Population Health – Page 43 – The National Academy for State Health Policy

How Governors Addressed Health Care in Their 2018 State of the State Addresses

February 26, 2018/in Policy Georgia, Hawaii, Idaho, Iowa, Massachusetts, New Hampshire, New Jersey, New Mexico, Rhode Island, South Dakota, Utah, Washington, Wisconsin, Wyoming Charts Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Healthy Child Development, Housing and Health, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Quality and Measurement, Social Determinants of Health, Value-Based Purchasing, Workforce Capacity /by NASHP Staff

Overview: How the President’s Proposed FFY 2019 Budget Impacts Critical State Health Programs

February 13, 2018/in Policy Blogs Behavioral/Mental Health and SUD, CHIP, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Infant Mortality, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health, Social Determinants of Health, State Insurance Marketplaces /by NASHP Staff

On Monday, the Office of Management and Budget released the president’s FFY 2019 budget request that proposes $68.4 billion for health programs administered by the U.S. Department of Health and Human Services (HHS) – which is $17.9 billion less than 2017 funding levels. The budget proposal included an addendum designed to align the proposed White House budget with the recently passed Bipartisan Budget Act.
The following highlights some of the key components of the president’s budget proposal that could impact state health programs.
Affordable Care Act (ACA) and Insurance Markets
The proposed budget recommends the following changes to the ACA and insurance markets:

Replace the ACA with the Market-Based Health Care Grant Program: This would be a block grant structure that state could use to implement their own insurance reforms, which was originally proposed by Sens. Graham, Cassidy, Heller, and Johnson. Under the Graham-Cassidy-Heller-Johnson bill, $1.176 trillion would be appropriated from FFY 2020 to FFY 2026 for states to explore experimenting with a variety of insurance reforms or affordability programs. The bill would allow greater flexibility over enrollment in copper (catastrophic health) plans in 2019 and provide greater flexibility over health savings accounts. (For more details see, NASHP’s summary).
Phase out the federally-facilitated marketplace (FFM): Related to its proposed ACA repeal, the budget includes funding for “critical functions” and “wind down” of the FFM.
Increase funding to support Association Health Plans (AHPs): Funding would be directed to the Employee Benefits Security Administration to develop policy and enforcement capacity to expand access to AHPs, which would not have the consumer protections that ACA plans currently have and may be exempt from state regulation. This reflects recently-proposed regulations designed to increase flexibility over the formation of AHPs.
Fund the cost-sharing reduction (CSR) program: Funding would be available to cover CSR expenses from October 2017 through December 2019. The Administration discontinued payments to the CSR program in October 2017.
Reduce the grace period for payment of health insurance marketplace premiums: This suggests that the 90-day grace period consumers are given to enact marketplace coverage be reduced to 30 days.
Allow for state certification of qualified health plans (QHPs): The change is consistent with recent actions taken by the Administration to defer oversight and certification of QHPs sold through Healthcare.gov to states.
Include mandatory funding for the Risk Corridor program: Funding would reconcile outstanding balances owed to insurers under the temporary Risk Corridor program established under the ACA.

Medicaid
The president’s FFY 2019 budget proposes:

Overall program funding cuts: Proposes to cut federal Medicaid funding by $250 billion over 10 years.
Repeal of ACA’s Medicaid expansion and targets Medicaid funding: Advocates repealing the ACA’s Medicaid expansion and supports state efforts to prioritize Medicaid dollars for the “most vulnerable” individuals.
Medicaid financing changes: Indicates support for proposals to change the structure of Medicaid financing, similar to what the Graham-Cassidy bill proposed, such as implementing per capita cap or block grant funding models, which would be trended over time by the Consumer Price Index.
Work and community engagement initiatives: Encourages state initiatives to implement community engagement initiatives for able-bodied adults enrolled in Medicaid.
Prohibit Medicaid payments to public providers: Proposes to limit Medicaid reimbursement for health care providers operated by a unit of government to no more than the cost of providing services to Medicaid beneficiaries.
Giving states the ability to change certain program elements and eligibility determination processes: Plans to provide states with additional flexibility over Medicaid benefits and cost sharing, including allowing states to use state plan authority to increase copayments for non-emergency use of emergency departments. Proposes to also allow states to make changes to Medicaid eligibility determination, such as counting savings, lottery winnings, and other assets.
Mandated coverage of medication-assisted treatment: Requires state Medicaid programs to cover approved medication-assisted treatments for opioid use disorder. These investments are expected to reduce Medicaid expenditures over time.
Resources for program integrity and data collection: Includes measures designed to address waste, fraud, and abuse, as well as forthcoming guidance from the Centers for Medicare & Medicaid Services (CMS) about improving data collection of Medicaid supplemental payments.
Medicaid Disproportionate Share Hospital (DSH) payments: Continues DSH reductions by $8 billion per year from FFY 2026 to FFY 2028 (the Bipartisan Budget Act delayed DSH cuts until FFY 2020, and then increased scheduled payment reductions for FFY 2021 to FFY 2025 to $8 billion for each fiscal year).

Children’s Health Insurance Program (CHIP)
Although the recent Bipartisan Budget Act along with the earlier Jan. 22, 2018, continuing resolution (CR) extended CHIP funding until FFY 2027, the president’s budget includes some suggestions for policy changes to CHIP.

Eliminates the 23-percentage point federal match rate increase earlier: Known as the 23 percent bump, the budget proposes to eliminate this entirely in FFY 2019. (This does not include the provisions that were in the Jan. 22, 2018, CR to continue the 23 percent bump in FFY 2018 and FFY 2019, phase it down to 11.5 percent in FFY 2020, and then return to the regular enhanced CHIP match rate in FFY 2021 and beyond).
Limits enhanced CHIP match rate: Proposes to cap the increased CHIP federal match rate for states by restricting this enhanced match rate only for children in families with income up to 250 percent of the federal poverty level (FPL).
Eliminates the maintenance of effort (MOE) in FFY 2019: Proposes to end the MOE that requires states to cover children with family incomes up to the same eligibility level that was in place in 2010. In contrast, the Bipartisan Budget Act continued the MOE requirements through FFY 2019 as in current law, and then through FFY 2027 for families with incomes up to 300 percent of FPL.
Transitioning children from Medicaid to CHIP: Allows states to transition children ages 6 through 18 with family income between 100 to 133 percent of FPL (known as the bright line or stair steps kids) from Medicaid to CHIP, thus eliminating the current 133 percent FPL Medicaid eligibility level floor for children.

