Cost, Payment, and Delivery Reform – Page 43 – The National Academy for State Health Policy

Oral Health – Evidence and Strategies to Improve Care and Reduce Costs

Friday, April 24, 2015
2:00-3:00 PM EDT

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Oral health is linked to overall health, and mounting evidence suggests that addressing oral health can improve patient care, improve population health, and reduce costs. In this webinar, a leading researcher shares findings from a study of private insurance claims linking treatment of gum disease with significantly lower costs for individuals with diabetes and other chronic conditions. You will also hear about a program under way at Hennepin Health in Minnesota to connect patients with regular dental care and prevent costly visits to hospital emergency departments. And NASHP provides an overview of a new brief and online toolkit that explore these topics and draw out lessons for state policymakers.
This webinar is supported by the Washington Dental Service Foundation.
Speakers

Dr. Marjorie Jeffcoat, Professor and Dean Emeritus, University of Pennsylvania School of Dental Medicine
Julie Bluhm, Clinical Program Manager, Hennepin Health
Reactor: Dr. Bob Russell, Public Health Dental Director, Iowa Department of Public Health
Moderator: Andrew Snyder, Program Manager, NASHP

Contact: nmention@oldsite.nashp.org

Oral Health and the Triple Aim Toolkit

April 20, 2015/in Policy Toolkits Child Oral Health, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Maternal, Child, and Adolescent Health, Oral Health, Population Health /by NASHP

Oral health is linked to overall health, and mounting evidence suggests that addressing oral health can help states move toward the Triple Aim goals of improving the patient experience, improving the health of populations, and reducing per-capita health care spending. Poor oral health—including high rates of tooth decay, missing teeth, and gum disease—and inadequate access to oral health services are persistent problems for low-income populations. This can lead individuals to turn to costly emergency rooms for preventable dental problems; one study estimates that these visits result in up to $2 billion in spending annually. Moreover, the effects of poor oral health are not limited to the mouth – studies have associated oral diseases with systemic health conditions including diabetes.
This toolkit contains a variety of resources for states to learn how an oral health strategy could help them work toward their goals of improving health and reducing costs. The toolkit builds on a NASHP brief, Oral Health and the Triple Aim: Evidence and Strategies to Improve Care and Reduce Costs. It summarizes research articles and policy briefs on the links between oral health and diabetes, maternal and child health, and avoidable emergency room utilization; provides case studies on state and local initiatives to bring together oral health and primary care; and provides information on policy solutions that states have implemented to improve oral health coverage and access.

Medicaid Adult Dental Coverage map

NASHP also has resources on a range of oral health policy topics. You may also be interested in:

This toolkit was made possible with support from the Washington Dental Service Foundation.

Making Multipayer Reform Work: What Can Be Learned From Medical Home Initiatives

April 7, 2015/in Policy Reports Cost, Payment, and Delivery Reform, Health System Costs, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Mary Takach and Sarah Kinsler

Medical home initiatives across the United States are demonstrating that multipayer reform, although complex and difficult to implement, is feasible when committed stakeholders negotiate strategies that are responsive to the local context. Seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points germane to any multipayer payment model: convening stakeholders; establishing provider participation criteria; determining payment; and measuring performance. The NASHP medical home team explores in the April issue of Health Affairs the lessons learned from these experiences. Heeding these lessons will help inform those leading multipayer efforts “to better anticipate and navigate known obstacles and improve their chances for successful implementation.”

The full article is available on the Health Affairs web site.

Support for this paper was provided by The Commonwealth Fund.

Building an Equitable Health Care Delivery System: Federal and State Strategies

April 2, 2015/in Policy Louisiana, Ohio Webinars Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Population Health, Social Determinants of Health /by NASHP

Thursday, April 2, 2015
3:30 pm – 4:30 pm EDT

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Federal and state policymakers are increasingly focused on addressing health disparities as part of their approach to improving health, improving health care quality, and reducing costs. This webinar discusses aligning payment models, creating new partnerships, and building infrastructure and data systems to achieve health equity. Speakers from Ohio and Louisiana describe their states‘ health equity initiatives and federal programs they are leveraging. An official from the CMS Office of Minority Health describes federal resources to help states advance health equity and opportunities for alignment of federal and state activities.

