Transcript Slide 1

Health Reform & the
Delivery System:
A New Medley of
Payment & Incentives
Anne K. Gauthier
Senior Fellow
National Academy for State Health Policy
October 6, 2010
1
Overview
Numerous provisions in
PPACA promote movement
toward a high-performance
health delivery system
 State opportunities and
obligations to promote high
quality, efficient care
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State Activities and Strategies to
Improve Quality & Efficiency
Strategic coordination & alignment of activities
Data collection, aggregation, & standardization
for performance measurement
Public reporting and transparency of cost & quality data
Payment reform & alignment of financial incentives
to encourage value-based purchasing
Consumer engagement to drive policy change &
encourage care self-management
Provider engagement in policy making &
transforming care delivery
STRATEGIC
COORDINATION &
ALIGNMENT OF ACTIVITIES
Strategic Coordination & Alignment
of Activities : State Challenges
Need to evaluating how current initiatives will align
with ACA ex. HITECH
 Increased coverage expansions need cost
containment mechanisms
 Reform efforts span across varying state and federal
agencies
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Strategic Coordination & Alignment of
Activities: State Opportunities in ACA
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Collaboration to improve system performance
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National Strategy to Improve Health Care Quality
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Center for Quality Improvement and Patient Safety
(AHRQ)
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Will emphasize quality and efficiency in delivery system; establish
priorities for system improvement
Will identify best practices, develop tools, disseminate
information, and build capacity at state and local level
Interagency Working Group on Health Care Quality
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Will coordinate reform efforts to avoid duplication, develop
streamlined process for reporting and compliance, and assess
alignment across public and private sectors
DATA COLLECTION,
AGGREGATION, &
STANDARDIZATION
FOR PERFORMANCE
MEASUREMENT
Data Collection, Aggregation,
& Standardization: State Challenges
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States lack…
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standardized measures
streamlined data aggregation
access to Medicare data
complete datasets
Small/ rural practice integration
of data implementation and reporting requirements
Data Collection, Aggregation, &
Standardization: State Opportunities in ACA
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Creation of standard measures
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AHRQ developed provider-level quality measures
Convention of stakeholders to develop quality measures,
and standards for reporting and payment in fed. programs
Medicaid Quality Measurement Program
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Streamlined data aggregation
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Program Integrity Database
Integration of quality reporting
with EHR
Data Collection, Aggregation, &
Standardization: State Opportunities in ACA
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Complete datasets for population based approaches
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Incentive payments and penalties under the Physician
Quality Reporting Initiative
Release of Medicare claims data
Required reporting on
value-based purchasing
Fed-state Diabetes Report Card
Health plan quality reporting as
part of exchange participation
PUBLIC REPORTING
AND TRANSPARENCY OF
COST & QUALITY DATA
Public Reporting & Transparency of
Cost & Quality Data: State Challenges
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Identification of useful information
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Complexity of issues
Consumer confusion
Fed-state alignment of measures/ data linkages
Public Reporting & Transparency of Cost &
Quality Data: State Opportunities in ACA
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Publically reported data to inform decision making
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HHS collection, aggregation, & reporting of quality data
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Disclosure of financial relationships among providers,
suppliers, & manufacturers
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Access to CMS hospital-acquired condition data
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Annual reports from the Payment and Advisory Board on
health care for Medicare beneficiaries
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Public availability of quality reporting initiatives
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Physician Compare website
PAYMENT REFORM &
ALIGNMENT OF FINANCIAL
INCENTIVES TO
ENCOURAGE VALUE-BASED
PURCHASING
Payment Reform & Alignment of
Financial Incentives: State Challenges
Medicare participation
 Lack of coordination in PPACA rollout
 Preclusion of participation in programs because of
previously established programs
 Conflict with current state initiatives
 Federal prioritization of
payment reform
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Payment Reform & Alignment of Financial
Incentives: State Opportunities in ACA
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Innovative payment reform models
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Center for Medicare and Medicaid Innovation
Health home program for those with chronic conditions
HHS guidelines on value-based design
Medicare Participation
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Payment adjustments based on provider productivity
FFS modifier based on value
HHS programs for value-based purchasing in specialized
facilities
Proposals from Independent Payment Advisory Board to
improve quality
Payment Reform & Alignment of Financial
Incentives: State Opportunities in ACA
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Multi-payer payment models
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Medicare Shared Savings Program => ACOs
Medicaid demos to test bundled payments, global
captivated systems, and pediatric ACOs
Medicare bundled payment pilot
Incentives to reduce hospital-acquired conditions
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Reduction of Medicare payments
related to preventable readmissions
No Medicaid payments for
hospital-acquired conditions
CONSUMER ENGAGEMENT
TO DRIVE POLICY CHANGE
& ENCOURAGE CARE SELFMANAGEMENT
Consumer Engagement to Drive Policy Change &
Encourage Self-Management: State Challenges
Perception of reform as
limiting choice
 Access issues outweigh
quality issues for
consumers
 Patients already limited in
ability to participate in
making decisions about
own care
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Consumer Engagement to Drive Policy Change & Encourage
Self-Management: State Opportunities in ACA
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Inclusion of consumers in strategy development
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Consumer advisory council to advise Independent
Payment Advisory Board on consumer impact of payment
reforms
Tools for informed decision making
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Patient-centered education by
exchange plans
Grants to develop patient decision
aids & disseminate best practices
Test of payment models that
support shared decision making
Patient Navigator grant program extended
PROVIDER ENGAGEMENT
IN POLICY MAKING &
TRANSFORMING CARE
DELIVERY
Provider Engagement in Policy Making and
Delivery Transformation: State Challenges
Perverse payment incentives
 Lots of coaching/ training necessary
 Resistance to change
 Lack of forums to share
programmatic input
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Provider Engagement in Policy Making and Delivery
Transformation: State Opportunities in ACA
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Provider engagement in quality initiatives
 Provider implementation of quality improvement strategies
in order to contract with exchange plans
 Provider inclusion on Independent Payment Advisory
Board
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Provider support for quality improvement
 Physician feedback program with new reports and data
analysis
 Grants for health professional curricula on patient safety
and quality improvement
 IOM study on best practices for clinical guidelines
Provider Engagement in Policy Making and Delivery
Transformation: State Opportunities in ACA
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Provider support (cont.)
 Comparative effectiveness research by the Patient-
Centered Outcomes Research Institute
 State grants to create interdisciplinary teams to support
primary care physicians in creating medical homes
 Primary Care Extension Program to support, assist, and
educate primary care providers
• Grants to establish State Hubs to coordinate with quality
improvement organizations and health education centers
 Grants to support community-based collaborative care
networks for safety-net hospitals and FQHCs
Keys Themes from States
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Reform is an opportunity for program
transformation
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ACA provides opportunities to build momentum on
current quality and efficiency efforts
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Not just “supersizing” existing programs
Ex. ARRA reforms
Quality and efficiency should not
be divorced from coverage
expansions
Keys Themes from States
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States face dire staff and financial challenges
in implementing ACA
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Scarce resources; pressure to
implement mandatory reforms
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Leadership is critical to advancing
state agendas
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Federal officials can learn from
the efforts of leading states
Thanks to…
Jill Rosenthal
Program Director, NASHP
Abby Arons
Intern, NASHP
Christina Miller
Research Assistant, NASHP
For further information…
Rosenthal, J., Gauthier, A., Arons, A. State Strategies to Improve Quality and Efficiency:
Making the Most of Opportunities in National Health Reform,
Forthcoming CMWF/ NASHP publication, October 2010
Anne Gauthier
Senior Fellow, NASHP
[email protected]
http://www.nashp.org