Prevention and Public Health Issues
The HHS budget request prioritizes the opioid crisis, mental illness, and infectious diseases. This is a shift from the former HHS Secretary’s priorities of addressing opioid/substance abuse, mental illness, and childhood obesity. Some other things of note are:

Funding to address the opioid epidemic: Proposes $10 billion in funding in FFY 2019 to HHS to combat the opioid epidemic and serious mental illnesses.
Prevention and Public Health Fund (PPHF): Proposes to eliminate the PPHF but backfill PPHF-funded programs with discretionary budget authority.
Infectious diseases demonstration: Includes a $40 million request for a new demonstration program for five or more states or localities that focuses on eliminating multiple infectious diseases using screenings and referral to treatment. It would focus particularly on states/localities with infectious disease increases related to opioids.
National Strategic Stockpile: Proposes to move the National Strategic Stockpile program out of the Centers for Disease Control and Prevention and house it in the HHS Office of the Assistant Secretary for Preparedness and Response.

Health and Housing Issues/Other Programs Addressing Social Determinants of Health
Some components of the HHS budget, as well as several aspects of the U.S. Department of Housing and Urban Development (HUD) budget, could affect states’ abilities to address health through housing and other social determinants of health.

Decreases funding for HUD rental assistance programs: Proposes to reduce funding for HUD rental assistance programs by 11.2 percent over 2017. The administration maintains that this would be enough to support the currently-housed families, while shrinking the program over time. The addendum would provide $1.7 billion to maintain current levels of housing vouchers and exempt elderly and disabled households from “rent reform proposals.”
More state and local resources will be necessary to develop affordable housing: Expects states to pick up a greater share of the tab for affordable housing, and does not request funding for the Public Housing Capital Fund, indicating that the responsibility for providing affordable housing should be more fully shared with state and local governments.
Supplemental Nutrition Assistance Program (SNAP): Proposes cutting SNAP by $17 billion in FFY 2019 (and by $98 billion over the next five years), and proposes combining SNAP with a program that provides “100 percent American-grown foods” directly to households.
Social Services Block Grant: The budget proposes to eliminate the Social Services Block Grant with the justification that it funds services that are currently funded by other sources and lacks the ability to track the impact of spending.
Elimination of the Community Development Block Grant (CDBG) and Low-Income Home Energy Assistance Program (LIHEAP): Calls for the elimination of both programs.
Increases rent payment requirements for certain individuals in subsidized housing: Calls for able-bodied people in affordable housing to pay a greater share of their income (more than 30 percent) toward rent, in an effort to encourage them to work more.

Medicaid Prescription Drugs

Medicaid Drug Coverage Demonstration: Establishes a statutory demonstration authority to allow up to five states more flexibility in negotiating prices directly with drug manufacturers, rather than participate in the Medicaid Drug Rebate Program. Participating states will be required to include an appeals process so beneficiaries can access non-covered drugs based on medical need. The demonstration would exempt prices negotiated under the demonstration from best price reporting. (The budget estimates $85 million in savings over 10 years.)
Clarify definitions under Medicaid Drug Rebate program: Clarifies the Medicaid definition of brand and over-the-counter drugs, as well as drugs approved under a biologics license application, by codifying existing regulations to ensure appropriate Medicaid drug rebates. (Estimates $319 million in savings over 10 years.)

Federal Health Safety Net Programs

Health center funding: Provides $5.1 billion of discretionary funding for community health centers.
Consolidates Graduate Medical Education (GME) funding: Proposes to consolidate GME funding into a new mandatory GME capped grant program, no longer allowing categorical funding for certain medical specialties.
Reductions in nursing education funding: Proposes to reduce funding for nursing workforce development by $145 million from FFY 2018.

Proposals Affecting Individuals Dually Eligible for Medicare and Medicaid

Coordinated review of Dual Eligible Special Needs Plan marketing materials: Allows for joint state and CMS review of marketing materials for Dual Eligible Special Needs Plans.
Part D special enrollment period for dually eligible individuals: Clarifies the Special Enrollment Period (SEP) for Medicare Part D to allow CMS to apply the same annual election process for all eligible individuals, but maintain the ability for dually eligible beneficiaries to use an SEP to opt into integrated care programs or to change plans following auto-assignment.

Center for Medicare and Medicaid Innovation (CMMI)

Additional funding for CMMI: Proposes an increase of $314 million in funding for CMMI for FFY 2019.

Other Programs

Temporary Assistance for Needy Families (TANF) funding reductions: Proposes a 10 percent decrease in funding for the TANF program, and require states to use at least 30 percent of federal TANF and state maintenance-of-effort funds on the following: work, education, and training activities and work supports, including child care.
Family to Family (F2F) Information Centers: Funds the F2F Health Information Centers, however not at the same rate as the recently passed CR, which included $6 million per year in FFY 2018 and FFY 2019, and an additional $1 million per year to establish centers in the territories and for Native American tribes. Under the president’s proposal, F2F centers would receive $1 million in FFY 2018 and $4 million each in FFY 2019 and FFY 2020.
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program: Includes an addendum that would fund the MIECHV program for FFY 2019 at the same level included in the recently passed CR at $400 million per year.
Reforms for families with more than one child enrolled in the Supplemental Security Income (SSI) Disability Program: Creates a sliding scale for multi-recipient SSI families. For families with more than one child receiving SSI disability payments, they would still receive up to the current maximum benefit for the first child, but SSI payments for additional children would operate on a sliding scale that takes into the account the number of additional children.
Paid parental leave and child care funding: Allocates money to establish a paid parental leave program, which would require states to provide parents six weeks of paid leave to new mothers and fathers and give states wide latitude to design and implement their programs. It also enhances funding for child care programs, including increasing the Child Care and Development Block Grant by $169 million over FFY 2018 levels.
Individuals with Disabilities Education Act (IDEA): Proposes maintaining current level of funding ($12.8 billion) for IDEA formula grants to states to support special education and early intervention services.
Women, Infants, and Children (WIC): Proposes maintaining current level of funding ($5.8 billion) for the Special Supplemental Nutrition Program for WIC.

