2010 in New Orleans:
Implementing Health Reform: When the States Go Marching In

2010 Conference Guide

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Post-Katrina: The Pitch and Modulation of Recovery
The devastating effects of Katrina continue to be felt across southern-Louisiana five years later. Progress has been made to rebuild the State’s health care capacity in the affected areas as residents continue to return to rebuild their lives. Come hear the local voice on New Orleans’ recovery efforts and what challenges and opportunities still wait ahead.

Speakers: Anthony Keck
Diane Rowland
Eboni Price Haywood
Fred Cerise

Show and Tell: Orchestrating State Health Reform Implementation
An ensemble of state health leaders will discuss their unique experience to date preparing for the many aspects of health reform implementation. Come hear about the advancements their states have made, lessons learned, and practical solutions to challenges that have been faced. As an encore, attendees with gain perspective on what to expect in the interlude leading up to 2014, when many of the law’s provisions take effect.

Speakers: Alan Weil
Jane Beyer
Paul K. Halverson
William A. Hazel Jr.
Christopher Koller
Carol Steckel

Exchanges: A New State Composition
The Accountable Care Act (ACA) gives every state the option of establishing one or more new health insurance exchanges. This primer session will focus on the nuts and bolts of health insurance exchanges, starting with the purposes of the exchange and the policy questions that follow from the major design choices states must make. This session will discuss the decisions states will need to make to build and administer an exchange and how the exchange will interact with Medicaid, the existing insurance market, and insurance brokers. While reviewing the provisions of the new federal law, the session will also draw upon the experiences of states preparing to implement their own exchanges.

Speakers: Joel Ario
Sandra Shewry
PDF-icon Trish Riley

Integrating Care for Dual Eligibles: Evolving Options for States
States are exploring a range of options for coordinating Medicare and Medicaid to better integrate long term supports and health care services for Medicare-Medicaid dual eligibles. These options include shared savings approaches, opportunities for states to serve as the integrated care entity, and contracts with Special Needs Plans. This session will provide the latest information on these evolving options as well as new opportunities.

PDF-icon Alice Lind
PDF-icon Brendan Hogan
PDF-icon Denise Levis Hewson
PDF-icon James Verdier
Pamela Parker

Learning the ABCs of APCs or Medical Homes
This session will examine state approaches to organizing primary care using Advance Primary Care (APC) or medical home models in both managed and fee for service delivery systems. Speakers will describe a variety of strategies that states are using to support primary care providers by connecting them to necessary resources including care coordination, public health and social services. The discussion will also include approaches to engage patients and family in their own care. This session is funded as part of a grant from The Commonwealth Fund.

PDF-icon Foster Gesten
PDF-icon Joan Henneberry
PDF-icon Lisa Letourneau
PDF-icon Ross Owen

Leveraging Public Health Capacity to Improve Health System Efficiency
Many provisions of the ACA hold promise for public health agencies. The reorganization of the healthcare system in the wake of health reform also poses challenges for the public health system. This session will address how public health agency roles may change, opportunities to use public health agencies to lower health costs and improve health outcomes, and the integration of categorical funding streams to build a comprehensive public health system in a post-health reform world.

Speakers: Janet Olszewski
PDF-icon Sharon Moffatt
Susan Cooper
Wendy Davis

Moving from Overtreatment to Patient-Centered Care
As federal health reform expands access to care, the need to control health care costs–already a serious problem–will only become more urgent. Rosemary Gibson, a national leader in patient safety and health care quality, and renowned author, will discuss the impact of overuse of medical services on health care costs and the significant consequences faced when patients are put at risk by treatments that are unnecessary.

PDF-icon Rosemary Gibson

Addressing Post-Health Care Reform Coverage Gaps
While health care reform will expand coverage for millions of the uninsured, there will still be groups of people who are left behind. The need for safety net programs and providers will remain. This session will discuss the populations that remain uninsured after 2014, and how health systems can adapt to meet their health care needs. This session will also examine the post-health reform role of safety net providers in a state with a large undocumented immigrant population, and plans for adapting existing state access programs for a changing uninsured population.

Carrie Bridges
PDF-icon Lynn Blewett
Suzan Martinez de Gonzales

Addressing the Health Care Needs of People with Serious Mental Illnesses
Compared to the general population, people with serious mental illness have significantly higher rates of physical illnesses, and chronic diseases in particular. Recent research indicates that these individuals often have dramatically shorter life spans, more frequent visits to the ER, and a higher likelihood of using nursing home care. This session will present models used by states for integrating primary care with community behavioral health services and supports in order to improve outcomes for people with both serious physical and behavioral health care needs. Funding for this session is provided by Abt Associates Inc. through a SAMHSA Task Order Award.

Glenace Edwall
PDF-icon Jeanene Smith
John O’Brien
PDF-icon Robert Sack

Harmonizing Eligibility, Enrollment and Coverage: Can States Hit the Right Notes?
The Accountable Care Act (ACA) requires significant changes to Medicaid and CHIP eligibility, enrollment, and coverage rules. This primer session provides an overview of ACA’s new requirements and will explore key issues and best practices for states in coordinating enrollment for low-income individuals in Medicaid, CHIP, and the exchanges. Presenters will discuss key changes including the use of Modified Adjusted Gross Income, online enrollment, electronic data exchange, “no wrong door” enrollment and seamless enrollment and transitions among programs. Come hear states talk about their experiences planning for and implementing these types of changes, and the challenges they face in harmonizing program rules and requirements to maximize enrollment post-reform. This session is funded as part of a grant from the Robert Wood Johnson Foundation.

