State Roles in Promoting Accountable Care Organizations and Medical Homes Richard K. Onizuka, PhD Health Policy Director Washington State Health Care Authority

The “Why” and “What” for Washington State State budgets – driven by health purchasing costs Health system status quo is unsustainable Leveraging state roles as purchaser, regulator, and licensor Facilitator/convener for payment reforms with multiple payers Governor’s 4% challenge 2

Key State Roles in ACO Development* Designing and promoting data Designing and promoting new payment models Fostering the use of accountability measures Identifying and promoting systems of care Supporting a continuum of care and medical home models * from NASHP report 3

Designing and Promoting Data Governor’s five point plan (2005) includes data transparency Puget Sound Health Alliance (PSHA) Community Checkup Medicaid Predictive Risk Intelligence System (PRISM) HITECH coordination, HIE development All payer claims database? 4

Designing and Promoting New Payment Models Multiple payer, payment reform pilot –Public private collaboration –Performance outcomes (reduction in avoidable ER use) –Key challenges Consolidated purchasing of Medicaid and public employees (HCA) ACO pilot legislation ACA opportunities 5

Fostering the Use of Accountability Measures Puget Sound Health Alliance – resource use measures – Dartmouth Atlas frame Multi-payer pilot outcomes Consolidated state health purchasing, and self funded plan third party administrator (e.g., eValue8) Beacon community coordination 6

Systems of Care and Medical Home Models Primary care health homes and new legislation Expansion of Boeing IOCP model with public employees and other purchasers ACO pilot legislation ACA opportunities, e.g., dual eligibles, 2703 funding Regional health authorities 7

8 Other Opportunities/Final Thoughts Other HIT activity (e.g., Beacon) Leveraging our Health Insurance Exchange Needed resources, challenge to health system status quo (technical, political, etc.) Role within state’s overall health system change strategy Private sector opportunities and collaboration 8

Additional Resources PSHA community checkup: ACO legislation (ESSB 6522): 10/Pdf/Bills/Session%20Law%202010/6522- S.SL.pdf 10/Pdf/Bills/Session%20Law%202010/6522- S.SL.pdf Multi-payer medical home pilot: Governor Gregoire’s health reform site: view.asp?pressRelease=1469&newsType=1 view.asp?pressRelease=1469&newsType=1 9

Questions? 10