The State of Partnering with StatesAligning Forces for Quality National Meeting

May 9, 2013

John M. ColmersVice President Health Care Transformation and Strategic Planning

Outline

• Introduction• Range of models available to states

– As purchaser– As traditional regulator– As convener– As market setter/enabler

• Prospects for success– Examples in Maryland with Community

Organizations– Examples at Johns Hopkins

State of Play in the States

• Economy improving, but many still confronting budgetary shortfalls

• Fear of the impact of (in)action in Washington, DC

• Role of Medicaid and other state programs

• Wide variations in approaches to ACA BUT market forces impacting virtually every state

Implementation of the Affordable Care Act at the State Level

• Considerable responsibilities left to states– Creation of exchanges

• Federal/State/Partnership

– Role of insurance commissioners on pricing

– Medicaid expansion

• Uncertain outcome

State Context

Although wide variation regarding the ACA, virtually every state is considering or developing new policy approaches that address:

Coverage and access Quality Delivery reform/cost control

State Policy Approaches to Delivery System Integration

The Role of the State as:PurchaserTraditional RegulatorConvenerMarket Setter/Enabler

State Role as Purchaser

• Medicaid payment reform– PCMH– P4P

• Medicaid interface with insurance exchange

• State employee benefit plan design

State Role as Traditional Regulator

• Health insurance exchanges– Essential benefit plan design

• Role of Insurance Commissioner– Conditional rate approval– Affordability standards– Provider contracting standards

• Transparency requirements• Health IT and HIE

State Role as Convener

• Health Reform Task Forces– Roadmaps

• Include focus on population health issues

– Collaborations– Workforce development

• Continued role for legislature– Oversight– Policy development

State Role as Market Setter/Enabler

• Use of statutory authority to SET market conditions– State multi-payer PCMH– Multi-payer ACO options

• Market power and antitrust

• Gain sharing and anti-kick back

Prospects for Success

• Reasons for optimism– Failure is not an option– Significant federal investment from CMMI– Increasing recognition of shared interest among

stakeholders in payer and provider communities• Reasons for pessimism

– Federal barriers• Budget meltdown• Regulatory inertia

– Change is hard– Provider and payer market concentration

• Status quo is always second best solution

Examples in Maryland

• SIM Planning Grant– Multipayer Medical Home

• Significant community involvement in design and implementation

• J-CHiP CMMI Innovation Grant– 7 zip codes around JHH and JHBMC– Community health workers