A Huge Opportunity to Fix Our NM Healthcare System

Does any of this sound familiar?

  • Confusing plan options with too many misleading and confusing marketing pitches to sign up for competing coverages;
  • Long waits for appointments, often months, even for time-critical conditions;
  • High premiums, deductibles, and co-pays;
  • A litany of confusing letters from healthcare and coverage providers detailing charges and balances;
  • Soaring pharmaceutical prices.

Our healthcare system is a mess, but in New Mexico we are fortunate to have a cadre of individuals and legislators who understand the problem and have a plan to fix it.

On Tuesday, Sept. 13 at 6 pm, Retake’s Health Security Zoominar will dive into these problems and discuss how Health Security Campaign leadership and key legislators propose to fix these dysfunctions and create a healthcare plan that will guarantee coverage for all New Mexicans and control costs.

Our panelists include Mary Feldblum, Exec. Director of Health Security for New Mexicans Campaign, who for over 30 years has been leading the effort to achieve health security in NM. Joining Mary will be two of her key legislative allies, Senator Jerry Ortiz y Pino and Representative Day Hochman-Vigil, who will be working to pass legislation to advance the HSA in 2023. Also joining the panel will be Rick Madden, MD, who is with the NM Academy of Family Physicians. He will speak about how difficult it is for physicians to focus on patients, with the onerous billing and administrative burdens in the current system, and how the Health Security Act would reduce those burdens dramatically. Panelists will discuss the exciting Health Security Plan design process that focuses on how this plan will work, how it will simplify the administrative burdens and costs. Mary will discuss six key design topics critical to Health Security Plan implementation that are currently being explored, thanks to legislative funding support.

Fixing our healthcare system, not with band-aids but with serious reforms that will address access and rising cost issues is critical. Rep. Hochman-Vigil and Sen. Ortiz y Pino will discuss their plans for the upcoming legislation to ensure that we remain on track. Legislation to continue the design of the Health Security Plan will be one of the most important bills we support in 2023. This careful process will enable New Mexico to have more affordable, higher quality, and more accessible health care.  Our state could become a model for the nation.

Be sure to register for this exciting panel. You must register to attend. Click here to register.

Below are details on what is at stake and why supporting the design process is so important. Start your own health security education by reading what follows. You will be better able to ask good questions to our panelists. We can do this, but we need lots of well-informed and motivated constituents to help educate legislators and the public. Read on! You will finish the piece better educated and certainly more motivated, I promise.

What is the Status of the NM Health Security Plan Design Process?

Background: There have now been three independent cost analyses regarding the Health Security Plan (HSP): The Lewin analysis in 1994, the Mathematic analysis in 2007, and the KNG analysis in 2020. Their conclusion? The Health Security Plan would cost less than the current system and would ensure that everyone in NM has healthcare coverage. 

Each of these studies projected cost savings while making assumptions about how the Health Security Plan could reduce costs. In 2020, bill sponsors and Health Security Campaign (HSC) leadership determined it is time to stop studying possible models and to design exactly how the Health Security Plan would work. Once designed, the costs and revenues can then be calculated based upon the actual design of the HSP. That is why it is so critical to work on the details of the Health Security Plan as described in the Health Security Act (HSA). To clarify, the HSA is the legislation that will create the Health Security Plan.       

The design process: It will take time to decide how to seek needed federal waivers, how to design payment schedules, lower drug prices, implement hospital global budgets, and other design elements. In 2021, $575,000 was appropriated to the design process. In 2022, $790,000 was appropriated to continue the design process work.

The funds were to be administered by the State Superintendent of Insurance. The final reports from the excellent consultants he hired in the first year are available on the Health Security Campaign website. The consultants laid out clear ideas for next steps. As far as we know, work on the second year has not yet begun. We are hearing that the Superintendent of Insurance is buried in mandated tasks and has limited bandwidth for managing this important process.

HSC leadership has developed a solution that will be introduced in the 2023 legislative session. The legislation would shift responsibility for the design process from the Supt. of Insurance’s office, moving it to a legislatively authorized board of experts. The board of experts would select consultants to complete each phase of the design process, ensure public input, and be able to move forward with the work required to create the Health Security Plan.

The completion of this careful design work is critical to being able to launch the Health Security Plan because the issues being studied are at the core of what would finally enable our state to address our health care system’s systemic problems – access AND rising costs.

In addition, an accurate projection of the cost and revenue needed for the Health Security Plan requires knowing exactly how the Plan would operate.

To use an analogy, if you had purchased a piece of land and wanted to build a house, you wouldn’t just ask a builder to give you an estimate without creating specs defining how large the house would be and the features of the house. You would design the house before you started building. Indeed, you would design the house first to verify you could afford it. So too, with building a healthcare system.  

The design process is also important because some critical elements of the design can be implemented sooner than others. For example, a program can be created that reduces drug prices (such as bulk purchasing of drugs), a global budget system could be created, providing financially challenged hospitals with a stable revenue source and federal funds to launch the system.

Why Do We Need Health Security in NM?

Our national healthcare system is broken. A recent report stated that healthcare costs are “double the per capita average as in a comparable developed nation, yet outcomes are far worse. People die younger. Infant mortality rates are higher.”

