One thing is certain about the world of health care in Kentucky, it is constantly changing.
Unfortunately, that doesn't make life easy for the 4.3 million Kentuckians who must navigate our way through the health maze each day. As the health care landscape evolves, it is critical that individuals understand their responsibilities as well as those of their providers, insurance carriers and the government. And most important, what all these changes mean in regard to their access to high-quality health care.
The major health policy story of 2011 was Kentucky's switch to Medicaid managed care — a move that will affect more than 540,000 Kentuckians. But much more is on the way, and it will have a major impact on the rest of us as soon we begin seeing more reforms as a result of the Affordable Care Act.
As the federal law is implemented, it is important that patient access to care is not jeopardized. That is why Kentucky Voices for Health has designated several focus areas to help guide the way policy makers, consumers and health care providers interact with the health care system.
These include consumer engagement in the development of new health exchanges ("a shopping mall for individual and small business health plans"), increasing access to preventive services, greater transparency in coverage and costs and, most important, maintaining access to high-quality care.
The public must become more educated and engaged to take advantage of the new opportunities and greater amount of health-related information available. Standardizing the language used by plans and insurance companies is important for consumers to be smart, active purchasers of health coverage.
Individuals also need to be more aware of their personal health information and the care they are receiving to have a complete understanding of what they are paying for. Health information technology is a tool that patients and providers should use to improve care coordination and consumer engagement. Individuals and employers are the real payers, through the premiums paid to insurance companies.
That is why the Medical Loss Ratio is so important to consumers; it requires that 80 percent of all premiums paid be used for medical services and quality improvement and not on marketing, administrative fees, commissions and executive salaries. It is important that the Medical Loss Ratio be retained with strong consumer protections and rebates to ensure accountability to all of us who pay for care.
Health reform will result in significant changes in Kentucky and will present many interesting challenges to our policy makers as they build health insurance exchanges that will make it easier for individuals to shop for coverage.
In addition, Medicaid will be expanded to cover additional Kentuckians with incomes up to 133 percent of the federal poverty level — making more than 250,000 additional Kentuckians eligible for Medicaid. The bottom line is that for implementation to be successful in making coverage more affordable, it is important for all Kentuckians to be covered — including the estimated 604,000 Kentuckians who now have no health insurance.
So health reform is not just a political endeavor, nor is it just about insurance companies, hospitals, clinicians. It is about me, you, our employers and 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 or procedure necessary for improving your quality of life? These are all questions we should be asking.
The concept of value-based health care purchasing is that buyers (you, me and our employers) should hold providers and plans accountable for 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 money spent toward 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.
Health reforms must promote fairness and provide security to families while allowing consumers and small businesses to buy affordable coverage and compare health plans. All stakeholders win in a value-based purchasing model with active consumer engagement.