2012 in Baltimore: Promoting Excellence Today and Tomorrow

As states seek to reform delivery and payment systems to accomplish the Triple Aim, they are identifying opportunities to integrate clinical and population health approaches. The Affordable Care Act provides momentum for integrating preventive, primary, and hospital-based services through new care models, data integration, and innovative payment approaches. This preconference is designed to help state policymakers across agencies, programs, and branches of government take advantage of significant transitions in health delivery systems by strengthening partnerships and leveraging opportunities to improve population health and reduce more costly interventions.
Speakers:
 Abbey Cofsky
 David Kindig
 John Auerbach
 Joshua Sharfstein
Mary McIntyre
 Paul Wallace
 Robin Lunge
Jeanene Smith
Paul K. Halverson
 Rebecca Pasternik-Ikard
Christopher Atchison
Anne M. Barry

Individuals enrolled in both the Medicare and Medicaid programs—the dual eligibles—have the most complex needs of participants in both programs, yet often receive fragmented care. States and CMS are collaborating to develop new service delivery and financing systems to better coordinate the physical health, behavioral health and long term services and supports provided to dual eligibles and improve individual outcomes. This preconference will explore state implementation of several initiatives, most specifically the Demonstration to Integrate Care for Dual Eligible Individuals, as well as the Multi-payer Advanced Primary Care Practice Demonstration, and health homes.Speakers:
 Tim Engelhardt
Alan Weil
Alice Lind
Diane Justice
 MaryAnne Lindeblad
 Paul J. Saucier

The Affordable Care Act sets new guidelines for essential health benefits that health plans must provide, but states still face important related decisions in health insurance exchanges and Medicaid. Key questions we will address include: Where have states landed on benchmark plan decisions? What issues remain to be resolved in bringing qualified health plans to life? How can states weave value-based benefit design into their efforts? How might states approach sticky issues like access to oral health, mental health, and rehabilitative and habilitative services?
Speakers:
Andrea Rosen
Colin Reusch
Mark Fendrick
Molly Huffstetier
Nancy Smith-Leslie
Robert Hall
Christopher Koller
Jane Beyer
Trish Riley

States face many challenges—uninsured and underserved populations, high health care costs, an insufficient health workforce, and rapidly approaching deadlines in ACA implementation.  States are forging solutions and transforming the way they do business – developing consumer friendly systems for selecting and enrolling in health programs and plans, reforming insurance markets, and building delivery system models that emphasize population and preventive health and reward efficiency and health outcomes.  Come hear state leaders from around the country talk about how they are steering a course to achieve their state’s goals and provide value for their residents.  Hear about the advancements they have made, lessons learned, and the practical solutions they have developed.Speakers:
Anya Rader-Wallack
Bruce Greenstein
Joshua Sharfstein
Mary G. McIntyre
Norman Thurston
Trish Riley

With years of experience and a track record of accomplishments, children’s coverage programs hold lessons for current reform efforts. Several states will discuss what they have accomplished and learned in getting kids into coverage and providing them services once enrolled.  Cindy Mann of the Center for Medicaid and CHIP Services will share her thoughts on lessons for reform and challenges ahead. She will also discuss relevant CMS initiatives, such as Early and Periodic Screening Diagnostic and Treatment (EPSDT) improvement efforts including strategy guides currently in development.
Speakers:
 Cathy Kaufmann
Jennifer Ryan
 Sylvia Lopez
Charles Milligan

The widespread adoption of the Patient-Centered Medical Home is shifting future healthcare workforce demands.  As team-based primary care becomes more common, states will need to adapt by changing both the mix and skill sets of their primary care providers.  This session will feature a health economist’s overview of how the primary care workforce is expected to shift in the coming years. Speakers from Connecticut and Ohio will discuss how their states are working to ensure expanded care teams are prepared to provide medical home care.Speakers:
 Andrew Wapner
 David Auerbach
 Marie Smith
Paul K. Halverson