Speakers

Chip Allen, Director of Health Equity, Ohio Department of Health
Rebekah Gee, Medicaid Medical Director, Louisiana Department of Health and Hospitals
Cara James, Director of the Office of Minority Health, CMS

Achieving a Culture of Health: Governors Weigh In

April 2, 2015/in Policy Accountable Health, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Housing and Health, Population Health, Social Determinants of Health /by NASHP and Kaitlin Sheedy

Governors hold a unique capacity to help promote a culture of health using the tools of their state governments in purchasing, regulating, and policymaking. In their 2015 State of the State or inaugural addresses, governors referenced a variety of health issues and are recognizing the need for policies to focus more broadly in order to promote good health and build healthy communities. A new NASHP brief looks at the ways governors are creating a culture of health by developing policy agendas to make their states healthier.
Cross Sector Collaboration to End Silos of Care and Focus on the Whole Person
State officials are taking a cross cutting, more coordinated approach to create a culture of health by partnering across state agencies and sectors to look at health from a more holistic perspective.

Michigan’s Governor Snyder proposes combining the state’s health and human services departments to achieve more coordinated processes across state agencies and create “people-focused” policies.
In Nebraska, Governor Ricketts notes that the “people who need our help do not fit neatly into the silos we have created…we need a system that cares for the entire person.”
Ohio’s Governor Kasich calls for greater coordination of care and a more holistic, less siloed approach to providing social services to individuals and families in poverty, and notes the state plans to address health issues through action involving other sectors.
In Colorado, Governor Hickenlooper is looking at community design and the intersection between the environment and health by seeking improved bike and hiking trails and outdoor programs.

Childhood Interventions
Several governors called for a comprehensive approach to caring for children through childhood interventions. Access to education and quality nutrition in states are contributing to efforts to achieve health equity and a culture of health.

Governor Deal of Georgia is focusing on education as a means to break the cycle of poverty, which is inextricably linked to poor health. Investing in providing quality education “leads to a good job, a stable family, and the stairway to the future,” all of which contribute to a culture of health. He calls on state legislators to do their part in assuring that “a child’s hopes of success aren’t determined by his or her ZIP Code.”
In Virginia, Governor McAuliffe’s budget plan includes funding to expand school breakfast programs “so that every Virginia student can start his or her day ready to learn.” The governor recognized that quality nutrition is essential for good health and is “a key element of increasing student achievement.”

Access to Health Care
Access to affordable and equitable healthcare is a critical piece of achieving a culture of health, and many states are working hard to ensure that communities can provide individuals with the care they need to be healthy and productive citizens. In addition to addressing the expansion of health care coverage through health insurance exchanges and Medicaid programs, governors talked about how states are improving access to health services through programs assisting specific populations.

In Texas, Governor Abbott outlined budget priorities that included a commitment to improving military service members’ and veterans’ access to mental health screenings, enhancing women’s access to screening and treatment for cancer and postpartum depression, and increasing the availability of in-home care attendants to care for people with disabilities and seniors.
Alabama’s Governor Bentley acknowledged the link between health issues and “access to quality healthcare.”
Governor Daugaard of South Dakota highlighted efforts to expand the healthcare workforce and incentivize practice in rural areas to address the unique challenges of ensuring access to care in regions of the state with large rural populations.

Employment Opportunities and Support
Stable employment in safe working conditions leads to better health, enabling individuals to provide their families with nutritious foods, quality childcare, educational opportunities and healthier homes. Governors across the country are focusing on improved access to employment opportunities and support to improve the health of the residents in their states.

Governor Bill Walker of Alaska observed, “People cannot work, hunt, or fish unless they are healthy.”
In Kentucky, Governor Beshear spoke to the importance of an educated, well-trained, and healthy workforce.
Governor Kasich discussed the work Ohio is doing to create jobs and provide opportunities to help all residents of the state.

Governors are increasingly committed to fostering a culture of health in their states as evidenced in their 2015 State of the State addresses. What is your state doing to promote a culture of health? Let us know in a comment below.

