Wednesday, Aug. 15, 2018
8 a.m. to 4 p.m.
Breakfast and lunch will be served during preconference sessions.
This preconference, for state officials only, drills deeply into the health care cost conundrum and explores strategies states can implement to stem the trajectory of rising costs.
A recent JAMA article reminds us, “It’s the prices stupid,” but what’s a state to do? States pay ever-increasing health care costs, including higher insurance premiums with more cost shifting and less choice for consumers. The number of uninsured is rising, there is less money for other social benefits such as investments in social determinants of health, and states face serious budget challenges. The trade-offs are significant — one person’s cost savings is another person’s salary (health care continues to be a powerful jobs engine), and savings for one payer can shift costs to others.
This session provides a safe space to tackle these vexing problems. With the help of expert faculty, we examine the current state of a health care marketplace driven by consolidation, innovation, and competing demands, including the need to balance costs against Wall Street expectations. What does the emergence of new partners like Walmart and Berkshire-Hathaway portend? What is our vision to address costs across sectors and payers? What strategies will get us there?
Are the current tools in state toolboxes, such as insurance regulation, state certificate-of-need laws, payment reform, rate regulation, licensure, public purchasing, and anti-competitive actions by state attorneys general, up to the task? Can states develop new, innovative tools to catalyze a multi-partner movement for real change? Instead of simply shifting costs, how can states take on the longstanding challenge of unaffordable prices?
This preconference is for state officials including legislators and staff, executive branch officials, and attorneys general staff. The following experts, and others to be announced, will address each topic:
- Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation
- Erin Fuse Brown, associate professor of law at Georgia State University
- Jamie King, University of California Hastings College of Law professor and executive editor of The Source on Healthcare Price & Competition
- Ana Gupte, PhD, managing director and senior research analyst of health care services for Leerink Partners LLC
This preconference is supported, in part, by Kaiser Permanente
This preconference is open to state officials only.
In this facilitated discussion, state leaders will focus on multi-payer system approaches to address increasing spending on health care. Because there is a later state–only session on Rx pricing, we steer clear of more narrow Rx strategies and draw a bright distinction between affordability and health care costs.
We can subsidize health care to make it more affordable for more people — but that requires investing more money, not containing rising costs. This day-long session will examine evidence to unravel what’s behind the health care spending trajectory, identify strategies that are working to address it, and develop practical cost containment solutions that states can implement.
Welcome and Setting the Context: 8-9 a.m.
Trish Riley, NASHP Executive Director
Larry Levitt, Senior Vice President for Health Reform and Senior Advisor to the President of the Kaiser Family Foundation
- Cost drivers – what is the evidence?
- Emerging market forces – new entrants, consolidation, and new technologies
- Role of employers and insurance
- Jobs vs. cost containment
- Lower costs or shifting costs
- Consumer affordability may not mean lower costs
- Access/choice vs. lower costs
State kick-off discussion leader: Greg Moody, Director, Governor’s Office of Health Transformation, Ohio
Transparency and Data: 9-9:45 a.m.
Jaime King, JD, PhD, Associate Dean and Professor, UC Hastings School of Law, and Executive Editor, The Source on Healthcare Price and Competition
- What are the opportunities and limits of health care price transparency?
- All-payer claims databases (APCDs) vs. other data sources. Should more states expand them? Is there enough consistency in what they show? How can they be more effective? Are there better options to secure needed data?
State kick-off discussion leader: Karynlee Harrington, Executive Director, Maine Health Data Organization, and others to be announced
Break: 9:45-10 a.m.
Consolidation and Market Trends 10-11:45 a.m.
Erin Fuse Brown, JD, MPH, Associate Professor of Law, Center for Law and Health Policy, Georgia State University School of Law
- Effectiveness of anti-trust regulations
- Adequacy of certificates of need/Certificates of public advantage
- State licensing powers: can they be tools to address costs??
State kick-off discussion leader: Melanie Fontes Rainer, California Special Assistant to the Attorney General, and Nora Mann, Massachusetts Director of Determination of Need, Department of Public Health
Working Lunch: 11:45 a.m.-12:15 p.m.
