NASHP pre-conference on payment reform

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Today’s pre-conference meeting to the National Academy of State Health Policy’s annual conference took on the elephant in the health policy room – how to align incentives among payers, providers and consumers to reward quality and efficiency. Health care is a very fragmented, very large business and it doesn’t turn on a dime. But a number of states have had success in reforming payment systems both in the care the state directly purchases (Medicaid, state employees, etc.) and using its bully pulpit to move other payers. States have a unique role as a major payer and the primary regulator of health care. Models vary from pay for performance that most states have implemented (but not CT yet) to global capitation payments (proposed in MA). Spending per person varies significantly between and, in some cases, within states and there is no evidence that better quality of care or outcomes follow higher spending. States have identified significant savings and improvements in quality. There was a lot of discussion about how to develop Accountable Care Organizations, integrated health systems that can be held accountable for value across the care continuum. CT is unique in that we have alot of small physician practices that are not formally linked to hospitals or other institutions so creating ACOs here will take more organization and more time. PA has an extensive medical home program covering 1.2 million patients that is helping reform payment systems and improving coordination of care for state residents. Minnesota described their reforms that include “baskets” of bundling payments for care to promote transparency, P4P, public health improvements including obesity and tobacco prevention, medical homes, health information technology, and health care cost measurement. We also heard from Washington State legislative and administration staff, cooperating across branches of government, about their success in integrating evidence based science into payment decisions that has saved the state between $40 and 60 million in pharmacy costs alone. Fascinating stuff.
Ellen Andrews