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Building State-Based High Performing Systems of Care

Building State-Based High Performing Systems of Care. Strengths and Threats Christopher F. Koller Health Insurance Commissioner: State of Rhode Island Alliance for Health Reform and Commonwealth Fund Briefing on State Scorecard June 15, 2007.

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Building State-Based High Performing Systems of Care

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  1. Building State-Based HighPerforming Systems of Care Strengths and Threats Christopher F. Koller Health Insurance Commissioner: State of Rhode Island Alliance for Health Reform and Commonwealth Fund Briefing on State Scorecard June 15, 2007

  2. Characteristics of High Performing Systems of Care(Commission on High Performing Health System) • Organize System for Care Coordination and Access • Promote Health Information Technology • Pursue Excellence in Quality • Produce Transparency of Price & Quality and Reward It • Increase Number of People with Health Insurance • Promote Workforce for Primary Care and Innovations • Develop Leadership and Collaboration – Cross Sectors

  3. Elements in Place in Rhode Island • Insurance Access: • Steady expansion of Rite Care • Leveraging SCHIP • State Led Emphasis on Quality • NCQA Certified Health Plans • Rite Care purchasing and evaluation • Public Reporting by Providers • Public Immunization Programs • Leadership and Collaboration • “Line of Sight Trust”

  4. Threats to System in RI 1. Erosion of Employer Based Health Insurance:

  5. Threats to System in RI (cont’d) 2. Medicaid Budget - could consume 100% of every new dollar in next 5 years - Spending is in elderly and disabled political challenge. 3. Primary Care infrastructure - Only part of system where increased dollars = improved quality and efficiency - Medicare payment system at core of underpayment 4. Chronic Care - Poor management of chronically ill population. - No investment in prevention.

  6. What’s Needed? Help from DC to Make States Better • Fund Prevention – CDC and NIH • Set the bar high – measurement and comparison. • Medicare Innovation • CMS leads commercial payers in P4P and DRGs. • Primary Care Payment changes needed. • Facilitated Collaboration among stakeholders • Performance measurement and payment reform • Promote efforts to increase health insurance access.

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