How the Bipartisan Budget Act Impacts Key State Health Care Programs

February 13, 2018/in Policy Blogs Behavioral/Mental Health and SUD, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Health Coverage and Access, Health Equity, Health System Costs, Healthy Child Development, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Population Health, State Insurance Marketplaces /by NASHP Staff

The Bipartisan Budget Act of 2018, which continues government funding through March 23, 2018, addressed funding for several health care programs that heavily impact states. The temporary federal budget includes bipartisan agreement on discretionary budget caps for two years, which should help Congress put together a larger omnibus spending bill in March. The following outlines some key health-related provisions in the bill of interest to state health officials.
Children’s Health Insurance Program (CHIP)

Provides an additional four years of funding for CHIP at the regular enhanced CHIP match rate, resulting in 10 years of federal CHIP funding through FFY 2027 (the January continuing resolution (CR) provided six years of funding for CHIP, and phased down and after FFY 2020 eliminated the current 23 percent enhanced CHIP match rate).
Continues the maintenance of effort (MOE) requirements through FFY 2027 for children in families with incomes up to 300 percent of the federal poverty level (FPL). The January CR continued MOE through FFY 2019 as in current law, and extended it to FFY 2023 for families with incomes up to 300 percent FPL.
Extends the following through FFY 2027:
- Child enrollment contingency fund;
- Qualifying state option, which provides the CHIP-enhanced matching rate for Medicaid-enrolled children in states that had expanded children’s coverage before the establishment of CHIP in 1997;
- Authority for states to use Express Lane Eligibility;
- Funding for outreach and enrollment grants; and
- Funding for the Pediatric Quality Measures Program. Also, beginning in FFY 2024, states will be required to report on the quality measures in the child core set, currently reporting is voluntary.

Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program

Extends funding for the MIECHV program through FFY 2022, and maintains the current level of funding at $400 million per year.
Gives states the option to implement a “pay-for-outcomes” initiative. This allows them to use up to 25 percent of federal funds to support outcomes or success payments to home visiting programs that demonstrate improved outcomes.

Federal Health Safety Net Programs

Extends federal funding for the Community Health Center Fund for two years (FFY 2018 and FFY 2019) by $3.8 billion in FFY 2018 and $4 billion in FFY 2019. (In FFY 2017, community health centers received, in total, around $5 billion through a combination of $3.6 billion in mandatory funding from the Community Health Center Fund and $1.2 billion in discretionary appropriations.)
Extends federal funding for the National Health Service Corps for two years (FFY 2018 and FFY 2019) by $310 million each year. (In FFY 2017, the corps received, in total, around $380 million through a combination mandatory funding and discretionary appropriations.)
Extends and expands the Teaching Health Centers Graduate Medical Education program for two years (FFY 2018 and FFY 2019) by $126.5 million each year. (This is an increase from $60 million in funding in FFY 2017.)

Prevention and Public Health Fund

Returns $400 million to the Prevention and Public Health Fund over three years (FFY 2019 to FFY 2021), bringing the prevention fund to $950 million in FFY2020 and FFY2021.
Cuts the fund between FFY 2022 and FFY 2027 by $1.35 billion, compared to current law. Restores funding to $2 billion in FFY 2028.
The reductions to the fund, compared to current legislated funding levels, compound prior cuts. Over time, states are expected to lose millions of federal dollars that currently support state efforts to prevent disease, conduct immunization programs, respond to infectious disease crises, and promote health and well-being.

Medicaid Disproportionate Share Hospital (DSH) Payments

Delays DSH cuts until FFY 2020, and then increases scheduled payment reductions for FFY 2021 to FFY 2025 to $8 billion for each fiscal year.

NASHP and AcademyHealth Invite State Medicaid, Public Health, and Immunization Officials to Join an Initiative to Boost Immunization Rates among Medicaid Enrollees

February 9, 2018/in Policy Health Coverage and Access, Maternal, Child, and Adolescent Health, Population Health /by NASHP Staff

AcademyHealth and the National Academy for State Health Policy (NASHP), with support from the Colorado Children’s Immunization Coalition, are working with state health officials interested in improving their immunization rates to participate in a Community of Practice (CoP). Through a project funded by a US Centers for Disease Control and Prevention cooperative agreement, Immunization Barriers in the United States: Targeting Medicaid Partnerships, state Medicaid agencies will collaborate with their public health and immunization information system partners to improve Medicaid policies and immunization outreach to increase immunization rates among low-income children and pregnant women.
Despite the availability of vaccines through Medicaid and the Vaccines for Children program, immunization rates for children and pregnant women enrolled in Medicaid remain lower than the rates for those with higher incomes or who are privately insured. In particular, disparities in vaccine coverage exist for African-American children and those living in poverty.
Through virtual and in-person meetings over the course of the project, AcademyHealth and NASHP will work with CoP states to identify barriers and share promising practices for increasing immunization rates.
Over the two- to three-year project, the CoP will provide:

One-on-one consultation (with calls every other month) to support state-identified needs;
Regular opportunities to interact with other CoP members to address challenges as well as share experiences and lessons learned; and
Yearly in-person meetings of CoP teams to discuss state goals and provide in-person technical assistance.

Areas of focus for moderated calls, webinars, and light-touch technical assistance could include:

State cross-agency collaboration;
Population-based interventions;
Health care provider and delivery site issues;
Access to experts and other collaborators;
Data-sharing and health informatics; and
Financing and sustainability support.

Virginia Cooperative Promotes Evidence-Based, Prevention Improvements in Primary Care

January 23, 2018/in Policy Virginia Reports Care Coordination, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health System Costs, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement, Value-Based Purchasing /by Olivia Bacon

Years can pass before providers fully integrate evidence-based approaches that can saves lives and provide more cost-effective care into their practices. To speed that process, NASHP worked with Virginia’s EvidenceNOW cooperative to share findings from that initiative’s effort to promote evidence-based primary care prevention with 1,500 small- to mid-sized primary care practices in 12 states. The focus was to prevent heart disease by improving provider performance on four basic cardiac care measures. This brief focuses on lessons learned from practice facilitation efforts and includes examples of state approaches to promote evidence-based prevention in primary care. The first brief in this series looked at the problem of primary care provider burnout and explored a range of strategies and policy options that states have for mitigating burnout.

