RGPPC Health Care Summit

August 29-30th
Washington, DC
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Note subject: RGPPC HC Summit
Listed below are all the panel session titles and discussion
points for the RGPPC Health Care Summit. In an effort to make
sure that the panels address the issues that are most important
to your state and assist in our networking efforts, we would
like to give you the opportunity to give us some feedback in
preparation for our conference. Please use the space below to
express any suggestions you may have on any of the panel
discussions.
May we publish your responses for other participants to see?
xYes
____ No
If yes, may we attribute your responses to you in the published
document for other participants to see? x Yes ____ No
Discussion Points and Questions for the Panel Sessions. Submitted by Dan
Derksen MD, Director, New Mexico Office of Health Care Reform. Dan.Derksen@state.nm.us

1. The Overreaching Burdensome Regulatory Environment

Point of Discussion: Will include a discussion on asset tests, pharmacy
costs and fraud waste and abuse, etc. as well as the impact of the
Obama Administrations harmful regulations on states
Streamlining regulation is essential to controlling cost growth and
spurring innovation for entitlement programs such as Medicaid. What
has CMS done to help states reduce duplicative and at times conflicting
regulations?
Have states with many waivers and incredibly
burdensome regulatory and reporting requirements been able to get a
single, unified waiver that allows the state flexibility to innovate?
2. Enhancing Personal Responsibility
Point of Discussion: Programs that have been successful- or could be
successful-- in requiring more personal responsibility
Comment: In New Mexico, a shared accountability model for the cost
and quality of health care included fiscal incentives / disincentives for

health plans, providers, and individuals enrolled in the State Coverage

Insurance (SCI) Plan, made possible by a CMS HIFA waiver. SCI
enrollees pay modest co-pays. These fiscal incentives / disincentives
decreased the no-show rate for primary care appointments, increased
adherence with preventive services, reduced unnecessary visits to
subspecialists, and reduced length of stay and hospitalization rates.
Yet vocal advocates vehemently oppose similar, evidence based
Medicaid interventions to:
encourage personal responsibility,
enhance cost awareness,
encourage appropriate use of primary and preventive services,
discourage over-utilization of unnecessary procedures, imaging,
lab, or expensive medications when less costly alternatives are
just as effective.
Questions: Are other states able to use Medicaid waivers to allow
flexibility in designing and implementing fiscal incentives /
disincentives to control cost growth in their Medicaid programs? Has
CMS facilitated these innovations? Have states found that the costs of
collecting co-pays end up reducing overall costs while maintaining
quality and access? Have Patient Centered Medical Home payments to
reward integration and coordination of care helped control cost growth
compared to the usual fee-for-service payment methodologies?
3. Healthcare Exchanges
Point of Discussion: A conversation on the various approaches to
healthcare exchanges
Comment: States have difficult choices (1) to take advantage of federal
dollars to set up their own Health Insurance Exchange (HIX), or to hold off
and risk having the federal government run the HIX for them, (2) to leverage
federal support to upgrade state Medicaid eligibility and enrollment IT
systems and link that to the IT systems that will be needed to run the HIX,
or to have separate systems and try to build costly interfaces later.
Questions: What are states deciding related to running their own HIX, and
linking or keeping separate the Medicaid and HIX eligibility and enrollment IT
Systems? Are the IT vendors able to deliver on their promises? How will
states, already struggling to balance budgets, assume the maintenance costs
of running an exchange, and operating the new IT systems? Can these (HIX
and the IT systems) really be self-sustaining by 2015?
4.

Medicaid Reforms: Waivers, Innovative Reforms and Pilot

Programs

Point of Discussion: Learn from other states, experts, and the

private sector regarding creative ideas to manage the current
Medicaid programs.
Questions: Are there examples of states using per-member-permonth (or quarter) payment methodologies to encourage coordination
and integration of care especially for the subset of patients with one or
more chronic diseases (ex diabetes) such as Patient Centered Medical
Home? Do these pilots use blended payment methodologies (a feefor-service and a per-member-per-month coordination / integration of
care payment) for their primary care providers? Does such payment
reform reduce overall per enrollee costs for Medicaid patients? In New
Mexico, legislation encouraged the vendors doing Medicaid managed
care to pilot such programs for Medicaid, CHIP and the HIFA waiver
State Coverage Insurance programs.
5. Improving Healthcare and Reducing Costs: A Discussion on Dual
Eligibles and Cost Containment
Point of Discussion: Discuss what states are doing to control costs and
what states need to effectively manage their dual eligibles program.
Question: While the number of enrollees in dual eligible programs in
New Mexico is small compared to the overall number of enrollees in
the Medicaid program, the cost generated by this group represents a
disproportionate share of the costs. Are there pilot programs that we
can look to in other states to address this dual eligible population?
6. What Medicaid Reform Should Look Like
Point of Discussion: What would repeal and replace look like? A
discussion to guide our work moving forward.
Question: How can states do contingency planning for both scenarios - the
tax mandate is / is not declared unconstitutional?
Considerable state
investment is necessary to ramp up for the expansion of Medicaid, and to
create the Health Insurance Exchange (HIX) infrastructure and operations.
Yet the federal appropriations for the expansion of Medicaid and the HIX are
uncertain. How can states best prepare if, for example, federal support of
Medicaid moves to a block grant methodology proposed in several versions of
the House budget, negotiations related to raising the debt ceiling, and now
kicked down the road to a small group of Members of Congress? What is the
most likely outcome of budget cuts related to Social Security Act entitlement
programs such as Medicaid? How can states, already struggling to balance
budgets, prepare for efforts to reign in the federal budget by driving cost
growth risk to states by using Medicaid block grants?