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Some National Standards, Many State Decisions NLGA Annual Meeting | Oklahoma City, OK July 18, 2013
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
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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