This publication is No. 2 in our EvidenceNOW: Insights for State Health Policymakers Series

Click here to read No. 1: Primary Care Provider Burnout: Implications for States & Strategies for Mitigation

State CHIP Officials Speak Out on Impact of Congressional Funding Delay

January 16, 2018/in Policy Blogs CHIP, Chronic Disease Prevention and Management, Eligibility and Enrollment, Maternal, Child, and Adolescent Health, Population Health /by Maureen Hensley-Quinn

In early January, the National Academy for State Health Policy (NASHP) asked all state Children’s Health Insurance Program (CHIP) and Medicaid officials:

How state CHIP funding exhaustion dates and contingency planning had changed as a result of the Dec. 22, 2017, continuing resolution that provided states with a short-term allotment of $2.85 billion, and
What has been impact of the extended uncertainty about long-term, predictable funding on states and their CHIP programs.

The following is a summary of the information shared by 34 states whose officials responded to the poll.
Estimating the Exhaustion of Federal CHIP Funds
Given the temporary changes to the allocation of redistribution funds, states are uncertain how much future federal funding they can count on to keep their CHIP programs operational. The officials shared estimates of when their state may exhaust federal funds with NASHP on the condition of confidentiality.

Eleven states anticipate exhausting their funds sometime in February 2018
Ten states anticipate exhausting their funds sometime in March 2018

State contingency plans evolve with the emerging information from the Centers for Medicare & Medicaid Services (CMS) and with potential legislative action from Congress, which must pass a financial package by Jan. 19, 2018, to avoid a federal government shutdown. CMS officials have told states that future redistribution funds cannot be guaranteed and, as expected, state officials hope Congress will take action to provide long-term, predictable funding soon. Without Congressional action, there are states that may need to either freeze enrollment or initiate disenrollment by the end of January or early February.
The Impact of Prolonged Uncertainty
The impact of sustained uncertainty for the future of CHIP varies across states. Some officials report they face more significant and immediate implications than others, but all states are experiencing challenges operating a health coverage program without guaranteed funding. Here are some key budgetary and program concerns:

Continued uncertainty has a significant impact on budgeting and planning for state resources. Should a state assume that Congress will extend CHIP? How much money should states budget for children’s coverage – enough to ensure they match CHIP dollars? A higher level of funding to provide state matching dollars for more children in Medicaid? If so, where do those funds come from?
Should states with biennial legislative sessions convene special sessions? If so, when should they address the potential changes in states budget as a result of changes to federal funding for CHIP?

Limited Medicaid and CHIP resources are stretched thin:

Agency staff have focused on contingency planning, budgeting, and keeping the program operational rather than make additional improvements to CHIP or other state health initiatives, such as delivery system reforms and eligibility and other information technology systems improvements.
For months, a significant amount of staff resources has been devoted to communications and outreach to families, stakeholders and partners (including health plans, providers, contractors, vendors, and community-based organizations) to ensure they have accurate and current information.
Uncertainty has delayed implementation of new state laws – both laws related to the CHIP program and to other health programs because the responsibility for implementing the laws falls to the same agency officials who must focus on CHIP.

Loss of participating providers and increased utilization of the delivery system:

Although not wide-spread yet, there are reports of states losing participating providers from health plans that contract with CHIP due to the uncertainty of future funding for the program.
There is an increased demand from families seeking primary care and specialty health services for their children while the program is still operational. This has been taxing to the delivery system in some areas and also results in an increase in spending that more rapidly depletes the available funding.

System changes:

Given the time required to make significant eligibility and claims systems changes, some states have had to make the changes even though they have not had to implement them yet. This has resulted in expenditures for staff and contractor/vendor time, as well as the cost of systems changes, even though these actions may not be needed if Congress ultimately extends the program.

States’ responses to NASHP’s poll underscore the fact that Congressional delay in extending the CHIP program’s funding could soon result in children losing their health coverage and highlight the systemic implications for states. Budgetary, systems, provider network, and agency work delays will likely affect states and their coverage programs for months after the uncertainty is resolved.

States Develop New Approaches to Improve Population Health Through Accountable Health Models

January 12, 2018/in Policy California, Colorado, Connecticut, Delaware, Massachusetts, Michigan, Minnesota, New York, Oregon, Rhode Island, Vermont, Washington Blogs, Reports Accountable Health, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health IT/Data, Housing and Health, Medicaid Managed Care, Population Health, Quality and Measurement, Social Determinants of Health, Value-Based Purchasing Accountable Health /by Amy Clary, Tina Kartika, Jill Rosenthal and Elinor Higgins

In this time of changing federal health priorities, state health policymakers play a crucial role in breaking the cycle of poverty and inequity so everyone can live healthy, prosperous lives. Many state leaders, with federal support, are implementing community-wide prevention initiatives that acknowledge that health is affected by factors that extend beyond clinical care. Policymakers are also fostering innovative strategies to promote community engagement so low-income, disadvantaged individuals and families help define community health priorities so all may achieve and maintain health.

To improve population health and health equity, states are working across Medicaid, public health, and other agencies to develop accountable health structures. State accountable health models — both currently operating and those in development — fall along a continuum. All of them promote healthy communities through community partnerships, but some contract with Medicaid agencies to provide health care services directly to individual Medicaid beneficiaries, while others focus only on community-based interventions.

In October 2017, the National Academy for State Health Policy (NASHP) convened state health officials representing 10 state accountable health models to discuss strategies for using accountable health structures to promote population health. Participants also discussed strategies to assess these structures’ impact on health, determine their return on investment, and develop sustainable funding approaches. The following are some of the key strategies that they identified:

Use states’ policy and contracting levers to address prevention and health-related social needs in payment and delivery reform. States can leverage Medicaid managed care contracting, build on the flexibility available through Section 1115 demonstration waivers, and maximize State Innovation Model (SIM) investment in population health to focus efforts to improve health.
Align population health goals, agendas, and, where possible, metrics across communities, payers, and stakeholders. Accountable health structures are most effective in reaching their goals and engaging stakeholders across sectors when they work toward shared goals.
Use data and measurement to raise the bar on performance, and consider financial incentives to address prevention and health-related social needs. Some policymakers suggest identifying a unified, small set of metrics that can be used across various systems and are tied to payment and accountability and based on community outcomes as well as provider outcomes.

