Health Reform Implementation: When Sausage-Making Moves Downtown Alliance for Health Reform Briefing Linda E. Fishman, Senior Vice President, Public Policy Analysis and Development July 9, 2010

Health Reform Implementation… This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning. Winston Churchill, November 10, 1942 at the Lord Mayor's Luncheon at Mansion House in London, in response to the Allied victory at the Second Battle of El Alamein.

Strategies for Regulatory Advocacy Develop member resources/tools Identify key issue areas for AHA involvement; chart timelines Identify need for advisory groups, networks, taskforces Solicit input/gather information from members, allied associations Lead hospitals in rulemaking activities Identify and pursue legislative fixes

Key Implementation Areas for Hospitals Delivery System Reforms Integrated care models of delivery system reform (ACOs, bundling, medical home, CMS Center for Innovation) Major hospital payment changes (update reductions, VBP, readmissions, hospital-acquired conditions (HACs), variation) National Quality Strategy Reducing health disparities

Key Implementation Areas for Hospitals Other Health Reforms Insurance reforms and exchanges Medicaid expansion and payment adequacy Program integrity and recovery audit contractor (RAC) expansion to Medicaid Tax-exempt hospital requirements Administrative simplification Workforce State-Based

Fitting It All Together Medical Homes ACOs Readmissions VBP Center for Innovation

Accountable Care Organizations Models of Service Delivery Primary Care Physicians Specialty Care Physicians Outpatient Hospital Care and ASCs Inpatient Hospital Acute Care Long Term Acute Hospital Care Inpatient Rehab Hospital Care Skilled Nursing Facility Care Home Health Care Readmissions VBP HAC Post Acute Care Episode Bundling Acute Care Episode with Post Acute Care Bundling Law has lots of different models to be tested. (20) We have silos today. Want to pay for larger units of service. Acute Care Bundling Medical Home

Health Reform Implementation: When Sausage-Making Moves Downtown Alliance for Health Reform Briefing Linda E. Fishman, Senior Vice President, Public Policy Analysis and Development July 9, 2010