Traveling Medical Home Team Brings Multi-Disciplinary Services to Remote Tasmania

March 27, 2015/in Policy Blogs Cost, Payment, and Delivery Reform, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Mary Takach

Tasmania, Australia’s only island state, encompasses an area of 26,262 square miles – an area roughly the size of West Virginia – and is home to just over half a million Australians, most of them low income. According to Tasmania Medicare Local CEO Phil Edmondson, “We are the oldest and sickest and most poorly educated population in the country. We have the highest rates of chronic disease and highest age demographic in terms of skewed towards the elderly.”
Integrated Care Chronic Disease Teams, initially focused on those with diabetes, now operate with the goal of delivering comprehensive, integrated services including mental health, diabetes education, exercise physiology, nutritional counseling, among others in a state where short distances can take hours to navigate. These services enable primary care clinicians to serve as medical homes to their patients living in remote and rural mountainous regions and in small island communities.
Funding for the team came from a flexible funding stream to the Medicare Local from the federal government as well as the Tasmania Department of Health and Human Services. With federal grant funds, a few years later, the Medicare Local expanded the scope and reach of services. Describing the service delivery, Aitor Baonza, Manager of Allied & Refugee Health Services at the Tasmania Medicare Local explained, “The services are integrated in the way we work and the way we fund our services.” The multi-disciplinary team members including mental health therapists, exercise physiologists, diabetes educators, and dieticians also deliver Medicare based services (Australia’s national health insurance) to augment funding streams when referred by the primary care physician. The primary care physician gets a payment by Medicare to oversee members of the team through the formulation of a chronic disease management plan.
The Tasmania Medicare Local hires members of the teams when local commissioning or subcontracting is not possible and manages the referral and appointment process. The teams travel together sharing a van to remote or rural settings or a small plane to islands including Flinders and King islands. Patients in these areas generally receive services on a monthly basis, but for those with mental health needs, services may be delivered weekly. The team meets the patients on site at the primary care practice, but if space does not allow, patients are then seen at community health centers. The team has been well received by both the patients and the practices. Patients are reported to be better educated about their disease processes and their self-management of their disease.
Aussie Habits, Part I
One habit that Aussies are keen to kick is smoking. Like many Western countries, tobacco rates are falling in Australia. Daily smoking rates for Aussies aged 14 years or older are at 12.8% (AIHW 2013). Picking up a couple of empty cigarette boxes littered on a street reveals one part of Australia’s multi-prong tobacco strategy. Since December 2012, all tobacco products sold, offered for sale, or otherwise supplied in Australia must be in plain packaging. As you can see, the packaging is hardly plain—it’s actually quite startling and leaves no question about the deleterious health effects of smoking.

Building An Equitable Health Care Delivery System: Considerations For State And Federal Policymakers

March 23, 2015/in Policy Reports Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Housing and Health, Population Health, Social Determinants of Health /by NASHP

Health disparities persist in the United States, with disadvantaged groups disproportionately bearing the burden of poor health outcomes and shortened lifespans. States cannot effectively control healthcare costs or improve quality without addressing health disparities. Fortunately, state and federal policymakers can work together to build an equitable health care delivery system by aligning payment models, creating new partnerships, and building infrastructure and data systems to reduce health disparities.
This brief reflects on a discussion of health equity held at a meeting of state and federal leaders convened by the National Academy for State Health Policy with the support of The Commonwealth Fund. Included in the brief are highlights of several states’ efforts to promote health equity, including New York, Ohio, and Louisiana.

New Brief Outlines State Options Pending Supreme Court Ruling

March 17, 2015/in Policy Reports Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, State Insurance Marketplaces /by NASHP, Allison Wils, Alice Weiss and Anne Gauthier

In this new issue brief, NASHP identifies considerations and policy options for states pending the outcome of King v. Burwell. A pro-King decision might end federal subsidies provided to individuals in the 34 states that used the Federally-Facilitated Marketplace to enroll in health insurance coverage, impacting about 7.3 million people. Although the outcome of the case is uncertain, states may want to begin exploring responses if the Supreme Court decision supports King. This brief provides context for how states might be impacted and analyzes options for future action, including a detailed review of state exchange options and pending legislation in the states.

Wyoming – Medical Homes

March 13, 2015/in Policy Wyoming Cost, Payment, and Delivery Reform, Health System Costs, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by Medical Homes

Wyoming’s 2013 Supplemental Budget included a $300,000 earmark to “[develop] a primary care medical home network in Wyoming.” The Wyoming Department of Health, which administers the state’s Medicaid program, leveraged a $14 million Health Care Innovation Award led by the Wyoming Institute for Population Health to help achieve this goal. The Department of Health allocated $250,000 of the earmarked funds to increase the number of practices receiving TransforMED support through the Innovation Award.
As a pilot, The Wyoming Department of Health began making enhanced payments ($3.00 per-member per-month) to four NCQA-recognized medical homes participating in WyHealth, a care management program for Medicaid enrollees. Beginning April 10, 2015, the Wyoming Department of Health will make enhanced payments to any WyHealth-participating primary care practice that completes a PCMH attestation form. The attestation form is built off of NCQA PCMH standards, but practices will not be required to achieve NCQA PCMH recognition to receive the enhanced payments.
Last updated: March 2015