In Brief :

Accountable health structures are community-based entities that invest in, or are accountable for, population health improvement.
This brief highlights policy levers, performance measurement strategies, and sustainable financing options that states can use to support accountable health structures.
State accountable health entities are often built into health system transformation efforts and provide a strategic framework for states seeking to integrate health-related social needs into their health systems.
These states work across agencies and sectors to improve population health, advance prevention, and reduce health disparities.
State accountable health entities can take a range of forms. Some — such as Health Equity Zones — focus only on community-based interventions, while others — such as accountable care and coordinated care organizations — contract with Medicaid to provide direct clinical care.

Work across sectors and agencies to develop a range of financial strategies to support investment in prevention and community health. Identify any gaps and duplication in funding streams. States can bolster the resilience of their accountable health structures by braiding and blending funds across agencies and seeking private sector investment. Cross-sector financial mapping of health-related programs and services can ensure that federal funds support activities that align with state priorities.
Learn from other states’ value-based payment roadmaps and lessons learned. Instead of reinventing the wheel, state policymakers can adopt and adapt other states’ tools to fit their state’s needs.

Next Steps
As state and federal policymakers seek opportunities to promote good health and its associated benefits, initiatives that enable communities to set public health priorities and maximize resources will be critical. States with active accountable health structures will continue using available policy levers to advance their goals, from improved health and equity to lower medical costs and economic sustainability. Information about the viable strategies and experiences of these states will help policymakers use available funding and policy levers to craft their own sustainable accountable health entities that achieve measurable long-term success to improve population health. NASHP will continue to convene these states, drill down into their experiences, and share lessons so other states may develop accountable health models in the future.
Related Resources
To read NASHP’s in-depth reports on accountable communities for health that explore initiatives in states including California, Minnesota, Vermont, and Washington, please visit:

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.

State Health Watch – What’s Ahead in 2018?

January 9, 2018/in Policy Blogs Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Equity, Health System Costs, Healthy Child Development, Immunization, Maternal, Child, and Adolescent Health, Population Health, Quality and Measurement, Value-Based Purchasing /by Trish Riley

State health policymakers enter 2018 buffeted by unsettled insurance markets, reductions in public health and prevention revenue, and uncertain funding for Medicaid and health care delivery reforms.
Will state innovation and more flexibility to restructure insurance and payment and delivery systems be enough to reduce medical costs and safeguard access to health care? Will new federal action undermine states’ authority to regulate insurance markets and protect consumers? How will federal tax reform affect state revenue?
This year promises both change and opportunity against a backdrop of continued budget pressures in many states and the unsettling shadow of election year politics. This year, 36 governorships and 82 percent of all state legislators face elections, in addition to Congressional midterm elections. Campaigns provide opportunity for important policy debates, but they can also have a chilling effect on major policy decisions. Despite those dynamics, recent enactment of the Tax Reduction and Jobs Act plus federal changes that affect health insurance markets in every state require the attention of policymakers now.

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How will the new tax plan affect state coffers? Will corporate and income tax cuts really generate dramatic economic growth? Since 2011, 11 states enacted substantial tax cuts designed to stimulate their economies. A more careful analysis of the cuts’ impact is needed, but what happened in Kansas offers a cautionary tale. It eliminated a 6 percent income tax on businesses, which led to a 25 percent drop in income tax revenue, precipitating a budget crisis and sharp reductions in program spending.
Will the impact of federal tax cuts on the federal deficit – which CBO projects to be $1.455 trillion over 10 years — also force deep cuts in discretionary spending? What will that mean for states that currently depend on federal dollars for one-third of their total revenues? The overall budget picture suggests a continuation of state budgeting challenges in 2018 and beyond, which will limit the ability of states to backfill any federal cuts.
State budgets have faced challenges since the Great Recession and have not fully recovered. Some states are in stronger financial positions than others, but the total projected increase in state revenue for FY 18 is only 1 percent, the smallest increase since 2010 despite the stock market’s recent record highs. In 2016, while there was considerable state variation, personal income tax revenue dropped overall by 1.1 percent and states with corporate taxes saw those revenues drop 9.3 percent. States also face structural deficits, driven by unfunded liabilities for state employee pensions and retiree health plans.
The recent federal tax reform will require states to examine their own tax policies. Some changes, like the elimination of deductions, could result in more revenue, but other changes could reduce state coffers. Many states automatically integrate federal changes into their state tax policies in some measure. Of 41 states with a personal income tax, the National Association of State Budget Officers reports all but five automatically conform with federal tax law in some way as a basis for calculating state income tax. The situation is similar for the 44 states with corporate income taxes — 41 of which use federal taxable income to some degree to determine state corporate taxes. Debates about tax policies are inevitable as states weigh the pros and cons of conforming with federal reforms or maintaining their current tax rates – decisions that will significantly impact state revenues.
Impact on health insurance marketplaces and Medicaid: Faced with this political and budgetary reality — and with considerable uncertainty about future federal policies — states still need to act to provide access to health care, lower medical costs, and improve their populations’ health. The Affordable Care Act (ACA) channeled significant new federal dollars to states and reduced the nation’s uninsured rate to historic lows through subsidized private market coverage and expansion of Medicaid to more low-income adults. But funding the cost-sharing reductions that helped pay out-of-pocket medical costs for many has been eliminated as has the individual mandate. Each elimination puts a strain on the affordability and value of commercial market coverage, especially for middle-class families who do not qualify for subsidies.
Meanwhile, greater federal flexibility over the use of Section 1115 waivers to set time limits, create work requirements, and other new requirements as a condition for Medicaid coverage, and ongoing conversations about deep federal cuts to Medicaid funding, could significantly alter the program’s role in providing coverage to low-income individuals. Funding for safety net providers, such as federally-qualified health centers (FQHCs) and long-term funding for the Children’s Health Insurance Program (CHIP), remains uncertain.
Intending to spur choice and affordability in the commercial market, the federal government has eliminated the individual mandate requiring everyone to have coverage. Washington has proposed a constellation of new and proposed products, such as greater flexibility over association and short-term health plans, that could attract younger, healthier people, but would also be exempt from many consumer protections and, in some cases, state regulations. These changes could fragment the individual markets, consigning the sicker and older consumers to purchase ACA exchange products, which could effectively make that market a high-risk, high-cost pool for those who need comprehensive coverage.
These lower-cost, lower-benefit products also could put consumers at greater risk for out-of-pocket expenses and could reduce state insurance regulation protections. Whether Congress adopts bills designed to continue cost-sharing reductions to limit out-of-pocket costs for those unable to afford them (Alexander-Murray) and fund reinsurance (Collins-Nelson) to help the affordability of the individual market remains an important question in 2018. Without these investments, affordable, comprehensive individual insurance will be at risk and states will face new challenges in promoting health coverage and insurance regulation.
Can state innovation save the day? Reducing the underlying cost of health care is the cornerstone of affordability, as health care costs plague states as payers, employers, and protectors of consumers. State Medicaid programs have actively promoted payment and delivery reform strategies that reward health care value, not volume, sometimes in collaboration with commercial payers. Many are supported by Center for Medicare and Medicaid Innovation (CMMI) grants through State Innovation Models (SIM) and waiver opportunities like Delivery System Reform and Incentive Payment (DSRIP) programs, implemented through Medicaid Section 1115 waivers. As with Medicare and commercial payers, states know the challenge of changing a long-standing delivery system that developed in response to fee-for-service incentives.
CMS recently sought comments about the role CMMI should play and states await more information about possible opportunities to expand their health care delivery reform efforts. The CMMI request for information identified state-based and local innovation as one of its focus areas, and recognized multi-payer reforms, Medicaid demonstration projects, and value-based payment structures as possible state-based models that CMMI might support.
Pharmacy expenses have gained considerable attention as they are growing so quickly and unpredictably. As the 21^st Century Cures Act speeds the introduction of new drugs, states continue to seek ways to address these costs for all payers and may need federal support for those initiatives
Preventing disease and promoting policies that address the social determinants of health, such as housing, income, and education, will in the long term improve health and reduce costs. Evidence shows that low-income adults who participate in the Supplemental Nutrition Assistance Program have lower health care spending than those who do not, and improving housing can lower health care costs for some experiencing homelessness. However, investments in population health and prevention need to be made now to generate savings and health improvements and build on existing state initiatives.
States rely heavily on support from federal sources such as the Prevention and Public Health Fund to maintain the state infrastructure needed to prevent chronic health conditions, monitor and respond to outbreaks of infectious diseases, support vaccination programs, and promote healthy communities. Recent federal legislation cuts this fund by more than half over eight years. States could lose more than $350 million in 2019 alone if the cuts occur, according to Trust for America’s Health. By 2023, most states would lose more than $20 million each from their state health budgets.
This coming year promises to generate considerable policy debate about access and affordability of health coverage. Many states, already juggling competing demands and tight budgets, will find themselves jockeying to meet obligations with fewer dollars and they will need federal flexibility and support to test new approaches and ideas. Looming over these discussions will be an election year that will impact the majority of state legislatures and governors. In this environment, states and the federal government will be challenged to find middle ground and produce meaningful reforms and initiatives that advance more affordable, accessible care. But as state policymakers know well, the needs of America’s families demand just that.

