SustiNet Health Partnership Overview December 2010 Anya Rader Wallack Katharine London Linda Green Stan Dorn

What is the goal of SustiNet? A public health insurance plan that Controls costs, Promotes good health, and Offers a high quality, affordable health care choice to Connecticut residents In combination with federal reform, SustiNet makes quality, affordable health coverage available to state residents 2

The idea behind SustiNet: If the state managed its health care spending better, it could: Save money for the state’s taxpayers Provide better access to higher quality care for more people Offer an affordable, high quality insurance product to individuals, municipalities, small business, and non-profit organizations Use its leverage to improve health care delivery statewide 3

State resources The State of Connecticut oversees $7 billion in health care spending (mostly in Medicaid, HUSKY, and state employee health plans) Connecticut will receive additional health care funding from the federal government under the Patient Protection and Affordable Care Act (national health reform) Net state health spending will fall because of increased federal resources and SustiNet’s effect on health care costs 4

How could SustiNet improve health care? (1 of 3) Make sure patients have access to a team of doctors, nurses, community health workers, and others who will help each patient: –Develop a care plan to manage chronic conditions and maintain health, including smoking cessation and healthy weight –Coordinate appointments, tests and prescriptions, so patients get the care they need when they need it –Prevent illnesses from worsening, avoiding the need for expensive emergency visits and hospitalizations 5

How could SustiNet improve health care? (2 of 3) Help clinicians access tools that will help them provide better care: Electronic health records Notifications when patients are due for a visit Evidence-based guidelines for best quality care Data showing clinicians how they compare to their peers in terms of quality and cost of care Support to become a Patient Centered Medical Home Workforce training, including cultural competence 6

How could SustiNet improve health care? (3 of 3) Pay health care providers more when their patients have better outcomes, not just for providing more services; pay less when patients get an infection in the hospital Reduce racial and ethnic disparities in health care Make sure that state residents have affordable access to quality health coverage, even if they lose a job or start a business 7

The SustiNet Board Co-Chaired by the State Comptroller and Health Care Advocate Members include clinicians, small business, faith community, public employees, insurance expertise, and knowledge of racial and ethnic disparities. Public officials (DSS, DPH, DOI) are non-voting members. 5 Advisory Committees: Information Technology, Medical Home, Health Care Quality, Preventive Health, Health Disparities and Equity 3 Task Forces: Obesity, Tobacco Cessation, Health Care Workforce 8

The SustiNet Board process Met 1-2 times/month since November 2009 Reviewed reports from committees and task forces Identified opportunities to improve existing programs Reported to the legislature about national health reform Identified options for expanding coverage, estimated costs, and investigated availability of federal funding Developing recommendations to the legislature: Structure of the SustiNet plan Steps, timeline, and legislative authority required to implement SustiNet 9

SustiNet: potential timeline 2011 SustiNet includes state funded health insurance programs: Medicaid, HUSKY, SAGA, active and retired state employees 2012 The state may expand HUSKY eligibility if funding is available; new HUSKY enrollees included in SustiNet As soon as feasible, allow municipalities, small businesses, and non-profits to purchase SustiNet for their employees Begin raising HUSKY payments, based on available funding 2014 State health insurance Exchange established under national health reform. SustiNet is one of the health plans individuals and businesses can buy through the Exchange. Individuals and businesses can also purchase SustiNet outside the Exchange 10

Current areas of board focus include: Who should be on the SustiNet board? Who should appoint board members? How much flexibility should the board have to operate SustiNet and implement changes over time? To what extent should public health initiatives be a responsibility of SustiNet versus other agencies of state government? 11