2011 in Kansas City: Show Me…New Directions In State Health Policy
2011 Conference Guide
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Oct 4, 2011, 10:15am – 11:45am
Eliminating Waste, Fraud and Abuse in Public Programs
Every election cycle, well-meaning political candidates assure us that we can solve our budget woes by targeting and eliminating the “waste, fraud and abuse” in public health care programs. It is imperative that state officials constantly monitor spending on public programs to assure that limited resources are spent both efficiently and effectively. This session highlighted strategies that states have adopted to limit the growth of health care spending without sacrificing access to care.
Show and Tell: Improving and Integrating Children's Coverage into Health Reform Implementation
In the context of health reform, states have an opportunity to maintain and build on the gains made in covering children and apply lessons learned in planning for coverage of other newly eligible populations, including low-income parents. This session focused on sustaining and improving children’s coverage, while offering insight on policies and practices that can serve as models for enrolling and covering other populations as the health reform law is implemented. This session also addressed strategies to maintain continuity of coverage and care for families across systems and programs.
Building Health Homes in Medicaid
Section 2703 of the Affordable Care Act (ACA) created a Medicaid state option to provide health homes for individuals with chronic conditions. States creating health homes under this authority will benefit from two years of enhanced federal funding for health home services. The legislation specifies a number of services that health homes must provide while reserving considerable discretion for states. This session explored questions such as: What are the key design considerations for states? What choices are states making? How are states building on existing medical home projects?
Promoting the Public's Health in Reform Implementation
Title IV of the Affordable Care Act (ACA) offers a number of new public health initiatives beyond the Preventive Health and Health Services and Title V Block Grants. This gives states the opportunity to take meaningful steps toward improving the overall health of their population. This session focused on state strategies that take advantage of this section of the ACA. The session also discussed the future of public health agencies as coverage for the uninsured public increases.
The ACA and its Impact on Persons with Disabilities
The Affordable Care Act (ACA) presents opportunities and challenges for addressing the health care needs of people with disabilities. Expanding coverage may help slow growth of participants in the Supplemental Security Income and Social Security Disability Insurance programs, while Medicaid buy-in programs can continue to help current beneficiaries return to work. State decisions impacting people with disabilities include the design of essential benefit packages for exchanges, benchmark plans for Medicaid expansion, and strategies to minimize churning and its effect on continuity of care. These issues were addressed by a national expert, with reactions from state officials.
Oct 4, 2011, 1:30pm – 3:00pm
Gearing Up for Enrollment in the Digital Age
The Affordable Care Act provides historic opportunities for states to update their eligibility and enrollment systems for the digital age. This session offered ideas to help states thrive in this changing environment, including models for making the online enrollment process intuitive for consumers, tools for managing IT projects, and lessons from states that have already implemented updated eligibility systems. Speakers discussed the California HealthCare Foundation’s User Experience 2014 Project (UX 2014 Project), a project creating a model prototype for states to improve the user enrollment experience; shared tips on managing major IT projects; and offered models for managing casework in the digital age.
Reducing Avoidable Re-Hospitalizations and Improving Care Transitions
Reducing avoidable re-hospitalizations has become a significant priority of both Medicaid and Medicare programs. One way states can address this priority is through strategies to improve transitions from hospitals, skilled nursing facilities, and community settings. Vehicles available to states to focus on transitions include medical/health homes, home and community-based services waivers, Money Follows the Person projects, and managed care programs. This session presented strategies for improving care transitions using these options.
Health Homes for People with Serious Mental Illness: Emerging Strategies and Challenges
Health Homes, a new Medicaid option authorized by Section 2703 of the Affordable Care Act (ACA), provides states with additional tools to coordinate care for people with chronic conditions, including people with serious mental illness. This session provided an opportunity to hear from states that are developing health homes specifically to address the complex needs of people with serious mental illness. Discussion included emerging models and strategies, and some of the unique considerations and challenges involved in integrating care for people with serious mental illness within the health home.
Building a Stronger Health Care Workforce: Strategies for Increasing System Capacity
As the Affordable Care Act (ACA) brings a flood of new enrollees into the health system, states are looking at ways to increase the capacity of their health care workforce. While states are taking a variety of approaches to address this issue, some are re-examining scope of practice regulations, medical homes, and the use of community health workers. States are also exploring how to leverage graduate medical education to address state strategic needs. This session included a panel of state speakers who discussed their state’s approach to increasing the capacities of their health care workforce.
Increasing the Value of Data: EMRs and Disease Registries
This session focused on examples and ideas illustrating how health outcomes and associated costs can be improved on a population level by including disease registries in the use of Electronic Medical Records (EMRs). Presenters shared ideas pertaining to how data from successful disease registries has been used to enhance patient care, and how EMR development can expand the impact of disease based registries. Lessons learned from existing projects funded by the federal government (Beacon Communities and establishment grants etc.) were shared.
Oct 4, 2011, 3:30pm – 5:00pm
Looking into the Crystal Ball: Preparing for Essential Health Benefits
States are seeking guidance regarding Essential Health Benefits (EHB). This session will help states prepare for the benefits package the Department of Health and Human Services defines as essential. What are the implications of the proposed EHB package for the Exchange and Medicaid? What are the effects on the commercial insurance market and for existing state benefit mandates? What flexibility will exist for states to depart from a federal definition? Panelists provided context and guidance on how to interpret the HHS guidance on the EHB package. State officials responded from the perspective of the Exchange, Medicaid and the legislature.
