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She Sees Light in Health Reform Tunnel

Greg Bordonaro

May 30, 2011

To say Jeannette DeJesús has had a hectic last few months may be an understatement.

As the newly minted deputy commissioner of the Department of Public Health, DeJesús has taken on the role of special advisor to Gov. Dannel P. Malloy on health care reform, where she is spearheading efforts to implement the federal Patient Protection and Affordable Care Act in Connecticut.

She’s also juggling health care reform efforts on the state level as well.

DeJesús, a former Connecticut Hospital Association executive and CEO of the Hispanic Health Council, said the task of developing and implementing policies that expand access to quality health care and make it more affordable to small businesses and individuals in particular, is a difficult one.

But she said she’s confident Connecticut is in a good position to make it happen.

DeJesús, who holds masters degrees in social work and public administration from New York University and Harvard respectively, said her approach to health care reform is not just about setting up more efficient delivery systems, which will be a monumental task in and of itself. It’s also about transforming the way providers in Connecticut deliver health care and how individuals view their own health.

That will require changes like establishing new models of care — including patient centered medical homes and accountable care organizations — and finding ways to better manage and reduce chronic diseases.

“Reform is more than just setting up systems,” DeJesús said. “It’s about transforming how people think about their own health care.”

DeJesús said the cornerstone to federal health care reform will be the establishment of the insurance exchange, which the state is required to set up no later than Jan. 1, 2014.

The insurance exchange will essentially be an online marketplace for individuals and small businesses to obtain coverage from an array of insurers competing for consumers. The federal government will require participating health plans to meet certain benefit standards and also provide ratings on health plan quality.

But states have a lot of freedom in choosing how they want to operate the exchange, and lawmakers are closing in on agreement for the framework of Connecticut’s version, DeJesús said.

Three bills have been proposed in the legislature on the issue, but the one likely to carry weight was drawn up by the Malloy administration.

DeJesús said the proposal is based on model legislation from the National Association of Insurance Commissioners and calls for the creation of a quasi public agency to run the exchange. The agency would be made up of a 14-member board of directors that would choose an executive director.

The board members would represent many different industry groups including business, insurers, health care providers, consumers, and labor, although there has been debate over who should be represented on the panel.

Some lawmakers have been pushing to restrict certain industry groups from being represented on the board, which will also be responsible for administering the exchange’s programs and activities.

But the Malloy administration proposal bypasses most policy decisions like what size businesses will be eligible for the exchange. That was done intentionally, DeJesús said, because there is still a lot of uncertainty about final regulations.

Additionally, a market analysis for the exchange has not yet been completed, and state officials are still seeking input from various stakeholder groups, including business.

“We believe this is the best model because there is a lot of information that has not yet been issued by the federal government that we would like to take into consideration before we make very important policy decisions about the exchange,” DeJesús said. “This gives the state the flexibility we need to move forward.”

Other versions of the bill, however, attempt to incorporate more policy decisions like requiring the state to offer a basic health plan to low-income adults. It’s not clear if that measure will be in the final bill.

Eric George, a lobbyist for the Connecticut Business & Industry Association, said he favors the administration’s approach of setting up a framework for the exchange, but waiting on the implementation of policy decisions.

He said it’s particularly important that industry representatives have a seat on the exchange board.

“This is going to be a new health insurance marketplace that will completely reshape the way people buy their health insurance,” George said. “We need to make sure we bring all stakeholders to the table so it’s done the right way.”

DeJesús said she believes the exchange will lead to more affordable coverage for small businesses in particular, because it gives them an opportunity to pool together, increasing their purchasing power. There are also tax breaks available for certain businesses that qualify.

“That will enable them to lower cost,” she said. Besides the exchange, developing new health care delivery systems is also on the agenda, including the adoption of medical homes and accountable care organizations.

The Obama administration recently outlined guidelines for accountable care organizations, which are networks of care providers that work together to coordinate care in order to keep patients out of the ER and reduce duplicative testing and medical errors.

DeJesús said she is constantly talking to hospitals, individual practitioners, and other providers about ways to more closely link their care. There has been a recent wave of consolidation among hospitals in Connecticut, which could spur some of that closer coordination.

“Long term sustainable health care is going to require we have efficient systems,” DeJesús said. “To the degree that these mergers and acquisitions enable us to have effective systems, I think it is a good thing.”

The state’s primary care physician shortage, payment reform initiatives and finding ways to use health IT more effectively are also issues that must be dealt with, DeJesús said.

In addition, developing wellness and preventative medicine programs that target segments of the population that are high utilizers of the health care system is also a must to drive down costs, she said.

But despite the laundry list of issues, DeJesús said she remains optimistic, even excited, about the size of the task.

“Not only is Connecticut in a very good position to take full advantage of federal health care reform, but Connecticut is being very innovative, creative, and comprehensive in how we approach it,” she said.