2013 in Seattle: What's Brewing in State Health Policy

Reliable and meaningful performance measurement is an increasingly important ingredient in achieving the Triple Aim of better health, better quality and lower costs. This preconference will draw from the experience of leading states and measurement pioneers to offer practical information to help design and implement performance measurement strategies for health system improvement. It will address critical questions such as:

• What approaches have states taken to measure performance for plans, providers, and complex populations like dual eligibles?
• How can states use performance measurement to hold providers and payers accountable for the cost and quality of services delivered?
• What are best practices for selecting, developing, and using appropriate performance measures?

This preconference will begin with a look at promising cross-payer measurement initiatives and the lessons they offer for state officials. It will also feature a series of case studies to highlight first-hand accounts of quality improvement through performance measurement, including lessons learned.

Session Presentation

Alan Weil Alice Lind Cheryl Roberts Diane Stollenwerk Jacqueline Matson Neva Kaye Rebekah Gee Scott Leitz Susie Dade Timothy Cowan

Join state experts to learn the latest strategies to help eligible individuals enroll in and keep public coverage! Since 2009, states participating in the Maximizing Enrollment program have worked to revamp cumbersome, paper-driven enrollment processes and modernize eligibility systems and policies in advance of the changes required by ACA. This preconference will share lessons from these states’ efforts to:

• Harness technology to make enrollment more simple, efficient, and accessible;
• Simplify and streamline processes to reduce the burden on applicants and eligibility workers; and
• Manage programmatic change by setting a consistent, data-driven vision for coverage within and across agencies.

Presenters, including experts on performance measurement and process improvement, will share practical lessons useful to other states implementing ACA’s eligibility provisions and will look forward to the next frontiers in enrollment and retention in public programs.

Session Presentation

Alice Weiss Andrew Snyder Catherine Hess Christopher Trenholm Maureen Hensley-Quinn Tricia Brooks Victoria Wachino

Open enrollment has begun and the major coverage elements of the Affordable Care Act are set to take effect on January 1, 2014.  Meanwhile, other provisions of the law have been in place for a few years and are already starting to affect how care is organized and delivered.  After NASHP’s Executive Director Alan Weil provides an up-to-the-minute report on ACA implementation, Susan Dentzer, Senior Adviser at the Robert Wood Johnson Foundation and national thought leader, will deliver the keynote address which will put recent events in the context of the broader delivery system and coverage changes under way.  This session will set the stage for two days of discussion about what’s brewing in state health policy.

Alan Weil Anne M. Barry Susan Dentzer

Alan Weil Presentation Susan Dentzer Presentation

With some ACA deadlines now passed and more critical ones to come, no matter where they stand on ACA, states have their hands full dealing with operational issues and meeting the law’s requirements. At the same time, state leaders have their own visions and ambitions for improving health and the health care systems in their states. This panel of state leaders from across the country and a diversity of agencies and branches of state government will discuss the immediate challenges of reform and the longer term agenda.

Alan Weil Eileen Cody Jose Montero Julie Weinberg Linda Sheppard Nora Leibowitz

Launching and sustaining a successful state-based insurance exchange (or marketplace) takes cooperation and collaboration among multiple stakeholders. During this session NASHP will provide a national snapshot of state-based exchange activity then further explore Washington’s exchange efforts—from the overall vision and operations to network adequacy and consumer assistance. We’ll hear from the exchange’s CEO, the state’s insurance commission and a large local public health agency charged with assisting consumers in the new health coverage environment.

Anne Gauthier Lois Steinbeck Meg Jones Patty Hayes Richard Onizuka

Anne Gauthier Presentation Meg Jones Presentation Patty Hayes Presentation Richard Onizuka Presentation

This session focuses on the mechanisms states have available to reform delivery and payment systems with the goal of improved health, a key component of the Triple Aim. It highlights state and community examples of these mechanisms in action. Attendees will learn about the efforts to build an accountable care community in Akron, Ohio and its implications for states; New York’s strategies to implement its prevention agenda; and Mississippi’s integration of public health objectives into its trauma care system.
This session is supported by the Robert Wood Johnson Foundation.

