Terry’s Platform for Putting Virginia First: Healthcare
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Read the PDF of Terry’s Healthcare Policy Plan here or read the full text below.


A Healthier, Stronger Virginia

Changes in healthcare present a tremendous opportunity to create jobs as we transition toward 1) a modern and efficiently managed health delivery system, 2) implement the Affordable Care Act, and 3) transition toward more home and community based care. Terry’s goals in addressing these transitions will be to create jobs, save patients money, improve the quality of care, save the taxpayers money, and grow our economy.

  1. Making Healthcare Management more Modern and Efficient

    1. A Chief Operating Officer for state health systems efficiency
      By reorganizing the way state health plans and delivery systems are managed we can save time and money while delivering better value for our tax dollars. Critical to this reorganization will be the creation of a high-skill managerial position that will focus on efficiency and modernization of Virginia’s management of state health services.
    2. Virginia’s Healthcare Industry
      Virginia is home to some of the finest institutions, personnel, and health companies in the world. We should continue to work with our remarkable providers, insurers, and associated industries that contribute to our economy and wellbeing.
      1. Focus workforce training.
        We know that Medicaid Expansion will create over 30,000 jobs; and we’re going to need people to fill them. We need to ensure that this growing segment of our economy has the talent it needs. Virginia’s Community College System will be our primary focus as we expand workforce training.
      2. Integrate the system.
        As a Commonwealth, we must do all we can to ensure coordination of high-quality care. By giving guidance and incentives for providers to coordinate all health professionals and para-professionals into more integrated systems of care, where appropriate, we can improve outcomes for patients and lower costs.
      3. Stick with Virginia’s current framework on tort reform.
        The recent tort reform agreement between lawyers and doctors was a model for civil dialogue in public policy in the best Virginia tradition.
    3. Tackle tough healthcare challenges directly.
      Virginia should work with healthcare providers to help deal with the changes coming in our healthcare system.
      1. The Doctor-Patient Relationship. Our commitment to provide high quality medical care to every Virginian would be impossible without a healthy doctor-patient relationship. As Governor, Terry will oppose any legislation that plays politics with this central tenet of medical ethics by intruding on the doctor-patient relationship.
      2. Keep more of our Virginia-trained doctors.
        As a Commonwealth we need to work with our hospitals and the federal government to increase residency slots and keep Virginia-trained doctors in Virginia.
      3. Address chronic conditions through better coordination of patient-centered care. Virginia must focus our efforts on cost effective strategies at managing chronic conditions (heart disease, diabetes, asthma, hypertension, and obesity) and preventing avoidable expense in our healthcare system.
      4. Continue and improve disaster and emergency planning coordination. Our medical facilities do an excellent job coordinating with state emergency management officials, but continuing and improving that state of readiness requires consistent training and planning.
      5. Attract and retain our health care workers. EMTs, home healthcare workers, and the medical supply industry should all be able to earn a good wage and work in decent conditions.
      6. Continue and expand veterans’ services. If veterans can’t get their VA healthcare in a timely fashion it’s up to the state government to be their advocate and give them access to existing state programs to fill the gap.
      7. Continue to support efforts to expand rural health delivery. By encouraging the federal government to expand residency slots and by supporting state programs that aid in loan repayments for rural health professionals we can ensure that all Virginians get access to quality care.
      8. Increase support for home and community-based services through the Area Agencies on Aging. The Area Agencies on Aging are essential to keeping older adults and people with disabilities in their homes and communities.
      9. Adequately fund nursing home and long-term care. Virginia should ensure adequate training and resources are available for nursing home and long-term care to ensure quality care.
    4. Medicaid Reform Medicaid is a critical program for hundreds of thousands of Virginia families, people with disabilities, and older adults, including a majority of our senior population in long-term care. However, the system can be improved in significant ways to make it more efficient for patients, healthcare providers, and Virginia taxpayers. Reforms to payment and delivery systems and the inclusion of a system-wide COO will save money and create efficiencies that improve outcomes.
      1. Continue efforts to reform the delivery and payment systems. The reforms pursued by the Reform Commission are a good start, but we can continue to build on those reforms to make improvements beyond those goals.
      2. Payment and delivery system improvements. The systems we use to deliver Medicaid treatments can be improved to save taxpayer dollars while delivering better care for our citizens. By focusing on outcomes, not procedures, the Commonwealth can move toward a system of care that rewards quality not the volume of services.
        • Using modern metrics and outcome tracking. By applying modern industry best practices and demanding that we track our successes and failures through registries, we can improve our delivery systems, identify strengths and weaknesses, and provide timely feedback to improve care.
        • Use modern technology. Updating our technology will allow us to improve care through new solutions like telemedicine.
        • Apply innovative cost reduction strategies and systems. Virginia should test proven innovative methods of care through pilots using Accountable Care Organizations, bundled payments, the patient-centered medical home, etc. as a way to better coordinate care, improve the quality of care, improve outcomes, and lower costs.
        • Develop more case managers for care. Coordination of services and making sure that different providers know all the details of patients’ healthcare can save money and time while providing better outcomes.
      3. Create savings and efficiencies by focusing on long-term and community care for our senior citizens. The Commonwealth can be much more innovative when it comes to strategies that help our seniors stay healthier and stay in their homes longer. We should encourage more regular and preventive interactions with healthcare professionals. This will improve quality of life even as it bolsters our communities and conserves valuable healthcare resources.
    5. Health IT
      The revolution in information technology is poised to dramatically improve healthcare, but it’s critically important that we get this right. A huge volume of the world’s internet traffic flows through Northern Virginia and across the Commonwealth we’ve got some of the brightest minds in both healthcare and computer science. We can increase our citizens’ safety as they use multiple medical facilities. Additionally, this transition will save patients, providers, and the Commonwealth money and resources.