Case Studies: Innovative State Programs That Promote Children’s Health

January 2, 2018/in Policy Blogs, Reports CHIP, CHIP, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Health IT/Data, Healthy Child Development, Maternal, Child, and Adolescent Health, Population Health, Quality and Measurement /by Alexandra King and Carrie Hanlon

Many states use innovative approaches in their Children’s Health Insurance Program (CHIP) and Medicaid programs to improve the quality of pediatric care and preventive services. With support from the Health Resources and Services Administration (HRSA) under the Alliance for Innovation on Maternal and Child Health, NASHP has developed several case studies that highlight successful initiatives designed to improve the health of children and adolescents.

Idaho’s Preventive Health Assistance (PHA) program uses incentives that target Medicaid and CHIP beneficiaries to promote healthy behaviors and encourage parents to help children and adolescents adopt healthy lifestyle changes.
Tennessee has a pay-for-performance program that rewards improvement on Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for pediatric preventive services.
Minnesota and Oregon use innovative measures at the provider and health plan level to track rates of adolescent depression screening and to measure and incentivize follow-up treatment for adolescents with depression.
To learn about more programs, see the NASHP map and chart: State Strategies for Promoting Children’s Preventive Services.

Toolkit: State Strategies to Improve Health Outcomes for People Living with HIV

December 19, 2017/in Policy Alaska, California, Connecticut, Georgia, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nevada, New Hampshire, New York, North Carolina, Rhode Island, Virginia, Washington, Wisconsin Toolkits Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Featured Policy Home, Health Coverage and Access, Health IT/Data, HIV/AIDS, Medicaid Managed Care, Population Health, Quality and Measurement /by Lyndsay Sanborn and Hannah Dorr

Collaboration between state health department HIV programs and Medicaid is integral to providing quality, comprehensive care to people living with HIV (PLWH). With consistent, well-coordinated care and access to antiretroviral therapy (ART) many PLWH can achieve virologic suppression. Those who achieve sustained virologic suppression tend to have better health outcomes and a reduced risk of transmitting HIV to others. Collaboration and partnership can be challenging in many states, particularly when the Medicaid and state health departments are housed in separate agencies. There are, however, numerous strategies states can implement to improve collaboration and partnership between Medicaid and state health departments to implement policy and program changes to achieve this goal.

In 2017, NASHP completed work with 19 states to support them in identifying and implementing policy and program changes to improve rates of sustained virologic suppression among Medicaid and CHIP beneficiaries living with HIV. While working with these states, NASHP identified that state officials needed additional resources on a variety of topics, such as data sharing and use and quality improvement.

This toolkit, supported through a cooperative agreement with the Health Resources and Services Administration, is intended provide state officials with tools and resources, including issue briefs, webinars, and presentations, they need to improve rates of sustained virologic suppression. New items will be added to the toolkit on a regular basis, providing state officials with up-to-date information and timely policy resources.

Tools and Resources

Publications

One-Page Summary: HIV Health Improvement Affinity Group Evaluation Report
March 2019

This two-page summary 2019 highlights state action plans designed to increase viral suppressions and improve health outcomes for people living with HIV enrolled in Medicaid.

HIV Health Improvement Affinity Group Evaluation Report
March 2019

This full report explores the state action plans that 19 states and Medicaid agency staff developed to increase viral suppression and improve the health of people living with HIV. Federal agency partners and NASHP supported this one-year, peer-to-peer learning initiative.

