Michigan & DCH 3.0 Era of Innovation

1. Michigan & DCH 3.0Era of Innovation UPHCN Trustee Forum March 25, 2011

2. Content • Governor Snyder’s strategic direction………………………. 3-9 • DCH: Values, Mission, Vision…………………………………….. 10-13 • How DCH will accomplish its vision during 2011-2013.. 14-18 • Strategic Priorities for this year: Jan. – Dec. 2011……… 19 • Operating performance metrics…………………………………. 20-22 • 2012 Budget………………………………………………………………. 23-37 • Personal change curve……………………………………………….. 41

3. Michigan 3.0 • Michigan has undergone fundamental transformations before with great success. (1.0) Natural resource economy (2.0) Industrial economy (3.0) Era of Innovation Governor Snyder’s vision is Michigan 3.0, an era of innovation that transforms our society into a vibrant force of entrepreneurs and innovators that can compete in the global economy.

4. Top 10 Plan • Create More and Better Jobs • Cultivate a thriving and globally competitive economy with a diverse business base, enabling job growth and prosperity • Reform Michigan's Tax System • Reduce the tax burden on families and businesses in Michigan • Reform Michigan's tax system so it facilitates economic growth by being simple, fair, competitive and efficient • Fix Michigan's Broken Government • Restore ethics, accountability and transparency to state and local government • Governing that is solution oriented • Taxpayers will get results for their tax dollars

5. Top 10 Plan • Create an Environment that Will Keep Our Youth in Michigan • Restore Cities and Control Urban Sprawl • Improve the state's city centers and create attractive living and working environments for its citizens • Infrastructure and transportation funding must be prioritized • Supports the establishment of a proper mass transit backbone in the state • Enhance Michigan's National and International Image • Encourage and support tourism • Create a culture of entrepreneurship • Invest in the arts • Protect and improve the quality of life for citizens

6. Top 10 Plan • Protect Michigan's Environment • Protecting the environment and growing the economy can be done simultaneously • Michigan needs to be a leader in alternative and cleaner energy • Reform Michigan's Educational System • A child's progress from pre-kindergarten through college and advanced degrees is the cycle on which the state's efforts should be focused and coordinated • Schools, teachers and parents must renew their commitment to ensuring that each child is given the best possible preparation and education for life

7. Top 10 Plan • Reform Michigan's Health Care System • Every citizen should have access to affordable and quality health care • The Governor strongly believes in prevention, wellness and personal responsibility • Move Michigan to a more patient-centered model to achieve large cost savings, promote wellness, and improve overall service quality • Bring “Winning Back to Michigan” • Create a hopeful, positive culture and attitude where personal responsibility and collective determination introduce us to a new era. • Embrace our racial, social and geographic diversity to reach common goals for the state http://www.michigan.gov/midashboard

8. White Papers for Reinventing Michigan • Aquatic Invasive Species • MEDEC Reform • Growing Michigan Agriculture • Eliminating the Michigan Business Tax (MBT) Replace with flat 6% corporate income tax, $1.5 M net reduction) • Regulatory Reform • Value for Money Budgeting • Youth Retention Central Cities Michigan’s International Image Protect Michigan’s Environment General Efficiency and Transparency Reform Michigan’s Educational System Reform Michigan’s HealthCare System Bringing Winning Back to Michigan Ethics Reform http://www.michigan.gov/midashboard

9. Health Care Reform – White Paper “Michigan’s citizens should have access to the highest quality care available. As Governor, I will manage rising costs by implementing innovative management strategies, expand access through community based solutions, and promote wellness programs that identify health problems before they become chronic or more serious.” ~ Governor Rick Snyder Promote wellness programs to reduce costs, improve quality of life, and increase the chances of detecting health conditions before they become chronic. Create Patient-Centered Medical Homes for Medicaid populations not enrolled in coordinated care programs to improve the quality and efficiency of care. Increase Medicaid reimbursement rates. Use Federally Qualified Health Centers to increase access and reduce costs. Leverage community solutions to provide immediate support for high-risk populations. Implement Health IT initiatives to reduce administrative costs, enhance fraud protection, and eliminate costly redundant testing. Create a catastrophic event coverage policy to help Michigan’s citizens.

10. Department of Community Health Operations Administration Medical Services Administration Health Policy and Regulation Administration (Reorganization in process) Public Health Administration Behavioral Health Dev. Disabilities Administration Office of Services to The Aging

11. Our Values

12. Our Mission MDCH will protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations.

13. Our VisionDCH 3.0 Improve Health, Improve Care, Lower CostsThrough Competitive and Collaborative Organized Systems of Care

14. We will Accomplish Our Vision By:2011 - 2013 • Improving the health of our population: • Investing in wellness and disease prevention to improve the health status of the population, particularly in the areas of obesity and infant mortality. Work with foundations, employers, health systems, local public health systems, and other stakeholders to leverage and channel dollars already being spent in these and other areas of wellness. • Reducing obesity. • Reducing infant mortality. • Continuing to provide state of emergency preparedness during threats to public health and addressing human health issues. • Continuing surveillance of and response to public health threats. • Adapting public health code to changing industry.

