State Coverage Initiatives August 2, 2007

1. Washington State Health Reform Efforts State Coverage InitiativesAugust 2, 2007 Richard K. Onizuka, PhD Health Policy Director

2. Today’s Presentation A chronology of Washington State’s Health Reform efforts Governor Chris Gregoire’s vision for Health Reform 2005-2007 legislative activities Blue Ribbon Commission on Health Care Costs and Access

3. 2005: Governor’s Five-Point Health Care Strategy • Emphasize evidence-based health care • Promote prevention, healthy lifestyles, and healthy choices • Better manage chronic care • Create more transparency in the health care system • Make better use of information technology

4. 2005 Legislation • SSB 5064: Health Information Technology • Collaborate with Health Information Infrastructure Advisory Board (HIIAB) • Develop strategy for adoption and use of EMRs and Health IT • Final report December, 2006 for health record banking model • SSB 5471: Drug Consortium • Builds on evidence based state preferred drug list • Discount card introduced 2007 King County Task Force → Puget Sound Health Alliance

5. 2006 Legislation • E2SHB 2575: Health Technology Assessment Program • SHB 2573: Health IT Goal • Washington Health Information Collaborative • E2SSB 6459: Community Collaborative Grant Program • Blue Ribbon Commission Executive Orders

6. Blue Ribbon Commission Strategies • Build a high-quality, high-performing health care system • Provide affordable health insurance options for individuals and small businesses • Ensure the health of the next generation • Promote prevention and healthy lifestyles 16 Recommendations

7. 2007 Legislation • E2SHB 1569: Health Insurance Partnership • Voluntary small group market “connector” • Premium subsidies • Enrollment September, 2008 • Program begins January, 2009 • SSB 5093: Children’s health coverage expansion • E2SSB 5930: Implement BRC Recommendations

8. Senate Bill 5930 “An act relating to providing high-quality, affordable health care to Washingtonians based on the recommendations of the Blue Ribbon Commission on Health Care Costs and Access” • Section 1: Five year reimbursement plan • Section 2: Patient decision aids pilot • Section 6: Chronic care management • Section 9: Washington State Quality Forum

9. 5930 (cont.) • Section 10: Consumer-centric health record bank pilot • Section 14: Unnecessary ER utilization • Section 18: PEBB dependent coverage to 25 • Section 39: 5 year plan for health promotion • Section 41: State employee health demonstration project

10. Prescription Drug Program • State evidence based preferred drug list • Created by 2003 legislation • Based on state P&T Committee review and recommendations • Used by HCA (UMP), Medicaid, and L&I • 25 drug classes as of July, 2007, eight additional by 2009 • Cost avoidance of $44M 2005-2007 • Continued annual drug class review updates • Prescription drug purchasing Consortium • Created by 2005 legislation • 56,000 enrolled in drug discount card as of July, 2007 • High generic utilization, significant consumer savings

11. PEBB Procurement • 320,000+ State employees, dependants, and retirees, K-12 • Health care premium trends • 2007 – 4.5% • 2008 – 3.0% • Portfolio strategies • More affordable health plan choices • Managed care medical plan consolidation • Self insurance and other alternatives where prudent • Self funded PPO (UMP) strategies

12. Governor’s 5-Point Strategy • Emphasize evidence-based health care. • Promote prevention, healthy lifestyles and healthy choices. • Better manage chronic care • Create more transparency in the health care system • Make better use of information technology • Cover All Kids • BRC Strategies • Build a high quality, high performing health care system • Provide affordable health insurance options for individuals and small businesses • Ensure the health of the next generation • Promote prevention and healthy lifestyles • BRC Recommendations • Use State Purchasing to Improve Health Care Quality • Lead in prevention and management of chronic illness • Provide cost and quality information • Deliver on the promise of HealthIT • Reduce unnecessary ER visits • Reduce health administrative costs • Promote cost-effective community care initiatives • Increase choices for private insurance • Partner with federal government to improve coverage • Organize the insurance market to improve access • Address affordability of coverage for high cost individuals • Link health insurance to Children’s Health policies • Improve childhood nutrition and physical activity • Pilot a health literacy program for parents and children • Strengthen the public health system • Integrate prevention & wellness into state health programs • State Actions • PDP program (PDL and Drug Consortium) • HTA program (first technology assessment 2007) • P4P pilots (DSHS managed care, UMP generic utilization) • Health Insurance Partnership • 5 year strategic plan to change reimbursement • Patient decision aides pilot • Chronic care management • Washington State Quality Forum • Children’s coverage expansion • Pilot health record banks and extend provider grants • Health promotion • Health literacy pilot

13. The Future of Health Care Reform in Washington • Governor’s vision of access, costs, and quality • Key role of State and community collaboration • Key involvement and participation of the consumer of health care • Presence of the proper tools for systemic change/reform

14. Washington State Health Reform Efforts Questions? Richard K. Onizuka, PhD Health Policy Director richard.onizuka@hca.wa.gov (360) 923-2820 Web site: http://www.hca.wa.gov