1. Reforming What We Have Into the Delivery System We Want Catherine Hess Senior Program Director National Academy for State Health Policy NASHP Annual Conference October 6, 2009

2. NASHP-BPHC National Cooperative Agreement Goal to better inform state policy making Goal to better inform state policy making as it relates to federal health centers Shaped by, implemented with Academy members & State Health Policy and Primary Care Teams Shaped by, implemented with Academy members & State Health Policy and Primary Care Teams –PCOs, PCAs and other key officials –AK, DC, HI, MA, MI, MS (2006-2008) –MO, NM, OR, PA, RI, TN (2009-2011) All work has been framed in context of health reform; state-CHC forums, papers, webinars All work has been framed in context of health reform; state-CHC forums, papers, webinars 2Catherine Hess

3. June 2010 Forum for State and CHC Strategy Development Teams and Academy Advisors Teams and Academy Advisors Other state policymakers Other state policymakers National organization partners National organization partners Federal CMS and HRSA partners Federal CMS and HRSA partners Vision and Promising Models Vision and Promising Models Challenges and Strategies Challenges and Strategies 3Catherine Hess

4. The Vision for Re-Forming Foundation is primary care, health homes Foundation is primary care, health homes New models, new efficiencies for workforce New models, new efficiencies for workforce –Coordinated teams, including behavioral health and community health workers Electronic communication, sharing Electronic communication, sharing Horizontal and vertical measure alignment Horizontal and vertical measure alignment Align payment to support coordination, performance, quality Align payment to support coordination, performance, quality Focus on populations, especially vulnerable Focus on populations, especially vulnerable 4Catherine Hess

5. … and the reality Differing cultures and incentives Differing cultures and incentives System capacities strained even now System capacities strained even now Workforce - shortages, need new skills Workforce - shortages, need new skills Limited integration in many respects Limited integration in many respects Funding limitations Funding limitations Commitment, political will needed Commitment, political will needed Need more Federal flexibility, guidance Need more Federal flexibility, guidance 5Catherine Hess

6. Workforce Challenges, Strategies Limited best practices, evidence Limited best practices, evidence Changing scope of practice difficult Changing scope of practice difficult Develop pipeline payment strategies Develop pipeline payment strategies Provide guidance, assistance, e.g: Provide guidance, assistance, e.g: –Determining providers needed –How much/how to raise rates Change HPSA designation policies Change HPSA designation policies 6Catherine Hess

7. Workforce Strategies Think outside the box/develop new models Think outside the box/develop new models –Training placement models –Shorter training programs for PAs –Bring training to states –Working to limits of scope of practice –Redefine team roles; use community workers Use tools we have Use tools we have –GME, Residency slots 7Catherine Hess

8. Coordination/Integration Strategies Develop, test, spread models Develop, test, spread models –Care coordination –Telehealth –Community utilities –Teaching health centers –Multi-payor Support state roles, leadership in model development and spread Support state roles, leadership in model development and spread 8Catherine Hess

9. Challenges and Strategies for Aligning Incentives in Measurement and Payment Bringing the players together difficult Bringing the players together difficult Data system silos and inadequacies Data system silos and inadequacies Limited state resources to address Limited state resources to address Federal & state measurement priorities Federal & state measurement priorities Help more states to lead Help more states to lead Develop tools for consumer engagement and measurement Develop tools for consumer engagement and measurement 9Catherine Hess

10. Strategies for Aligning Measurement and Payment HRSA funding priority to integration HRSA funding priority to integration Provider training Provider training Change reimbursement models Change reimbursement models Develop, support care management and navigator models Develop, support care management and navigator models Develop more rational system for distributing resources- reinvent health planning? Develop more rational system for distributing resources- reinvent health planning? 10Catherine Hess

11. Providing assistance to advance re-forming Need alternatives to grant funding Need alternatives to grant funding –limited capacity to write grants –need to promote collaboration, not competition –higher match rates as alternative Need Federal platforms/templates/models Need Federal platforms/templates/models Need flexibility Need flexibility –Federal: design, operation, payment methods –State: hiring and procurement 11Catherine Hess

12. Providing assistance to advance re-forming Need federal partnerships, including CMS, HRSA, SAMHSA Need federal partnerships, including CMS, HRSA, SAMHSA Need to engage and support key providers, including for vulnerable Need to engage and support key providers, including for vulnerable –Health plans –Non federal health centers –Public hospitals 12Catherine Hess

13. For More Information, Contact a Team Member Catherine Hess, Senior Program Director chess@nashp.org Mary Takach, Program Manager mtakach@nashp.org Laura Grossmann, Policy Analyst lgrossmann@nashp.org Jennifer Dolatshahi, Research Assistant jdolatshahi@nashp.org 13Catherine Hess