The Tennessee Medical Association fully supports Insure Tennessee as a way to extend health insurance coverage to more working Tennesseans. We back Governor Haslam’s plan because it will allow more Tennesseans to access affordable medical care.
More people having health insurance means more people will be on the road to better health and better lives. We became physicians to help heal the sick, and we see Insure Tennessee as a great opportunity for our state to help our citizens and improve our overall health.
What has concerned – and confused – many Tennessee physicians is the state’s implementation of the Tennessee Health Care Innovation Initiative, or TennCare payment reform.
State officials have lumped payment reform into the Insure Tennessee conversation, but they are two entirely separate issues, and it’s important for all Tennesseans to understand the difference.
Insure Tennessee is about covering more people under health insurance plans with a sliding scale of pay assistance or subsidies. TennCare payment reform is about changing the way TennCare compensates healthcare providers for treating patients.
Through the payment reform effort, TennCare is moving from fee-for-service to a value-based reimbursement model. The program pays for an entire episode of care as opposed to a single visit to the hospital or doctor. The state aims to reduce its overall healthcare costs by rewarding providers for achieving specific goals, and penalizing those who exceed cost thresholds for episodes of care.
As physicians, we understand the concept of TennCare analyzing cost data and using it to drive more efficiency. Tennessee is one of the first states to reform Medicaid payment in this way and is doing so using federal grant funding. It is true marketplace innovation and we have a real opportunity to bend the cost curve and improve quality with the experimental program, if we get it right.
So far, we are not getting it right.
We have serious concerns, for instance, about how the state is reporting data back to providers about their episodes of care. The data has to be timely, accurate and consistent. The providers have to actually see it and learn from it to be able to alter their treatment patterns to reduce variation. The state needs to be accountable for making this happen or the payment reform initiative will not work.
Why, one might ask, should anyone who is not employed in healthcare or state government care whether TennCare payment reform works?
One universally acknowledged truth is that our healthcare spending is out of control and we have to do something about it.
It also matters to patients because physicians will no longer participate in TennCare if the state ignores input from healthcare providers and pushes ahead with a flawed process for payment reform. If the process is not fixed now, in the early stages, the problems will only worsen as the state adds more episodes of care and expands from TennCare to commercial insurances.
Leading physicians in the TMA are working with state officials to advocate for our patients. We have communicated these and other concerns to officials with the TennCare Bureau on multiple occasions, and directly to the governor himself.
We will continue to address our concerns with the state and work with the TennCare Bureau to try to affect the process, but ultimately it is the state’s responsibility to get it right.
The TennCare payment reform effort has already been underway for nearly two years, long before Insure Tennessee was even conceptualized, and the state intends to keep pursuing it regardless of what happens with Insure Tennessee.
The outcome of the legislature’s special session in February will have no effect on the future of payment reform in our state, but if payment reform problems are not fixed now then it will have a severe effect on healthcare in Tennessee for all patients.
Our state leaders must address the issues with payment reform and give Insure Tennessee the consideration it deserves as an entirely separate issue so both programs can ultimately be successful.
Douglas J. Springer, MD, FACP, FACG
Kingsport Gastroenterologist
President, Tennessee Medical Association