Consolidation and Market Trends continued: 12:15-1:45 p.m.
- Do payment and delivery reforms lower cost growth? Does cost benchmarking help?
- Lessons from Medicaid: Is Medicaid buy-in a viable cost containment strategy? What have we learned from Delivery System Reform Incentive Payment (DSRIP)?
- Public purchasing – Can harnessing a state’s buying power lower cost growth?
State kick-off discussion leaders: MaryAnne Lindeblad, Washington Medicaid Director and Renee Walk, Strategic Policy Advisor, WI Dept. of Employee Trust Funds
Pricing Strategies: 1:45-3:15 p.m.
Larry Levitt, Kaiser Family Foundation Senior Vice President for Health Reform and Senior Advisor to the President
- Reference pricing
- Global budgets
- Rate-setting strategies
- Balance billing
- Insurance rate review
State kick-off discussion leader: Donna Kinzer, Executive Director, Maryland Health Services Cost Review Commission, and Dan Villa, Montana Budget Director
Next Steps 3:15-3:45 p.m.
Many states were already experimenting with health reform even before the federal legislation passed. Learn how Minnesota and Massachusetts have taken significant steps toward multi-payer healthcare delivery reform, cost control, and improving the value of health care services. A presentation titled “Reforming Health Care Delivery Through Payment Change and Transparency: Innovations in Minnesota and Massachusetts,” was delivered NASHP Senior Fellow Anne Gauthier at the AcademyHealth State Health Research and Policy Interest Group (SHRPIG) meeting held in Boston, last month. The experiences in Minnesota and Massachusetts offer substantial lessons for other states in this post-reform world. View the presentation.
One of a series of issue briefs designed to share with federal and state policymakers, as well as other stakeholders, the issues and options raised by the Making Medicaid Work for the 21st Century workgroup. This brief discusses state options to control costs.
This paper tracks changes and trends in Medicaid managed care between 1990 and 2002. The report is based on six NASHP surveys of state Medicaid managed care programs (conducted in 1990, 1994, 1996, 1998, 2000, and 2002). The surveys gathered information on the scope and operation of both risk and primary care case management (PCCM) programs. The report also looks ahead and includes a discussion with state officials of trends that may continue and factors that may impact the future of Medicaid managed care.
Introduction to the Data
Contractor Type and Covered Services
Selection and Payment
Access to Care
Appendix: 2002 Survey Instrument
The rapid growth of health care spending is of deep concern to payers, purchasers, providers, the public, and policymakers. This paper focuses on lessons learned from cost containment efforts designed to address the supply of services (Certificate of Need programs), the pricing of services (hospital rate setting), and the demand for services (managed care). It also explores state efforts to control the price and business of health insurance.
This paper examines cost containment strategies in Medicaid and SCHIP and their potential impact on children enrolled in these programs. It is designed to help states think through cost control measures, the potential savings to be realized from such actions, and their impact on children and families. It identifies a menu of cost containment options that states have considered, along with the pros and cons of those options.
This policy brief examines state policies and procedures concerning enrollment caps and freezes, wait lists, and open enrollment periods in SCHIP programs. The brief provides information from six states that have experience with these strategies.
This paper reports on findings from a series of focus groups with parents of current and former SCHIP enrollees in Alabama, Nevada, New Hampshire, and New Jersey. The focus groups were designed to explore parents’ feelings about and experiences with cost sharing. The groups addressed the following topics: attitudes about paying premiums and copayments, opinions about premium and copayment amounts, and aspects of the premium payment process (such as periodicity, billing and payment methods, and penalties for late and missed payments).
The focus groups were an invaluable tool in studying SCHIP, yielding nuanced, multifaceted results not attainable from surveys or analysis of enrollment data. The groups provided in-depth insight into parents’ experiences with their state SCHIP programs and the cost-sharing elements of those programs.
This issue brief examines the early implementation of the Dirigo Health Reform Act, Maine’s comprehensive effort to create a sustainable health care system. Developed by NASHP for the Maine Governor’s Office of Health Policy and Finance.