1. Insured the Uninsured Project Conference February 17, 2015 The Future of Reform Thomas P. Traylor Vice President Boston Medical Center/Boston HealthNet

2. 2 “Be patient. Reform takes time”

3. Reform Takes Time…. in Massachusetts Massachusetts health reform = 20 year process –1997 Medicaid Waiver; 14% uninsured –2006 Medicaid Waiver; vehicle to expand coverage –2010 Medicaid waiver; launch of Delivery System Transformation Initiative (DSTI), which is similar to DSRIP –2014 Medicaid Waiver; 2% uninsured. Uncompensated care pool and DSTI only funded for 3 years of five-year waiver. Reform is still playing out in safety net: –10% uninsured at BMC today –Medicaid underpayments Key policy questions among state and feds –DSTI evolution and continuation post 2017 –Open question about funding uncompensated care beyond 2017 3

4. 4 "Your market must evolve. Hospitals & health centers can work together to improve patient care.” Patients 7 Boston HealthNet Community Health Centers 22 Physician Practice Plans BMC HealthNet Plan Boston Medical Center

5. Boston Medical Center’s Evolution Merger Exploration: BMC + Tufts Medical Center ACO Boston Accountable Care Organization formed DSTI BMC DSTI programs begin Medicaid MCO BMC HealthNet Plan created Merger Boston City Hospital + Boston University Medical Center = BMC Network Boston HeatlhNet created including 15 CHCs, BU School of Medicine & BMC 5 1995 19961997201220142015

6. 6 “Make a plan. Consider where California wants to be in five years and detail clear cost, quality, and coverage goals. Map out the role of Medicaid.”

7. What’s the Plan? 1.Detail clear cost, quality and coverage goals. 2.Hold stakeholders accountable for results. 3.Invest in data collection and analysis. 4.Consider relationship among coverage programs. 5.Create a sustainable Medicaid financing plan. 6.Set a realistic timeframe. 7.Convert your complex plan into an understandable story. 7

8. Additional Resources Massachusetts Center for Health Information & Analysis – http://chiamass.gov/http://chiamass.gov/ –Information on cost, quality, access and health system performance The Blue Cross Blue Shield Foundation of Massachusetts –http://bluecrossfoundation.orghttp://bluecrossfoundation.org –Summaries and analysis of MA health reform Massachusetts Health Policy Commission –http://www.mass.gov/anf/budget-taxes-and-procurement/oversight- agencies/health-policy-commission/http://www.mass.gov/anf/budget-taxes-and-procurement/oversight- agencies/health-policy-commission/ –Cost Trends Reports 8

9. For Additional Information Contact: Tom Traylor, Vice President Boston Medical Center (617) 638-6730 tom.traylor@bmc.org 9