      1. Virginia hospital systems are already making great strides. Virginia should continue to support our healthcare providers in adopting electronic medical records and other health IT systems, and should act as a convener to assist others in the transition away from non-digital operations.
      2. Telemedicine. Not every Virginian can get to see specialists in every field, and in 2013, you shouldn’t have to drive for hours just to have a quick conversation and evaluation. By increasing the use of telemedicine we can bring expertise to every corner of the Commonwealth and improve care while saving money.
      3. Health IT exchange. The creation of an exchange that aggregates and makes shareable health data will provide tremendous benefits to consumers, doctors, and researchers.
  2. Making the Affordable Care Act Work for Virginia

    1. Virginia’s Responses to the Affordable Care Act The next Governor is going to need to work hard to ensure that, as the Affordable Care Act is implemented, we get the best result possible for Virginia. Well-intentioned policymakers supported and opposed that legislation, but that debate is over and it’s time to implement the law in the way that creates jobs and brings about savings and better outcomes for Virginia patients, doctors, and businesses.
      1. Rapid response team. We know that there are going to be bumps in the road as Virginia and other states set about implementing the Affordable Care Act. Individuals and business will need help navigating the marketplace, understanding eligibility for certain tax credits, choosing a plan, etc. By creating a team of business and healthcare specialists to help us navigate our way, we can provide businesses and individuals a simple place to go to answer questions, solve problems, and get enrolled in the plan that is right for them.
      2. Seek flexibility from the federal government. The Obama Administration has already delayed the business mandate, which will allow Virginia employers’ concerns to be heard. Some parts of the ACA law simply aren’t going to work for all Virginians. As Governor, Terry will work with federal regulators to get flexibility for Virginia’s citizens, providers, and businesses to incorporate new models of care across the Commonwealth that have proven to improve quality, improve outcomes, and reduce costs.
      3. Learn from other states. The Governor must have a team ready and able to talk to their counterparts in other states to see what’s working and what isn’t. During his administration, Terry’s health team will conduct formal reviews of implementation successes and failures with a specific eye toward models that have been more successful in other states.
    2. Medicaid Expansion Both morally and economically, expanding Medicaid is right for Virginia. Implemented properly, the Medicaid expansion can create jobs, reduce costs, and provide lifesaving coverage to hundreds of thousands. Additionally, Virginia can expect over $500 million in net General Fund savings by reducing indigent care costs and creating other efficiencies under an expanded Medicaid. Terry will include Medicaid expansion in every budget he submits to the General Assembly.
      1. Accept the federal Medicaid expansion. Expanding Medicaid will:
        • Bring over $21 billion of Virginia federal tax dollars back to the Commonwealth according to the Richmond Times Dispatch
        • Provide health care coverage for over 400,000 Virginians according to state projections
        • Create approximately 33,000 jobs according to the Senate Finance Committee
        • Create high quality jobs in areas where the economy is struggling
        • Keep rural hospitals and clinics open, creating jobs and investing in high-quality, life-saving technologies to provide optimal care for all Virginians.
      2. Support the efforts of the Bipartisan Medicaid Reform Commission. The Medicaid Reform Commission created by the General Assembly during the 2013 session is pursuing important improvements in our Medicaid system.
      3. Work with the federal government to implement reforms. By having the Governor’s office engage aggressively with the federal government, Virginia can get the flexibility it needs to implement any needed reforms to the Medicaid system.
    3. Health Benefits Marketplace One of the most important aspects of the Affordable Care Act is the creation of health insurance marketplaces called Health Benefits Exchanges. If allowed to function properly, these marketplaces will lower costs through participation from individuals and business and through increased competition while making it easier for people to comparison shop.
      1. A Virginia exchange. Terry believes that we should have implemented a state run exchange when we had the chance. Now that a plan for a modified version of a federally administered exchange is being developed, Virginia should continue to move incrementally toward Virginia control while learning from our peer states’ implementation efforts.
      2. Strong consumer protections and diverse viewpoints. As the exchange is implemented, Virginia should ensure that the voices of medical professionals, health plans, hospital systems, consumer advocates, and patients are all heard.
      3. Build on the VHRI recommendations. The Virginia Health Reform Initiative was a successful example of bringing together many stakeholders to design complex policy.
  3. Improving Care in our Communities

