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Reforming What We Have Into the Delivery System We Want


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Reforming What We Have Into the Delivery System We Want

  1. 1. Reforming What We Have Into the Delivery System We Want<br />Catherine Hess<br />Senior Program Director<br />National Academy for State Health Policy<br />NASHP Annual Conference<br />October 6, 2009<br />
  2. 2. NASHP-BPHC National Cooperative Agreement<br />Goal to better inform state policy making <br /> as it relates to federal health centers<br />Shaped by, implemented with Academy members &State Health Policy and Primary Care Teams <br />PCOs, PCAs and other key officials<br />AK, DC, HI, MA, MI, MS (2006-2008)<br />MO, NM, OR, PA, RI, TN (2009-2011)<br />All work has been framed in context of health reform; state-CHC forums, papers, webinars<br />2<br />Catherine Hess<br />
  3. 3. June 2010 Forum for State and CHC Strategy Development <br />Teams and Academy Advisors<br />Other state policymakers<br />National organization partners<br />Federal CMS and HRSA partners<br />Vision and Promising Models<br />Challenges and Strategies<br />3<br />Catherine Hess<br />
  4. 4. The Vision for Re-Forming<br />Foundation is primary care, health homes <br />New models, new efficiencies for workforce<br />Coordinated teams, including behavioral health and community health workers<br />Electronic communication, sharing <br />Horizontal and vertical measure alignment <br />Align payment to support coordination, performance, quality<br />Focus on populations, especially vulnerable<br />4<br />Catherine Hess<br />
  5. 5. … and the reality<br />Differing cultures and incentives <br />System capacities strained even now<br />Workforce - shortages, need new skills<br />Limited integration in many respects <br />Funding limitations<br />Commitment, political will needed<br />Need more Federal flexibility, guidance<br />5<br />Catherine Hess<br />
  6. 6. Workforce Challenges, Strategies<br />Limited best practices, evidence<br />Changing scope of practice difficult<br />Develop pipeline payment strategies<br />Provide guidance, assistance, e.g:<br />Determining providers needed<br />How much/how to raise rates<br />Change HPSA designation policies<br />6<br />Catherine Hess<br />
  7. 7. Workforce Strategies<br />Think outside the box/develop new models<br />Training placement models<br />Shorter training programs for PAs<br />Bring training to states<br />Working to limits of scope of practice<br />Redefine team roles; use community workers<br />Use tools we have<br />GME, Residency slots<br />7<br />Catherine Hess<br />
  8. 8. Coordination/Integration Strategies<br />Develop, test, spread models<br />Care coordination<br />Telehealth<br />Community utilities<br />Teaching health centers<br />Multi-payor<br />Support state roles, leadership in model development and spread<br />8<br />Catherine Hess<br />
  9. 9. Challenges and Strategies for Aligning Incentives in Measurement and Payment<br />Bringing the players together difficult <br />Data system silos and inadequacies<br />Limited state resources to address<br />Federal & state measurement priorities <br />Help more states to lead<br />Develop tools for consumer engagement and measurement<br />9<br />Catherine Hess<br />
  10. 10. Strategies for Aligning Measurement and Payment<br />HRSA funding priority to integration<br />Provider training<br />Change reimbursement models<br />Develop, support care management and navigator models<br />Develop more rational system for distributing resources- reinvent health planning?<br />10<br />Catherine Hess<br />
  11. 11. Providing assistance to advance re-forming<br />Need alternatives to grant funding<br />limited capacity to write grants<br />need to promote collaboration, not competition<br />higher match rates as alternative<br />Need Federal platforms/templates/models<br />Need flexibility<br />Federal: design, operation, payment methods<br />State: hiring and procurement<br />11<br />Catherine Hess<br />
  12. 12. Providing assistance to advance re-forming<br />Need federal partnerships, including CMS, HRSA, SAMHSA<br />Need to engage and support key providers, including for vulnerable<br />Health plans<br />Non federal health centers<br />Public hospitals <br />12<br />Catherine Hess<br />
  13. 13. For More Information, Contact a Team Member<br />Catherine Hess, Senior Program Director<br /><br />Mary Takach, Program Manager<br /><br />Laura Grossmann, Policy Analyst<br /><br />Jennifer Dolatshahi, Research Assistant<br /><br />13<br />Catherine Hess<br />