Guthrie Birkhead Janine Janosky Jose Montero Norman Miller

Guthrie Birkhead Presentation Janine Janosky Presentation Jose Montero Presentation Norman Miller Presentation

Enrollment outreach and marketing are in the spotlight, but there’s even more to health care reform communications. From launching exchanges to revamping eligibility systems, there are public relations risks and opportunities at every step. In this session state panelists and public affairs experts will discuss ways of performing stakeholder engagement, interagency relations, and reputation management during times of major change. Attendees will hear about states’ experiences with ACA implementation, as well as lessons learned from other highly consequential policy changes.

Alison Betty Ed Long Jeanene Smith Laurie Jinkins

Alison Betty Presentation Ed Long Presentation Jeanene Smith Presentation

Improving care coordination is a major goal of delivery system redesign and payment reform.  Successful care coordination that integrates health and community-based services, including public health, social services, behavioral health and long-term services and supports, requires timely and efficient exchange of information.  Focusing on the role of Health Information Exchanges in supporting care coordination, the session will highlight successful systems integration examples from California, Illinois, and Vermont.

Laura Zaremba Linette Scott Lisa Dulsky Watkins

Laura Zaremba Presentation Linette Scott Presentation Lisa Dulsky Watkins

This session will feature two states that have launched or are preparing to launch their dual eligible demonstrations, and look ahead to the evaluation. The project director of the CMS funded evaluation will provide a national overview of the demonstrations and discuss how state demonstrations will be evaluated. Then a representative of a state using a managed fee-for service model and one of a state using a capitated model will provide a contrasting perspective and discuss implementation.

Edith Walsh Gregory Allen MaryAnne Lindeblad Susan Yontz

Edith Walsh Presentation Gregory Allen Presentation MaryAnne Lindeblad Presentation

Many health policymakers believe it is critical to engage stakeholders in policymaking but sometimes struggle with how to do so effectively.  Liz Baxter has spent her career building public priorities into complex policy initiatives. She led a successful effort to build community consensus on the goals of health reform in Oregon and now chairs the Board of Cover Oregon (Oregon’s Health Insurance Exchange).  In these efforts she learned many lessons about how to create policies rooted in community priorities. In this plenary she will share successful strategies for increasing community understanding of health reform, helping communities identify their priorities for change, and translating these priorities into policy.

Anne M. BarryLiz Baxter

Liz Baxter Presentation

Many states began moving forward with plans to expand Medicaid even before the Supreme Court’s ruling on the ACA. This session will provide a closer look at how states are making progress in implementing the Medicaid expansion and preparing for 2014. State panelists and a national expert will discuss issues related to the expansion, including the potential health needs of those expected to enroll and decisions on the benefit package and structuring the alternative benefit plan. Speakers will also address provider capacity needs for the new enrollees and decisions around the delivery system used for the expansion population.

Deborah Bachrach Jane Beyer Kari Armijo Susan Birch

Resource

Section 2703 of the ACA established the State Option to Provide Health Homes for Medicaid Enrollees with Chronic Conditions. Health homes provide an opportunity to better coordinate and improve services and supports for Medicaid enrollees with complex needs. Building an effective health home program requires states to build and strengthen connections across their physical health, behavioral health, and long term services and supports systems—systems that have historically operated in silos. Attendees will join in a facilitated discussion with three states implementing health home programs.

Gregory Allen Jon Barley Marc Gold Rebecca Boss

Gregory Allen Presentation Jon Barley Presentation Rebecca Boss Presentation

It has been widely reported that the United States trails many countries on population health measures. Speakers will discuss how their states are taking advantage of new health data sources such as all payer claims databases and clinical data from electronic health records to develop a more focused assessment of population health needs at the state and community level.

Christopher Atchison Josephine Porter Karen Matsuoka Rebekah Gee

Josephine Porter Presentation Karen Matsuoka Presentation Rebekah Gee Presentation

Federally qualified health centers (FQHCs) have a long history of using innovative strategies to meet their patients’ complex physical health, mental health, and social needs. Now, spurred by cost pressures and the momentum brought by health reform, states and safety net providers are working together to pursue payment reforms. This session will explore models from Oregon, Minnesota, and Hawaii that seek to promote value and increased coordination without compromising safety net providers’ ability to serve vulnerable populations.
This session is supported through a Cooperative Agreement with the Health Resources and Services Administration.

