The National Academy of State Health Policy (NASHP) is an independent academy of state health policymakers
working together to identify emerging issues, develop policy solutions, and
improve state health policy and practice. Recently, its executive committee
identified ten aspects of health reform that states must get right in order to
successfully implement federal health reform. Like the health reform law, the
top ten list covers a broad range of objectives
and responsibilities:
1) Be Strategic with Insurance Exchanges
2) Regulate the Commercial Health Insurance Market
Effectively
3) Simplify and Integrate Eligibility Systems
4) Expand Provider and Health System Capacity
5) Attend to Benefit Design
6) Focus on the Dually Eligible
7) Use Your Data
8) Pursue Population Health Goals
9) Engage the Public in Policy Development and
Implementation
10) Demand Quality and Efficiency from the Health Care
System
With the dust settling on the passage of health reform,
attention is shifting from the early provisions of the law such as coverage for
young adults under their parent’s plan and consumer-friendly
insurance reforms including eliminating pre-existing exclusions for children,
lifetime caps and rescissions of policies. Many states have launched formal or
informal groups to begin the planning and decision-making process. According to
the National Governors Association
(NGA),
at least a quarter of the states have formally
launched commissions, task forces or advisory groups. The lack of consumer
representation on these state structures is a bit disappointing given that
engaging the public has been flagged as one of the top ten critical areas.
Two of my favorites among the top ten are simplifying and
integrating eligibility systems and using data to analyze and improve your
programs. Those of us working on children’s coverage know how important
these aspects of program administration are to the ultimate success of
enrolling all eligible children and families. Both rely on well-designed,
high-functioning technology based on simplified processes and streamlined
procedures.
The NASHP brief puts it bluntly: “36 million
Americans cannot be enrolled in Medicaid or the new exchanges by relying upon
what, in most states, is a county-based eligibility platform designed around the
cumbersome and intrusive processes of the welfare eligibility system.” Touche`!
Effective systems are expensive and time-consuming to
build and implement. There is an important role here for the federal government
to assist states in system procurement, to standardize data reporting
requirements and to require that systems meet data reporting standards as a
condition of federal funding. We cannot hope to meet our coverage goals without
data to
analyze how well our programs are working and identify where improvements are
needed. Public reporting of data on enrollment, retention, access to care,
health outcomes and much more will be the best way for Americans to know when
states are truly getting it right!!