UtHealthPolicyProject-GuidingPrinciplesforReformInUtah2007

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UtHealthPolicyProject-GuidingPrinciplesforReformInUtah2007
Utah Health Policy Project – Quality Health Care Coverage for All Utahns
455 East 400 South – Suite 312
Salt Lake City, Utah 84111
(801) 433-2299
www.healthpolicyproject.org

Guiding Principles for Health Care Reform in Utah 2007

Introduction

The Utah Health Policy Project has developed the Guiding Principles to help policymakers and the public evaluate proposals for health reform. Through our participation in solution seeking processes and refinement of our own proposal, the Utah Health Cooperative, we have made every effort to identify the right set of principles to achieve our goal of quality, affordable, and sustainable health care coverage for all Utahns. We welcome suggestions for making the principles more useful as a tool for evaluating reform proposals.

1) Health and Financial Security through Shared Risk
The end goal is for all Utah residents to have comprehensive, quality coverage assured. Risk is shared through guaranteed issue and community rating. Community rating means risk is pooled and spread, so that everyone pays about the same, regardless of age, health status, or any other factor.

2) Affordable Premiums and Medical Care
Contributions for health coverage are based on ability to pay. Medicaid and CHIP financing is maximized to ensure affordability through premium subsidies or eligibility expansions. Medical care costs not paid by insurance or other coverage mechanisms need to be affordable to the patient.

3) Shared Responsibility
Employers, individuals, and state/Federal government share in the cost of coverage and care. Individuals and families have the resources to seek health care in the most appropriate settings.

4) Cost Control and Financial Sustainability
Money currently spent on uncompensated care is re-invested in cost-effective coverage. Costs to businesses, families, and taxpayers are predictable from one year to the next.

5) Prevention and Wellness Facilitated by ‘Medical Home’
Coverage solutions address the lack of primary care access points in Utah. Every Utahn has a primary care provider. This relationship allows the health system to do more than treat illness and injury, but provide preventive care. Health benefits should also go beyond clinical prevention and provide individuals and families with incentives and tools to pursue wellness.

6) Publicly Responsive, Evidence-Based Benefit Management
The scope and management of benefits is guided by evidence-based medicine through a publicly accountable and transparent process.

7) Lean Administration and Maximum Purchasing Leverage
Health plans compete on administrative efficiency. Purchasers and payers leverage their purchasing power or pool membership to bring down costs of pharmaceuticals and medical supplies.

Quality Improvement and Systematic Elimination of Health Disparities
Efforts to improve the quality, safety, efficiency, and effectiveness of health care are centralized and coordinated in an Institute for Best Practices (or Quality Forum). All providers and consumer stakeholders participate in statewide efforts to eliminate health disparities and deliver quality health care across cultural and language barriers.