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Some National Standards, Many State Decisions

Some National Standards, Many State Decisions

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Some National Standards, Many State Decisions

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  1. Some National Standards, Many State Decisions

    NLGA Annual Meeting | Oklahoma City, OK July 18, 2013
  2. Some National Standards,Many State Decisions STATE DECISIONS NATIONAL STANDARDS Design of Health Benefits Exchange Baseline Insurance Rules Medicaid Expansion Preventative Care Delivery Reform Efforts Medicare Changes Essential Health Benefits
  3. Buzzwords State Innovation Model Bundled Payments Patient-Centered CMMI ACO Pioneer ACO Shared Savings Value-based Purchasing
  4. The Greatest Threats to Health and Our Pocketbooks Alzheimer’s $183 billion Mental Illness $317 billion Chronic Lung Diseases $173 billion Arthritis & Other Rheumatic $128 billion HIV/AIDS $22 billion Heart Disease & Stroke $444 billion Cancer $228 billion Diabetes $174 billion Chronic diseases affect almost 1 in 2 people, account for more than 80% of all health spending, and contribute to 7 out of 10 deaths in the U.S.
  5. Inaction is Not an Option Reimbursement evolution is necessary, but which direction will it take? “Embracing Defined Contribution” “Optimizing Defined Benefit” Fee-for-Service Medicare Advantage Prior Authorization Means Testing Rate Cuts Global Spending Caps Pure Voucher System Potential Payer Spending Hybrid Voucher System Accountable Payment Models Reimbursement Involvement in Financing Care Delivery
  6. Medicare ACOs are Off and Running 32 Pioneer and 221 Shared Savings Program ACOs as of January 2013
  7. State Innovation Models (SIM)
  8. State Health Care Innovation Plan (SCHIP) A SIM Initiative ” The State Health Care Innovation Plan (“SHCIP”) is a proposal that describes a state’s strategy to use all levers available to it to transform its health care delivery system through multi-payer reform and other state-led initiatives The CMS Innovation Center
  9. States Involved
  10. CMMI Model Testing States Over $250,000,000 awarded to the six states to help them transform their health care delivery systems.
  11. State Innovation Models Initiative Model Design Awards Model Pre-testing Awards Colorado $2 million New York $1 million Washington $1 million
  12. Elements of the State Health Care Innovation Plan
  13. Community Partnerships: YMCA
  14. US Health Care System Evolution Community Integrated Care System Coordinated Seamless Health System Uncoordinated Health System