Government healthcare systems face the same challenges as the overall US healthcare system, and some additional special issues. Costs are steadily growing and the long-term outlook is concerning as healthcare costs project to be a larger fraction of total government spending. Challenges include that different organizations are responsible for different parts of the system with mis-aligned control and impacts and that there are long time delays involved in making changes. Leaders were interested in objective analysis to assess the long-term outlook for costs and service levels, and to help prioritize options to improve. There were many different ideas but it was difficult to systematically compare the short and long-term impacts of very different initiatives across such a large and complex system.
We developed a tailored model of the entire system, starting with beneficiaries (members and their families) grouped into different age, geographic, and health categories, and how these would change over time. The model covered at a high-level all key elements of the system such as the infrastructure of facilities (of widely varying age, quality, focus, and efficiency) and the utilization of facilities over time. The model also captured the use of external health facilities for some services, and the costs and funding over time. While covered at high-level, an integrated model of the entire system was very useful to examine outlook and test the impact over time of different types of possible changes and initiatives.
We first analyzed the full impacts of different initiatives to understand relative cost and benefit without regard to feasibility. A second step considered feasibility — both “political feasibility” in terms of what would be likely to receive support from congressional and other stakeholders, and resource feasibility – how much funding or other resources would be required for each initiative. Combining the steps we identified the highest leverage options that were the most feasible considering stakeholder support and resource demand.
Given the high stakes, difficulty of implementing change, and long time horizons, the analysis helped in two ways. First, it helped illustrate the likely future cost growth and service levels to aid planning and understand likely outcomes including the impact of uncertainties. Second, the analysis helped identify the set of initiatives with greatest positive impact and return on investment that were also more feasible to implement.
