Prescription for Pennsylvania Presentation by Barbara J. Holland Chief Counsel Governor’s Office of Health Care Reform

1. Prescription for Pennsylvania Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Prescription for PennsylvaniaPresentation byBarbara J. HollandChief CounselGovernor’s Office of Health Care Reform PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

2. Prescription for Pennsylvania: The Need for Action Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com • Pennsylvania businesses suffer a competitive disadvantage in the global marketplace against companies from countries where health care costs less and is universally available. • Pennsylvania spends 11 percent more per person on health care than the U.S. average, and our health care costs are increasing twice as fast as average wages. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

3. Prescription for Pennsylvania: The Cost of Inaction Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com • Pennsylvania’s businesses, consumers and taxpayers pay at least $7.6 billion a year for unnecessary and avoidable health care costs. • Inaction would not only continue these unnecessary and avoidable costs, it would jeopardize the health and safety of our residents and perhaps even weaken the commonwealth's economic competitiveness. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

4. Prescription for Pennsylvania Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Prescription for Pennsylvania is a set of integrated practical strategies introduced by Governor Rendell in January, 2007 to: • Increase access to affordable health care coverage for all Pennsylvanians • Improve the quality of care delivered throughout the commonwealth • Help bring health care costs under control for employers and employees PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

5. Prescription for Pennsylvania Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Prescription for PennsylvaniaWill Reduce Health Insurance Costs • Putting all Rx for PA initiatives in place, including small group and individual insurance reforms would: • Lower average insurance cost over the next several years by nearly 25 percent • Slow the erosion of employer-sponsored insurance and make insurance rates more affordable and predictable for both employers and consumers • Consumers could realize a $2,000 savings on a $9000 policy. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

6. Prescription for Pennsylvania: Affordability, Access & Quality Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Rx for Affordability Cover All Pennsylvanians Coverage for College Students and Young Adults Community Benefit Requirements Uniform Admission Criteria Fair Billing and Collection Practices Capital Expenditures Small Group Insurance Reform Transparency of Cost and Quality Data • Rx for Access • Health Care Workforce • Removing Practice Barriers • CRNP’s • Physician Assistants • Nurse Midwives • CRNAs • Pharmacists • Cost-Effective Sites • Co-Occurring Disorders Rx for Quality Health Care Acquired Infections Quality Outcomes Technology Pay for Performance Chronic Care Health Disparities Child and Adult Wellness Long Term Living End of Life and Palliative Care PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

7. Prescription for Pennsylvania: Rx for Affordability Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Rx for Affordability • Cover All Pennsylvanians: • Legislation introduced in both houses. (HB 1870 & SB 1117) • Meetings ongoing with CMS to obtain federal matching funds • Coverage for College Students and Young Adults: • Legislation introduced in the House (HB 1556 & HB 2005) • Community Benefit Requirements: • In draft regulations • Uniform Admission Criteria: • In draft regulations. • Fair Billing and Collection Practices: • In draft regulations. • Capital Expenditures: • Draft Executive Order prepared. • Small Group Insurance Reform: • Legislation introduced in the House. • Transparency of Cost and Quality Data: • Website with prices of the 200 most commonly prescribed drugs available in PA pharmacies in the final stage of development. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

8. Prescription for Pennsylvania: Rx for Access Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Rx for Access • Health Care Workforce: • Legislation introduced in the House to institutionalize the PA Center for Health Care Careers, which has been effective in increasing the number of nursing graduates from PA nursing schools. • Removing Practice Barriers: • Scope of practice bills passed, for CRNPs, nurse midwives and dental hygienists. Scope of practice legislation introduced in the House for pharmacists, physical therapists, nurse anesthetists and physician assistants. Working with insurers to credential and include non-physician practitioners in all networks. • Cost-Effective Sites: • Requirement that hospitals have cost effective primary care available for those presenting at hospital emergency rooms who do not need emergency room care is in draft regulations. Funding obtained to start up additional Federally Qualified Health Centers, nurse managed centers and mobile wellness vans for medically underserved areas. RFPs issued and grants will soon be awarded. Working with insurers to include all cost-effective sites in networks where geographically appropriate. • Co-Occurring Disorders: • DPW and DOH are jointly credentialing mental health and substance abuse treatment providers who treat patients with co-occurring disorders. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

