The pandemic has been tragic in both lives lost and economic damage, especially to low wage workers. Our already flawed healthcare system has been seriously disrupted. Insurer profits are up, hospitals are losing money, and Connecticut healthcare jobs in April were down 28,400 from the year before. As the pandemic winds down, the recovery offers opportunities to improve our healthcare system as it re-opens.
Federal support has been crucial to protecting the system, but it’s not enough. As legislators consider relief for Connecticut’s struggling healthcare providers, we need to ensure our system grows stronger. Given scarce resources, that support must be targeted and accountable.
Relief to address rising uninsured rates because of the recession should go directly to consumers. State premium subsidies to supplement federal insurance subsidies will make coverage more affordable. Running relief through indirect reinsurance is less efficient and less likely to make coverage affordable.
Relief must be conditioned on quality performance. We have an opportunity to create standards that reward better health outcomes, rather than checking boxes. Standards should be specific to conditions and populations. What heart disease patients need is not what pregnant women need. Emphasizing process measures discourages innovation, missing opportunities for better care and to identify low-value services that aren’t working and could be eliminated.
There are growing signs that the pandemic’s economic and social stresses have increased the need for behavioral health care. Drug overdoses are up and prescriptions for anti-anxiety, anti-depression, anti-insomnia medications are up sharply. Behavioral health capacity in Connecticut was tight before the pandemic. We need to do more to improve access to behavioral health care and support evidence-based community and medication options.
Relief for hospitals and large health systems must come with accountability. Relief should be conditioned on maintaining services and improving access to care, rather than plugging revenue holes, especially for institutions with large reserves. As health systems grow larger, they charge higher prices for care, making healthcare less affordable. Connecticut’s better future healthcare system must be less commercially concentrated but more clinically integrated.
Large hospital health systems must agree to certification and reporting requirements as Accountable Care Organizations. Completely unregulated ACOs are responsible for making important decisions about care for a growing number of Connecticut residents.
Any hospital that received federal relief funds but laid off, furloughed, or cut the pay of workers while paying extreme salaries to executives should be disqualified from state relief.
Racial and ethnic disparities in COVID death rates have highlighted the impact of social determinants of health (SDoH). SDoHs include non-medical needs that are critical to good health such as healthy food, affordable housing, and safe neighborhoods. Post-pandemic community-medical partnerships that address SDoHs will be critical to a better health system for Connecticut. Providers should be required to screen for social risks, partner with social service organizations, and should be compensated based on SDOH-associated quality metrics. But without more resources for the increased demand for those essential community services, referrals will not lead to services.
Primary care is the foundation of a great healthcare system. Connecticut’s future healthcare system should remove cost sharing for all primary care – including behavioral health. CIGNA has removed all consumer cost sharing – copays, deductibles and coinsurance – for primary and behavioral healthcare, in-person or telehealth. Employers and providers in California have called for state relief payments to independent primary care providers with a very reasonable reconciliation process that avoids over-compensation.
Many providers have moved to telehealth during the pandemic with great results. It doesn’t work for all conditions or for all consumers, but it is a critical option that should continue post-COVID. Telehealth can improve access to care, lower costs for practices, keeps people out of waiting and exam rooms with other ill patients, and lowers time, transportation, and childcare barriers. However, not all practices have telehealth capacity. This is a perfect place to invest Connecticut’s federal technology grant now being used by the Office of Health Strategy (OHS) to create a redundant Health Information Exchange that plans to sell sensitive patient data to fund ongoing costs.
While federal COVID relief has been helpful, the state also needs to step in to ensure that Connecticut’s health system returns stronger and healthier post-pandemic.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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