Three-Part Series: Improving Care for People Living with HIV, Opportunities for State Medicaid-Ryan White HIV/AIDS Program Collaboration
August 2018

States play critical roles in ensuring that people living with HIV (PLWH) have access to quality care through their Medicaid and Ryan White HIV/AIDS programs. PLWH can be among the most medically complex individuals covered by state health programs, and their care can cost five-times the average Medicaid beneficiary. Given limited resources, state policymakers are working to develop policies and strategies that are accessible, well-coordinated, and effective. This three-part series explores policy levers and strategies that states are using to focus limited resources and provide comprehensive and accessible care to PLWH.

Prioritizing Care: Partnering with Providers and Managed Care Organizations to Improve Health Outcomes of People Living with HIV
December 2017

This mini-brief highlights promising strategies for HIV Health Improvement Affinity Group states to successfully engage managed care organizations, health systems, and providers in quality improvement efforts aimed at increasing rates of virologic suppression. Louisiana, Michigan, New York, and Wisconsin are featured. This mini-brief was written as part of the HIV Health Improvement Affinity Group project.

How States Use Medicaid and State Health Department Data to Improve Health Outcomes of People Living with HIV
December 2017

This issue brief discusses key considerations and promising state strategies to share and then analyze Medicaid claims and HIV surveillance and Ryan White HIV/AIDS Program data. Analyses of these interagency data sets can help inform state and local policy and program changes aimed at increasing rates of virologic suppression for Medicaid and CHIP beneficiaries living with HIV. The brief also provides an overview of select data sets that states may be interested in sharing. This issue brief was written as part of the HIV Health Improvement Affinity Group project.

Prioritizing Care: Partnering with Providers and Managed Care Organizations to Improve Health Outcomes of People Living with HIV
December 2017

States Share Data to Improve the Health of People Living with HIV
December 2017

This blog presents lessons learned from three HIV Health Improvement Affinity Group states—Alaska, Louisiana, and Maryland—that are working toward sharing and analyzing Medicaid and state health department data to ultimately increase rates of virologic suppression among people living with HIV. This blog was written as part of the HIV Health Improvement Affinity Group project.

Better Together: How Cross-Agency Data Sharing Can Improve the Care Continuum for People Living with HIV/AIDS
October 2017

The state of Georgia leveraged a data sharing agreement between its public health and Medicaid departments in order to assess care quality for Medicaid beneficiaries living with HIV. Data use agreements are critical for agencies interested in sharing data. This blog was written as part of the HIV Health Improvement Affinity Group project.

Data, Delivery, and Decisions as Levers for Enhancing Whole-Person Care for People Living with HIV: Lessons from the Ruth M. Rothstein CORE Center
January 2017

As states continue to focus on integrated care and delivery system reform, meaningful opportunities exist to improve care for people living with HIV. The Ruth M. Rothstein CORE Center in Chicago, Illinois – part of the Cook County Health & Hospitals System – operates an integrated care model they call “one-stop shopping.” This issue brief showcases the CORE Center’s model and how it is partnering with the Illinois Department of Health to improve care for people living with HIV. The accompanying webinar can be accessed here. The webinar and issue brief were developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.

Advancing HIV Prevention Through Health Departments: Health Homes for People Living with HIV/AIDS
June 2016

This case study highlights Wisconsin’s health home program for Medicaid beneficiaries living with HIV, which is the first and only health home program exclusively for this population. Wisconsin’s experience may assist other states considering the health home state plan option as a strategy to support integrated care for Medicaid beneficiaries living with HIV. This case study was developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.

Advancing HIV Prevention Through Health Departments: HIV-Specific Quality Metrics for Managed Care
June 2016

This case study highlights New York’s use of HIV-related performance metrics to incentivize its Medicaid managed care plans to improve care for their members living with HIV. Their experience may assist other states considering how to incentivize quality improvement in their managed care program. This issue brief was developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.

Strategies for Coordination Between Medicaid and Ryan White HIV/AIDS Programs
November 2013

This policy brief discusses the importance of coordination between a state’s Medicaid agency and the Ryan White HIV/AIDS Program (RWHAP) to ensure that people living with HIV have access to comprehensive, high-quality care. NASHP interviewed Medicaid and RWHAP officials in 14 states about successful coordination efforts. This brief highlights those examples, along with additional promising practices for coordination that facilitate delivery improvements for people living with HIV. An accompanying webinar can be accessed here. The Health Resources and Services Administration (HRSA) provided support for this issue brief and webinar.

Webinars and Presentations

Overview of state and federal HIV programs

State Health Department HIV Programs: An In-Depth Look
February 23, 2017
View the webinar | Download the slides

The purpose of this webinar was to provide Medicaid and other state officials with information about the structure and components of state health department HIV programs and resources, as well as opportunities for collaboration between these programs and Medicaid. The Centers for Disease Control and Prevention discussed state HIV surveillance and prevention programs and the Health Resources and Services Administration discussed the Ryan White HIV/AIDS Program. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Housing Opportunities for Persons with AIDS: Presentation for HIV Health Improvement Affinity Group
December 7, 2016
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This presentation described the Housing Opportunities for Persons with AIDS (HOPWA), a federal program dedicated to assisting with the housing needs of people living with HIV, and work in Alabama focused on improving health outcomes for people living with HIV/AIDS through greater access to housing. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Health Resources and Services Administration and HIV/AIDS Bureau Update
December 6, 2016
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Laura Cheever, Associate Administrator for the HIV/AIDS Bureau within the Health Resources and Services Administration presented an overview of the Bureau’s priority areas and a preview of 2015 Ryan White HIV/AIDS Program Services Report data. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides

This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.

Overview of state Medicaid programs

The Medicaid Program: An In-Depth Look
February 16, 2017
View the webinar | Download the slides

While Medicaid programs vary greatly across states, the purpose of this webinar was to provide state health department and other officials with information about the structure and components of this program, as well as opportunities for collaboration between Medicaid and state health departments. The Centers for Medicare & Medicaid Services and NASHP presented about Medicaid structure, eligibility, benefits, financing, payment and delivery, as well as waivers and state plan amendments. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Interagency collaboration

Rhode Island Lessons Learned: Relocating Ryan White
December 7, 2016
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Rhode Island presented on how Medicaid and its Ryan White HIV/AIDS Program are partnering on quality improvement projects and the implementation of Medicaid benefits, such as a targeted case management program. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination
August 29, 2013
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This webinar highlighted strategies that California, Massachusetts, Tennessee, and Washington have used to improve interagency coordination, as well as implement policy changes to improve health outcomes for people living with HIV. An accompanying issue brief is available here. The Health Resources and Services Administration (HRSA) provided support for this webinar and issue brief.

