Health insurance

We can have health insurance that pays for quality, not quantity

In my nearly six years as a state representative, I have devoted more time and energy to health care reform than to any other topic. I sponsored legislation to improve regulation of stand-alone emergency rooms, require hospital cost transparency, implement a reinsurance program (which saved consumers more than 20% on individual market premiums) and to establish a board to set upper payment limits on prescription drugs.

Representative Chris Kennedy

I’ve also proudly supported the work of my colleagues on preventing out-of-network surprise bills, capping the price of insulin, implementing a standardized health insurance option, and more.

While these efforts have gone a long way in saving people money and improving health outcomes, they treat all symptoms rather than cure disease: a health system that encourages a higher volume of services rather than higher healing value.

I am not the first to notice this problem. From 2015 to 2019, the Colorado State Innovation Model used federal grants to advance payment structures that reward quality outcomes rather than quantity of billable services. These types of payment models are commonly referred to as “value-based payments”.

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The state’s innovation model was also about integration, namely the integration of behavioral and physical health care in 344 primary care practices and four community mental health centers in the state.

The Hospital Transformation Program, created by a 2017 law, and the Primary Care Payment Reform Collaborative, created by a 2019 law, have also significantly advanced conversations about paying for value versus volume.

In the spring of 2021, after the passage of the U.S. federal bailout law, Colorado House Speaker Alec Garnett encouraged my colleagues and I to think about how we can use these one-time federal resources to significantly transform systems. Many of my colleagues are doing incredible work transforming behavioral health, housing, workforce development, and economic support programs in Colorado.

For me, it kept coming back to value and integration in health care. I remember lying awake in my bed one night, my mind exploring the possibilities, when I decided to get up a little after midnight and write an initial proposal for what I called “State Innovation Model 2.0”.

I know I’m not the only person who’s thought of this idea or nickname, but my proposal included a new grant program to help primary care practices integrate behavioral health services and move towards payments value based.

The theory was that grants and technical assistance could help firms upgrade technology and change workflows. These improvements, in turn, would be supported over the long term by the improved payment models, as the delivery of care became more efficient, health outcomes improved, and the downstream costs caused by untreated conditions were avoided.

That idea is now at the heart of House Bill 22-1302, which earmarks $32 million in American Rescue Plan Act funds for primary care practice transformation grants and technical assistance programs.

As these ideas developed, I began to work on another component of this problem: the conflicting requirements of health insurance plans. You see, many health insurance companies have made progress in incorporating value-based payments into their contracts with primary care providers.

But they all do it in their own way, requiring the average medical practice to manage a different set of quality metrics and payment metrics for each insurance company. Can you imagine a doctor having to identify their patient’s insurance company before they could know what health outcomes would determine how they are paid? It does not mean anything.

That’s why I’m sponsoring House Bill 22-1325 with Rep. Yadira Caraveo, a pediatrician who shares my commitment to transforming our healthcare system. The bill will require the alignment of certain value-based payment parameters between insurance companies. The alignment will reduce administrative costs and simplify the work of primary care providers, allowing them to spend less time dealing with insurance companies and more time focusing on their patients.

I sincerely believe that a health system that integrates physical and behavioral care, operating in a value-based payment environment, is the single most important thing we can do in Colorado to improve equity, outcomes and value. of our health system.

Together, these efforts lay the foundation for a universal primary care system in Colorado that will provide more effective, comprehensive care that will improve people’s health and save them money. They will receive high quality preventive care at the right time. And when there is a serious disease, it is likely to be detected earlier.

These are the types of transformations that go beyond treating the symptoms of a broken system to actually begin to heal the disease.

Chris Kennedy represents District 23 in the Colorado House of Representatives.

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