By Kelly Kennedy, USA TODAY
WILLIAMSBURG, Va. - One day after a USA TODAY survey showed the states are divided along party lines when it comes to implementing the Affordable Care Act, governors meeting here tried to focus beyond politics on what needs to be done to cut health care costs.
And unlike the bitter battle at the national level, they calmly found middle ground by sticking with issues that could be addressed at the state level. The USA TODAY survey found that only Republican governors have refused to expand Medicaid and only Democrats say they will. But Saturday, the governors said they saw solutions.
"Fifteen years ago, we thought we would never, ever get a handle on violent crime," said Gov. Martin O'Malley, D-Md., and he then talked about innovative ideas that worked in that arena, such as performance reviews and incentives. "I'm hearing all the same ideas. I've seen what you all are doing. It sounds like what we need is a common platform."
Speakers talked about the high cost of patients with chronic health issues, keeping track of patients who needed follow-up care to keep them healthy and cut costs, and creating incentives for providers that lower costs for the states.
Some of the lessons seemed obvious, such as addressing the Medicaid dental patients in Minnesota who went to the hospital for pain medication, rather than to the dentist for treatment; or providers at 11 centers who duplicated medical tests because there was no incentive to stop, said Jennifer DeCubellis, director of Hennepin County Health in Minnesota.
Many of the states are already working through solutions that were included in the Affordable Care Act: providers who work together as a team, better medication management, and trying to better share information between health care systems, including with electronic records.
Some of the governors latched on to the idea that they could address the problem using resources they already have.
"Are you suggesting the current system has more than sufficient funding?" said Gov. Dave Heineman, R-Neb., to the presenters. "We're just not using it efficiently?"
Jeffrey Brenner, director of the Camden (N.J.) Coalition of Healthcare Providers, said the United States spends more money than any other country, but "you don't see the French dying in the streets." In other words, other countries have created good health care systems without watching the quality go down. He said the states with the most efficient health care systems are the states where the governors have "banged their fists on the table and said, 'Let's get this together.'"
But it's not quite that simple, DeCubellis said.
She said she believed the money is in the system, but some problems cannot be solved in 20 minutes with the doctor, such as getting the word out the public about obesity or making sure people can get to the resources - such as fruits and vegetables at a local grocery store - they need to make healthy choices.
Gov. Gary Herbert, R-Utah, picked up on some of those problems, such as trying to make change in a large, bureaucratic system. "It gives us pause for thought for what we can do at the state level," he said. Then he asked Brenner to explain what he meant when he said health care has not "innovated."
Brenner said amazing progress has been made in health care, but that, unlike a company like Apple that immediately makes sure the innovations reach down to the lowest level, health care still struggles with getting the word out about basics.
As an example, he talked about a 70-year-old man who couldn't keep his blood-sugar levels under control. Because hospitals face penalties for patients who are readmitted within 30 days of a hospital stay, some organizations have nurses calling patients after they go home to make sure they're taking their medications, to see if they have any questions and to see if they've noticed any changes in their health. In the case of the 70-year-old, a team visited to figure out the problem: He sees poorly, and he had been sucking air, rather than insulin, into his hypodermic needle. Brenner called that a "process failure."
About 100,000 patients die every year to provider errors, Brenner said, adding that they get great care at the hospital, but then are sent out into the world without follow-up care.
"There's no incentive to do it," he said. If everyone worked together, "you'd close hospitals."
Gov. Jack Markell, D-Del., asked how, then, can a state reward quality, rather than using a fee-for-service system, across the health care system. Brenner suggested hospital bonds. "Half of the costs are doctors and hospitals," he said.
Emergency room physician Andrea Archer traveled to the conference from Midlothian, Va., because what the governors talk about and the policy decisions they make will affect her work. She said many of those decisions should be made at the local level, echoing comments in the meeting that one solution will not work for every state.
"It's interesting to see how some people with their boots on the ground are making things work," she said. "That was really exciting."