    1. Mental Health Mental health services are a critical part of Virginia’s healthcare and public safety services, and recent events in Newtown, Aurora, Oak Creek, and Virginia Tech have all shown us that we need to take serious steps to continue to improve our mental health services. Beyond preventing violence, improvements in our mental health safety net can save us money and improve the quality of life for thousands of Virginians and their friends and family. Our mental health system should be able to support full continuum of care – from a sufficient crisis response, to intense community services, and ultimately to a recovery-focused care leading to independence. By keeping mental health patients in their homes and jobs and out of institutions or the legal system we can save money and improve lives.
      1. Increase resources for Crisis Intervention Training for public safety officers. Making sure that all of our law enforcement agencies have enough personnel trained to deal with mental health emergencies just makes sense. These programs can be completed quickly and at a low cost, and they allow our first responders to even better serve the public.
      2. Incentivize the creation of more and higher capacity crisis stabilization units. Once a public safety officer has de-escalated a mental health crisis, they need to be able to transport the citizen in crisis to a nearby crisis stabilization unit. Ensuring that we have adequate numbers of these facilities will guarantee medical care for all citizens in crisis.
      3. Increase resources for and personnel performing intensive case management – particularly for children. Our dedicated case managers deserve our gratitude for handling as many cases per person as they do, but it’s simply too much to ensure that every citizen needing their support gets it.
      4. Improve the quantity and quality of long-term supportive housing for severely mentally ill and homeless citizens. Housing services and supports are integral components in the community-based systems of care for individuals with serious mental illness and there is a direct correlation between psychiatric stability and stable housing. This form of treatment is less expensive than mental health institutions or imprisonment, and leads to dramatically improved outcomes. Increasing our support for these programs actually saves the Commonwealth money while providing better care to our citizens.
      5. Improve accountability and effectiveness within the system. These measures can help to control the growth of Medicaid-funded mental health services and also will ensure that adults and children receive only the most effective types of services, and that providers and the system as a whole is held to high standards of accountability. With limited and precious resources, it is extremely important that all dollars are spent wisely.

        To ensure that Medicaid-funded mental health services for adults and children are effective and that there is adequate accountability in the system, it is extremely important to ensure that:

        1. Licensure and regulatory standards define the minimum eligibility criteria for Medicaid-funded mental health services, provider credentialing requirements, and acceptable services activities
        2. Best practice models are articulated for Medicaid-funded mental health services. Currently there is a lack of clear practice models, which is something that should be addressed. A lack of clear practice models explains why some Medicaid-funded mental health services are being provided in very different ways across Virginia.
        3. Department of Behavioral Health and Developmental Services has adequate staffing capacity for licensing, administering audits, and otherwise ensuring that services are delivered efficiently and effectively. This will help save taxpayers money and improve care.
      6. Filling the gap for veterans’ mental health Many of our service members returning from Iraq or Afghanistan join a population of older veterans, which experience signs of combat stress, depression, post-traumatic stress disorder or a traumatic brain injury. Suicide has claimed the lives of more veterans than have been killed in action during recent wars. We have a duty to our veterans and we must do more. As Governor, Terry will ensure that Virginia does aggressive outreach to our veterans who might be struggling with mental illness.
        1. Promotion. Mental health programs must be widely promoted and made accessible in ways that are easy and avoid stigma for veterans.
        2. Access. Virginia needs to provide access to transition services and supportive housing for veterans struggling with homelessness, substance abuse, or mental illness.
        3. Funding. Virginia needs to properly fund crisis intervention training, counseling, and facilities so that veterans and other Virginians in crisis can get the treatment they need.
        4. Counseling.Virginia needs to ensure that outreach, treatment, and resources are available for those veterans who have been victims of sexual violence.
      7. Ensuring people with disabilities receive quality care and services If we are going to have a Commonwealth that works for all of us we must work to create a system that advances opportunities for independent living, personal decision-making, and robust participation in community life for Virginians with developmental and other disabilities. Disabled Virginians should be able to get the care they need in the setting they desire.
        1. Increase access to quality community care. As disabled Virginians transition from institutional to community care we must ensure that systems are in place to guarantee quality of care in all settings.
        2. Work to get our citizens off of waiting lists and in front of health care providers. Entirely too many Virginia families spend entirely too long hoping to get access to a limited number of slots in our healthcare system for disabled Virginians. As Governor, Terry will work with legislators of both parties and the disability community to improve the system.
        3. Ensure smooth transition from institutional care to home and community-based care. With the recent agreement with the DOJ to close institutions for people with intellectual disabilities, we need to ensure adequate resources are in place to guarantee the quality of care is as good in the community as it was in the institution.