The Connecticut Health Foundation has a new strategic plan for 2018 through 2022. Patricia Baker, the foundation’s president and CEO, explains what the plan is designed to do, the reasons behind some of the decisions, and what might be different in five years if the plan succeeds.
What are you trying to achieve with this plan?
We are working to end racial and ethnic health disparities and ensure that everyone in Connecticut has access to quality, affordable health care.
To do that, our plan aims to do three things:
- Ensure that Connecticut residents – particularly people of color – have health care coverage
- Make sure people can use that coverage to get care and build a meaningful relationship with a care provider
- Make sure that care improves patients’ health and is connected to the communities where they live
What does that mean?
We want everyone to have health care coverage, because that coverage opens the door to getting care.
For good health, however, people need more than an insurance card. They need a relationship with a primary care provider – one who knows their race, ethnicity, and language preference, takes into account their culture and values, and has access to the best possible information about their health.
We also want to broaden the reach of the health care system and improve how it operates.
Health care providers should be rewarded for keeping patients healthy or helping patients manage chronic diseases, rather than simply paid for delivering more care.
Improving patient outcomes will require better links between clinical care and patients’ communities. It matters whether a patient takes his medication and gets all his lab work done, but it also matters whether he has a stable place to live, transportation to his appointments, and healthy food to eat. We want to see meaningful links develop between the clinical care system and community organizations that serve the same people, so they can work together to improve health.
What’s different about this plan compared to the old plan?
This plan builds on what we’ve learned in the past five years. We still see access to coverage and care as critical. We’re still committed to delivery system reform.
What’s new is thinking about how to build systems-level linkages between clinical care and the community, so health care is more closely tied to all the factors in people’s lives that influence their health. Our goal is to improve health outcomes, and we can’t do that without better linking clinical care with what happens in the community.
Can you describe the kinds of linkages you envision between the clinical care system and communities? Are there examples?
Yes. The idea is that if you want to reduce asthma hospitalizations, for example, you need clinical interventions, but you also need nonclinical interventions – such as remediating homes to reduce asthma triggers, or zoning changes to improve air quality. In any aspect of health, there are clinical pieces that matter, but they will be more powerful if they work in coordination with nonclinical interventions.
Oregon has done a good job of decentralizing a lot of their health care delivery. There are now coordinating organizations that bring together people from a wide range of organizations, from community health centers and hospitals to community action agencies and Meals on Wheels providers, for example. They work on improving health and addressing the challenges in their community.
The cost containment study conducted in 2016 for Connecticut’s Healthcare Cabinet recommended similar models in which people from many different types of organizations would come together to work on goals such as reducing diabetes or asthma hospitalizations.
In our strategic plan, we envision having hospital systems develop true collaborations with community organizations. All these organizations would share data about their shared patients or clients, plan ways to address the most pressing health issues in a coordinated manner, and work together to improve health outcomes for the people in their communities.
What will be different in five years if your plan succeeds?
Here are four examples:
- The uninsured rate for people of color in Connecticut won’t be any higher than it was in 2016.
- All people of color will have a meaningful relationship with a primary care provider that serves as the basis for a partnership to address their health needs.
- At least 50 percent of payments for health care services will be provided through alternative payment models that reward improved outcomes for people of color.
- Three hospital systems will have developed community collaboratives between the health care delivery system and community organizations, sharing data on their shared patients and working together to improve health outcomes. These will be models that other health systems and communities can adapt for their own use.
Why is your insurance coverage goal just to not lose ground?
I wish we were talking about expanding coverage. There is more work to do to reduce the uninsured rate in Connecticut.
However, we recognize there are significant challenges to coverage, which could make it difficult to even maintain coverage for those who have recently gained it. These challenges include federal proposals to repeal and replace the Affordable Care Act – which the Congressional Budget Office projected would result in huge coverage losses – and the state’s fiscal crisis, which limits Connecticut’s ability to mitigate any loss of federal funding.
Will changes in the state budget or federal health policy affect this plan?
Yes. Our goals will not change, but objectives and tactics could.
The foundation grappled with the uncertainty of the times. What we came to terms with is that health equity is still an imperative, and while the times might be challenging, the goals can’t change.
Our job is to make sure that when it comes to health equity, all that can be done is being done.
The strategic plan talks about health information exchange. What do you envision and why is this important?
Health information exchange refers to having a way for health care providers to securely share medical records, so every provider who treats a certain patient knows what the other providers are doing.
Everybody has a story about the lack of connection between their various doctors or having to repeat a test because a provider didn’t get the results. This can be an annoyance, but it can also be dangerous and detrimental to people’s health outcomes. Making sure every provider you see can access your records and know what the other providers are doing can improve efficiency, minimize duplication, and improve cost-effectiveness.
This is important for the health system overall too. Having the ability to exchange health information makes it possible to pinpoint health needs and intervene. Researchers can use this data – in a “de-identified” form, meaning it can’t be traced to any individual patient – to compare health outcomes for different populations. They might find pockets of the state where people’s needs are not being met, or that certain populations are dying from certain conditions at much greater rates. This can lead to targeted interventions.
Are you focused on just people of color?
The foundation’s mission is to improve the health of all Connecticut residents. We focus on people of color because in health, the most egregious challenges are the disparities that exist for people of color.
Many of our approaches are universal – that is, they are designed to benefit everyone.
However, if we’re going to be effective in reducing disparities, we need targeted interventions within those universal strategies.
For example, we will work on ensuring access to care for everyone, but we’re going to make sure there are targeted efforts and initiatives for people of color, who are far more likely to be uninsured and less likely to have a regular source of care.
How did you do on your last plan?
I judge it by whether we embedded health equity in the foundational building blocks of health reform implementation in Connecticut.
When I look around, I see that the All-Payer Claims Database has health equity as a goal. The State Innovation Model – a federally funded initiative to redesign how care is financed and delivered – is taking it on. Access Health CT, the state’s health insurance marketplace, has health equity as a goal.
I think we have the building blocks on which to continue the work. This new strategic plan is in large part about building on that architecture.