States can play a leading role in broad and targeted payment reform to improve quality and efficiency and replace traditional fee-for-service payment, which rewards volume. SPEAKER will give an overview of state payment reform efforts and highlight three very different approaches:  Arkansas’s initiative to use episode based payments for certain conditions, Massachusetts’ recent legislation to slow healthcare spending growth, and Oregon’s unique delivery and payment approach that uses a global budget for coordinated care organizations.Speakers:
 Anne Gauthier
 Joseph Thompson
 Jeanene Smith
 Richard Gottfried
 Sarah Iselin

Many states have had a long-standing policy goal of improving the balance in their long term services and supports systems by moving the delivery of services from institutional to community-based settings.  This panel will provide an overview of current initiatives underway to achieve that goal. Framed by CMS’s vision for the initiatives, the panel will discuss Maryland’s experiences with the Balancing Incentive Program, and the critical role housing supports play in creating a sustainable long term services and supports system.Speakers:
 Bruce Greenstein
 Lorraine Nawara
Barbara Edwards
Marc Gold

The January 1, 2013 certification deadline is fast approaching for states electing to operate a state based health insurance exchange or participate in a partnership exchange. This session will feature three states that are hard at work on exchange planning: Maryland, Nevada and Arkansas. Representatives from these states will discuss issues they’re facing and progress they have made on governance, procurement, and integration of Medicaid and commercial insurance coverage.Speakers:
 Cynthia Crone
 Jon Hager
 Rebecca Pearce
 Tricia Leddy

As NASHP celebrates its 25th Anniversary, its Executive Director Alan Weil will take this opportunity to look back on the evolution of state health policy over the past 25 years.  How much progress have we made?  How many issues remain unresolved?  What have we learned?  With the nation poised to implement dramatic changes in health policy over the next few years, what can state health policy leaders expect to find on the NASHP annual conference agenda 5, 10 or even 25 years from now?
Speakers: Alan Weil

North Carolina has developed a statewide infrastructure that supports a nationally recognized program of primary care redesign and ongoing improvement and serves as a model for aligned state-level, multi-sector practice support.  This infrastructure includes payment strategies, network support, practice-based quality improvement, and informatics.  This session will feature an overview of North Carolina’s continuous innovations along with initiatives in two states, Maryland and West Virginia, which are participating in a learning community to adapt this model to their local environments.
Speakers:
 Nancy Atkins
 Thomas Bacon
 Ben Steffen
Christine Collins

States are employing more innovative approaches to prevent fraud and abuse, increasingly moving away from post-payment “pay and chase” strategies to monitor Medicaid spending on health and long-term care services as it occurs.  Speakers will provide an overview of states’ efforts to combat wasteful Medicaid spending, then detail recent initiatives in Virginia and Florida.  The session will conclude with an update from CMS on federal support for efforts to scrutinize Medicaid spending.
Speakers:
 Angela Brice-Smith
 Jennifer Johnson
 Kavita Choudhry
 Louis Elie
Joseph Flores

From health insurance exchanges (HIX) to health information exchanges (HIE), states are diligently building enhanced infrastructure to collect and mobilize data across states, populations and health systems. While each effort is designed to meet certain goals, there is also overlap between their functions, presenting prime opportunities for alignment. This session will explore these opportunities, examining state strategies to leverage HIEs and HIXs to create more efficient and integrated systems for data collection, sharing and analysis.Speakers:
 Hunt Blair
 Patricia MacTaggart
 William A. Hazel Jr.
Scott Leitz

As health care delivery systems evolve to better focus on whole-person care, community-based services, and population health outcomes, expectations for Medicaid managed care plans are evolving as well. Learn from a national expert and state policymakers in California and Tennessee about how Medicaid plans are responding to new delivery system needs by managing new populations, including people with disabilities and dual eligibles; new services including behavioral health and long term services integration; and fitting into new models including accountable care and multi-payer medical homes.Speakers:
 Leonard Finocchio
 Mary Kennedy
 Patti Killingsworth
Pamela Parker

