Some National Standards,

Many State DecisionsNLGA Annual Meeting | Oklahoma City, OKJuly 18, 2013

Some National Standards,Many State Decisions

NATIONAL STANDARDS

Baseline Insurance Rules

Preventative Care

Medicare Changes

STATE DECISIONS

Design of Health Benefits Exchange

Medicaid Expansion

Delivery Reform Efforts

Essential Health Benefits

Buzzwords

Pioneer ACO

CMMI

Patient-Centered

Bundled Payments

State Innovation

Model

ACO

Value-based Purchasing

Shared Savings

Heart Disease & Stroke $444 billion

Diabetes $174 billion

Chronic Lung Diseases

$173 billion

Mental Illness$317 billion

Cancer $228 billion

Arthritis & Other Rheumatic$128 billion

Alzheimer’s $183 billion

HIV/AIDS $22 billion

The Greatest Threats to Health and Our Pocketbooks

Chronic diseases affect almost 1 in 2 people,

account for more than 80% of all health spending,

and contribute to 7 out of 10 deaths in the U.S.

Reimbursement evolution is necessary, but which direction will it take?Inaction is Not an Option

Pure Voucher System

Fee-for-Service

Means Testing

Rate Cuts

Medicare Advantage

Prior Authorization

Hybrid Voucher System

Accountable Payment Models

Global Spending Caps

“Embracing Defined Contribution” “Optimizing Defined Benefit”

PotentialPayer

Spending

Reimbursement Involvement in Financing

Care Delivery

Medicare ACOs are Off and Running32 Pioneer and 221 Shared Savings Program ACOs as of January 2013

States are well positioned to partner to transform health care:

States pay for a large percent of health care services

States have broad regulatory powers over providers and payers

States regulate public health, social service, and educational services.

States have the ability to convene multiple parties

States are closer than the federal government to the actual delivery of care

States can integrate and align the health information exchange infrastructure with other initiatives

State Innovation Models (SIM)

”

The State Health Care Innovation Plan (“SHCIP”) is a proposal that describes a state’s strategy to use all levers available to it to transform its health care delivery system through multi-payer reform and other state-led initiatives

The CMS Innovation Center

State Health Care Innovation Plan (SCHIP)A SIM Initiative

States Involved

CMMI Model Testing States

Arkansas $42 million

Maine $33 million

Massachusetts $44 million

Minnesota $45 million

Oregon $45 million

Vermont $45 million

Over $250,000,000 awarded to the six states to help them transform their health care delivery systems.

State Innovation Models Initiative

Colorado $2 million

New York $1 million

Washington $1 million

Model Pre-testing

Awards

Model Design Awards

12

Alignment of stakeholders around a common approach to delivery system and

payment reform

Engage communiti

es and citizens in improving

state’s health system

Include specific multi-payer models that

state proposes to test

Framework for state governme

nt resources

to support delivery redesign process

Elements of the State Health Care Innovation Plan

Community Partnerships: YMCA

US Health Care System Evolution

• Episodic Non-integrated Care

1.0• Outcome

Accountable Care

2.0• Community

Integrated Healthcare

3.0

Uncoordinated Health System

Coordinated Seamless Health System

Community Integrated Care System