Judy Mohr Peterson Julie Weinberg Richard Bettini Scott Leitz

Judy Mohr Peterson Presentation Julie Weinberg Presentation Richard Bettini Presentation Scott Leitz Presentation

Ensuring access to oral health services for vulnerable populations is a perennial challenge that touches many areas of states’ work – public coverage, population health, workforce, and the medical care delivery system among them. What new ideas are emerging to address this challenge? In this policy café, conference participants will engage in a series of small-group discussions to share successful strategies, think together about new ideas, and learn from one another.

Joseph Flores

Millions of children with behavioral health conditions could benefit from tighter linkages and greater integration between behavioral health service providers and primary care. This session will examine behavioral health integration for children from multiple perspectives. A speaker from CMS will discuss existing opportunities to integrate care under the Medicaid benefit for children and adolescents. The CEO of a non-profit corporation implementing integrated care models will offer a “boots on the ground” perspective. Finally, a state Medicaid official will describe her state’s innovations around behavioral health integration for children.
This session is supported by the Centers for Medicare & Medicaid Services through a contract to NORC at the University of Chicago.

Kristine Hobbs MaryAnne Lindeblad Neva Kaye Richard Weaver

Kristine Hobbs Presentation Neva Kaye Presentation Richard Weaver Presentation

Churn, when enrollees cycle on and off or across different types of coverage, is an instability nightmare not only for individuals and families but also for states’ health insurance coverage programs. As coverage landscapes change, state health officials will need to revisit and develop new strategies for mitigating churn. Learn about efforts in Minnesota, Louisiana and Washington that range from tried and true retention strategies to establishing new opportunities that reduce gaps in coverage for individuals and families.
This session is partially supported by The Atlantic Philanthropies.

Carol Backstrom Jeanene Smith Nathan Johnson Rhett Decoteau

Carol Backstrom Presentation Jeanene Smith Presentation Nathan Johnson Presentation Rhett Decoteau Presentation

The ACA enacted new Medicaid financing authorities that states can adopt to finance long term services and supports. In this session, we will hear from three state officials who are working to implement the Balancing Incentives Program, the Community First Choice Option, and State Plan Home and Community Based Services in their states. Join us in a discussion of the various state policy considerations in deciding to adopt these financing options and how these new initiatives align with other programs in these states.

Alan Weil Dawn Lambert Diane Justice Jay Yedziniak Jennifer Vermeer

Diane Justice Presentation Jay Yedziniak Presentation Jennifer Vermeer Presentation

States are at different stages of using managed care to transform their Medicaid delivery systems. Hear from three states using different managed care approaches—one with a long history of capitated managed care, one that traded its capitated system for an administrative services organization/managed fee-for-service system, and another using both capitated and managed fee-for-service systems—to drive Medicaid delivery system transformations. How are the states leveraging these models to improve care and enrollee outcomes? What progress has been made toward these and other goals?

Cheryl Roberts Kate McEvoy Lesli Boudreaux Mary McIntyre

Cheryl Roberts Presentation Kate McEvoy Presentation Lesli Boudreaux Presentation Mary McIntyre Presentation

Many public or publicly-subsidized programs cover important services for children with autism spectrum disorders. Many of these services, including those covered by public education, are available throughout childhood—until between ages 18 and 22, depending on the program and state. However, fewer coverage options are available to adults. Through small-group discussions, this policy café will explore the current coverage of services for individuals with autism spectrum disorders across the lifespan and foster the sharing of ideas on how to cover these populations in the future.

Debra Waldron

The Supreme Court’s ACA ruling put the Medicaid expansion decision in states’ hands and at least two states are pursuing non-traditional Medicaid expansion alternatives. Representatives from Arkansas and Iowa will highlight lessons learned in developing an alternative option, including how they worked with CMS to get a commitment for enhanced funding. A national expert will present creative options to help states adapt to the changing public and private health coverage landscape.

Jennifer Vermeer Patricia Boozang Suzanne Bierman William A. Hazel Jr.

Jennifer Vermeer Presentation Patricia Boozang Presentation Suzanne Bierman Presentation

States are rapidly adopting managed care as their financing and delivery system for long term services and supports (LTSS). A researcher will discuss national trends, and present findings of a study on the impact of managed care on direct service providers. State speakers from Arizona and Texas will discuss their states’ well-established managed LTSS programs, state infrastructure needed for effective implementation and management, and share their thoughts on the effect of managed care on beneficiaries’ access to long term services and supports.