Medicaid Managed Care for Older People and Persons with Disabilities
In an effort to enhance quality of care and contain costs for populations with complex needs, states are examining options for developing Medicaid managed care plans for older people and persons with disabilities. This session explored lessons learned from states that are at varying stages of development, ranging from those with extensive experience, to others that have just begun implementation. Specifically addressed were design features such as scope of benefits, performance and quality measures, and contractual issues that are unique to plans covering these populations.
Fitting the Pieces Together: The Safety Net and the ACA
This session explored how states are actively thinking about the future need for safety net providers as delivery systems transform Federally Qualified Health Centers (FQHCs), free clinics, public hospitals, and what kinds of providers are needed to serve vulnerable populations. States that are working actively to integrate a safety net into reforming delivery systems through a variety of policy levers and engagement strategies were highlighted. This session also included a discussion of the impact of the Affordable Care Act on safety net providers and patients.
State Strategies to Improve Birth Outcomes through Timely Deliveries
This session focused on states’ experiences and strategies employed to reduce late term elective inductions, unnecessary Cesarean section deliveries, and the demand for Neonatal Intensive Care Unit services. The costs of late preterm births related to health care costs, patient safety, and the need for newborn intensive care were discussed. The panel also discussed methods to improve breast-feeding rates and increase the number of baby-friendly facilities to ensure newborns have a healthy start.
Oct 5, 2011, 8:30am – 10:00am
From Primary to Community Care: Coordinating Services for Children and Beyond
Five states that are participating in the ABCD III Learning Collaborative are implementing new strategies to improve care coordination and service linkages to support healthy child development. They are piloting communication tools, facilitating data sharing, implementing quality improvement processes, and involving families. A number of early lessons have emerged from the initiative with implications for young children and other populations. These states discussed their interventions, lessons, and implications for broader state agendas, including medical homes and health reform.
Choose your Own Adventure: State Health Insurance Exchange Update
The 2013 deadline for state Exchange establishment is quickly approaching. With the year’s legislative session at an end, many states have moved forward with Exchange implementation through legislation. Other states, unable to pass legislation, have turned to alternative means of establishing an Exchange. This session looked at how states with different Exchange approaches tackle various issues related to implementation. The panel provided overall context on where states stand by comparing and contrasting two state approaches and the implications for various issue areas.
New Opportunities for Payment Reform
The Affordable Care Act (ACA) provides payment reform opportunities like Accountable Care Organizations (ACOs) and non-payments for never events. This session looked at how states are anticipating and leveraging federal payment reforms within different programs, such as Medicaid, and through various mechanisms, including provider and insurer regulation.
Strategies to Address the Behavioral and Chronic Care Needs of Medicaid Beneficiaries
Five percent of Medicaid enrollees account for over fifty percent of program costs. This session presented strategies states can employ to address the needs of high-cost populations in a more cost-effective manner. Speakers presented methods for identifying individuals with high health care costs that both retrospectively rely on claims data and prospectively use predictive modeling. Discussions included approaches to meeting the needs of these populations with service delivery systems innovations and care coordination, supported by health technology.
Oct 5, 2011, 10:15am – 12:00pm
Medicaid Waivers in the Era of Federal Health Reform
With the advent of the Affordable Care Act (ACA), states have new opportunities to foster delivery system innovation and ensure access to affordable coverage options for all. This session explored state options for flexibility using existing tools, like Medicaid 1115 waivers. An expert provided context for state waiver approaches both before and after the ACA. A speaker from Washington discussed the state’s recently approved Transitional Bridge 1115 Waiver, as well as additional flexibility the state is seeking to implement the ACA and recent state-level health reforms. A presenter from Utah highlighted features of the Utah Medicaid Payment and Service Delivery Reform 1115 Waiver Request, including the proposed Utah Medicaid ACO model and the creation of a premium subsidy option for enrolling Medicaid-eligibles into coverage through the state’s Exchange.
Advancing Health Equity through Implementation of Health Reform
The Affordable Care Act (ACA) generates various opportunities for lasting and comprehensive systems change to achieve health equity for states’ most vulnerable populations. This session featured the experiences of two states and described policy levers within ACA to advance health equity through the implementation of federal reforms, financing of community interventions, and redesigning of delivery systems to improve chronic care.
New Approaches to Medical Liability Reform
When it comes to medical malpractice damages and caps, stakeholders with divergent objectives are often at odds. Innovative demonstration programs may be just what the doctor ordered. This session highlighted different liability reform models, including those funded by recent Agency for Healthcare Research and Quality (AHRQ) grants. It also reviewed Affordable Care Act (ACA) provisions providing grants to states to develop demonstrations that encourage efficient dispute resolution, improve provider access to liability insurance, and enhance patient safety.
Emerging Models for Improving Care for Dual Eligibles
Dual eligibles have complex needs that are often poorly addressed by health and long-term care service delivery systems. To date the Program of All-Inclusive Care for the Elderly (PACE), and Special Needs Plans (SNPs) have been the primary models available to states for integrating care and overcoming the fragmentation of Medicare and Medicaid financing. The newly established Duals Office within Centers for Medicare & Medicaid Services (CMS), has recently awarded contracts to 15 states to plan demonstrations testing new approaches. This session presented an overview of the models being developed and focused in-depth on two state’s approaches.