1. 1 Health System Reform in Kansas: Context, Challenges and Capacity Marci Nielsen, PhD, MPH Executive Director, Kansas Health Policy Authority

2. 2 Objectives Challenge: Failing national health system Challenge: Failing national health system Context: Health reform from perspective of States Context: Health reform from perspective of States Capacity: What’s happening in Kansas Capacity: What’s happening in Kansas

3. 3 Challenges…. A Failing National Health “System”

4. 4 Rising Rates of Uninsured

5. 5 Insurance Affordability

6. 6 Getting what we pay for?

7. 7

8. 8

9. 9 Context: States Attempts to Improve the “System”

10. 10 What are states trying? Premium assistance programs: Premium assistance programs: States subsidies to low-income uninsured individuals to purchase private insurance;States subsidies to low-income uninsured individuals to purchase private insurance; New insurance products: New insurance products: High Deductible/Consumer Driven Plans: Extends more affordable coverage to small businesses, self-employed individuals;High Deductible/Consumer Driven Plans: Extends more affordable coverage to small businesses, self-employed individuals; Tax credits: Tax credits: For small businesses who offer health care and contribute toward employees' health insurance expenses;For small businesses who offer health care and contribute toward employees' health insurance expenses; Children's health coverage: Children's health coverage: Expansion through both SCHIP program and innovative 1115 waivers;Expansion through both SCHIP program and innovative 1115 waivers; Access to community health centers: Access to community health centers: As an alternative, non-emergent care option for uninsured populations seeking primary care services.As an alternative, non-emergent care option for uninsured populations seeking primary care services. Source: National Governors Association, 2006

11. 11 State leadership, but… “Laboratories of Democracy” for innovative reform, but… “Laboratories of Democracy” for innovative reform, but… Must have for federal assistance with Must have for federal assistance with Health insurance reform (ERISA pre- emption)Health insurance reform (ERISA pre- emption) Cost containment strategiesCost containment strategies Growing cost of Medicaid (Long Term Care) as population agesGrowing cost of Medicaid (Long Term Care) as population ages Standards for HIT/HIE interoperabilityStandards for HIT/HIE interoperability Resolving “Border Issues”Resolving “Border Issues”

12. 12 Capacity: What’s Happening in Kansas?

13. 13 Created in 2005 Legislative Session Created in 2005 Legislative Session Built on Governor Sebelius’ “Executive Reorganization Order” Built on Governor Sebelius’ “Executive Reorganization Order” Modified by State Legislature to: Modified by State Legislature to: Create a nine member Board to govern health policyCreate a nine member Board to govern health policy Executive Director reports to BoardExecutive Director reports to Board Added a specific focus on health promotion and data driven policy makingAdded a specific focus on health promotion and data driven policy making

14. 14 The general charge of the Authority is to: The general charge of the Authority is to: (1) develop and maintain a coordinated health policy agenda that (1) develop and maintain a coordinated health policy agenda that (2) combines effective purchasing and administration of health care (2) combines effective purchasing and administration of health care (3) with health promotion oriented public health strategies (3) with health promotion oriented public health strategies (4) which is driven by health data(4) which is driven by health data 2005 Summary of Legislation, Kansas Legislative Research Department

15. 15 July 1, 2005 January 1, 2006 March 1, 2006 July 1, 2006 2007 Legislative Session 2008 Legislative Session Kansas Health Policy Authority Established. Transfer programs of programs to a Division first, then to a separate agency. Assume responsibilities of Health Care Data Governing Board and oversight of KS Business Health Partnership program. Authority plan for various program transfers submitted to Legislature. Transfer programs to Authority. Authority plan for additional program transfers submitted to 2007 and 2008 Legislatures.

16. 16 KHPA Board Members Nine voting board members Nine voting board members Three members appointed by the GovernorThree members appointed by the Governor Six members appointed by legislative leaders.Six members appointed by legislative leaders. Seven nonvoting, ex officio members include: Seven nonvoting, ex officio members include: Secretaries of Health and Environment, Social and Rehabilitation Services, Administration, and Aging; the Director of Health in the Department of Health and Environment; the Commissioner of Insurance; and the Executive Director of the Authority.Secretaries of Health and Environment, Social and Rehabilitation Services, Administration, and Aging; the Director of Health in the Department of Health and Environment; the Commissioner of Insurance; and the Executive Director of the Authority.