Opportunities for state policy improvement

Webinar: Increasing Rates of Virologic Suppression: Promising Practices from HIV Health Improvement Affinity Group States
Wednesday, Dec. 6, 2017
View the webinar | Download the slides

Increasing rates of virologic suppression among people living with HIV is critically important to improving their quality of life and decreasing the risk of further HIV transmission. For the last 12 months, the HIV Health Improvement Affinity Group has worked with state health departments and Medicaid agencies from 19 states to develop and implement performance improvement projects aimed at improving rates of sustained virologic suppression among Medicaid beneficiaries living with HIV. This webinar featured leaders from the Office of HIV/AIDS and Infectious Disease Policy in the US Department of Health & Human Services, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention. It also featured Affinity Group states, Alaska and North Carolina, that shared lessons learned and best practices from their performance improvement projects.

Improving Quality of Care for Medicaid Beneficiaries Living with HIV: Strategies to Engage Managed Care Plans and Providers
August 17, 2017
View the webinar | Download the slides

It is important for states to engage key partners, such as managed care plans and providers, in order to improve the quality of care provided to Medicaid beneficiaries living with HIV. This webinar showcased New York state’s work to incentivize managed care plans to improve rates of virologic suppression for their members living with HIV. The New England AIDS Education and Training Center also shared resources and promising strategies to engage HIV providers in quality improvement. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group: Policy and System Change
December 7, 2016
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This presentation highlighted the role that Medicaid plays in ensuring many people living with HIV have access to comprehensive, high quality care. It also showcased policy changes that states could implement to improve access to and quality of care for beneficiaries living with HIV, including increased access to HIV testing, benefit design changes, and network adequacy standards. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Rhode Island Lessons Learned: Relocating Ryan White
December 7, 2016
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Recent HIV Data to Care (D2C) Experiences in Maryland
December 6, 2016
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Maryland presented on how it is using analyses of HIV surveillance and Medicaid claims data to identify people living with HIV who are not engaged in regular HIV care, and then developing policy and program changes to address these gaps in care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides

Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination
August 29, 2013
Download the slides

Data sharing and use

Data Sharing and Use: Creating Platforms for Exchange, Insight, and Action
May 24, 2017
View the webinar | Download the slides

This webinar highlighted the importance of building technological infrastructure to link and use data sets across state agencies, programs, and provider groups, as well as provided details about available 90/10 match funding to support infrastructure development. Louisiana and the District of Columbia both shared their experiences with developing information technology infrastructure to share data among agencies and programs. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Data Transfer and Use: Navigating Federal and State Laws and Regulations
March 28, 2017
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This webinar discussed various data sharing regulations at the state and federal level, such as HIPAA and 42 CFR Part 2, and how these regulations may impact the sharing and use of HIV-related data across state agencies. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

North Carolina’s Engagement in Care Database for HIV Outreach (NC Echo): A Collaborative Effort
December 7, 2016
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North Carolina presented on its Engagement in Care Database, which analyzes data from Medicaid claims and health department surveillance and Ryan White HIV/AIDS Program to identify people living with HIV that are not engaged in HIV care. State program staff then use this information to target outreach to these individuals to get them re-engaged in HIV care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Public Health Innovation: Emerging Opportunities for Leveraging Health Systems Data
December 6, 2016
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This presentation explained why data sharing between Medicaid and state health departments is critical to better understanding utilization patterns and health outcomes for people living with HIV. It also identified key considerations for states interested in advancing this work. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Data analysis and presentation

How Data Visualization Efforts Impact Care and Decision Making
July 20, 2017
View the webinar | Download the slides | Presentation handout

The way in which data is presented is important when trying to increase stakeholder understanding and engagement on a particular issue. This webinar discussed strategies states can use to tailor their communication of data to specific audiences. The Massachusetts Department of Public Health shared how it designed a new website about the impact of the state’s opioid epidemic to be a rich, user-friendly resource for policymakers and community members. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Recent HIV Data to Care (D2C) Experiences in Maryland
December 6, 2016
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HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides

Provider- and system-level quality improvement

Improving Quality of Care for Medicaid Beneficiaries Living with HIV: Strategies to Engage Managed Care Plans and Providers
August 17, 2017
View the webinar | Download the slides

Data, Delivery, and Decisions as Levers for Enhancing Whole-Person Care for People Living with HIV: Lessons from the Ruth M. Rothstein CORE Center
January 26, 2017
View the webinar

As states continue to focus on integrated care and delivery system reform, meaningful opportunities exist to improve care for people living with HIV. The Ruth M. Rothstein CORE Center in Chicago, Illinois – part of the Cook County Health & Hospitals System – operates an integrated care model it calls “one-stop shopping.” This webinar featured speakers from the CORE Center and the Illinois Department of Health who shared lessons learned from their partnership to improve care for PLWH. The accompanying issue brief can be accessed here. The webinar and issue brief were developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.

Process Improvement Methods and Tools
November 18, 2016
View the webinar | Download the slides

Dr. Kevin Larsen from the Centers for Medicare & Medicaid Services shared methods and tools that states can use to design quality improvement initiatives. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Addressing social determinants of health

Housing Opportunities for Persons with AIDS: Presentation for HIV Health Improvement Affinity Group
December 7, 2016
Download the slides

How the Bipartisan Budget Act Impacts Key State Health Care Programs

NASHP and AcademyHealth Invite State Medicaid, Public Health, and Immunization Officials to Join an Initiative to Boost Immunization Rates among Medicaid Enrollees

Virginia Cooperative Promotes Evidence-Based, Prevention Improvements in Primary Care

State CHIP Officials Speak Out on Impact of Congressional Funding Delay

State Health Watch – What’s Ahead in 2018?

Case Studies: Innovative State Programs That Promote Children’s Health

Toolkit: State Strategies to Improve Health Outcomes for People Living with HIV

Tools and Resources

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