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New America ForumApril 12, 2010
New America Forum:A First Look at Implementing Health Reform
The Delivery System Challenge
State Implementation Issues and Opportunities
Anne GauthierSenior Fellow
National Academy for State Health PolicyApril 12, 2010
New America ForumApril 12, 2010
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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New America ForumApril 12, 2010
Health Reform: State Challenges
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Timing
Capacity
Resources
Leadership
New America ForumApril 12, 2010
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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New America ForumApril 12, 2010
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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New America ForumApril 12, 2010
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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New America ForumApril 12, 2010
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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New America ForumApril 12, 2010
• 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
State Innovations – A Place to Start?
New America ForumApril 12, 2010
• 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
Example from Minnesota
•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!
New America ForumApril 12, 2010
It won’t 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
New America ForumApril 12, 2010
www.nashp.org
