March 7, 2013

At the forefront of designing and implementing innovative payment and delivery reforms in health care, states are approaching the task through a range of strategies, from Medicaid-supported investments in primary care capacity to multi-payer efforts that shift reimbursement methods from volume to value. Although state efforts predate the Affordable Care Act, many states are building upon new opportunities contained in the federal law. Ideas that are first incubated and tested in the states often become models for national policy and practice. In addressing states’ efforts, Mr. Weil discussed payment and delivery system reform; reflected on the challenges and lessons learned thus far; provided advice on making the most of federal opportunities; and led a discussion on how states, such as New York, can advance reform agendas and provide leadership for the nation.

Mr. Weil began the discussion by posing a two-part question: “Where are you now and where do you want to go?” He emphasized that each state first must acknowledge its starting point, and then base subsequent interventions on what direction it wants to move toward reform. Given a state’s unique set of characteristics, each state will need to determine its own model or strategy. There is no one-size-fits-all solution. States can, however, learn from one another by examining ideas, tools, and processes that emerge in different places.

Attendees included health care providers; insurers; consumers; representatives from the State and local government; and funders. A defining question of the discussion was whether the health care industry should focus on cutting 5% of health care system costs, or if it should be on a path toward cutting something on the order of 30-40% of costs? While Mr. Weil offered no one answer, he underlined that these are two different conversations and require different approaches. The event emphasized the importance of asking these difficult questions, and initiated a conversation about ways to transform the health care system in fundamental ways.

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