Bipartisan Group of Governors Unveils Blueprint to Reform Health System

A bipartisan group of governors has unveiled a blueprint to reform the US health system in an effort to produce better health outcomes at a lower cost to governments, employers, and individuals.

“Governors understand that, while some issues may temporarily divide us, on most issues we can find agreement and act for the good of our states and country,” the blueprint states. “This paper represents a bipartisan approach for improving our nation’s health system performance, including principles and core beliefs to guide reform, as well as specific strategies that address the most urgent problems in the current system in ways that we believe will sustain broad support.”

The plan, put forward by Governors John Hickenlooper, D-Colorado; John Kasich, R-Ohio; Bill Walker, I-Alaska; Tom Wolf, D-Pennsylvania; and Brian Sandoval, R-Nevada, emphasizes collaboration between the federal government and states to improve affordability, stabilize insurance markets, provide state flexibility, encourage innovation, and improve the regulatory environment.

As the term "value" becomes increasingly important in healthcare and states move towards paying providers based on quality over quantity, the group asserts that reorienting the system on value needs to be the greatest priority, urging Congress and the Trump administration to work with states and make a clear commitment to value-based care. To do this, there needs to be a measure of value that is fair, relevant, and transparent to all stakeholders, according to the plan. Other components of the strategy include shifting from a reactive and fragmented approach of primary care to a holistic and coordinated one, and holding providers accountable for end-to-end costs and outcomes.

The plan also pushes to align consumer incentives, ensuring that all Americans have access to appropriate, affordable, high-quality coverage independent of their health, age, gender, employment status, or financial situation. The governors argue that the federal government and states can work together to encourage responsible choices by empowering consumers with useful information and incenting healthy lifestyles as well as ensuring that each American financially contributes to their healthcare consistent with their financial capacity.

Noting the increase of consolidation among healthcare providers in recent years, the plan states that it is crucial that competition and innovation is encouraged in business, technology, and workforce models and that there is a direct combat of anticompetitive behavior, specifically among local hospital systems, pharmacy benefit managers, and pharmaceutical companies.

To reform insurance markets, the plan calls for strengthening the current system while taking immediate action to stabilize the volatility of the individual market. Key components of the measure include encouraging consumers to participate in plans available to them through their employer or other markets and building upon the bipartisan governor’s recommendations from August 2017 to strengthen individual health insurance markets.

Carrying over value into Medicaid programs, the plan highlights the efforts of certain states taking the lead on value-based payments and care coordination, encouraging federal and other state governments to follow suit. As social determinants continue to play a larger role in healthcare and the majority of health executives adopt them into their programs, the plan pushes for the incorporation of social determinants of health into Medicaid.

The plan concludes by placing emphasis on modernizing the state and federal relationship, encouraging Congress and federal agencies to work with states. The plan calls for the federal government to provide leadership where a national approach is efficient, a full alignment of governance and incentives in programs shared among states and the federal government, and streamlined administrative processes, such as waiver requests.