17. 17 Programs Transferred to KHPA in 2006 Medicaid Medicaid (Regular Medicaid) (Regular Medicaid) MediKan MediKan State Children’s Health Insurance Program State Children’s Health Insurance Program Ticket to Work/Working Healthy Ticket to Work/Working Healthy Medicaid Management Information System Medicaid Management Information System Medicaid Drug Utilization Review & related programs Medicaid Drug Utilization Review & related programs State Employee Health Insurance State Employee Health Insurance State Workers Compensation State Workers Compensation Health Care Data Governing Board Health Care Data Governing Board Business Health Partnership Program Business Health Partnership Program

18. 18 Where is KPHA going in the future?

19. 19 Vision Principles Adopted by the Board last month Adopted by the Board last month Will provide direction to the Board as they and this agency develops and maintains a coordinated health policy agenda Will provide direction to the Board as they and this agency develops and maintains a coordinated health policy agenda Guiding framework of the Board and the work the Agency intends to accomplish Guiding framework of the Board and the work the Agency intends to accomplish

20. 20 Access to Care Kansans should have access to patient centered health care and public health services which ensure the right care, at the right time, and at the right place. Indicators: Indicators: (1) Health insurance status;(1) Health insurance status; (2) Health professions workforce;(2) Health professions workforce; (3) Safety net stability;(3) Safety net stability; (4) Medicaid eligibility;(4) Medicaid eligibility; (5) Health disparities(5) Health disparities

21. 21 Quality and Efficiency The delivery of care in Kansas should emphasize positive outcomes, safety and efficiency and be based on best practices and evidence-based medicine. Indicators Indicators (1) Use of Health Information Technology/Health Information Exchange;(1) Use of Health Information Technology/Health Information Exchange; (2) Patient Safety;(2) Patient Safety; (3) Evidence based care;(3) Evidence based care; (4) Quality of care;(4) Quality of care; (5) Transparency (of cost and quality of health information).(5) Transparency (of cost and quality of health information).

22. 22 Affordable & Sustainable Health Care The financing of health care and health promotion in Kansas should be equitable, seamless, and sustainable for consumers, providers, purchasers, and government. Indicators Indicators (1) Health insurance premiums;(1) Health insurance premiums; (2) Cost sharing by consumers;(2) Cost sharing by consumers; (3) Uncompensated care;(3) Uncompensated care; (4) Medicaid and SCHIP enrollment;(4) Medicaid and SCHIP enrollment; (5) Health and health care spending.(5) Health and health care spending.

23. 23 Health and Wellness Kansans should pursue healthy lifestyles with a focus on wellness as well as a focus on the informed use of health services over their life course. Indicators Indicators (1) Physical fitness;(1) Physical fitness; (2) Nutrition;(2) Nutrition; (3) Age appropriate screening;(3) Age appropriate screening; (4) Tobacco control;(4) Tobacco control; (5) Injury control.(5) Injury control.

24. 24 Responsible Stewardship The KHPA will administer the resources entrusted to us by the citizens and the State with the highest level of integrity, responsibility and transparency. Indicators Indicators (1) Open decision making;(1) Open decision making; (2) Responsible spending;(2) Responsible spending; (3) Financial reporting;(3) Financial reporting; (4) Accessibility of information;(4) Accessibility of information; (5) Cooperation with the Centers for Medicare and Medicaid Services—our federal partners for the Medicaid and SCHIP programs.(5) Cooperation with the Centers for Medicare and Medicaid Services—our federal partners for the Medicaid and SCHIP programs.

25. 25 Education & Engagement of the Public Kansans should be educated about health and health care delivery to encourage public engagement in developing an improved health system for all. Indicators Indicators (1) Advisory Council Participation;(1) Advisory Council Participation; (2) Data Consortium Participation;(2) Data Consortium Participation; (3) Public communication;(3) Public communication; (4) Community/Stakeholder/Advocacy Partnership;(4) Community/Stakeholder/Advocacy Partnership; (5) Foundation Engagement.(5) Foundation Engagement.

26. 26

27. 27