Slide 1

State Initiatives That Push The Envelope Brian Rosman Health Care For All Boston rosman@hcfama.org Slide 2 Frame: Cost Control / Delivery Reform LawChapter 224 Slide 3 Transparency Slide 4 Wouldnt it be cool if... Slide 5 ... states had lots more financial data on the health care industry Creates Center for Health Information and Analysis Requires insurers and providers to provide detailed cost and price data Provider price variation Insurer TME Annual public Cost Trends Hearings (also consumer price transparency) Slide 6 Slide 7 Slide 8 Slide 9 Transparency Cost Growth Goal Slide 10 Wouldnt it be cool if... Slide 11 states set a Cost Growth Goal YearPer Capital Total Cost Growth Benchmark 2013-2017Potential Gross State Product (PGSP)(3.6% in 2013 and 2014) 2018-2022PGSP 0.5% (may be modified up to PGSP) 2022- PGSP Not a requirement on each individual contract (but it seems to act that way) Slide 12 Slide 13 Slide 14 Enforcement Health Policy Commission notifies health care entities (hospitals, ACOs, physicians, payers) that exceed cost growth goal May conduct Cost and Market Impact Review May require a performance improvement plan $500,000 fine for not implementing plan Slide 15 Transparency Cost Growth Goal Tools Slide 16 Wouldnt it be cool if... Slide 17 ... Insurers paid for community-based prevention programs Prevention and Wellness Trust Fund $60 million from insurers 9 communities partnerships Focus on prevention and disparities (whole-of-life approach) 4 priorities tobacco use childhood asthma hypertension elder falls prevention Slide 18 Slide 19 Wouldnt it be cool if... Slide 20 ... Doctors could refer patients to community-based prevention programs Bidirectional e-Referral and feedback 4 pilot sites Referrals to: Tobacco Quitline Diabetes education YMCA nutrition counseling and fitness Meals on Wheels and Falls Risk assessment Slide 21 Slide 22 Other Tools in the law Patient Centered Medical Homes Accountable Care Organizations Malpractice Reforms Primary Care and Workforce investments Health Planning Community Hospital transformation grants Small group/non group Medical Loss Ratio of 88% Hospital Checklists Palliative Care info Patient Family Advisory Councils Slide 23 Transparency Cost Growth Goal Tools Patient-Centered Care Slide 24 Wouldnt it be cool if... Slide 25 ... Communities measured their patient engagement Health Confidence campaign Bottom-up Top down Slide 26 State Initiatives That Push The Envelope Brian Rosman Health Care For All Boston rosman@hcfama.org Slide 27 Resources Chapter 224 summary: http://bluecrossmafoundation.org/publication/summary-chapter-224-acts-2012 http://bluecrossmafoundation.org/publication/summary-chapter-224-acts-2012 Cost Trends reports: http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy- commission/publications/ http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy- commission/publications/ http://chiamass.gov/ Prevention and Wellness Trust Fund: http://www.mass.gov/eohhs/gov/newsroom/open-meeting-notices/dph/prevention-and-wellness- advisory-board.html http://www.northeastern.edu/iuhrp/wp-content/uploads/2014/01/PreventionTrustFinalReport.pdf http://www.mass.gov/eohhs/gov/newsroom/open-meeting-notices/dph/prevention-and-wellness- advisory-board.html http://www.northeastern.edu/iuhrp/wp-content/uploads/2014/01/PreventionTrustFinalReport.pdf e-Referral Program: http://www.mass.gov/eohhs/docs/dph/com-health/prev-wellness-advisory-board/141002-e- referral.pdf http://www.mass.gov/eohhs/docs/dph/com-health/prev-wellness-advisory-board/141002-e- referral.pdf Health Confidence: http://www.healthconfidence.org/hc/ http://www.aafp.org/fpm/2014/0900/p8.html http://www.healthconfidence.org/hc/ http://www.aafp.org/fpm/2014/0900/p8.html