Republicans for Single-Payer
Universal Healthcare with Informed Choice

Reforming Healthcare with "Balanced Choice"

How does our existing healthcare system perform?

·         It’s not universal health care.  15% uninsured, 50% underinsured, and hundreds of separate plans.

·         Insurance plans promote adverse selection, cost-shifting and endless, expensive inefficiencies.

·         Consumers must abide by the guidelines of 3^rd party payers, often limited to provider panels.

·         Communities lack integration of care, lack accountability, lack timely data about needs.

·         Consumers and providers lack accurate cost and efficacy data on alternative healthcare options.

·         Businesses entail huge costs of selecting insurance plans and managing them, and costs are rising.

·         Healthcare is subject to excessive political and 3rd party payer guidelines and regulation.

How will Balanced Choice be different from our existing healthcare system?

·         It’s universal health care - one single risk pool to simplify funding and service payments.

·         Consumers are free to make informed choices of providers and health care services.

·         Providers are free to develop ethical and effective services in an economic manner.

·         Community leaders, working with Public Health, are empowered by availability of population data.

·         Value-conscious consumers and providers collaborate on appropriate healthcare options.

·         It’s portable, and de-links the burden of healthcare insurance from employers.

·         It is much more cost-effective and responsive to market forces, and avoids government price controls.

What are the options for funding the Balanced Choice healthcare system in Colorado?

·         Create a “Colorado Collaborative Health Trust (CCHT)” made up of consumers and providers.

·         Strategy levers balance funding with payments as determined by the CCHT, collaboratively.

·         Fed/State contributions to the CCHT at current levels of Medicare, Medicaid and other programs.

·         Employers and consumers contribute according to income (equitable payroll deductions).

·         Option for taxation of alcohol or tobacco, or development of other appropriate funding sources.

Why does Balanced Choice maintain a 60/40 split (Standard/Independent Options)?

·         Standard Option pays standard rates with minimal or no out-of-pocket fees.

·         Independent Option pays provider-determined fees, less consumer “gap” payments.

·         Providers collaborate with Consumers to choose best option:  Standard or Independent.

·         A 60/40 target ratio facilitates a balance of the Standard vs Independent Options.

What is the “Single-Payer” Claims and Payment Process?

·         Consumers use a “Colorado Healthcare Card” with HIPAA-compliant confidentiality.

·         Providers submit standard claims data to a “central clearinghouse” via electronic interface.

·         Providers can set their own fees, using standard service codes, as % of standard rates.

·         Consumers receive or have access to a user-friendly display of services and payments.

·         Providers are paid at the time of claim, without pre-authorizations and/or denials.

How is quality healthcare assured?

·         Quality management requires timely and understandable information (HIPAA-compliant).

·         A Colorado Regional Healthcare Information Organization (CORHIO) is fully implemented.

·         Consumers and providers have electronic health records for efficient summary and review.

·         Voluntary “Medical Homes” assist residents with chronic or special health care needs.

·         Providers have evidence-based guidelines to inform clinical decision-making.

·         Provider data is available to consumers to facilitate informed, value-conscious decisions.

·         Communities have data to facilitate effective and economic health services to residents.

·         Providers are registered so that credentials for licensing and certification are on-line.

·         Public Health objectives are improved by timely access to HIPAA-compliant data repositories.

·         Key performance indicators guide corrective action (eg Healthy People 2010, JCAHO Oryx).

With Balanced Choice, residents of Colorado can achieve the six aims of a healthcare delivery system as described by the Institute of Medicine (IOM) in Crossing the Quality Chasm (2001):

·         Safe — avoiding injuries to patients from the care that is intended to help them.

·         Effective — providing essential and appropriate services while avoiding underuse.

·         Patient-Centered — respectful and responsive to patient preferences, needs, and values.

·         Timely — reducing waits and sometimes harmful delays for everyone involved.

·         Efficient — creating a value-conscious collaboration and avoiding waste or overuse.

·         Equitable — providing care in a consistent quality regardless of ethnicity, gender etc.

For more information, see:    www.balancedchoicehealthcare.org                            Revised: 1 Jul 07