1. The State of Partnering with States Aligning Forces for Quality National Meeting May 9, 2013 John M. Colmers Vice President Health Care Transformation and Strategic Planning

2. Outline Introduction Range of models available to states –As purchaser –As traditional regulator –As convener –As market setter/enabler Prospects for success –Examples in Maryland with Community Organizations –Examples at Johns Hopkins

3. State of Play in the States Economy improving, but many still confronting budgetary shortfalls Fear of the impact of (in)action in Washington, DC Role of Medicaid and other state programs Wide variations in approaches to ACA BUT market forces impacting virtually every state

4. Implementation of the Affordable Care Act at the State Level Considerable responsibilities left to states –Creation of exchanges Federal/State/Partnership –Role of insurance commissioners on pricing –Medicaid expansion Uncertain outcome

5. State Context Although wide variation regarding the ACA, virtually every state is considering or developing new policy approaches that address: Coverage and access Quality Delivery reform/cost control

6. State Policy Approaches to Delivery System Integration The Role of the State as:  Purchaser  Traditional Regulator  Convener  Market Setter/Enabler

7. State Role as Purchaser Medicaid payment reform –PCMH –P4P Medicaid interface with insurance exchange State employee benefit plan design

8. State Role as Traditional Regulator Health insurance exchanges –Essential benefit plan design Role of Insurance Commissioner –Conditional rate approval –Affordability standards –Provider contracting standards Transparency requirements Health IT and HIE

9. State Role as Convener Health Reform Task Forces –Roadmaps Include focus on population health issues –Collaborations –Workforce development Continued role for legislature –Oversight –Policy development

10. State Role as Market Setter/Enabler Use of statutory authority to SET market conditions –State multi-payer PCMH –Multi-payer ACO options Market power and antitrust Gain sharing and anti-kick back

11. Prospects for Success Reasons for optimism –Failure is not an option –Significant federal investment from CMMI –Increasing recognition of shared interest among stakeholders in payer and provider communities Reasons for pessimism –Federal barriers Budget meltdown Regulatory inertia –Change is hard –Provider and payer market concentration Status quo is always second best solution

12. Examples in Maryland SIM Planning Grant –Multipayer Medical Home Significant community involvement in design and implementation J-CHiP CMMI Innovation Grant –7 zip codes around JHH and JHBMC –Community health workers