PDF-icon Alice Weiss
Cindy Mann
PDF-icon Deborah Bachrach
Jim Jones

Health Care Reform: New Options for Rebalancing Long Term Services and Supports
The Affordable Care Act (ACA) created a range of new options for states to finance and deliver long term services and supports, and to enhance chronic care coordination. This session will explore these new options, and will also offer state officials’ assessments of the new opportunities that would best advance their own state policy agendas for improving long term services and supports, as well as chronic care for persons with complex needs.

Speakers: Barbara Edwards
PDF-icon Donna McDowell
PDF-icon Kathy Leitch
PDF-icon Krista Hughes

Improving the Quality of Children’s Care: Marching to the Beat of a Different Drum
This session will highlight how states are using CHIPRA grants to test and evaluate promising ideas for improving the quality of children’s health care. South Carolina and Oregon will highlight efforts to develop new measures for quality, and promote the use of health information technology for the delivery of care to children covered by Medicaid and CHIP. States will also explore provider-based models for improving care coordination and linkages to assure better child health and development. This session is funded as part of a grant from The Commonwealth Fund.

Speakers:PDF-icon Charles Gallia
PDF-icon Cheryl Roberts
PDF-icon Felicity Myers

Linking Eligibility and Enrollment Systems Post-Reform: Making the Pieces Fit
Integrating eligibility and enrollment systems for Medicaid, CHIP, and Exchanges is crucial for health reform implementation, but it is challenging for states. Many Medicaid eligibility systems are outdated making it difficult to link systems especially to other human service programs that operate using different eligibility criteria. However, there are some states that have already begun linking eligibility and enrollment systems across health and other human service programs. This session will focus on how states are currently using technology to share data and link systems, which both encourage efficiency within their programs and provide early lessons to help prepare for health reform implementation. This session is funded as part of a grant from the Robert Wood Johnson Foundation.

Speakers:PDF-icon Andy Allison
Rebecca Pasternik-Ikard
Richard Evans
Sam Karp

Making Quality Count: Promising State Efforts
States’ efforts to drive quality improvement now take on heightened significance in the context of evolving health care reform and health information initiatives. This session examines how states are poised to leverage quality information in the context of HITECH, state HIE, Medicaid, and health care reform. State panelists will examine state strategies and address the intersection of state policy, current and emerging data capacity, impending quality reporting meaningful use requirements and the potential of quality improvement initiatives. They will share experiences and perspectives on turning data into information to address statewide health policy goals, multi-payer claims database and other strategies, links to state HIE development and public-private organizational infrastructure for advancing value in health care.

Speakers: Ann Torregrossa
PDF-icon Ben Steffen
PDF-icon Joan Henneberry
PDF-icon Trish Riley

Reforming State Long Term Services and Supports Programs through Participant Direction
Over the past decade states have developed new models for enhancing participant direction of long term services and supports. Some states are implementing replications of the Cash and Counseling Demonstration, others are establishing individual global budgets for support services, and most are infusing some aspects of participant direction into the ongoing operations of their programs. New provisions of the Affordable Care Act provide an additional impetus for participant direction. This session will examine the scope and variation of participant direction policies adopted by state long term services and supports programs and profile the approaches used in state programs targeted to older people, persons with physical disabilities and persons with developmental disabilities.

Speakers: Catherine Ivy
PDF-icon Julia Kenny
PDF-icon Marc Gold
PDF-iconPDF-icon Susan Crisp

Tuning Up the Workforce: Building Capacity to Meet Demand
The Accountable Care Act (ACA) expands coverage to tens of millions of Americans who will place new demands on the health care system. This primer session will review the various provisions of the law that affect system capacity: provisions related to health education, primary care, and services for underserved, minority, and rural populations. This session will focus on how states are preparing the new workforce, and will discuss topics such as scope of practice, and the role of community clinics.

Speakers:PDF-icon Craig Hostetler
Julia Dyck
Lisa Dodson
Richard Figueroa

Chronic Disease Self-Management
As the number of people with multiple chronic diseases continues to increase, states are seeking ways to involve patients in better managing their own illnesses. Over the past several years most states have received federal grants to establish partnerships among state aging, public health and Medicaid agencies to implement Stanford’s Chronic Disease Self-Management Program. In addition, some states have developed their own initiatives for chronic disease management. This session will present state program strategies and data on performance measures.

Speakers:PDF-icon Donna McDowell
Julie Hudman
MaryAnne Lindeblad
Susan Lachenmayr

Closing the Gap: Reducing Disparities and Achieving Health Equity
AHRQ’s 2009 National Healthcare Disparities Report reveals that the nation is not making significant progress toward reducing health disparities which disproportionately disadvantage racial and ethnic minorities. Secretary Sebelius’ National Partnership for Action details action steps for states and private partners to reduce disparities. This session will focus on strategic initiatives that states are implementing, and opportunities within health reform legislation, to reduce disparities in access and outcomes. This session is funded as part of a grant from Thompson Reuters.

