CEO: More people with health coverage is better for all

This month we’ve been publishing essays by health care leaders about improving the system. They were asked: Now what? With repeal-and-replace shelved for now, what should be done to improve the health care system for patients, communities and health care organizations? What’s right? What’s wrong? What needs to be fixed and what needs to be left alone?

Here’s the first, by Preston Simmons, interim CEO of Providence Health & Services Western Washington.

Medicaid coverage grew under the Affordable Care Act. While far from perfect, the ACA resulted in broader eligibility for Medicaid helping about 20 million people across the country get coverage. Here in Washington state, 1.9 million people now have coverage under Medicaid and another 184,000 individuals get insurance through qualified health plan coverage. Many of them are working.

We have a lot to be proud of in Washington. The uninsured rate since 2014 in our state has dropped by 61 percent, reaching the lowest uninsured rate ever at 6 percent, and we have one of the most successful exchanges in the country.

These results come from hard work and cooperation between the health care industry, many social agencies and the Washington State Health Care Authority, all working together for the people of Washington. The absolute right thing to do is to keep all of our fellow Washingtonians covered. At the same time, we must continue the many improvements in how care is provided under our Healthier Washington initiatives (http://bit.ly/2xBa5M0).

We must also focus on long-term social determinants of health everyone deserves, to help improve the conditions where people live, work and play, and ensure life can be lived to its fullest potential.

Coverage for everyone in our communities is key for many reasons. To start with, it’s important to be able to walk into a doctor’s office and not worry about insurance. Good routine access to primary care is where it all begins, so that preventive care can happen and thus avert costlier, more acute interventions in higher-cost settings later. Many diseases and illnesses can be treated in lower-cost ambulatory/primary care if caught early, or avoided all together, which is better for everyone. Consistent care allows partnerships between providers and the patients they serve geared to better personal health.

Investing in children’s health is never wrong. Right now, we need to ensure continued funding for the Children’s Health Insurance Program. Congress allowed that funding to lapse Sept. 30, although some members of Congress are working to restore the program.

Providence is urging policymakers to continue their historic, bipartisan support of the program and the millions of children it covers.

Looking forward, we can and should find ways to improve the entire Medicaid program. Examples include: expanding access to primary care for Medicaid enrollees to help identify health issues early; continuing the integration of physical and behavioral health programs for whole person care; and getting patients very engaged in their primary care, including improving social determinants of health.

We also need to stabilize insurance markets. Until this year insurance premiums were very stable on the exchange in Washington. For a 40-year-old nonsmoker, the unsubsidized cost was $281 per month in 2014, and in 2017 was actually lower at $238.

Due to the uncertainty in the ACA debate, rates have skyrocketed in preliminary 2018 filings to $306 per month, and in many states around the country by significantly more. It is our hope that Congress can come together around common-sense solutions to stabilize the market, and premiums in particular, and we are encouraged by the bipartisan discussions underway at the time of writing.

More can be done to transform care delivery, building on reforms already in place. In the short term, we need to keep protections in place for those with pre-existing conditions.

Longer term, there is great potential with new technologies to streamline and improve the delivery of care. There are huge opportunities to eliminate waste and administrative complexity in our complicated regulatory environment.

For all insurance coverage, we should continue creating payment systems that support patient-centered care, good care results and pay for value versus volume. Investments that will improve the health of entire populations will allow us to concurrently reinvest the efficiencies gained through reform into programs that support the communities where we live, work, and play.

There is a lot of activity in developing digital health care solutions, including at Providence. We are making care more patient-centered through digital innovations. An example of this is the Circle app (http://apple.co/2yCt2fw) for pregnant moms that supports them from prenatal care through their baby’s first year. Moms get useful information designed for each step along the way, including simple ways to connect digitally with their provider.

Providence believes that health care is a basic human right. This commitment is part of our mission to care for all in our community, especially those who are poor and vulnerable — the very people who would feel the worst impact from reductions in coverage.

Without health coverage, studies have shown time and time again, that individuals and families tend to delay care due to affordability, leading to poorer health, especially for the chronically ill. Smarter health care must be built on coverage that improves quality of life for individuals and families.

Preston Simmons is interim CEO of Providence Health and Services of Western Washington.