1 / 38

National Association of Public Hospitals and Health Systems

Health Care Reform Implementation: Innovation and Funding Opportunities. Sarah Mutinsky NAPH Counsel, Ropes & Gray, LLP Claudine Swartz Assistant Vice President for Policy, NAPH June 3, 2010 . 1. National Association of Public Hospitals and Health Systems. 1. Objectives.

lotus
Download Presentation

National Association of Public Hospitals and Health Systems

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Health Care Reform Implementation: Innovation and Funding Opportunities Sarah Mutinsky NAPH Counsel, Ropes & Gray, LLP Claudine Swartz Assistant Vice President for Policy, NAPH June 3, 2010 1 National Association of Public Hospitals and Health Systems 1

  2. Objectives • Highlight key innovation and funding opportunities in the health reform law • Begin ongoing dialogue • Suggest ways to identify and prioritize opportunities • Answer your questions 2

  3. NAPH Reform Implementation Webinars • April 22 – Reform Overview (webcast available) • May 6 – Coverage Expansion Issues (webcast available) • May 20 – Provider Payment Issues (webcast available) • June 3 – Innovation & Funding Issues • June 17 – Exchange & Health Plan Issues • July 1 – Primary Care & CHC Issues • July 15 – Compliance Issues • July 29 – Employer Issues All webinars begin at 2:00 PM Eastern For more info, visit the Health Reform Implementation section on NAPH’s website: www.naph.org

  4. Innovation and Funding Opportunities:Stimulating health system changes

  5. Innovation & Funding Opportunities: Overview • Funding and/or program opportunities to: • Drive delivery system reform • Create a stronger workforce • Improve access • Better manage care • Many funds & programs require change and improvement – there may be associated opportunity costs

  6. Innovation & Funding Opportunities: Overview • Innovation & opportunities funded via: • Medicare • Medicaid /State waivers • Discretionary funding: • Directly funded in law • Specific funding level stated in law & subject to congressional appropriations • No specific funding level stated in law & subject to congressional appropriations process • In many cases, funding mechanisms are unknown

  7. Innovation & Funding Opportunities: Awaiting Answers….Providing Guidance • Agency (principally HHS) must implement. Requires staffing, technical expertise. • Many key questions outstanding: • Will programs actually be funded? • Will programs be implemented on time? • What guidance will HHS provide – who will be eligible to participate and what is criteria? • How will programs fit together? • Questions create opportunities for NAPH and safety net hospital guidance

  8. Keeping Track of Opportunities • NAPH Innovation & Funding Opportunities Chart • Check often for updates

  9. What are the Funding Opportunities? • Delivery System Reforms • CMS Innovation Center • Payment Demonstrations • Care Coordination • Trauma Care • Long Term Care • Workforce & Training • Primary Care • Coverage & Access • Primary Care • Vulnerable Patients • Prevention & Chronic Disease

  10. Innovation & Funding Opportunities:Delivery System Reforms Center for Medicare and Medicaid Innovation What?Design, implement, test, evaluate and expand payment models & methodologies under Medicare, Medicaid, & CHIP that foster patient‐centered care, improve quality, & reduce the cost of care. When? Operational by Jan. 2011 How much?$5 million in FY2010 and $10 billion for FY2011-FY2019 What’s next?Innovation Center lead, Tony Rodgers, developing framework for Center. Consider possible projects in statute. Consider recently announced Advanced Primary Care Practice Demonstration. NAPH and members to shape safety net models.

  11. Innovation & Funding Opportunities:Delivery System Reforms Payment Demonstrations: Medicare Shared Savings/ACO Program What? Permits providers or provider groups to be recognized as ACOs and share in cost savings above a certain threshold if quality standards are met. When? Begins Jan 2012 What’s next? Monitor developments in market via Premier, Brookings, etc. Engage in regional discussions. Develop Medicaid models with NAPH.

  12. Innovation & Funding Opportunities:Delivery System Reforms • Payment Demonstrations: • Medicare Shared Savings/ACO Program • No payment penalty/withhold for participation. • Consider size of your Medicare population related to investment. • At least 5,000 participating Medicare beneficiaries in ACO • 3 year commitment • Legal structure to permit ACO to receive and distribute payments for shared savings • Quality reporting, activities to promote care coordination and patient-centeredness • Consider level of integration/relationships with other primary care providers and community hospitals in your area

  13. Innovation & Funding Opportunities:Delivery System Reforms Payment Demonstrations: Medicaid Pediatric ACO Program What? Permits pediatric providers or provider groups to be recognized as ACOs similar to Medicare model When? Begins Jan 2012 What’s next? Engage in discussions with states. Consider opportunities for ACO models for low-income adults through Innovation Center and waivers

  14. Innovation & Funding Opportunities:Delivery System Reforms Payment Demonstrations: Medicaid Global Payment System Demonstration What? Allows up to 5 states to alter Medicaid payments to large safety net hospital systems to a capitated, global payment structure. When? FY2010-FY2012 How much? “Such sums as necessary” authorized What’s next? Assess how quickly CMS will move given short time frame. Discuss alternatives with state. Consider link with waivers.

