Connecticut took a big step this week toward a new network that will steer state employees, retirees and the general public toward the hospitals, doctors and other providers that provide the best possible care, Comptroller Kevin P. Lembo announced.
The “Centers of Excellence” network will highlight those care providers who offer the most cost-effective treatment. And the contractor selected also will help state government cut its health care costs by millions of dollars across this fiscal year and next combined.
“Patients have been forced to make important decisions about where to receive treatment or have major surgical procedures with little to no information about which facilities have the best outcomes. This is unacceptable,” said Lembo. “Patients will, for the first time, be able to see who performs best for each procedure or service and make informed decisions about where to receive care.”
Lembo announced the selection Tuesday of two contractors that will help implement the excellence network.
Remedy Partners of Norwalk will provide software and other services that help Connecticut negotiate prices and compile data about health care providers.
HealthAdvocate of Plymouth Meeting, Penn., will provide information to patients about choices within the excellence network.
The project, which is expected to launch in 2020, will serve an estimated 210,000 state employees, retirees and their dependents. But Lembo said the goal also is to provide an information resource for the general public.
“The Northeast is home to some of the best health care providers in the country, which means no patient should settle for anything less than the best,” the comptroller said.
The concept of an excellence network has been explored by the comptroller’s office for more than a decade.
Lembo, a former state healthcare advocate who became comptroller in 2011, said the primary goal of this initiative always has been to help align patients with the best providers.
“This is a quality-first initiative,” he said. “Getting at those quality indicators is our primary charge and communicating them to our members is our primary responsibility.”
But concurrently, this initiative also will help state government control healthcare costs, both in the current two-year cycle and over the long haul.
Though quality of care is the main concern, the network also will analyze which providers deliver the more cost-efficient care. And the desire to be included within the excellence network is expected to provide incentives to providers to discount their charges.
Gov. Ned Lamont and state employee unions committed to save $50 million this fiscal year and $135 million in the 2020-21 fiscal year by identifying “win-win” health care efficiencies — various measures that would lower costs without reducing coverage for state employees or retirees.
For example, Lembo — who is working with the administration and the unions to achieve these savings — negotiated new pharmacy contracts earlier this summer for various state benefit plans. The savings are estimated to be worth about $30 million per year.
The comptroller said Tuesday that it is premature to estimate how much the excellence network might reduce costs further this fiscal year or next, but he’s confident there will be some reduction.
But the main approach to cost-cutting, Lembo added, would occur over the long-term.
For example, the network might refer a patient needing surgery to a hospital where the procedure is more costly than others. But if the targeted hospital has a superior rehabilitation program, or a better track record at avoiding post-operate infections, it still might be the best choice — both in terms of quality care and long-term cost savings.
“Driving people to cheap care is not the goal here,” he said. “We’re going to be look at everything, from the time of surgery, to the time rehabilitation is completed, to the time they are back to normal. We’re not looking at individual billing moments.”
Senate Minority Leader Len Fasano, R-North Haven, had criticized Lamont, Lembo and their fellow Democrats in the legislature’s majority regarding the health care savings.
Fasano argued Democrats adopted a new budget that relied on major savings without a fully developed plan to achieve them.
And given that consultants charged with implementing one component of this cost-cutting effort weren’t selected until late September — almost three full months after the fiscal year had begun — is concerning, the Senate Republican leader said.
“They are late to the game,” Fasano said. “They have savings they haven’t achieved yet and I don’t see how they get to their end game. I encourage them to go forward with it but who knows if we’re ever going to achieve those savings.”
“Implementing new ideas are hard — and cheering for failure is easy,” Lembo said, adding that his office has saved taxpayers hundreds of millions of dollars through health care and pharmaceutical reforms over the past nine years. “If Senator Fasano has any constructive ideas to contribute to this innovation space, then I always welcome them.”
It’ll never work. If you’re a provider and you’re in the circle of excellence, you’ll be overwhelmed with patients and the value for your services will immediately go up. Meanwhile, those not in the circle will be down trotted with a stigma that will harm their livelihood. Many times treatment decisions are based on a trust built between a human being and their medical provider where intimate details are exchanged. Software interfering with that will not save money but create more administrative work.
If it’s only about providing information to people, that’s one thing. But the State’s “SmartShopper” program is another. (Information can be found on the State’s website.) That’s a service provided to State employees and retirees to “help” them find “cost-effective” care. A “personal assistant” (third party) will “help” find the right doctor/facility and even “help” make appointments. And if the procedure is done in one of these “cost effective” places, why, there’s a “cash incentive” to be had.