Health reform and collaboration

By Alicia Caramenico

FierceHealthPayer: Why do you think we need healthcare reform?

Cynthia Crone: We have to have health reform to sustain our healthcare system and our national economy. I really believe it's also important to improving overall health, which is the end goal and which in turn effect our productivity and education and just about everything. Because our healthcare costs have risen much faster than inflation, and we still have the most expensive healthcare in the world that we've got do something to bend the cost curve.

Of course, we're talking about health insurance, but if the cost of care comes down, the insurance costs will come down. We're already seeing that: The costs for the marketplace plans came in 16 percent less than expected, and about 10 percent less in our state.

And we've already seen the payment and quality improvement projects--in our state we're doing bundled episodes of care and medical homes, and already those costs are going down. So I think it's going to work and I think we have to do it to sustain our healthcare system and keep our hospitals open and our healthcare local and save money and lives.

FHP: What role does healthcare collaboration play in exchange efforts?

Crone: It's huge. We've had a lot of support from our federal partners, being a state partnership exchange. But from the beginning, when we started exploring that, we had really engaged advisory groups of citizens coming from healthcare providers and consumer groups. They really led our plan management policies as well as our consumer assistance--how we built our guide, how we built our speakers' bureau. They'll be coming to help us know that we had to make a change in our consumer outreach.

We've really had a lot of collaboration. It takes time and it takes trust building and I think we've done that really well.

And if you look at our private option, in a really short time because that bill was passed at the end of April, our Medicaid agents and our insurance department and hazard department that don't usually work together had to align on policy and regulation. Actually our plans had to get everything  ready in a really short time, and while we were doing a lot of collaboration on everything from policy to operations, we also were having to collaborate with the Centers for Medicare & Medicaid Services at the Medicaid level.

I think that who private option was one big tasked collaboration on steroids that is going to be good for our people. I would say collaboration is the key to what we do

FHP: How has your experience as a nurse practitioner prepared you for your role as insurance deputy commissioner of Arkansas Health Connector?

Crone: It brought me foremost with a consumer focus and how to work within a teamwork framework. Our commissioner is very consumer-focused and had brought me in under that frame. But it's back to what we talked about before--the belief that if you truly collaborate, the product is always greater than the sum of its parts. And in this case, I think it's been greater than we ever though it could be.

An example would be our private option. And that happened in a real partisan way. So we were getting people in private plans that really were the lowest income. It was the only way were going to expand Medicaid. So we weren't expanding the Medicaid program but eligibility.

I've always my whole career served vulnerable populations, and so I came to this with the knowledge of healthcare systems and problems consumers have if they can't access care, the longstanding commitment to access and affordability, which is exactly what the Act promotes.

I think here I've been able to influence improved access through regulatory policies and I look forward to when we really grasp and focus on quality as we move forward.

There's going to be more of a role for nurse practioners going forward in the new marketplace and new delivery systems. That's going to take more changes--policy change, plans changing, panels changing, to accept NPs practicing within the scope of their education or license. It just gave me a solid base for launching this kind of work.

FHP: Is there anything about the job that makes you wake up in the middle of the night?

Crone: That would be not getting as many enrolled as we can, as we need to. I think about consumers not being fully informed when they choose plans and if we don't have time to really work with them so they understand that the lowest premium may not be their best choice, depending on their health status and use patterns. It's just difficult to achieve that kind of outreach and education with the political opposition pulling down our ability to get the breadth of information and education out to our people.