Speakers: Barbara Pullen Smith
Carrie Bridges
Owen Quinonez

Health Reform and the Delivery System: A New Medley of Payment and Incentives
With the passage of national health reform, states have a number of opportunities to improve quality and efficiency in health care delivery. This primer session will provide an overview of the Affordable Care Act’s provisions related to key strategies for delivery system transformation, such as payment realignment that promotes primary care, improved quality and reduced costs; increased transparency of cost, quality, and outcome performance measures; consumer incentives; and provider engagement. Two states will illustrate how these provisions will support their delivery system innovations already underway.

Speakers:PDF-icon Anne Gauthier
Lisa Dulsky Watkins
PDF-icon Richard Onizuka
Tricia Leddy

New Roles for FQHC's in State Delivery System Reform
While federally supported health centers are nationally accountable, they play important roles at the state level and can contribute to achieving state health policy goals. This session will identify model approaches and new strategies to strengthen, build upon and align community health centers with the existing state delivery system infrastructure in order to create a health system better able to meet state and national health care goals. Presenters will focus primarily on how FQHCs’ can engage and work with state health systems and their own provider networks in an effort to improve patient access to care and patient outcomes. This session is funded as part of a cooperative agreement with the Health Resources and Services Administration (HRSA).

Speakers:PDF-icon Catherine Hess
Janice Gomersall
PDF-icon Jennifer Vermeer
Tishaura Jones

HIT in the New World: Opportunities and Challenges
This session focuses on major challenges and opportunities for states as they seek to implement the HITECH Act and health care reform. It features leading states highlighting perspectives and critical issues from the field including: deploying the Medicaid EHR incentive program to ensure that “meaningful use” is meaningful; new ways of doing business within state government structuring shared leadership and accountability, as well as managing across projects and agencies; and demonstrating progress toward states’ health policy goals.

Speakers: Carol Steckel
PDF-icon Dave Goetz
Kim Davis-Allen
PDF-icon Lynn Dierker

Making Health Reform More than Sick Care Reform: Shifting the Focus to Better Population Health
The Affordable Care Act (ACA) creates new opportunities to promote the public’s health. This session will focus on ways in which federal health reform will refocus resources in the health care system from its sole focus on medical care to a more rational system aimed at population-based health and wellness, and why this shift is critical. Experts on this panel will describe the provisions of national reform which focus on improving population health, and how states can build on these provisions, through public health and insurance-based strategies, to make Americans healthier.

Speakers: Doug Farmer
Laura Kelly
Marcia Nielsen

Moving Dissonance into Harmony: Commercial Health Insurance Market Reforms and ACA
Enforcement of health reform’s new commercial health insurance regulation is now in the states’ hands. This function is not new, but most states will need to dramatically increase their scrutiny. Panelists will discuss the new insurance standards and what they mean; implications for state health and Medicaid agencies; flexibility to promote innovations and protect insurance markets; involving state health agencies and the legislature in implementing these reforms; and educating citizens to understand why there may be short-term cost increases for certain groups.

Speakers: Christine Barber
Christopher Koller
Mary Beth Senkewicz

Payment Reform Options: A Review of Existing and New Models
Establishing payment models that reinforce the state’s goals for the delivery system can drive meaningful change. As a result, aligning payment structures to reform a state’s delivery system has become a high priority for payers and providers. In this session we will discuss different payment approaches, including the use of managed care organizations (MCOs), accountable care organizations (ACOs) and multi-payer medical home initiatives. This session will also look at how these approaches may be used to promote quality, efficiency and improved outcomes, while meeting the increased demand for services produced by expanding coverage.

Speakers:PDF-icon Don Ashkenase
Richard Gottfried
PDF-icon Richard Slusky
PDF-icon Stuart Guterman

Leading the Band: Federal Action that Supports State Implementation
This year landmark legislation established the goal of transforming the health system—and provided resources and an approach to achieving the transformation. Turning the vision into reality will require federal and state policymakers to implement new programs, test and spread new models of payment and delivery systems, and coordinate policies across agencies and systems that now function independently. Success will require change and partnerships among both the state and federal governments. The federal government will both support states in achieving these goals and define the parameters within which states will work to implement health reform. Come hear from a key federal official about their plans for rolling out health reform. What will states have to do? How much flexibility will they have to implement health reform in a way that supports their goals and will work in their system? How will resources be rolled out? What structures are in place (or under consideration) to support coordination?

Speakers:PDF-icon Donald Berwick

State Overture: The Next Movement
As demonstrated throughout the conference, if done well national health reform will transform the system-enabling state policymakers to achieve long held goals for increased coverage, decreased cost, and improved quality. However, if executed poorly it may break the system (or at least the state budget). This state-only session provides the opportunity for state health leaders to strategize with your peer to identify real solutions and opportunities to make substantial progress toward successfully implementing health reform in your state.

Speakers: Alan Weil