executive director of Kentucky Voices for Health, a coalition of medical providers, public health departments, development districts, and other organizations. It aims to improve Kentuckians’ access to health care and make the state’s medical system more efficient.

Jodi has worked in health policy for more than 10 years at the state and federal levels. This includes positions in lobbying, strategic counseling, government relations for medical associations, and legislative assistance. She and her husband live in Louisville.

In past New Era stories, she has weighed in as an expert on the condition of Kentucky’s health.

I’m proud to feature Jodi as KNE Health Beat’s first guest blogger.

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The changing landscape in health care is not all politics

One thing is for certain about the world of healthcare in Kentucky, it is constantly changing. Unfortunately, that doesn’t make life easy for the nearly four million Kentuckians who have to navigate our way through the health maze each day. As the healthcare landscape evolves, it is critical that individuals understand their roles and responsibilities as well as those of their providers, insurance carriers and the government. And most importantly, what all these changes mean in regard to their access to quality healthcare. 

One of the major recent policy stories in Kentucky has been the Commonwealth’s switch to Medicaid managed care—a move that will impact more than 540,000 Kentuckians. Many more changes are occurring and will occur that have a major impact on all Kentuckians. Not only are we going to soon see the true effects of the switch to managed care, but we are also going to start seeing more health reforms related to the implementation of the Affordable Care Act (ACA).

Through the changing landscape of health care, it is of the upmost importance that patient access to care is not jeopardized. That is why Kentucky Voices for Health (KVH) has designated several focus areas to help guide the way our policymakers, consumers and health care providers interact with the health-care system.  These include the development of new health exchanges (“a shopping mall for individual and small business health plans”), increase access and focus on preventative services, greater transparency for consumers in regards to coverage and costs, and most importantly, maintaining access to quality care.

As the Affordable Care Act is implemented on both the national and state level, it is important that the public is educated and engaged in order to properly take advantage of the new opportunities and greater amount of information available to them. Standardizing the language used by plans and insurance companies is important for consumers to be able to compare and be active purchasers of health coverage. Individuals also need to be active participants in the care that they are receiving and paying for. Health information technology is a tool that is being used by providers to improve care coordination for patients. Individuals should also be informed and maintain their own health information and records and be active in not only the delivery of care but also in how their care is paid for. 

Insurance plans have often been referred to as the payors for care; however that is a misnomer. Individuals and employers are the payers of care through the premiums that are paid to insurance companies and then passed on to reimburse providers. That is why the Medical Loss Ratio (MLR) provision in health reform is so important to consumers by requiring that 80% of all premiums paid be used for medical services and quality improvement and not on marketing, administrative fees, commissions, and executive salaries. Health reforms must retain provisions that promote fairness and provide security to families while allowing consumers and employers, including small businesses, to buy affordable coverage and compare health plans.

Implementation of the ACA will result in significant changes to the Commonwealth and will present many interesting challenges to our policymakers as they build a health insurance exchange infrastructure making it easier for individuals to shop for coverage. Given the impact of the uninsured and the poor health rankings in Kentucky, Kentucky cannot afford to not expand Medicaid to cover an additional 250,000 Kentuckians with incomes up to 133% of the federal poverty level with federal dollars on the table to cover the expansion. The bottom line is that in order for health reforms to be successful in making coverage more affordable and reducing health costs causing premium increases, it is important for all Kentuckians to be covered including the currently estimated 604,000 Kentuckians who have no health insurance coverage.

So health reform is not a political endeavor, nor is it just about insurance companies, hospitals, clinicians, it is about me, you, our employer, our communities. I once heard the quote, "Health starts where people live, learn, labor, play and pray." What are you doing to live a healthier lifestyle? How are you engaged in the care that you are receiving? Do you know the actual costs of the health care services you are receiving?  Is the service/procedure necessary for improving your quality of life?  These are all questions that we need to be asking. 

The concept of value-based health care purchasing is that buyers (you, me, our employers) should hold providers and plans accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the delivery of high quality care. All stakeholders win in a value-based purchasing model with active consumer engagement.