1. New America Forum April 12, 2010 New America Forum: A First Look at Implementing Health Reform The Delivery System Challenge State Implementation Issues and Opportunities Anne Gauthier Senior Fellow National Academy for State Health Policy April 12, 2010

2. New America Forum April 12, 2010 States Current Roles Define populations to serve Link residents to available services Determine benefits and design delivery systems for targeted populations Purchase healthcare services Deliver services to institutional residents Promote population health Promote system-wide improvement Educate and train healthcare professionals Protect consumers Finance Regulate Employ Establish legal framework Coordinate with related programs 2

3. New America Forum April 12, 2010 Health Reform: State Challenges 3 Timing Capacity Resources Leadership

4. New America Forum April 12, 2010 Health Reform: State Opportunities Connect people to needed services Promote coordination and integration in the health system Improve care for populations with complex needs Orient the health system toward results Increase health system efficiencies 4

5. New America Forum April 12, 2010 Improve Care for Complex Needs Expansion of patient-centered medical homes New authority to align Medicaid and Medicare Improved access to home and community-based services 5

6. New America Forum April 12, 2010 Orient the Health System Toward Results Payment reform demonstrations Quality improvement incentives Investments in primary care and prevention Enhanced data collection and coordination Improved transparency 6

7. New America Forum April 12, 2010 Increase Efficiency Limit administrative costs Coordination between Medicaid & Medicare Financial incentives for preventative care Opportunities to allocate resources to higher-value care System-wide planning across agencies and programs 7

8. New America Forum April 12, 2010 Several states are leaders -- moving forward with innovative payment and delivery system reform models. The Patient Protection and Affordable Care Act and the Reconciliation Act provide multiple opportunities for further experimentation. A single courageous state [can] if its citizens choose, serve as a laboratory. – Justice Louis D. Brandeis State Innovations – A Place to Start?

9. New America Forum April 12, 2010 Landmark legislation in 2008 established statewide multi-payer methods to reward quality and value for bundled care –Baskets of care –Statewide quality-based incentive payment system –Standards of certification for health care homes Example from Minnesota Creatively piloting data collection on quality & costs, including reporting on physician performance Poised for ACO pilots – data infrastructure in place and many delivery systems ready Now to add Medicare!

10. New America Forum April 12, 2010 It wont be easy, but the rewards hold so much promise… State have huge responsibility for health reform implementation Meeting the delivery system challenge will stretch the creativity of all states and stakeholders Continued federal-state dialogue holds promise for the continuous learning that needs to occur

11. New America Forum April 12, 2010 www.nashp.org