Jeff Rowe, Editor, Future Care

Jeff Rowe is the editor of Future Care and a veteran healthcare journalist and blogger who has reported extensively on initiatives to improve the healthcare system at the local, regional and national level.

State reformers forge ahead as uncertainty reigns in Washington

January 13, 2017 AT 4:55 PM

In one week, we’ll have a new president, and it may be the understatement of a lifetime to observe that opinions vary as to what to expect from Donald J. Trump as the 45th President of the United States.

Given the steps taken by the outgoing Obama administration, of course, healthcare stakeholders – which, when you come down to it, includes all of us – are perhaps the most unsure how their world could change.  But in a recent commentary, one stakeholder suggests it may not hurt for us all to take a deep breath and, if not relax, at least take more of a wait-and-see attitude.  After, says Robin Gelburd, JD, president of FAIR Health, a national, independent nonprofit with the mission of bringing transparency to healthcare costs and insurance reimbursement, it’s not as if the federal government is the only place change is happening.

“In essence,” she writes, point to a range of initiatives at the state level, “there are 50 living laboratories around the country, trying out new legislation, regulations, policies and initiatives in the hope of improving both the cost-effectiveness and quality of healthcare.”

A couple areas she points to are workers’ compensation and consumer protection laws.  On the former, she notes, “In administering workers’ compensation (WC) programs, states have an interest in providing fair compensation for healthcare services. With private claims data that are national in scope, geographically granular—reflecting local market practices—and up to date, they can help evaluate reasonable rates and also can support the development of equitable WC fee schedules. Such data help states build new fee schedules, update existing fee schedules and compare their rates to costs in other states.”

As for the latter, she points out that “ an increasing number of states seek to protect consumers from ‘surprise’ bills for out-of-network or emergency services by holding consumers harmless to their in-network rates. They also are trying to ensure transparency regarding reimbursement levels when a consumer voluntarily goes out of network.”

Closer to the health IT front, Gelburd describes the new consumer engagement tools such as “free consumer websites . . . (which) allow consumers to estimate costs for out-of-network procedures and provide plain-language curricula about health insurance. States use that type of site in connection with their exchanges as an official tool to support transparency efforts.”

Similarly, she points to efforts to improve analysis and research efforts that can “provide states with reports revealing intended and unintended consequences of state statutes, regulations or public health initiatives. For example, such data can reveal whether state statutory and regulatory efforts to reduce opioid overdoses, heighten awareness of sports-related childhood concussions or increase utilization of the HPV vaccine are having their intended effect.”

Given the rancorous debates continually swirling around the Affordable Care Act, it’s obviously understandable for stakeholders and observers to be a bit tense as January 20th approaches. But Gelburd offers a valuable service by reminding us that, regardless of what comes out of Washington, DC, in the months ahead, the experimentation, lesson-learning and subsequent adjustments in the 50 “laboratories of democracy” will continue apace.