2. Health Reform in Washington State: Building Bridges Over Troubled Waters* NASHP Annual Meeting October 6, 2010 Richard K Onizuka, PhD Health Policy Director Washington State Health Care Authority * with apologies to Paul Simon

3. Agenda Our early (pre ACA) health reform efforts –Payment reform pilot –Accountable care organizations Early impact of ACA ACA and the future of our health reform 2

4. Early Reform: You can’t always get what you want* Governor Gregoire’s five point plan to improve health care (2005) –Evidence based medicine –Data transparency –Health information technology –Chronic care management –Wellness and prevention Blue Ribbon Commission (2006) –Omnibus health reform package (ESSB 5930)5930 * with apologies to the Rolling Stones 3

5. Where We Started: Stairway to Heaven?* 4 * with apologies to Led Zeppelin 2007 Health Technology Assessment Health Record Bank Pilots Patient Decision Aids Quality Forum Health Insurance Partnership Payment Reform HITECH SHAP grant Prescription Drug Program Health Information Infrastructure Advisory Board 2006 2008 2009 2010 2005 Health Reform Initiatives Health Insurance Partnership PSHA Community Checkup

6. Multi-Payer Medical Home Reimbursement Pilot: Money*Money* Legislation authorizes State and PSHA to convene participant group August, 2009 Eight regional and national health plans committing to participate What’s the goal? Two payment models, based on outcomes, to begin early 2011 Advanced practices, baseline data * with apologies to Pink Floyd 5

7. Accountable Care Organizations: Come Together* Legislation (SSB 6522) Lead organization (LO) to implement two ACO pilots by January 1, 2012 –One integrated and one network LO appointed August 30, 2010 –Group Health Cooperative Coordinate with Multi-payer Medical Home Reimbursement Pilot * with apologies to the Beatles 6

8. Preparing for ACA: ChCh Changes * Early opportunities – Basic Health waiver Budget realities: $3-$4B shortfall for 2011-2013 Driving delivery system transformation: Health Insurance Partnership and an exchange * with apologies to David Bowie 7

9. What’s Next: The long and winding road* Opportunities to expand payment reform and ACO pilots PCORI and Washington’s evidence based medicine programs Expansion of performance measurement: All payer claims database? Value based purchasing and benefit design * with apologies to the Beatles 8

10. Finally: We’ve got to get out of this place* 3 * With apologies to the Animals

11. Questions? http://www.governor.wa.gov/priorities/heal thcare/reform.asphttp://www.governor.wa.gov/priorities/heal thcare/reform.asp http://www.hca.wa.gov/ http://www.pugetsoundhealthalliance.org/ http://www.wacommunitycheckup.org/ 10