1. 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

2. 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.

4. 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

6. 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

7. 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

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

9. 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

10. 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