Roe Better Government Network Research

The combined use of limited, or selective, provider networks and a defined contribution strategy presents an immediate opportunity for government entities and employer groups to achieve significant and sustainable health insurance savings and reduce medical cost trends, while maintaining coverage levels and quality of care. This solution illustrates the impact of changes in consumer behavior that occur as a result of economic conditions and opportunities.

The combined use of limited, or selective, provider networks and a defined contribution strategy presents an immediate opportunity for government entities and employer groups to achieve significant and sustainable health insurance savings and reduce medical cost trends, while maintaining coverage levels and quality of care. This solution illustrates the impact of changes in consumer behavior that occur as a result of economic conditions and opportunities.

Health insurance markets are regulated by the states under the McCarran-Ferguson Act (15 U.S.C. 1011) of 1945. The 'purpose clause' of the Act states that regulation and taxation of the business of insurance by the states is in the public interest. As a result of McCarran-Ferguson, every health insurer must be licensed in the policyholder's state of residence. The states have responded with a complex patchwork of mandates and laws that vary widely across the country.

Sustainable healthcare should always involve an accountable partnership between the payor and the third party insurance administrator. The Wellness Health Incentive Payment (WHIP) Program facilitates better health/wellness outcomes by holding health insurance vendors fiscally responsible for health and wellness activity. The WHIP rewards or penalizes health insurance administrative vendors according to the vendor's wellness activity performance against nationally recognized health and wellness standards.

Like many other states, Massachusetts has struggled with out-of-control spending on school construction, often putting money into many unnecessary projects at the expense of more deserving ones. State Treasurer Tim Cahill, a long-time entrepreneur who took office in 2003, traced the wasteful spending to poor administrative organization, a lack of oversight, and an antiquated system of reimbursements whose legacy had become exorbitant debt and a backlog of projects. Applying his business acumen and experience, Cahill in 2004 created the Massachusetts School Building Authority, an entity that would bring the rigors of the private sector to eliminate wasteful spending while raising the quality of education offered by the state.

The Roxbury Preparatory Charter School in Boston's Mission Hill neighborhood prepares its students to enter, succeed in, and graduate from college. A public, grades 6-8 school, Roxbury Prep is founded on the philosophy that all students are entitled to and can benefit from college preparatory programs when: 1) the curriculum is rigorous and well-planned; 2) character, community responsibility, and exposure to life's possibilities are emphasized; and 3) a professional network supports a student's academic, social, and physical well-being.

The mission of the Museum Institute for Teaching Science (MITS) is to raise science literacy by improving the quality of elementary and middle school (K-8) teaching in science, technology, engineering and mathematics (STEM). Science literacy is a critical skill that, if learned at an early age, helps develop critical thinking, reading abilities and computation skills needed to make informed decisions in daily life. America's science literacy, however, has suffered in recent years, posing a serious risk to the nation as the world leader in innovation and its economic future.

The City of Gallup, NM, like many governmental bodies that employ field crews, suffered from an ever-increasing number of worker's compensation claims and associated annual increases in worker's compensation insurance premiums. The implementation of the Cash Incentive Safety Initiative has both improved the health of employees and reduced costs associated with absent and injured workers. As explained below, there is real potential for similar programs to benefit municipal and state governments nationwide.

In 2000, the Florida state legislature approved funding for an online e-procurement portal called MyFloridaMarketPlace. The project was overseen by Florida's Division of Management Services (DMS), which contracted with Accenture in the fall of 2002 to create and manage the portal.

This proposal involves collecting and integrating existing data on the health of elderly patients. This information would be used to construct patient profiles to help predict and prevent unexpected incidents. A data-driven coordination of programs and services would aid in early interventions, and also help evaluate how different strategies, programs, and agencies could reduce unnecessary nursing home institutionalization.