Children with complex health care needs eventually transition from pediatric delivery systems to adult health care services, potentially leaving these children at risk for gaps in coverage. This session will focus on two different state approaches to ensuring coordinated care and adult preparedness: Rhode Island, which has built an interagency, community based solution, and Utah, which charges medical homes with facilitating seamless transitions. This panel also includes a national expert on the design and financing of state programs that address the needs of this population.
Speakers:
 Alfred Romeo
 Deb Golding
Debra Waldron
Meg Comeau

Twenty-six states have submitted proposals to CMS to combine Medicare and Medicaid financing.  These demonstrations are designed to improve service outcomes, enhance care coordination, and streamline access to care for dual eligibles.  The demonstrations will integrate primary care, behavioral health, and long term services and supports. Melanie Bella of CMS will open the panel by reviewing national efforts.  Officials from two states will then discuss their plans:  one planning to implement a capitated model and one a managed fee for service model.
Speakers:
 Melanie Bella
 MaryAnne Lindeblad
Rebecca Pasternik-Ikard

Public and private payers across the country are increasingly turning to medical homes as one tool to help them achieve the Triple Aim and refocus spending priorities on primary care. States are using their considerable levers to forge multi-payer partnerships to achieve meaningful delivery system reform, creating alignment around payment, reporting, and infrastructure investments. This session will explore state strategies for convening, sustaining and expanding multi-payer medical home initiatives to include Medicare, State Employee Health Benefits, Medicaid plans, small group insurance and individual insurance markets.
Speakers:
 Jennifer Vermeer
 Kate Berrien
 Larry McReynolds
Christopher Atchison

This session will feature market-based health reform efforts that focus on consumer choice and engagement. To kick off the discussion, a researcher from Towers Watson will present findings from the organization’s recent survey about employers’ efforts to engage their employees.  Speaker will also highlight examples of market-based reform by states. One SPEAKERS will discuss Utah’s efforts to create a defined contribution program for small businesses. Another will present the Healthy Indiana Plan, a waiver program that creates choice and accountability for individuals enrolled in Medicaid.Speakers:
 Norman Thurston
 Ron Fontanetta
 Seema Verma
Christopher Koller

Public and private payers across the country are increasingly turning to medical homes as one tool to help them achieve the Triple Aim and refocus spending priorities on primary care. States are using their considerable levers to forge multi-payer partnerships to achieve meaningful delivery system reform, creating alignment around payment, reporting, and infrastructure investments. This session will explore state strategies for convening, sustaining and expanding multi-payer medical home initiatives to include Medicare, State Employee Health Benefits, Medicaid plans, small group insurance and individual insurance markets.
Speakers:
 Amanda Roccabruna Eby
 Chip Watkins
 Lisa Letourneau
Jeanene Smith

The Affordable Care Act’s framework of income-based eligibility for Medicaid, CHIP, the Basic Health Program and the Exchange will result in people “churning” across coverage as their incomes change. Churning affects health plans, provider relationships, and benefits, potentially causing harm to consumers, challenges for providers, and excess costs for state programs. In this session, national expert Stan Dorn will present and panelists from Massachusetts, Nevada, and Tennessee will discuss their states’ strategies for managing the impact of churning, and improving continuity of care and coverage.
Speakers:
Amy Andrade
 Jon Hager
Jane Beyer

Increasingly, states are finding that persons requiring behavioral health treatment also need long-term services to support community living. Often these two delivery systems operate in silos and individuals receive fragmented services and supports. It is particularly challenging to help nursing facility residents with mental health needs transition to community living. Two state speakers will discuss their efforts to build individualized service plans that integrate behavioral health treatment with home and community based services. A national expert will review exemplary initiatives around the country.
Speakers:
 David Hughes
 Catherine Ivy
 Marc Gold

