Health Reform in Washington State: Building Bridges Over Troubled Waters


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  • Access -> cost -> qualityProviding high quality, affordable health care to Washingtonians based on the recommendations of the blue ribbon commission on health care costs and access
  • Multiple payers = critical massPilot is early step in larger transitionTransformative payment reform: pay differently, for what?Two payment models for different practice typesFinding the “sweet spot” for payers, providersGOAL: cost savings vs system transformationASO clientsScale and scopeMedicare participation?
  • Infrastructure:Governor’s health cabinetHealth insurance exchangeLow income expansionworkforceConsolidated health purchasingMedicaid and state employees (HCA)Legislative Joint Select Committee & Commissioner’s Realization committeeEarly opportunities:BH Waiver
  • Patient Centered Outcomes Research Institute: Board of GovernorsFindings from CER may not be construed as mandates, guidelines, or recommendations for payment, coverage, or treatment or used to deny coverage
  • Health Reform in Washington State: Building Bridges Over Troubled Waters

    1. 1. Health Reform in Washington State: Building Bridges Over Troubled Waters*NASHP Annual MeetingOctober 6, 2010<br />Richard K Onizuka, PhD<br />Health Policy Director<br />Washington State Health Care Authority<br /> * with apologies to Paul Simon<br />
    2. 2. Agenda<br />Our early (pre ACA) health reform efforts<br />Payment reform pilot<br />Accountable care organizations<br />Early impact of ACA <br />ACA and the future of our health reform<br />2<br />
    3. 3. Early Reform: You can’t always get what you want*<br />Governor Gregoire’s five point plan to improve health care (2005)<br />Evidence based medicine<br />Data transparency<br />Health information technology<br />Chronic care management<br />Wellness and prevention<br />Blue Ribbon Commission (2006)<br />Omnibus health reform package (ESSB 5930) <br /> * with apologies to the Rolling Stones<br />3<br />
    4. 4. Where We Started: Stairway to Heaven?*<br />2010<br />Health Reform Initiatives<br />2009<br />Health InsurancePartnership<br />Payment Reform<br />2008<br />HITECH<br />SHAP grant<br />2007<br />2006<br />Health Insurance Partnership<br />PSHA Community Checkup<br />2005<br />Health Record Bank Pilots<br />Patient Decision Aids<br />Quality Forum<br />Health Technology Assessment<br />Prescription Drug Program<br />Health Information Infrastructure Advisory Board<br />4<br /> * with apologies to Led Zeppelin<br />
    5. 5. Multi-Payer Medical Home Reimbursement Pilot: Money*<br />Legislation authorizes State and PSHA to convene participant group August, 2009<br />Eight regional and national health plans committing to participate<br />What’s the goal?<br />Two payment models, based on outcomes, to begin early 2011<br />Advanced practices, baseline data<br /> * with apologies to Pink Floyd<br />5<br />
    6. 6. Accountable Care Organizations: Come Together*<br />Legislation (SSB 6522)<br />Lead organization (LO) to implement two ACO pilots by January 1, 2012<br />One integrated and one network<br />LO appointed August 30, 2010<br />Group Health Cooperative<br />Coordinate with Multi-payer Medical Home Reimbursement Pilot<br /> * with apologies to the Beatles<br />6<br />
    7. 7. Preparing for ACA: ChChChanges*<br />Early opportunities – Basic Health waiver<br />Budget realities: $3-$4B shortfall for 2011-2013<br />Driving delivery system transformation:Health Insurance Partnership and an exchange <br /> * with apologies to David Bowie<br />7<br />
    8. 8. What’s Next: The long and winding road*<br />Opportunities to expand payment reform and ACO pilots<br />PCORI and Washington’s evidence based medicine programs<br />Expansion of performance measurement: All payer claims database?<br />Value based purchasing and benefit design<br /> * with apologies to the Beatles<br />8<br />
    9. 9. Finally: We’ve got to get out of this place*<br />* With apologies to the Animals<br />3<br />
    10. 10. Questions?<br /><br /><br /><br /><br />10<br />