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The State of Partnering with StatesAligning Forces for Quality National Meeting
May 9, 2013
John M. ColmersVice President Health Care Transformation and Strategic Planning
Outline
• Introduction• Range of models available to states
– As purchaser– As traditional regulator– As convener– As market setter/enabler
• Prospects for success– Examples in Maryland with Community
Organizations– Examples at Johns Hopkins
State of Play in the States
• Economy improving, but many still confronting budgetary shortfalls
• Fear of the impact of (in)action in Washington, DC
• Role of Medicaid and other state programs
• Wide variations in approaches to ACA BUT market forces impacting virtually every state
Implementation of the Affordable Care Act at the State Level
• Considerable responsibilities left to states– Creation of exchanges
• Federal/State/Partnership
– Role of insurance commissioners on pricing
– Medicaid expansion
• Uncertain outcome
State Context
Although wide variation regarding the ACA, virtually every state is considering or developing new policy approaches that address:
Coverage and access Quality Delivery reform/cost control
State Policy Approaches to Delivery System Integration
The Role of the State as:PurchaserTraditional RegulatorConvenerMarket Setter/Enabler
State Role as Purchaser
• Medicaid payment reform– PCMH– P4P
• Medicaid interface with insurance exchange
• State employee benefit plan design
State Role as Traditional Regulator
• Health insurance exchanges– Essential benefit plan design
• Role of Insurance Commissioner– Conditional rate approval– Affordability standards– Provider contracting standards
• Transparency requirements• Health IT and HIE
State Role as Convener
• Health Reform Task Forces– Roadmaps
• Include focus on population health issues
– Collaborations– Workforce development
• Continued role for legislature– Oversight– Policy development
State Role as Market Setter/Enabler
• Use of statutory authority to SET market conditions– State multi-payer PCMH– Multi-payer ACO options
• Market power and antitrust
• Gain sharing and anti-kick back
Prospects for Success
• Reasons for optimism– Failure is not an option– Significant federal investment from CMMI– Increasing recognition of shared interest among
stakeholders in payer and provider communities• Reasons for pessimism
– Federal barriers• Budget meltdown• Regulatory inertia
– Change is hard– Provider and payer market concentration
• Status quo is always second best solution
Examples in Maryland
• SIM Planning Grant– Multipayer Medical Home
• Significant community involvement in design and implementation
• J-CHiP CMMI Innovation Grant– 7 zip codes around JHH and JHBMC– Community health workers