Reforming What We Have Into the Delivery System We Want

Catherine HessSenior Program DirectorNational Academy for State Health PolicyNASHP Annual ConferenceOctober 6, 2009

NASHP-BPHC National Cooperative Agreement

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 – 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

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

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The Vision for Re-Forming Foundation is primary care, health

homes New models, new efficiencies for

workforce– Coordinated teams, including behavioral

health and community health workers Electronic communication, sharing Horizontal and vertical measure

alignment Align payment to support coordination,

performance, quality Focus on populations, especially

vulnerable

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… and the reality

Differing cultures and incentives System capacities strained even

now Workforce - shortages, need new

skills Limited integration in many respects

Funding limitations Commitment, political will needed Need more Federal flexibility,

guidance

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Workforce Challenges, Strategies Limited best practices, evidence Changing scope of practice

difficult Develop pipeline payment

strategies Provide guidance, assistance, e.g:

– Determining providers needed– How much/how to raise rates

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Workforce Strategies

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

– GME, Residency slots

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Coordination/Integration Strategies Develop, test, spread models

– Care coordination– Telehealth– Community utilities– Teaching health centers– Multi-payor

Support state roles, leadership in model development and spread

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Challenges and Strategies for Aligning Incentives in Measurement and Payment

Bringing the players together difficult

Data system silos and inadequacies

Limited state resources to address

Federal & state measurement priorities

Help more states to lead Develop tools for consumer

engagement and measurement

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Strategies for Aligning Measurement and Payment

HRSA funding priority to integration

Provider training Change reimbursement models Develop, support care

management and navigator models

Develop more rational system for distributing resources- reinvent health planning?

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Providing assistance to advance re-forming

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 flexibility– Federal: design, operation, payment

methods– State: hiring and procurement

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Providing assistance to advance re-forming Need federal partnerships,

including CMS, HRSA, SAMHSA Need to engage and support key

providers, including for vulnerable– Health plans– Non federal health centers– Public hospitals

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For More Information, Contact a Team MemberCatherine Hess, Senior Program Director

chess@nashp.orgMary Takach, Program Manager

mtakach@nashp.orgLaura Grossmann, Policy Analyst

lgrossmann@nashp.orgJennifer Dolatshahi, Research Assistant

jdolatshahi@nashp.org

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