New America Forum: A First Look at Implementing Health Reform The Delivery System Challenge State Implementation Issues and Opportunities

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New America ForumA First Look at Implementing
Health ReformThe Delivery System
ChallengeState Implementation Issues and
Opportunities
Anne Gauthier Senior Fellow National Academy for
State Health Policy April 12, 2010
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States Current Roles

• Define populations to serve
• Link residents to available services
• Determine benefits and design delivery systems
  for targeted populations
• Purchase healthcare services
• Deliver services to institutional residents
• Promote population health

• Promote system-wide improvement
• Educate and train healthcare professionals
• Protect consumers
• Finance
• Regulate
• Employ
• Establish legal framework
• Coordinate with related programs

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Health Reform State Challenges
Leadership
Timing
Resources
Capacity
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Health Reform State Opportunities

• Connect people to needed services
• Promote coordination and integration in the
  health system
• Improve care for populations with complex needs
• Orient the health system toward results
• Increase health system efficiencies

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Improve Care for Complex Needs

• Expansion of patient-centered medical homes
• New authority to align Medicaid and Medicare
• Improved access to home and community-based
  services

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Orient the Health System Toward Results

• Payment reform demonstrations
• Quality improvement incentives
• Investments in primary care and prevention
• Enhanced data collection and coordination
• Improved transparency

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Increase Efficiency

• Limit administrative costs
• Coordination between Medicaid Medicare
• Financial incentives for preventative care
• Opportunities to allocate resources to
  higher-value care
• System-wide planning across agencies and programs

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State Innovations A Place to Start?

• Several states are leaders -- moving forward with
  innovative payment and delivery system reform
  models.
• The Patient Protection and Affordable Care Act
  and the Reconciliation Act provide multiple
  opportunities for further experimentation.
• A single courageous state can if its citizens
  choose, serve as a laboratory.
• Justice Louis D. Brandeis

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Example from Minnesota

• Landmark legislation in 2008 established
  statewide multi-payer methods to reward quality
  and value for bundled care
• Baskets of care
• Statewide quality-based incentive payment system
• Standards of certification for health care homes

• Creatively piloting data collection on quality
  costs, including reporting on physician
  performance
• Poised for ACO pilots data infrastructure in
  place and many delivery systems ready
• Now to add Medicare!

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It wont be easy, but the rewards hold so much
promise

• State have huge responsibility for health reform
  implementation
• Meeting the delivery system challenge will
  stretch the creativity of all states and
  stakeholders
• Continued federal-state dialogue holds promise
  for the continuous learning that needs to occur

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