1. Some National Standards, Many State Decisions NLGA Annual Meeting | Oklahoma City, OK July 18, 2013

2. Some National Standards, Many State Decisions NATIONAL STANDARDS Baseline Insurance Rules Preventative Care Medicare Changes STATE DECISIONS Design of Health Benefits Exchange Medicaid Expansion Delivery Reform Efforts Essential Health Benefits

3. Buzzwords Pioneer ACO CMMI Patient- Centered Bundled Payments State Innovation Model ACO Value-based Purchasing Shared Savings

4. Heart Disease & Stroke $444 billion Diabetes $174 billion Chronic Lung Diseases $173 billion Mental Illness $317 billion Cancer $228 billion Arthritis & Other Rheumatic $128 billion Alzheimer’s $183 billion HIV/AIDS $22 billion The Greatest Threats to Health and Our Pocketbooks Chronic diseases affect almost 1 in 2 people, account for more than 80% of all health spending, and contribute to 7 out of 10 deaths in the U.S.

5. Reimbursement evolution is necessary, but which direction will it take? Inaction is Not an Option “Embracing Defined Contribution” “Optimizing Defined Benefit” Potential Payer Spending Reimbursement Involvement in Financing Care Delivery

6. Medicare ACOs are Off and Running 32 Pioneer and 221 Shared Savings Program ACOs as of January 2013

7. States are well positioned to partner to transform health care: States pay for a large percent of health care services States have broad regulatory powers over providers and payers States regulate public health, social service, and educational services. States have the ability to convene multiple parties States are closer than the federal government to the actual delivery of care States can integrate and align the health information exchange infrastructure with other initiatives State Innovation Models (SIM)

8. ” The State Health Care Innovation Plan (“SHCIP”) is a proposal that describes a state’s strategy to use all levers available to it to transform its health care delivery system through multi-payer reform and other state- led initiatives The CMS Innovation Center State Health Care Innovation Plan (SCHIP) A SIM Initiative

9. States Involved

10. CMMI Model Testing States Arkansas $42 million Maine $33 million Massachusetts $44 million Minnesota $45 million Oregon $45 million Vermont $45 million Over $250,000,000 awarded to the six states to help them transform their health care delivery systems.

11. State Innovation Models Initiative Colorado $2 million New York $1 million Washingto n $1 million Model Pre-testing Awards Model Design Awards

12. 12 Alignment of stakeholders around a common approach to delivery system and payment reform Engage communities and citizens in improving state’s health system Include specific multi- payer models that state proposes to test Framework for state government resources to support delivery redesign process Elements of the State Health Care Innovation Plan

13. Community Partnerships: YMCA

14. US Health Care System Evolution Episodic Non- integrated Care 1.0 Outcome Accountable Care 2.0 Community Integrated Healthcare 3.0 Uncoordinated Health System Coordinated Seamless Health System Community Integrated Care System