1. State Initiatives That Push The Envelope Brian Rosman Health Care For All Boston rosman@hcfama.org

2. Frame: Cost Control / Delivery Reform LawChapter 224

3. Transparency

4. Wouldn’t it be cool if...

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)

9. Transparency Cost Growth Goal

10. Wouldn’t it be cool if...

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)

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

15. Transparency Cost Growth Goal Tools

16. Wouldn’t it be cool if...

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

19. Wouldn’t it be cool if...

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

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

23. Transparency Cost Growth Goal Tools Patient-Centered Care

24. Wouldn’t it be cool if...

25. ... Communities measured their patient engagement “Health Confidence” campaign Bottom-up Top down

26. State Initiatives That Push The Envelope Brian Rosman Health Care For All Boston rosman@hcfama.org

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