National Health Policy Conference (Day 2)

The second day of the National Health Policy Conference started bright and early with two simultaneous discussions. I attended one on the interactions between Medicaid and the ACA Marketplaces.

Medicaid & the Marketplaces (aka “When Churn Happens”)

Arkansas and Iowa are important examples of Medicaid premium assistance models for expanding Medicaid under the Affordable Care Act. But states such as Vermont and Utah might serves as better examples of how to create a converged marketplace. Vermont, of course, is moving their system towards a single-payer model using expanded Medicaid and ACA Marketplaces as a foundation. Utah is pursuing the opposite approach and trying to get a unified private marketplace. Several important factors were identified as helpful for forming this successful convergence of markets, none more important than accounting for Medicaid churn.

Churn, for those unfamiliar with the term, is when someone moves on or off Medicaid as a result of changes in eligibility. These changes may be due to income, household size, aging out, or situations such as pregnancy or disability. The Arkansas private option effectively eliminates churning since (private) coverage can be maintained regardless of income or other patient characteristics.

Congressional Plenary with Rep. Rob Wittman (R-VA)

Congressman Wittman, a representative from Virginia who has an MPH and a PhD in public policy, spoke to conference attendees on day 2. He echoed the call for transparency in billing and health care pricing. He focused on empowering patients and providers noting that currently the payers were in the driver’s seat. Wittman recited common Republican thoughts of tort reform and selling insurance across state lines. However, some novel thoughts emerged. One would provide tax credits for providers who deliver care pro bono in free clinics to encourage care for the underserved.

Congressional staffers noted that SGR repeal is likely (as long as the money to pay for it can be found). However, do not expect much legislative action on Ryan White funding, long-term care, or extending that Medicaid payment bonus for primary care during this session.

Obesity Prevention

Click to enlarge.

Penn’s Shiriki Kumanyika provided a few great points about using evidence to inform policy:

1. Invest in the most promising interventions where relevant evidence exists

2. Be systematic and transparent in weighing all relevant info where optimal evidence doesn’t exist

3. Use multiple disciplinary approaches to expand tools for generating policy relevant evidence

However, the overall obesity prevention session can best be summed up in this info graphic which illustrates that although medical care accounts for only about 10% of what makes us healthy we spend 88% of our resources on medical services.

Innovation Models in the States

Back to the theme of implementing multiple payer models of care, the final break out session of the conference had experts from CMS, Arkansas, and Massachusetts exploring lessons learned. Three main challenges when implementing multi-payer models emerged: (a) engaging all payers, (b) aligning incentives, and (c) getting to the community level. In Arkansas, their Medicaid private option helped with the partnership of state government employees insurance and private providers such as Walmart to align incentives for the transformation to patient-centered medical homes.  The caveat for those individuals trying to innovate elsewhere, however, is that everyone wants to align but nobody wants to change. Nevertheless, alignment of incentives is a key factor moving forward with health reform.

Summary

I came away with a few themes from this year’s National Health  Policy Conference:

  • Policy makers and payers in the public and private section need to cooperate and start aligning incentives for providers
  • There needs to be a focus on social determinants of health and the built environment
  • Medical care and (public) health are on a spectrum
  • Price transparency is right around the corner
  • SGR repeal is very close and very likely this year

See you back in DC in 2015!

by

Cedric Dark, MD, MPH

Did you miss the summary of day 1? Click here.