The Governor's Commission on Health Care Reform: Inaugural Meeting
The Governor's Commission on Health Care Reform: Inaugural Meeting
Good morning and thank you for being here. The word "crisis" is too easily used and too often used these days. But when it comes to the status of health and health care throughout Virginia - and our nation - there is no more accurate term to describe what's happening.
The average Virginian's access to the health care needed to lead a healthy, long and productive life is threatened today. Our lifestyle is threatened.
Inevitably, every discussion we have about this topic seems to get bogged down in a tangle of budget figures and statistics. While a firm grasp on those concepts is a must, we can never forget that what lies at the heart of this challenge is people: Our parents, our siblings, our spouse, our children and ourselves.
The story of health care in Virginia today - to borrow from Dickens - is in many cases the best of times and the worst of times. If you have a premature baby that needs neonatal intensive care, Virginia is one of the best places in the world to be. The Commonwealth is home to some of the best NICUs in the nation, from CHKD in Norfolk to Fairfax Hospital to the Carillon Medical Center in Roanoke to the VCU Medical Center, just across the street. And yet, in 2004, some 768 infants died in Virginia - and average of more than two babies every day, surpassing the national average infant mortality rate.
Virginia is also one of the best places in the world to be, if you are diagnosed with cancer that requires advanced treatment. The Massey Cancer Center in Richmond and the University of Virginia are both NCI designated cancer centers, offering world-class care. Community hospitals across Virginia also offer excellent cancer care.
But what do those world-class resources mean to the more than one million Virginians who don't have health insurance? The vast majority of uninsured Virginians either works full-time or lives with someone who does. Most work for small businesses. And all of them face a daily risk of having to choose between expensive health care treatment and other essentials, like food and shelter.
Dramatically rising health care costs also impact some of most vulnerable among us. People with disabilities and the elderly account for three of every four dollars that Virginia spends on Medicaid. And the payments Virginia makes to the medical care professionals who care for these people are among the nation's stingiest. Yet those payments, the Medicaid program, eat up roughly 14% of Virginia's General Fund budget. And that is growing at a rate of 8%-10% a year, faster than family incomes, faster than our most successful companies and faster than Virginia's economy - one of the best state economies in the nation.
This trend will continue as we see our elderly population grow bigger. And that dynamic will create competition for government dollars between the care for our loved ones need and other key priorities like public education, public safety and natural resources.
Almost anyone you talk to today will say they need to eat better and exercise more, but our behaviors don't reflect that understanding: our adult obesity rate was a staggering 24.1% in 2005.
It's a similar story for tobacco use. No one will argue with the detrimental health consequences of it. But one in five high school-age Virginia children smoke.
We are also facing a severe shortage of medical professionals, especially nurses and certain specialist. That's shortage is especially acute in rural parts of Virginia. And while many of our facilities provide top-notch quality, we have to prepare for a population that is expected to grow nearly 15% by the year 2020 and nearly 24% by the year 2030. By then, Virginia's population will be 9.3 million people.
Improving Virginia's overall health and improving the access Virginians have to affordable, accessible health care are top priorities of my administration.
When I asked each of you to join this commission, I was looking for strong leaders - from different parts of the Commonwealth, with different perspectives - who had personal interest in health and health care, a passion, expertise and the leadership skills to challenge the status quo and bring me recommendations to build on what we have already done to make effective, lasting improvements.
If you look at the Executive Order establishing this commission and the McKinsey presentation that follows my remarks this morning, you will see that I have organized my concerns into five critical areas. This commission will feature five separate working groups to examine each one. They are:
1. Improving access to care;
2. Strengthening long-term care;
3. Improving the quality and safety of health care;
4. Encouraging healthier lifestyles; and
5. Growing our health care workforce.
I'd like to briefly talk to you about these areas and pose some questions to help guide your work. My overall challenge for you: Remember that people are at the heart of this challenge, and let's do all we can to make them healthier and to make it easier for them to access affordable health care in Virginia. There is no penalty for being bold and we will not fear to do something differently.
Health Care Access go to table of contents
As I mentioned earlier, more than a million Virginians lack health insurance. There is some good news. We've made great strides in signing up children for the state's children's health insurance program (FAMIS). Families USA recently found that 1 in 11 children in Virginia do not have health insurance. That's better than the national average of 1 in 9. We are making progress, but that figure is still too high. We have to do better.
This past year, I signed into law a bipartisan-supported measure that authorizes small businesses to establish cooperatives for the purpose of providing health insurance for their employees. But more is needed. We need to strengthen our access to care for the uninsured, from hospitals to community health centers to free clinics. The Virginia Health Care Foundation has done amazing things over the years to help provide access to care, in partnership with state government; it's time to make this partnership even stronger.
I urge you to be as creative as possible in your search for solutions. I'm not convinced that any state has the right model and I think that this is an area where we need to be innovative.
Long-term Care go to table of contents
Linked closely to increasing access to health care is perhaps one of the biggest challenges facing our health care system as our population ages: the availability of long-term care services for seniors and persons with disabilities.
This is a difficult issue to talk about, and people don't like to focus on it.
But Virginians over the age of 85 is our fastest-growing population segment.