  15. Innovation & Funding Opportunities:Delivery System Reforms Payment Demonstrations: Medicare Bundled Payment Pilot Program What? Medicare pilot to evaluate alternative payment methodologies that promote care coordination for 10 conditions selected by HHS When? January 2013 - 2018 How much? No additional funds authorized (via Medicare payments) What’s next? Await guidance from HHS on relevant conditions. Proactively suggest alternatives for evaluation.

  16. Innovation & Funding Opportunities:Delivery System Reforms Payment Demonstrations: Medicaid Demonstration to Evaluate Integrated Care around a Hospitalization What? Eight state Medicaid demo under which states would make a bundled payment for physician and hospital services for an episode of care When? January 2012 – Dec 2016 How much? No additional funds authorized (via Medicaid payments) What’s next? Discuss alternatives with state. Consider appropriate “bundles” and advise state & NAPH.

  17. Innovation & Funding Opportunities:Delivery System Reforms Care Coordination: Community-Based Collaborative Care Networks What? Grant program for safety net providers to create collaborative care networks to provide low-income patients with comprehensive coordinated care When? FY 2011-2015 How much? “Such sums as necessary” What’s next? Join NAPH efforts to secure funding via Congressional appropriations process.

  18. Innovation & Funding Opportunities:Delivery System Reforms Care Coordination: State Option to Provide Health Homes for Medicaid Enrollees with Chronic Conditions What? States, through a state plan amendment, can allow Medicaid beneficiaries with chronic conditions to select a “health home” consisting of a designated provider or a team of professionals. States make Medicaid payments to “health home” using state methodology approved by HHS. When? State option begins Jan 1, 2011 How much? No additional funding authorized What’s next? Discuss with state.

  19. Innovation & Funding Opportunities:Delivery System Reforms Trauma Care Competitive Grants for Regionalized Systems for Emergency Care Response What? At least four multiyear contracts or competitive grants to eligible entities to support pilots that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems When? Participating states must agree to a non-federal contribution no less than $1 for every $3 of federal funds How Much? Appropriates $24 million for each of FYs 2010-2014 What’s Next? Look for guidance from HHS. Begin, or build on, discussion with regional partners

  20. Innovation & Funding Opportunities:Delivery System Reforms • Trauma Care – cont’d • Trauma Care Centers and Service Availability Grants • What? HHS is directed to establish 3 grant programs to qualified public, nonprofit Indian Health Services, Indian tribal, and urban Indian trauma centers to strengthen the country’s trauma care by, for example, assisting in defraying substantial uncompensated care costs • When? FY 2009 • How Much? Authorizes $100 million for FY2009 and “such sums as necessary” for FYs 2010-2015 • What’s Next? Monitor whether funds are appropriated. Then, look for HHS guidance.

  21. Innovation & Funding Opportunities:Delivery System Reforms • Trauma Care – cont’d • Grants to States for Trauma Service Availability • What? Grants to promote universal access to trauma care provided by trauma centers and trauma-related physician services. States must allocate at least 40% of their grants to safety net public or nonprofit trauma centers • When? FY 2010 • How Much? Authorizes $100 million for FY2010-2015 • What’s Next? Monitor whether funds are appropriated, then look to HHS for guidance.

  22. Innovations & Funding Opportunities:Delivery System Reforms • Long Term Care • Independence at Home Demonstration • What? Will test payment incentive and delivery model that utilizes physician and nurse practitioner directed home-based primary care teams to reduce costs and improve outcomes for certain Medicare beneficiaries • When? Program to begin no later than Jan 2012 • How Much? Authorizes $5 million for each of FYs 2010- 2015 • What’s Next? Monitor appropriations process

  23. Innovations & Funding Opportunities:Delivery System Reforms • Long Term Care • State Balancing Incentive Program • What? Program that enhances federal matching payments to eligible states to increase the proportion of non-institutionally-based long term care services. • When? Effective FY2012-FY2015 • How Much? Select state will generally be eligible for 2 percentage point increase in FMAP (5 percentage points in certain states) • What’s Next? Assess whether your state is interested in pursuing and ways to collaborate.

  24. Innovations & Funding Opportunities:Workforce and Training Primary Care & Preventive Medicine Training Programs Preventive Medicine & Public Health Training Grant Program What? Grants or contracts for eligible entities to plan, develop, operate, or participate in an accredited residency or internship in preventive medicine or public health. Eligible entities include, but are not limited to, public or private nonprofit hospitals. When? Beginning in FY 2011 How Much? Appropriates $43 million for FY2011, and “such sums as necessary” for each of the FYs 2012-2015. What’s Next?Assess your participation. Look for guidance from HHS.