Brian Burwell Gail Propsom Jami Snyder Marc Gold

Brian Burwell Presentation Jami Snyder Presentation Marc Gold Presentation

As states develop and implement the essential health benefits under the ACA, two issues—defining habilitative services and ensuring that mental health services are covered in parity with medical services— have proven particularly challenging. Private insurance plans, the benchmarks for essential health benefits implementation, have limited experience with offering habilitative services. Similarly, the ACA newly extends mental health parity requirements to private insurance plans. In this session, a national expert will provide a framework for the ACA changes, and state officials from Arkansas and Washington will discuss policy options their states have considered to address these two issues.

Cindy Crone Glenace Edwall Meg Jones

Cindy Crone Presentation Glenace Edwall Presentation Meg Jones Presentation

NASHP is pleased to present a selection of state-oriented health services research from AcademyHealth’s 2013 Annual Research Meeting.  Millions of Americans will become newly eligible for health insurance coverage in 2014 through Medicaid expansions or through the health insurance exchanges. It is likely that many of these newly insured individuals will have a host of untreated medical and behavioral health needs, which could put a strain on states’ health system capacity. Health services research can help states understand this population and their needs.  This session will feature research that focuses on predicting the health status and unmet health needs of this population and the potential implications for state health policymakers.

Cheryl Roberts Enrique Martinez-Vidal Lindsey Leininger Sharon Long Tami Mark

Enrique Martinez-Vidal Presentation Lindsey Leninger Presentation Sharon Long Presentation Tami Mark Presentation

States are busy implementing ACA’s enrollment systems and policies for “Day One,” but there is much work ahead.  This session will offer states’ and agencies’ perspectives on what’s done and what’s needed for future years. Speakers include a state exchange leader from a Medicaid expansion state, a cabinet secretary from a federally facilitated exchange state, and a state human services director from a state that is integrating health and human services eligibility. Come hear states craft a vision for eligibility and enrollment in 2014 and beyond.This session is supported by the Robert Wood Johnson Foundation.

Session Presentation

John Supra Nora Leibowitz Russ Barron

Health disparities, health inequities and social determinants are complex issues all states must address to improve health outcomes, a critical goal of the Triple Aim. This session will feature state officials from Minnesota, Oregon and Washington who will share how they are using multi-sector approaches and advancing policies to achieve health equity within their state–strategies that reach beyond their own agencies. Speakers will also discuss what they learned through the process, what strategies have worked, and how they engaged other policymakers.

Jeanne Ayers Johnnie (Chip) Allen Latricia Tillman Maxine Hayes

Jeanne Ayers Presentation Chip Allen Presentation Latricia Tillman Presentation Maxine Hayes Presentation

States are pursuing a range of strategies to promote more coordinated care and comprehensive support services for individuals with complex health needs. This session will explore states’ care coordination initiatives through three different lenses—primary care, home and community-based services and supports, and services for children with special health care needs—and highlight similarities and differences in service design and delivery.
This session is partially supported by The Atlantic Philanthropies.

Angie Goodger Betsy Van Heesch Eileen Cody Jenney Samuelson

Angie Goodger Presentation Jenney Samuelson Presentation

Multi-payer medical home initiatives are widespread, with 21 states participating in one or more of these initiatives. In this session, the moderator will facilitate a discussion among officials from states with initiatives that range from new to established, focusing on key implementation challenge such as: addressing antitrust issues; adding new payers and purchasers; avoiding common contracting barriers; and building common infrastructure.
This session is supported by The Commonwealth Fund.

Christine Collins Denise Chuckovich Diane Marriott

Christine Collins Presentation Denise Chuckovich Presentation Diane Marriott Presentation

Twenty-six states are currently engaged in perhaps the boldest opportunity to date to achieve lasting health system transformation in pursuit of the Triple Aim.  Under the Centers for Medicare and Medicaid Innovation’s State Innovation Model (SIM) initiative, 19 of these states have eight months to engage key public and private stakeholders to develop and embrace a State Health Care Innovation Plan that encompasses multi-payer payment and delivery reform.  SIM builds upon existing efforts to improve quality and population health while controlling costs. Its premise is that reforms will be sustainable if states play a leadership role to align public and private initiatives that would otherwise send conflicting signals and incentives to health plans and providers.  This panel discussion will explore how a diverse group of states has approached this daunting design task and offer insights to other states seeking a similar goal.

Alan Weil Brooks Daverman Daniel Meuse Marcela Myers