Health Care Planning And Accountability Advisory Council

Background Information

Basic steps
Some history
Range of scope

Health planning: Basic steps

Health planning answers 4 basic questions:

1. Where are we?
   — What does our past system look like? Our present system? Our future projections?
2. Where do we want to go?
   — What are our goals, objectives, priorities?
3. How do we get there?
   — What are alternative strategies and interventions? Which are cost-effective? Which are consistent with our priorities?
4. Did we get there?
   — How will we evaluate our work in relation to our objectives?

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Health planning: Some history

Health planning at the State and local levels received Federal direction and support in the forty-year period from 1946 to 1986. Four different Federal programs with slightly different emphases provided Federal funding and technical assistance to State and regional health planning agencies during this period:

1. The Hill-Burton Program emphasized planning for and expanding the supply of hospital facilities in the United States.
2. The Regional Medical Program (RMP) concentrated on the dissemination of new medical knowledge about heart, cancer and stroke from medical centers out to their natural catchment areas.
3. The Comprehensive Health Planning Program (CHP) as the name indicates fostered a comprehensive approach to health planning encompassing health status, health services, health care facilities and the health professions. Its hallmark was requiring consumer majorities on State and regional health planning councils.
4. The Health Planning & Resources Development Act created Statewide Health Coordinating Councils (SHCC) at the State level and Health System Agencies (HSA) at the regional level. The thrust of this program was to link health planning to Federal funding and Certificate-of-Need (CON) regulation.

The State of Rhode Island participated in all of the above four Federal health planning initiatives. With the exception of the RMP Program, the Rhode Island Department of Health was the main locus of these healthplanning activities. Although State authorizing legislation was secured in 1988, continuous health planning for personal health services and facilities was practically eliminated at the Rhode Island Department of Health when the Federal financial support was repealed in the mid-1980s.

Over the past twenty years, the main Federal/State health planning initiative has been the Healthy People program. Health objectives have been established at the national level for three decades now: 1990, 2000, and 2010. Most all of the States have followed suit and developed State level health objectives for their respective States. These health objectives have focused mainly on the reduction of behavioral risks such as tobacco use and sedentary lifestyle. However, unlike the previous four programs the Healthy People program provides the States and regions with no Federal financial support.

In addition to these official Federal/State health planning efforts that have operated over the past sixty years, there have been a number of State-only health planning initiatives that have contributed to the winding path of health planning in Rhode Island. These efforts can be divided into three main categories:

1. Gubernatorial Commissions – The 1989/1990 Governor's Steering Committee, the 1993/1994 Health Care Reform Commission, and the 1998-2002 Governor's Advisory Council On Health were all initiated by the Governor and they all performed tasks that could be considered parts of the health planning process: data collection & analysis, and/or establishing goals & objectives, and/or recommending strategies & interventions.
2. Private Sector Health Planning – The Health Planning Council, Inc. (1960s-1980s) and SHAPE (2002-2005) had different foci (the former health services & facilities planning, the later baseline measurement and projection of demand & supply of health care services and resources) but they were both conducted in the private, not-for-profit sector largely with funding from Blue Cross Blue Shield of Rhode Island.
3. Certificate-Of-Need (CON) Process – Following the Brosco Commission Report of the General Assembly, Rhode Island was the second State in the nation to establish a CON process to approve health care facility capital and new service proposals. From the beginning, the Health Services Council has served as an advisory body to the Department of Health in this process. Over the years, the Department of Health has commissioned a significant number of categorical health planning studies (e.g., diagnostic and interventional cardiac services) to assist in the CON review process.

Health Planning - National & State Chronology

National Health Planning Programs

1946 – Hill-Burton Act (P.L. 79-725) Hospital Survey & Construction Act, State Hospital Planning Councils,

1965 – Regional Medical Program (P.L. 89-239) Heart Disease, Cancer, and Stroke Amendments, 56 Regional Advisory Councils,

1966 – Comprehensive Health Planning (P.L. 89-749) Partnership For Health Act, State and Regional Health Planning Councils with consumer majorities,

1975 – Health Planning And Resources Development (P.L. 93-641) State Health Planning & Development Agencies, Statewide Health Coordinating Councils, Health System Agencies

1979 – Healthy People Health Objectives: 1990, 2000, 2010, unlike the above, no Federal funding for States and localities

Rhode Island Specific Health Planning Organizations

1960s thru 80s - Health Planning Council Inc., Rhode Island Blue Cross Blue Shield funded health care facility and services planning with advisories to the State Health Services Council for Certificate-Of-Need.

1968 to present – State Health Services Council, review and advisories to the Director of Health on Certificate-Of-Need applications for expansions of health facilities and services.

1989/1990 – The Governor's Steering Committee on the Year of Family Health, recommendations related to cost control, health insurance coverage and health care financing.

1993/1994 – Rhode Island Health Care Reform Commission, Assessed five major national health care reform proposals and a number of their likely impacts on Rhode Island.

1998 to 2002 – Governor's Advisory Council On Health, tracked key health care industry characteristics in Rhode Island.

2002 to 2005 – The Rhode Island SHAPE Foundation, studies and projections of the supply and demand for health care facilities, services, and professions financed by Blue Cross Blue Shield of Rhode Island.

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Health Planning: Range of scope

Health Planning can take place on many different levels. In terms of geopolitical loci, health planning can take place at the Federal, State, Regional, County, and City levels.

In terms, of scope health planning can cover:

• all aspects of health improvement (e.g., health status, lifestyle, environment, etc.), the full range of personal health services, or
• specific services, facilities, equipment, technology, personnel, or institutions.

Currently in Rhode Island, there is a mixture of health planning activities that are being conducted in both the private and public sectors. However, at this time there is no ongoing health services planning process that makes inter-related recommendations for the best mix and configuration of personal health services and related resource requirements.

Current health planning activities in Rhode Island:

There are many different options in conducting health planning. These options revolve around the scope, tasks to be performed, participants, auspices, and resources available for the health planning process.

In selecting the appropriate combination of characteristics for health planning, the most important consideration is impact. That is, what combination of characteristics will best insure that health planning will have a positive impact on the “real world”? All too often in the past, health planning has not had a sufficient impact on the operating system.

In order for health planning to be successful, the major stakeholders in Rhode Island need to develop a strong consensus on the best way to proceed with it. The success of a health planning process also depends on whether it is linked to decisions made about the operation of health care systems and on whether the health planning process itself has adequate and stable funding.

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