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State Health Insurance Exchanges Gregg A. Pane, MD, MPA

National Capital Area Chapter of the Health Information Management & Systems Society September 16, 2010. State Health Insurance Exchanges Gregg A. Pane, MD, MPA Director, Virginia Department of Medical Assistance Services. Where We Are: Virginia Health Reform Initiative.

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State Health Insurance Exchanges Gregg A. Pane, MD, MPA

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  1. National Capital Area Chapter of the Health Information Management & Systems Society September 16, 2010 State Health Insurance Exchanges Gregg A. Pane, MD, MPA Director, Virginia Department of Medical Assistance Services

  2. Where We Are:Virginia Health Reform Initiative • On August 16, Governor McDonnell announced the members of his Virginia Health Reform Initiative (VHRI) Advisory Council • Dynamic group of leaders from the legislature, health care delivery, health care policy, health insurance and the business community • Recommendations on a comprehensive strategy for implementing health reform • Ensuring a safe, effective and high quality healthcare delivery system while reducing costs

  3. Virginia Health Reform Initiative • Advisory Council to go beyond federal health reform and recommend other innovative healthcare solutions • Create an improved health system that is an economic driver while allowing for more effective and efficient delivery of high quality health care at lower cost.  • Staffed by the Office of the Secretary of Health and Human Resources (OSHHR) • Cindi B. Jones, Director of the VHRI • Previously served as the Interim Director and Chief Deputy Director of DMAS

  4. Virginia Health Reform Initiative • Initial meeting of Advisory Council on August 20 and 21 in Roanoke • Task forces established in six key areas • Medicaid Reform • Insurance Market Reform • Delivery and Payment Reform • Capacity • Technology • Purchasers Perspective • Additional health stakeholders and business representatives will serve on task forces

  5. Virginia Health Reform Initiative • Applied for the State Planning and Establishment Grant for the Affordable Care Act’s Exchanges • DMAS designated as grant applicant to work in close cooperation with the OSHHR and VHRI • Goals of the grant include: • Completing the research and analysis necessary to give Virginia’s decision makers the best information possible • Facilitating a decision on whether Virginia will establish a health benefit exchange

  6. The Patient Protection and Affordable Care Act (PPACA)Impact on Virginia • Health reform will affect all Virginians • Impact on all but the smallest employers • Substantial change to health insurance market • More business, more regulation • New, unprecedented function (Exchange) offered to states • Dramatic expansion of Medicaid and CHIP • Subsidies for previously unassisted individuals and families

  7. Lessons Learned • Existing state exchange experiences: • An exchange can be effectively operated • Health insurance premiums may not be reduced • Primary care physician availability may be impacted • State budget may be impacted • Successful health reform in Virginia will require involvement and support from many leaders and stakeholders • Upfront analysis and design will be time consuming and resource intensive

  8. Data Sharing Concerns • Effective communication of accurate information in a timely manner from the federal government to the state is imperative • Information standards and code sets need to be “harmonized” • COV HIT Standards Advisory Committee (HITSAC) established under the code of Virginia • Data sharing agreements

  9. How Industry Can Help • HIT is extremely important not only to the success of the health reform initiative, but to the overall improvement of patient care in the U.S. • Comprehensive management of health information to enable sharing of patient records securely with their providers • Health providers have ready access to complete patient information in a standard, electronic form • Improve chronic disease management and increase early detection of disease outbreaks • Improve health care quality, prevent medical errors and reduce costs through increased administrative efficiency

  10. How Industry Can Help • HITSAC will be harmonizing health related standards for Virginia • MITA Technical Architecture Standards specified for both the COV-HIE and COV State Government Gateway • MITA Technical Architecture will be leveraged for HIE and health reform initiatives • Information Architecture to be based on HL7 Services Aware Interoperability Framework (SAIF) using Reference Information Model (RIM) version 3

  11. How Industry Can Help • Monitor HITSAC progress (meeting public and information posted on VITA web site) • Align your organizational standards to HL7 for future interoperability with COV systems

  12. Additional References • Medicaid Information Technology Architecture (MITA) • http://www.cms.gov/MedicaidInfoTechArch/ • Commonwealth of Virginia (COV) Health Information Exchange (HIE) Draft Strategic and Operational Plans • http://www.hits.virginia.gov/ • Commonwealth of Virginia Draft State Medicaid HIT Plan (SMHP) • http://www.hits.virginia.gov/ • Health Level 7 • http://www.hl7.org/ • Health Information Technology Standards Advisory Committee (HITSAC) • https://www.vita.virginia.gov/ITIB/default.aspx?id=9706

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