Virginia should create and operate its own health-insurance exchanges and consider different models of care for some of the most costly Medicaid patients, according to a report from a state health-reform advisory panel.
The Virginia Health Reform Initiative advisory council, appointed by Gov. Bob McDonnell in August, made 28 recommendations in a report to the governor released Tuesday.
Regulated health-insurance or health-benefits exchanges — portals where people can go and comparison shop for affordable health insurance — are a key component of federal health-care reform.
An estimated 2.6 million Virginians, or about 56 percent of the private insurance market, theoretically would be eligible to buy insurance through the exchanges, according to the report. The advisory council said the "current state of the insurance market in Virginia is unsustainable, especially for small business."
"Our main focus was to have this panel develop a strategic plan for the governor on how to reform health care in Virginia that works for Virginia in terms of its citizens, the economy and the government," said Cindi B. Jones, director of the Virginia Health Reform Initiative office that oversees the implementation of federal health-care reform in Virginia.
Virginia and some other states are challenging federal reform on the grounds that the federal law's mandate that people buy insurance is unconstitutional. A federal judge in Richmond on Dec. 13 agreed with Virginia Attorney General Ken Cuccinelli, who filed suit last March challenging the mandate.
In other states, judges have decided the opposite, while other cases are pending. It is expected that the U.S. Supreme Court eventually will decide the issue.
"We took a much broader approach than just the federal health-care reform," Jones said. "There are certain timelines and deadlines in federal health reform that we had to address, but that was not our main focus. The governor and the attorney general both realize that it is still the law while it's going through the process."
The panel's recommendations are focused around six themes: Medicaid reform, capacity, service delivery and payment reform, technology, insurance reform, and purchaser perspectives.
Federal health-care reform will make more low-income people eligible for Medicaid, and the federal government will pick up most of the extra costs. In Virginia, an estimated 270,000 additional people will qualify for the program, which now covers about 1 million people, according to the report.
Jones said 67 percent of Virginia Medicaid recipients are in managed-care plans.
"The ones that are outside of it are the elderly and individuals with disabilities, and they make up only 30 percent of our enrollees but 70 percent of our costs. So if you ever are going to bend the cost curve you need to implement care coordination strategies with that population," Jones said.
Other recommendations include:
•Becoming a Medicare demonstration site on the use of telemedicine in areas with underserved populations;
•Increasing capacity of the health system to handle more patients;
•Creating the Virginia Gateway project, an automated system for determining eligibility across various health and human services agencies such as Medicaid, aging services, behavioral health and rehabilitation services; and
•Continuing to operate the advisory council, which would meet quarterly.
tlsmith@timesdispatch.com
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