The major health policy story of 2011 was Kentucky’s switch to Medicaid managed care—a move that will impact more than 540,000 Kentuckians.  But much more is on the way, and it will have a major impact on the rest of Kentuckians as soon we will begin seeing more reforms as a result of the Affordable Care Act (ACA).

As the ACA is implemented, it is important that patient access to care is not jeopardized. That is why Kentucky Voices for Health (KVH) has designated several focus areas to help guide the way policymakers, consumers and health care providers interact with the healthcare system.   These include consumer engagement in the development of new health exchanges (“a shopping mall for individual and small business health plans”), increasing access to preventative services, greater transparency in regards to coverage and costs, and most importantly, maintaining access to quality care.

The public must become more educated and engaged in order to take advantage of the new opportunities and greater amount of health-related information available to them. Standardizing the language used by plans and insurance companies is important for consumers to be smart, active purchasers of health coverage.  Individuals also need to be more aware of their personal health information and the care they are receiving in order to have a complete understanding of what they are paying for.  Health information technology is a tool that both patients and providers should use to improve care coordination and consumer engagement.

Individuals and employers are the real payors through the premiums paid to insurance companies.  That is why the Medical Loss Ratio (MLR) is so important to consumers by requiring that 80% of all premiums paid be used for medical services and quality improvement and not on marketing, administrative fees, commissions, and executive salaries.  It is important that the MLR be retained with strong consumer protections and rebates to ensure accountability to all of us who pay for care. 

Health reform will result in significant changes in the Commonwealth and will present many interesting challenges to our policymakers as they build health insurance exchanges that will make it easier for individuals to shop for coverage.  In addition, Medicaid will be expanded to cover additional Kentuckians with incomes up to 133% of the federal poverty level—making more than 250,000 additional Kentuckians eligible for Medicaid.  The bottom line is that for implementation to be successful in making coverage more affordable, it is important for all Kentuckians to be covered--including the currently estimated 604,000 Kentuckians who have no health insurance.

So health reform is not just a political endeavor, nor is it just about insurance companies, hospitals, clinicians. It is about me, you, our employers, and our communities.  I once heard the quote, “"Health starts where people live, learn, labor, play and pray." What are you doing to live a healthier lifestyle? How are you engaged in the care that you are receiving? Do you know the actual costs of the health care services you are receiving?  Is the service/procedure necessary for improving your quality of life?  These are all questions that we need to be asking. 

The concept of value-based health care purchasing is that buyers (you, me, and our employers) should hold providers and plans accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the money spent towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the delivery of high quality care.

Health reforms must promote fairness and provide security to families while allowing consumers and small businesses to buy affordable coverage and compare health plans. All stakeholders win in a value-based purchasing model with active consumer engagement.

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