Forming Partnerships	The Wyoming Department of Health has partnered with the Wyoming Institute of Population Health, a division of Cheyenne Regional Medical Center.
Defining & Recognizing a Medical Home	Recognition: The Wyoming Department of Health developed an attestation form built on NCQA PCMH standards; however, practices are not required to receive NCQA recognition in order to receive payment.
Aligning Reimbursement & Purchasing	Beginning in April 2015, The Wyoming Department of Health will pay medical homes an extra $3 per-member per-month. In order to receive payment, practices must: Participate in WyHealth, a care management program for Medicaid enrollees; Attest to implementing core medical home functions, based on NCQA PCMH standards. Pull continuity of care documents for at least half of their Medicaid patients from the state’s health information exchange on a quarterly basis, and Submit nine clinical quality measures into the State Level Registry on a monthly basis.
Supporting Practices	The Wyoming Department of Health provided $250,000 in funding to increase the number of practices receiving support from TransforMED through a Health Care Innovation Award led by the Wyoming Institute for Population Health.
Measuring Results	The Wyoming Department of Health selected nine clinical quality measures that practices are required to report in 2015: Tobacco Use Assessment and Cessation Intervention Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Childhood Immunization Status Diabetes: Hemoglobin A1C Poor Control Diabetes: Blood Pressure Management Diabetes: LDL Management and Control ADHD: Follow-up Care for Children Prescribed Medication.

Tennessee – Medical Homes

March 13, 2015/in Policy Tennessee Cost, Payment, and Delivery Reform, Health System Costs, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by NASHP

Since 2008, the Bureau of TennCare (Tennessee’s Medicaid agency) has worked with the Tennessee Chapter of the American Academy of Pediatrics (TNAAP) to advance the medical home model in pediatric practices. In 2012, TNAAP launched the Tennessee Medical Home Project, a three-year education and training initiative to increase providers’ medical home capabilities and capacity to coordinate care for children and youth with special health care needs. TNAAP implemented the Tennessee Medical Home Project in partnership with the Tennessee Department of Children’s Special Services and Tennessee Voices for Children through Health Resources and Services Administration grant funding.
Tennessee is pursuing a multi-payer medical home initiative as part of its State Innovation Model Test Award (see below for additional information). According to the state’s proposal, there are more than 500 NCQA PCMH-recognized practices in the state and all of the major health plans have implemented a PCMH incentive program; however, providers have found it difficult to participate in more than one initiative due to the disparate program requirements and incentives set by each plan. TennCare (Medicaid) managed care plans and commercial payers will pilot a new multi-payer initiative with greater alignment across payers in 12 practices in Knoxville and Memphis before the program rolls out statewide.
Participation in Federal Initiatives
State Innovation Models Initiative: In December 2014, Tennessee received a two-year, $65 million Model Test Award to implement and test the Tennessee Health Care Innovation Initiative. Key features of Tennessee’s innovation plan include a multi-payer patient-centered medical home program for adults, a pediatric medical home initiative, and health homes for individuals with severe and persistent mental illness. Tennessee previously received a $756,000 Model Design Award to develop their plan.
Last updated: March 2015

Forming Partnerships

The Tennessee Medical Home Project, which is primarily focused on children and youth with special health care needs, has been developed in partnership with:

The Bureau of TennCare;
The Tennessee Department of Children’s Special Services;
The Tennessee Department of Health
The Tennessee Chapter of the American Academy of Pediatrics;
Tennessee Voices for Children;
Family Voices of Tennessee; and
The Tennessee Pediatric Society Foundation.

Defining & Recognizing a Medical Home Definition:
The Tennessee Medical Home Project refers to both the definition of “medical home” set forth in the American Academy of Pediatrics’ 2009 Policy Statement as well as the Joint Principles of the Patient Centered Medical Home.

Supporting Practices

The Bureau of TennCare and the Tennessee Department of Children’s Special Services have partnered with the Tennessee Chapter of the American Academy of Pediatrics (TNAAP) and Tennessee Voices for Children to develop educational and training materials to support medical home implementation, particularly to serve children and youth with special health care needs. As part of this work, TNAAP has developed a website with resources and toolkits for practices; TNAAP has also held a series of online and in-person learning events.