Top 5 Themes We Saw Emerge From #NASHPconf15
State health policy leaders from all 50 states and the District of Columbia converged in Dallas for our largest-ever annual conference. Packed sessions and hallway conversations had the place abuzz with ideas and challenges as states move ahead with system-changing reforms. Without the brainpower of our members and attendees identifying key issues and best practices at events like this, we could not do our work. We are back in the swing of things here at NASHP, but I wanted to take some time to reflect on some of the leading issues and themes to emerge from the conference.
The Uninsured – Good News; Bad News
The ACA has reduced the rate of uninsured in every state – down to 11.4 percent nationally – but many states noted there’s still work to be done in reaching the remaining uninsured and shared key strategies and priorities. Although the rules are incomplete and the challenges many, some states are exploring 1332 waivers as a way to reorganize coverage programs and financing to create a more seamless system of coverage.
Whole Person Care (and Community Care) – Bridging the Silos
Health, specifically poor health, is often determined by social, economic, and physical environments. But what happens when we take on health needs holistically and cover the whole person? Coverage and delivery systems need to cover the whole person throughout the life span, while also linking to factors outside of traditional health care that extend to community life. Integrating care across silos of payment and delivery; across health and health care; as well as behavioral and physical health is no easy task but emerging models hold promise. Additionally, community development resources can be tapped to improve the built environment and address adverse social determinants.
Consolidation – A Bridge Too Far?
The emergence of ACOs and other integrated systems of care can reduce fragmentation, strengthen care coordination, and improve quality. Coupled with payment reforms, improving coordination by these entities can address overutilization – a key cost driver. But the flipside of coordinated care is the consolidation of health care delivery systems. As hospitals merge and more own physician practices, their market power increases and prices go up. States have important responsibilities to provide a check and balance on reform, increasing data availability and transparency, certifying health care consolidation, and developing approaches to rate oversight.
Total Cost of Care – Addressing Affordability
Health care costs have been stabilized with record low growth, but challenges with affordability of coverage remain; drug prices continue to rise and predictions show an expected increase in health care spending on the horizon. Importantly, health care premium and out of pocket costs far exceed wage growth and inflation. States are full of demonstrations to affect costs, largely financed by CMMI. Three- quarters of Medicaid programs are operating four or more. We have much to learn from these demonstrations, yet some payers and providers reel from “demo fatigue”. Three states, Maryland, Massachusetts, and Vermont, are experimenting with global hospital budgets and annual limits on expenditure growth through all payer models that will yield important lessons for the field.
Data, Data, Data- More States are Collecting and Using Data
Without comprehensive, accessible, and trustworthy data the health reforms noted above are stymied. Who is covered, at what cost, and with what outcomes? States are faced with the balance between consumer privacy needs and public policy interests, as well as how to use state and national claims data sets to track and monitor the impact of new policies. Some states shared how they are using a variety of methods to link and use data to target initiatives and improve population health efforts.
As we continue to reflect on all of the tremendous information that was presented and shared over the course of the conference, NASHP will provide more in-depth coverage of topics and ideas in the coming weeks. We look forward to working with state health policy leaders across agencies and branches of government to support their work and advance reforms.