  25. Innovations & Funding Opportunities:Workforce and Training Primary Care & Preventive Medicine Training - cont’d Primary Care Training and Enhancement What? 5-year grants or contracts to support and develop primary care training programs through accredited public or nonprofit hospitals, schools of medicine, physician assistant training programs or other public/nonprofit entities. When? FY 2010 How Much? Authorizes $125 million for FY2010 and “such sums as necessary” for FYs 2011-2014. Authorizes $75 million for each FY2010-2014 for grants or contracts with medical schools What’s Next? Monitor appropriations process. Begin discussing opportunities with affiliated medical schools.

  26. Innovations & Funding Opportunities:Coverage and Access Programs to Expand Access to Primary Care Teaching Health Centers Development Grants What? Grants to teaching health centers to establish new accredited or expanded primary care residency programs. When? FY 2010 How Much? Authorizes $25 million for FY2010, $50 million for FY2011, $50 million for FY2012, and “such sums as may be necessary” for each fiscal year thereafter What’s Next? Watch for CMS guidance

  27. Innovations & Funding Opportunities:Workforce and Training Programs to Expand Access to Primary Care Program of Payments to Teaching Health Centers that Operate GME Programs What? Payments for direct and indirect operational expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for expansion of existing or establishment of new approved graduate medical residency training programs When? FY 2011 How Much? Up to $230 million is appropriated for FYs 2011 through 2015 What’s Next? Look for CMS guidance.

  28. Innovations & Funding Opportunities:Coverage and Access Programs to Expand Access to Primary Care Community Health Centers Fund What? Community Health Center Fund established for expanded and sustained national investment in community health centers. When? FY 2011 How Much? Appropriates $9.5 billion from FY2011 to FY2015 What’s Next? Look for HRSA guidance on qualifying criteria.

  29. Innovation & Funding Opportunities:Coverage and Access Vulnerable Patients Demonstration Project to Provide Access to Affordable Care for the Uninsured What? A three-year demonstration in up to ten states to provide access to comprehensive health care services to the uninsured at reduced fees When? Must be established 6 months after enactment How much? Authorizes such sums as necessary. Max each state can receive is $2 million. What’s next? Watch for CMS guidance. Approach state about interest. Beyond this demo, consider opportunities for transitional local coverage programs under a waiver.

  30. Innovation & Funding Opportunities:Coverage and Access Prevention & Chronic Disease Community Transformation Grants What? Competitive grant program for State and local governmental agencies and community- based organizations to implement, evaluate, and disseminate evidence-based community preventive health activities to address chronic disease and health disparities When? No start date specified How much? No funds authorized. No less than 20% of grants awarded to rural and frontier areas What’s next? Monitor appropriations.

  31. Innovation & Funding Opportunities: The Million Dollar Question WHICH OPPORTUNIT(IES) TO PURSUE?

  32. Innovation & Funding Opportunities: How to prioritize? • Consider: • Are programs funded? • Duration and start date • Interplay with state? • How do programs fit with their priorities? • What will they have the resources to focus on? • What is the combination of opportunities you are pursuing via federal reform -- are they complementary?

  33. Innovation & Funding Opportunities: How to prioritize? • Look internally and at your market first and consider: • Competitive positioning: • Where does your hospital need to be in the next 5 years? • Which programs help you get there and/or may give you a leg up? • Focus: • Key service areas that need strengthened? • Recurring problems? • Focal patients or conditions? • Strengths and Weaknesses: • How do community relationships, integration, etc position you for opportunities? • Can you build your open pilot programs via initiatives --- models you want to further test?

  34. Innovation & Funding Opportunities: How to prioritize? • Consider: • Resources: • Where do you have resource gaps? • Do you have sufficient staff time and resources to devote? Is there an opportunity cost of the project? • How will incoming resources interact/affect other funds flow? • Culture & Collaboration: • Is cultural change necessary in your organization/community necessary to implement? • How must you work with your state and/or partners to access opportunities?

  35. Innovation & Funding Opportunities: Implementation • HHS prioritizing all health reform activities based on implementation timeline • Agency staffing and restructuring top priority: • CMS awaiting confirmation of CMS Administrator, Dr. Donald Berwick • Peter Lee – new Director of Delivery System Reform in the HHS Office of Health Reform

  36. Innovation & Funding Opportunities: What to Expect Next • As implementation deadlines draw near, HHS and its agencies issue program details via guidance, call for proposals, and regulations • Look for NAPH updates: • Innovations & Funding Opportunities Chart • Read Newsline (weekly newsletter) • Website

  37. Suggested Next Steps • Provide feedback to NAPH about this call • Inform NAPH of your opportunities of interest • Invite your colleagues to next webinar on Exchanges & Health Plan Issues: • Health System CEO • Health Plan CEO • Chief Financial Officer • Government Relations Director • Others • June 17 at 2PM ET

  38. NAPH Resources • www.naph.org – Health Reform Implementation Section • NEW Innovations & Funding Opportunities Chart • Summary of safety net Issues in reform law • Timeline for reform implementation • Newsline – NAPH’s weekly e-newsletter • NAPH staff and counsel: • Sarah Mutinsky: sarah.mutinsky@ropesgray.com • Claudine Swartz: cswartz@naph.org

More Related