The Affordable Care Act (ACA) envisions simplified eligibility and streamlined enrollment across multiple coverage programs. Speakers in this session will highlight areas where states will need to rethink their approach to Medicaid eligibility to achieve that goal.  Speakers will also offer models and information to support that endeavor.  They will provide an overview of Utah’s innovations in technology and new approaches to casework and staffing.  They will also discuss Rhode Island’s approach to an integrated eligibility model that includes human service programs.
Speakers:
 Amy Lapierre
Anne Marie Costello
 Casey Erickson
Rebecca Pasternik-Ikard

Since 2000, the Assuring Better Child Health and Development (ABCD) program has helped 27 states create models of service delivery and financing for early child development services, particularly for children covered by Medicaid.  During this session, Melinda Abrams of The Commonwealth Fund, which supports ABCD, will provide an overview of the initiative and its effect on policy and practice.  Speakers from Minnesota and North Carolina will share lessons from their work on screening, referral, care coordination and policy changes to sustain and spread healthy child development.
Speakers:
 Marian Earls
 Melinda Abrams
 Glenace Edwall

Benefit design is critically important to ensuring that the coverage available to those who become eligible in 2014 is meaningful. States have been hard at work selecting a benchmark plan to define the essential health benefits that will be included in Medicaid and qualified health plans offered through the exchange. This session will provide an opportunity to hear from New Mexico, Rhode Island, and Virginia about their approach to essential health benefits and how these experiences will inform their efforts to define a benchmark plan.
Speakers:
 Heather Howard
 Molly Huffstetier
 Nancy Smith-Leslie
 Christopher Koller

Waivers play an integral role in shaping the health care system.  Hear about California’s “Bridge to Reform” waiver, an early expansion of the Affordable Care Act to low-income individuals, and about Texas’s “Health Care Transformation and Quality Improvement” waiver that expands Medicaid managed care. Speakers from both states also will highlight efforts to improve care through finance and delivery system reforms. In addition, CMS staff will share their thoughts on the role and future of Medicaid Section 1115 waivers.
Speakers:
 Leonard Finocchio
 Lisa Kirsch
Victoria Wachino

The U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services, Office of Civil Rights have increased activities to enforce the community integration mandate of the Olmstead decision and the Americans with Disabilities Act. Whether states initiate action or respond to external forces, Olmstead provides an impetus to rebalance long-term services and supports.  Alison Barkoff of the DOJ will provide an overview of activity around the country.  Two state speakers will discuss their state’s efforts to expand home and community-based services and help residents of institutions transition to community living.
Speakers:
 Alison Barkoff
 Dawn Lambert
 James Stewart

Assuring access to dental care is a persistent challenge for states. New developments are now shifting the policy landscape.  Millions of children will be gaining dental coverage, and states are examining how best to use their dental workforce to meet this demand, including introducing new kinds of dental providers. This session will explore how dental benefits are being included in exchange plans; how Minnesota is operationalizing the participation of the state’s new dental therapists in Medicaid; and how Kansas is engaging in debate about its dental workforce.
Speakers:
 Colin Reusch
 Julie Marquardt
 Katherine Weno
Mary G. McIntyre

In recent years, accountable care models have emerged as ways to drive innovations in payment and service delivery. These models are helping providers assume responsibility for patient populations, linking payment to value, and enabling reliable performance measurements. This session will examine state approaches to accountable care. Speakers will highlight the shared savings payment model being used in Minnesota’s Health Care Delivery Systems Demonstration and lessons learned from accountable care organization pilots in Vermont. A speaker from Colorado will discuss the state’s Medicaid Accountable Care Collaborative.
Speakers:
 Laurel Karabatsos
Cheryl Roberts
 Richard Slusky
Scott Leitz

This free mini-conference will highlight the opportunities and challenges for states to work with the private sector to create consensus and alignment on health system goals and payment strategies to support those goals. Attendees will have the opportunity to learn from national, federal, and state experts about how states can leverage multi-payer initiatives that include private payers as well as public payers such as Medicaid, Insurance Exchanges, public employees, and use other regulatory and policy tools to create better coordinated and organized system of care.
Speakers:
Deidre Gifford
 Douglas Carr
 Lisa Watkins
Scott Leitz
Christopher Koller