Report: Indiana should boost spending on public health, establish all-payer claims database

The average Indiana resident is sicker and suffers from more health conditions than the average American, but there is no “magic bullet” to improve population health or to reduce costs.

That’s one conclusion from a new report from the Indiana University Fairbanks School of Public Health at IUPUI.

However, the study lays out numerous recommendations, including the establishment of an all-payer claims databases, increased investments in public health services, greater use of value-based payment models among commercial payers, and increasing the use of end-of-life services such as hospice care and advanced directives.

“Achieving the desired outcomes in Indiana can be facilitated with a comprehensive portfolio of activities, each of which encourages maximum collaboration among stakeholder groups,” said the report, which was issued Monday.

The report comes as Indiana lawmakers are discussing many of these topics and are considering establishing an all-payer database and a ban on surprise medical billing from out-of-network providers, such as anesthesiologists and radiologists.

It’s the latest contribution on a topic that has bedeviled Indiana for years. The state is widely viewed as unhealthy, placing 41^st in the nation by America’s Health Rankings, issued annually by the United Health Foundation.

The 88-page report from the Fairbanks School include dozens of charts and tables that compares Indiana to the nation and to surrounding states. For example:

• Indiana’s adult obesity and overweight rate is 68%, slightly higher than the national rate of 65%, and close to the rates in Ohio, Michigan, Kentucky and Illinois;
• Nearly 22% of Hoosier adults smoke—significantly higher than the national average of 16%;
• More than 39% of Hoosier adults report poor mental health status, slightly higher than all surrounding states and 4 percentage points higher than the national average;
• Hoosiers spent an average of $8,300 a year on health care in 2014—slightly higher than the national average of $8,045 and in line with surrounding states;
• The percentage of Hoosier on government health programs (14% for Medicare, 22% on Medicaid and CHIP) is nearly equal to the U.S. figures.

The report urges “maximum collaboration” among major parties, including groups representing doctors, hospitals, insurers, researchers and employer groups.

Notably, the report points to a few items that it does not recommend, such as implementing price caps or taxing accrued earnings of not-for-profit hospitals.

The research project was led by Nir Menachemi, professor and department head of health policy and management, and Paul Halverson, dean and professor of the Fairbanks School of Public Health.