9. Prescription for Pennsylvania: Rx for Quality Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Rx for Quality • Health Care Associated Infections: • Legislation passed to require infection prevention procedures and reporting of health-care associated infections by hospitals. Implementation is ongoing. • Quality Outcomes: • Included in legislation for hospitals for hospital-acquired infections and in draft hospital regulations for other hospital quality measures. • Technology: • Hired Director of Technology. Developed architecture for statewide interoperability and electronic health records. • Pay for Performance: • DPW has implemented performance based contracting features in both Health Choices and ACCESS Plus contracts for primary care providers. In addition, some hospital disproportionate share funding has been used to reward quality-related activities for hospitals since 2006. Enhancements are planned for 2008-09. A $2 million grant program is also set up for hospitals to access for quality-related projects. ACCESS Plus has already demonstrated cost savings and better outcomes for patients for patients with chronic diseases. • Chronic Care: • Executive Order created a Commission to make recommendations on establishing the infrastructure to change how chronic care is delivered across Pennsylvania. Strategic plan was presented to the Governor and Legislative Leadership in February. Implementation of the chronic care model will begin in Philadelphia in May, and in other regions of the state in September. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

10. Prescription for Pennsylvania: Rx for Quality (cont.) Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Rx for Quality (continued) • Health Disparities: • Executive Order established Office of Health Equity. Funding received to provide • grants to increase minority health care providers. • Child Wellness: • Increased funding for subsidized school breakfasts and improved health curriculums. • Adult Wellness: • Smoking ban has passed both Houses and is being considered by conference committee. • Long Term Living: • Assisted Living Residence licensure law passed, barriers to timely receipt of home and community waiver services eliminated, nursing home transition program established, regular meeting of the Long Term Living Cabinet and joint Deputy reporting to Aging and DPW. • End of Life and Palliative Care: • Advanced Directive bill enacted. DOH working on hospice regulations to include small residential hospices. • Cost /benefit analysis of mandating provision of palliative and hospice services planned. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

11. Prescription for Pennsylvania Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com 2008-09 Budget Initiatives PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

12. Prescription for Pennsylvania: 08-09 New Budget Initiatives Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com • $25.1 Million in State and Federal Funds • $5 million- to start Pennsylvania Health Information Exchange (PHIX), a 5-year project to create platform to share patient health care information, with investment from health care providers and insurers. Statewide implementation of e-Prescribing and Electronic Medical Records, are necessary steps for building PHIX. • $1.8 million - to increase access to primary medical and dental care in underserved areas through a new nurse loan repayment program, an enhanced primary care practitioner loan repayment program and an expanded community challenge grant program. • $100,000 – to assess the opportunities for increasing the availability of hospice and palliative care services for children PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

13. Prescription for Pennsylvania: Ongoing Initiatives Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com • $6.5 million – to provide financial incentives for local education agencies to increase the availability of nutritious foods for students. • Status: More than 500 local education agencies are currently participating in the School Nutrition Incentive program. • $4.6 million – to develop standardized identification and reporting of health-care-associated infections by hospitals and provide training in infection-control best practices. • Status: The Governor’s Office of Health Care Reform is coordinating the activities of the Department of Health and the Patient Safety Authority to implement the provisions of Act 52 of 2007. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

14. Prescription for Pennsylvania: Ongoing Initiatives Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com • $2.9 million – to increase access to primary health care in underserved rural areas • Status: Providers have been selected to establish a new community health center to serve the Gettysburg area and two mobile health clinics to serve Forest, Venango and Greene counties. • $2.2 million – to implement a comprehensive, evidence-based chronic-care management model for persons with chronic disease. • Status: The Chronic Care Management, Reimbursement and Cost Containment Commission presented the Governor with a strategic plan to improve the delivery of health care to Pennsylvanians who require chronic-care. Report issued February 13 – pilots to start in May, with statewide rollout by September. PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

15. Prescription for Pennsylvania: Ongoing Initiatives Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com • $700,000 – to manage and coordinate Prescription for Pennsylvania implementation • $515,000 – to enhance the delivery of health messages through an integrated and coordinated approach to health literacy • $500,000 – to increase the number of health professionals equipped to address the needs of racial and ethnic minorities • $266,000 – to expand premium rate review authority to all insurers providing coverage in the small employer market • $30,000 – to assist elementary school teachers with integrating healthy living concepts into lesson plans PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now

16. Prescription for Pennsylvania: Pending Initiatives Edward G. Rendell, Governor – Rosemarie B. Greco, Director, Office of Health Care Reform www.RxforPA.com Critical Legislative Action Still Needed • Provide uninsured adults access to affordable health care coverage through the new Cover All Pennsylvanians program • Make all Pennsylvania workplaces, restaurants and bars smoke free • Reduce cost and stabilize health insurance premiums for small employers with small group reforms, including modified community rating PRESCRIPTION FOR PENNSYLVANIA Right State| Right Plan| Right Now