So, with our national healthcare system, we pay double the cost so we can die younger and have more infants die at childbirth!  Where does NM rank in relation to healthcare affordability and access?

According to a 2014 study by the nonpartisan Commonwealth Fund, New Mexico ranks last in the nation for healthcare affordability and access. According to the report, employers and families are increasingly shifting to high-deductible insurance plans, and New Mexicans are paying more and more out of pocket for their healthcare.

So, the national healthcare system is obscenely costly and delivers care that fails to keep us healthy. AND of all the states in the nation, NM ranks last in healthcare access and affordability. Sounds like good reasons to design a different approach.

The situation is even worse with rural healthcare in NM. There have been multiple reports on struggling rural NM hospitals, a problem not limited to our state. This is a national problem. Passing the Health Security Act and implementing the Health Security Plan could revitalize our rural hospitals and provide the nation with a model for addressing failing rural hospitals across the country.

What Is the Health Security Plan Design Process & How Can It Improve Healthcare in NM?

The entire purpose of the Health Security Plan design is to gather information from other states and nations about proven effective healthcare policies, models, and systems that could improve healthcare access, affordability, and quality in NM. From Health Security for New Mexicans Campaign website, The Health Care System Jigsaw Puzzle: “If we are to create our own health plan in New Mexico, it needs to be done carefully, with public, legislative, agency, and executive input. The process may take several years. Many crucial pieces, however, can be put into place at earlier stages. There is no reason why we should delay strengthening struggling hospitals, addressing escalating drug prices, and simplifying a system that discourages providers from wanting to practice medicine in our state. Thus, piece by piece, the puzzle can be finally solved.”

There are six pieces. Ultimately the pieces must fit together to create a plan that simplifies our administratively complex system, addresses access, and controls rising healthcare costs. Let’s examine these key pieces.

The first two topics build on the consultants’ 2021 recommendations:

1. Global Budget Working Group — Global budgets provide guaranteed revenue for hospitals, which will particularly help our struggling rural hospitals and the communities that depend on them. Federal funding is available for states that want to create such a program. How to create such a program would be the focus of the working group.

2. All-Payer Health Professional Payment System — An all-payer health professional payment system sets uniform reimbursement rates for specific services that apply to all healthcare professionals within a specialty and may apply to both private insurance companies and public programs like Medicaid. Such a system greatly reduces billing complexity and increases transparency.

The remaining four design topics address other key aspects of our health care system:

3. Prescription Drug Affordability — This topic will focus on how to develop a prescription drug program that lowers prices for patients. There are various options that could be explored, including joining an existing drug purchasing network or establishing a public entity that would be responsible for negotiating prices.

4. Medicaid — This topic will focus on understanding the cost of the Medicaid managed care program, which covers 900,000 New Mexico residents. To address issues around Medicaid (and its impact on the state budget), it is imperative to have an accurate picture of its true costs. As last year’s expert consultant on federal waivers mentioned in their report, Connecticut decided years ago to drop its Medicaid managed care program and have the state administer it instead because of rising costs.

5. Inter-Operational IT system — This topic will focus on how to create an inter-operational IT system that applies to all New Mexico payers (private insurance and public programs) and providers of healthcare services. This system would include patient medical information (with privacy and security concerns addressed), so that no matter where you go to receive healthcare in New Mexico, health professionals and health facilities have access to your medical history. 

6. State Health Expenditure Data — This topic will focus on collecting New Mexico healthcare expenditure data so we know what we are actually spending on healthcare in our state. This data will serve as a baseline for future years and should be collected annually going forward. This expenditure data will also be required when the puzzle is finally put together – to determine the cost of the Health Security Act as designed. In fact, all efforts to increase the effectiveness, stability, and sustainability of our healthcare system will benefit from having this data available.

Note that each design topic includes options that need to be weighed by investigating how they have been implemented elsewhere. The intent is to ensure that the HSP incorporates the best thinking and the most effective policies and practices from other states and nations. Understanding what has worked elsewhere (and what has not worked) will help us make the decisions we need to come up with our own homegrown New Mexico plan.

During our Health Security Zoominar on Sept. 13, we will talk about this exciting design process, how the puzzle pieces fit together, and what we all can do to achieve health security in our state. Click here to register.

In Closing

Ranking last in the nation in healthcare affordability and access, with multiple rural hospitals at risk of bankruptcy, one would think policymakers and legislators would be cheering on the Health Security Design process and doing all they can to push the process forward. 

What can we do to ensure that  the Plan Design process continues? Please join us on Tuesday, Sept. 13, 6-7:30 pm, and learn how this process can lead to a more accessible, more affordable, and more effective healthcare system for New Mexicans. Find out what we can do to engage and educate our legislators and their constituents to support the Health Security Plan Design process. Details on the panelists and more about what will be discussed is summarized at the top of this post.

To be an effective advocate requires learning the ropes. To be an effective legislator requires understanding the issue and what is at stake, so join us on the Sept. 13 and please share this post with your legislators and encourage them to attend. The education process begins. We can do this. Reminder:  You must register to attend. Click here to register.

In Solidarity & Hope,

Paul & Roxanne


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