It is great to have our grandparents and parents with us longer. It is wonderful to think that it is no longer uncommon for someone to meet their great-grandchild. But the reality is that one out of two people who reach age 65 will need long-term care.
In addition, more and more people are living longer with disabilities due to great advancements in medicine. That includes veterans of the wars in Afghanistan and Iraq. Improvements in modern medicine mean fewer of our fighting men and women are dying from severe injuries on the battlefield. We must take the next step and see that these heroes have what they need at home to lead productive lives - a right they have clearly earned.
The need for long-term care is clear and present. But our lack of preparation is dangerous. Almost everyone is underinsured or simply not insured for long-term care. The state Medicaid program pays for 2/3 of all nursing home care in Virginia. It was never designed to do that. And the current practice is simply unsustainable.
I want the group working on this issue to give me their best ideas for strengthening long-term care across the continuum of care. I'm particularly interested in ways to help people remain in their own homes and ways to promote private long-term care insurance.
My administration recently announced $1.5 million in start-up grants to six PACE programs across the state. PACE programs combine both Medicare and Medicaid funding to provide an entire spectrum of health and long-term care services -- preventive, primary, acute, and long-term care services -- to the frail elderly in their homes and community, with the hope of delaying or even avoiding the need for those folks to move into institutions.
What other innovative things can we do in this area? I also want this group to work closely with the other groups to address the unique workforce, access, and quality issues in long-term care.
Quality, Safety, and Transparency go to table of contents
Ever since the Institute of Medicine released the report To Err is Human - the study of human mistakes in hospitals - there's been a lot of focus on patient quality and safety. That's appropriate. We have some of the best hospitals and health care providers in the world. They've done great things in recent years to improve quality, safety, and transparency in health care. But we need to keep getting better in these areas. We need to continue identifying and using new tools that will advance these goals. And I want state government to be an active partner in these efforts.
One thing we'll be looking at, where appropriate, is pay for performance, so that state health care financing programs reward quality care. We'll also be partnering with health care providers to help consumers compare price of health care, so they can comparison shop, just as they would for almost any other good and service.
Comparison shopping for prescription medication should be just as easy as comparison shopping for a flight to Florida, or purchasing a DVD. With information technology advances, we can empower patients to make this and other health care choices that are right for them. The charge for this group is easier to say than it is to execute: Find ways to promote health care quality and safety while making the entire system easier for the common person to understand.
Encouraging Healthier Lifestyles go to table of contents
America spends more of its GDP on health care than any other nation. In fact, we spend twice as much on health care as we do on food. Yet, we have a shorter life expectancy rate and a higher infant mortality rate than many other developed countries. I believe we need to focus on preventing some of our bad health habits such as smoking, physical inactivity, and poor nutrition. Those bad habits contribute to heart disease, stroke, and diabeteswhich can take years off of our lives and take loved ones away from us prematurely.
We do a great job in Virginia of treating people when they are sick, but we fail when it comes to keeping people well. We should do more to get women prenatal care to prevent premature births. We need to encourage healthier lifestyles, to avoid cancer and heart disease. I'm delighted that doctors can perform state-of-the-art open heart surgery in Virginia, but I'd just as soon more people stop smoking, lose weight, and not need the heart surgery at all.
When it comes to helping Virginians lead healthy lifestyles, I'm particularly interested in focusing on obesity prevention and smoking cessation. As I mentioned earlier, roughly one in five high-school-age students smoke. Our Tobacco Settlement Foundation, the VDH and other agencies are working hard to reduce those numbers and I am interested in sustaining those efforts.
I'm interested in your ideas in this area. What can we do to get Virginians, especially young Virginians, to eat better and to exercise more?
What can we do to improve other preventative health measures such as smoking cessation and prenatal care?
Health Care Workforce go to table of contents
The number of practicing doctors and nurses in Virginia is below the national average and the lack of those professionals is particularly felt in rural parts of the Commonwealth. We need to improve our capacity to train more nurses and physician specialties, such as child psychiatrists.
To improve our capacity to train health professionals, we need more faculty to teach and we need more places to teach. We've done innovative things with the private sector, such as the new partnership between John Tyler Community College and HCA. We need more of those partnerships.
We also need to make sure that we pay enough to recruit needed faculty. We need to make sure that our best asset in training nurses, our community college system, is used effectively. Right now we don't train registered nurses at every community college campus and we don't have a standardized curriculum. I'll be working with my friend Glenn Dubois, the Community College Chancellor on these and other issues. We'll also be working with our four-year and graduate institutions on training health professionals.
I have one overriding challenge for this group: how do we make sure that we have enough doctors, nurses, and other health professionals to take care of Virginians as our society grows and ages and as our health care needs become more complex? Are there opportunities to work with others, such as the TANF population to improve training and create career opportunities for them?
Conclusion go to table of contents
We have a strong health care system in Virginia and it generates success stories everyday. But the challenges Virginians face in accessing affordable health care are real. Without our focus and efforts, they will only get worse. I look around at the deep pool of talent that has come together for this commission and know that we can do better and we must do better. That's our challenge. Let's get started.
http://www.governor.virginia.gov/MediaRelations/Speeches/2006/HealthReformCommission.cfm