15. Michigan Dashboard: Obesity, Infant Mortality

16. We will Accomplish Our Vision By:2011 - 2013 • Improving the health care provided to our population. • Promoting patient-centered medical home concept. • Promoting development of FQHC’s. • Improving access to OB services in NE Michigan. • Evaluating Alzheimer’s population and defining systems of care solutions. • Promoting growth of primary care professionals and extenders. • Creating provider incentives for quality. • Integrating physical health and behavioral health to ensure patients receive optimal benefit from integrated services. • Evaluating psychiatric hospitals’ investment needs to ensure patients receive the best possible care. • Becoming better purchasers of services requiring performance on service level agreements from contracted providers and entities.

17. We will Accomplish Our Vision By:2011 - 2013 • Lowering the health care costs per person in our state. • Enhancing collaborative opportunities through partnerships with foundations and granting agencies. • Moving the remaining populations from fee for service programs into managed care systems. • Reforming/reinventing Michigan’s health system infrastructure to reduce administrative and unnecessary health delivery costs. • Evaluating our internal operations looking for opportunities where we can apply process improvements techniques, combine like functions where feasible, use technology, and apply other cost reduction techniques. • Leveraging federal financing opportunities when it is the best course of action for Michigan. • Evaluating our behavioral health and developmental disability administrative services for cost effectiveness. • Continue to promote electronic health records (EHR) and implement the Michigan Health Information Network (HIE) to achieve effective statewide and national connectivity. • Implement 2012 Budget.

18. We will Accomplish Our Vision By:2011 - 2013 • Planning and Implementing Health Care Reform if Feasible. Planning for each major area of the Affordable Care Act with wide input from stakeholders. • Expansion of Medicaid services to higher eligibility levels, 133% of FPL. • Health insurance exchange as it relates to Medicaid eligibility processes and benefit design. • Integration of the delivery and financing of Medicare and Medicaid dual eligible population. • Increase in the fee-for-service and managed care payments to 100% of Medicare during 2013 and 2014 for primary care services provided by family medicine, general internal medicine, and pediatric medicine practitioners. • Implementation of patient centered medical home demonstration projects. • Promotion of FQHCs (Federally Qualified Health Centers). • Integration of behavioral health with physical health. • Demonstration projects for public health and disease prevention. • Reduction of aggregate Medicaid DSH allotments as the number of uninsured in Michigan decrease. • Robust deployment of waste, fraud, and abuse programs in Medicare and Medicaid. • Permit employers to offer employee rewards for participating in wellness programs.

19. Strategic PrioritiesJanuary 2011 – December 2011 • Improve the health of our population: • Implement statewide stakeholder plan for obesity. (Chabut) • Implement statewide stakeholder plan for infant mortality. (Chabut) • Improve the health care provided to our population: • Implement patient-centered medical home demonstration grant. (Fitton) • Be a catalyst to create OB services access in northeast Michigan. (Chabut) • Develop plan to promote FQHCs in the state. (Brim) • Implement plan to promote integration of behavioral and physical health, including health homes (ACA 2703). (Head) • Lower the health care costs per person in our State. • Obtain grants from foundations for statewide planning: obesity, infant mortality, health system reform, FQHCs. (Brim) • Implement Office of Health Inspector General to reduce fraud, waste, abuse. (Krause) • Develop and implement internal audit plan with links to OHIG, DTMB, DHS, Auditor General, CMS. (Lyon) • Move fee for service programs into managed care. • Children with special health care needs. (Fitton) • Medicare and Medicaid Dual Eligibles. (Fitton) • Implement 2012 Budget. (Lyon) • Plan and implement health care reform if feasible. • Implement multidisciplinary bureau that focuses on planning and implementing health reform. (Priest) • Plan expansion of Medicaid to 133% of FPL. (Priest) • Complete health insurance exchange plan design and consider conclusions for implementation. (Priest) • Obtain planning grant for integration of dual eligibles and implement. (Fitton) • Implement 2013 and 2014 physician fee schedule increase to 100% of Medicare. (Fitton) • Expand Aging and Disability Resource Centers. (Brey) • Expand long term care option counseling through Community Living Program. (Brey) • Identify other health reform opportunities that meet Gov. Snyder’s reform goals. (Priest)

20. Questions?