Using the State’s Power to Push for Quality Care

Guest Blog By Kevin Lembo, Connecticut’s Comptroller |

Note: Universal Health Care Foundation of Connecticut invited the Comptroller to share how innovation in the state employee health plan can help change the health care landscape for all residents.

This has been an exciting year for me as Comptroller – and especially as one of Connecticut’s resident health care policy wonks.

Leveraging the state’s health plan to realign some of the most steadfast and powerful health care market dynamics in the country is tough business, but the payoff for patients and taxpayers alike is worth the work and has inspired my office to look at ways to innovate how we seek and pay for health care, all while improving the quality of care for Connecticut residents.

Focus on Better Care and Lower Total Costs

In September, after a competitive search, we awarded a contract to Remedy Partners to administer the state’s first Centers of Excellence program. The program will identify hospitals and provider groups that achieve the best patient outcomes for certain planned procedures, like joint replacements, bariatric surgery or certain types of cancer treatments.

The best performing providers will be designated Centers of Excellence. Facilities that have better than average patient outcomes can be designated as a part a Network of Distinction.  Participants of the state employee plan will be eligible for incentives to access care at designated Centers of Excellence or in the Network of Distinction.  Receiving care at high performing entities will result in better outcomes for plan participants and lower total costs for the state employee plan.

We are now in the process of working with Remedy Partners to identify which providers and hospitals are achieving the best patient outcomes so that we can establish “episode of care” contracts with them. This means that if someone goes in for a hip replacement, regardless of whatever associated services they receive before or after the surgery (anesthesiology, lab screenings, scans, etc.) the price for the service will be consistent.

Why is this important to the wellbeing of patients and the state health plan?

It means that hospitals and other providers will have a real financial incentive to deliver the best and most efficient care by reducing duplicative tests, unnecessary hospital stays and avoidable complications. The goal is to extend this quality of care focus to as many Connecticut providers as possible.

Until these efforts, the state has largely paid for health care on a fee-for-service basis, a payment model where providers get paid for every individual service, whether those services were duplicative, unnecessary or the result of an avoidable complication.

These inefficient fee-for-service payment models lead to wasteful and poor care delivery that often costs more than it should, without improving the quality of care or patient experience.

Switching to an episode of care model, an arrangement to cover a procedure and all associated services for a consistent dollar amount, will allow a more efficient style of care delivery, with improved quality and better patient experience.

Improving the Patient’s Experience

Receiving health care is more complicated than ever and we are working to relieve many of the challenges associated with accessing quality care to further improve the patient experience. That is why we are excited that Health Advocate came to the table with Remedy Partners. Health Advocate will act as navigators for the program, directing patients towards the care that they need.

We understand that the health care landscape is ever changing and, rather than trying to keep up, we want to help lead the way. Ultimately, the effects of this Centers of Excellence program will help improve the health care people all across Connecticut receive, not just those in the state plan.

By implementing this program and incentivizing the use of specific providers and facilities, we are saying that no one should settle for anything less than superior care, inspiring providers all around the state to do more to improve their quality of care and changing the way we pay for health care in Connecticut.