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The federal government and states are exploring new strategies for rewarding value in order to achieve better health outcomes at a lower cost. This report—the second in a series supported by The Commonwealth Fund to explore opportunities for improvement in federal and state policy— highlights relevant policy levers that can support payment reform and a number of current payment reform initiatives at the federal and state level. It also describes opportunities for federal-state alignment identified during a Commonwealth Fund-supported discourse among high-level state and federal officials hosted by NASHP.
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By Barbara Wirth
Information drives change, and, in today’s digital age, the transformation of the health care system is increasingly linked to the use of health information technology (HIT). The days of hand-written notes, manual chart reviews and paper bills sent to payers by a health care provider practice are all but gone. States increasingly need to collect accurate, timely and actionable measurements electronically and use that data to advance the triple aim of improving patient experience, improving health outcomes for the population and managing health care costs.
The HIT Trailblazer Project highlighted the challenges for states in creating the state-level HIT infrastructure that would align HIT with these goals for health care transformation. Sponsored by the Office of the National Coordinator for Health Information Technology (ONC), Deloitte Consulting LLP, and Research Triangle Institute International (RTI), eight states – Arkansas, California, Maine, Massachusetts, Michigan, Minnesota, Oregon and Rhode Island – received support to ‘blaze a trail’ forward into this complex and fragmented field. The challenges ahead are numerous.
For states and their partners seeking a better integrated delivery system through multipayer reform initiatives, effective use of data is the foundation, the “building” itself, and roof above. Easier envisioned than done, data can help participants in multi-payer initiatives offer constructive feedback on performance to providers, distribute rewards in value-based payment systems, and hold system participants accountable for the costs and quality of services delivered. This webinar will explore the types of data multi-payer initiatives need to succeed, where states can get data, and how to use it. It will also highlight approaches to using various types of data from three leading states.
- Lisa Dulsky Watkins, Associate Director, Vermont Blueprint for Health, Department of Vermont Health Access
- Brooks Daverman, Director, Strategic Planning and Innovation, Tennessee Division of Health Care Finance and Administration
- Karynlee Harrington, Executive Director; Dirigo Health Agency; Acting Executive Director, Maine Health Data Organization
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National media in recent months have featured the high and variable costs of common health care services. In this webinar you’ll hear from leaders in Virginia, Massachusetts, and New Hampshire on what they’ve done to address the issue and improve price transparency.
In a recent report, Catalyst for Payment Reform (CPR) and the Health Care Incentives Improvement Institute (HCI3) identified these states as among the highest performing in the nation when it comes to health care price transparency. After an overview of the issue from CPR and HCI3, the webinar’s discussion will turn to price transparency efforts in the three states, barriers they faced in reaching current levels of transparency, how challenges were managed or overcome, and other lessons for states interested in pursuing this work.
- François de Brantes, Executive Director, Health Care Incentives Improvement Institute
- Andréa E. Caballero, Program Director, Catalyst for Payment Reform
- Áron Boros, Executive Director, Massachusetts Center for Health Information Analysis
- Tyler Brannen, Health Policy Analyst, New Hampshire Insurance Department
- Michael Lundberg, Executive Director, Virginia Health Information
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The National Academy of State Health Policy (NASHP) conducted a survey in the summer of 1999 of the 31 states known to be using financial penalties or incentives in their Medicaid managed care contracts. This paper is based upon information provided by the 28 states that responded and examines recent trends in the use of these financial tools in managed care contracts. It also details the experiences of three states – Iowa, Massachusetts, and Rhode Island – that have the most extensive experience with innovative payment strategies.
Innovative payment models can support medical homes by decreasing the cost of care, incenting and rewarding quality over quantity, and enabling practices to invest in infrastructure and supports. Many leading states have learned from early initiatives and are moving forward with new payment models that to further drive system goals, including lowered costs, improved quality and increased patient satisfaction. Join us as program leaders in Colorado, Rhode Island, and Vermont describe advances in their medical home initiatives, including where they started and where they hope to go.
Mary Takach, Program Director, National Academy for State Health Policy
Kathryn Jantz, Program Performance Specialist, Colorado Dept. of Health Care Policy and Financing
Greg Trollan, Program Performance Specialist, Colorado Dept. of Health Care Policy and Financing
- Slides: Accountable Care Collaborative
Dr. Diedre Gifford, Rhode Island Medicaid Medical Director
Hunt Blair, Deputy Commissioner, Division of Health Reform, Vermont Dept. of Health Access
- Slides: Blueprint Evolution…Health Reform Evolution…Vermont’s Blueprint for Health as an Agent of Change
The rising number of people with Alzheimer’s disease presents significant challenges for family members, caregivers, advocates, public policy makers and service providers. Faced with budgetary pressures and concerns about access to care and continuity of care, states are developing managed care programs for elderly Medicaid beneficiaries, reviewing eligibility policies and fine tuning assessment tools used to measure need for long term care. This study focuses on the development of assessment tools and eligibility criteria and explores the implications of these developments for people with Alzheimer’s disease and related disorders. The study examined three areas: Medicaid spending patterns, case studies based on activities in two states and the assessment instruments used in selected states.
Health disparities cost the United States billions of dollars in direct medical expenditures in addition to the human costs. In an effort to improve quality and contain costs states are taking steps to measure these costs and address disparities. This issue brief, which features Virginia and Rhode Island, was prepared by NASHP authors Carrie Hanlon and Larry Hinkle for the Agency for Healthcare Research and Quality (AHRQ). It focuses on tools, challenges, and strategies states use to measure the costs of health disparities.
This report, prepared by NASHP for the federal Agency for Healthcare Research and Quality, summarizes how leading states analyze state and federal race/ethnicity data in strategic plans and reports aimed at reducing racial and ethnic disparities in health status and health care. It features Colorado, Connecticut, Georgia, Maryland, New Jersey, New Mexico, Rhode Island, and Utah, but also notes activity in Arizona, California, Massachusetts, Michigan, North Carolina, Ohio, and Virginia. Lessons from leading states can provide guidance for others exploring ways to launch or enhance health equity, consumer engagement, quality improvement, or cost containment initiatives.
Read full report here.