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Health System Reform in Kansas: Health System Reform in Kansas: Context, Challenges and CapacityContext, Challenges and Capacity

Marci Nielsen, PhD, MPHExecutive Director, Kansas Health Policy Authority

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ObjectivesObjectives

Challenge: Failing national health systemChallenge: Failing national health system Context: Health reform from perspective of Context: Health reform from perspective of

StatesStates Capacity: What’s happening in KansasCapacity: What’s happening in Kansas

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Challenges….Challenges….

A Failing National Health “System”A Failing National Health “System”

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Rising Rates of UninsuredRising Rates of Uninsured

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Insurance AffordabilityInsurance Affordability

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Getting what we pay for?Getting what we pay for?

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Context:Context:

States Attempts to Improve the States Attempts to Improve the “System”“System”

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What are states trying?What are states trying? Premium assistance programsPremium assistance programs::

• States subsidies to low-income uninsured individuals to States subsidies to low-income uninsured individuals to purchase private insurance; purchase private insurance;

New insurance productsNew insurance products: : • High Deductible/Consumer Driven Plans: Extends more High Deductible/Consumer Driven Plans: Extends more

affordable coverage to small businesses, self-employed affordable coverage to small businesses, self-employed individuals; individuals;

Tax creditsTax credits: : • For small businesses who offer health care and contribute For small businesses who offer health care and contribute

toward employees' health insurance expenses; toward employees' health insurance expenses; Children's health coverageChildren's health coverage: :

• Expansion through both SCHIP program and innovative 1115 Expansion through both SCHIP program and innovative 1115 waivers; waivers;

Access to community health centersAccess to community health centers: : • As an alternative, non-emergent care option for uninsured As an alternative, non-emergent care option for uninsured

populations seeking primary care services. populations seeking primary care services.

Source: National Governors Association, 2006

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State leadership, but…State leadership, but… ““Laboratories of Democracy” for Laboratories of Democracy” for

innovative reform, but…innovative reform, but… Must have for federal assistance withMust have for federal assistance with

• Health insurance reform (ERISA pre-Health insurance reform (ERISA pre-emption)emption)

• Cost containment strategiesCost containment strategies• Growing cost of Medicaid (Long Term Growing cost of Medicaid (Long Term

Care) as population agesCare) as population ages• Standards for HIT/HIE interoperabilityStandards for HIT/HIE interoperability• Resolving “Border Issues”Resolving “Border Issues”

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Capacity:Capacity:

What’s Happening in Kansas?What’s Happening in Kansas?

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Created in 2005 Legislative SessionCreated in 2005 Legislative Session Built on Governor Sebelius’ “Executive Built on Governor Sebelius’ “Executive

Reorganization Order” Reorganization Order” Modified by State Legislature to:Modified by State Legislature to:

• Create a nine member Board to govern health Create a nine member Board to govern health policypolicy

• Executive Director reports to BoardExecutive Director reports to Board• Added a specific focus on health promotion and Added a specific focus on health promotion and

data driven policy makingdata driven policy making

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The general charge of the Authority The general charge of the Authority is to:is to:• (1) develop and maintain a coordinated (1) develop and maintain a coordinated

health policy agenda that health policy agenda that • (2) combines effective purchasing and (2) combines effective purchasing and

administration of healthadministration of health care care • (3) with health promotion oriented (3) with health promotion oriented

public health strategiespublic health strategies• (4) which is driven by health data (4) which is driven by health data

2005 Summary of Legislation, Kansas Legislative Research Department

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July 1, 2005

January 1, 2006

March 1, 2006

July 1, 2006

2007 Legislative Session

2008 Legislative Session

Kansas Health Policy Authority Established. Transfer programs of programs to a Division first, then to a separate agency.

Assume responsibilities of Health Care Data Governing Board and oversight of KS Business Health Partnership program.

Authority plan for various program transfers submitted to Legislature.

Transfer programs to Authority.

Authority plan for additional program transfers submitted to 2007 and 2008 Legislatures.

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KHPA Board MembersKHPA Board Members

Nine voting board members Nine voting board members • Three members appointed by the GovernorThree members appointed by the Governor• Six members appointed by legislative leaders. Six members appointed by legislative leaders.

Seven nonvoting, Seven nonvoting, ex officio ex officio members members include:include:• Secretaries of Health and Environment, Social Secretaries of Health and Environment, Social

and Rehabilitation Services, Administration, and Rehabilitation Services, Administration, and Aging; the Director of Health in the and Aging; the Director of Health in the Department of Health and Environment; the Department of Health and Environment; the Commissioner of Insurance; and the Executive Commissioner of Insurance; and the Executive Director of the Authority.Director of the Authority.

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Programs Transferred to KHPA Programs Transferred to KHPA in 2006in 2006

MedicaidMedicaid (Regular Medicaid)(Regular Medicaid)

MediKanMediKan

State Children’s Health State Children’s Health Insurance ProgramInsurance Program

Ticket to Work/Working Ticket to Work/Working HealthyHealthy

Medicaid Management Medicaid Management Information SystemInformation System

Medicaid Drug Utilization Medicaid Drug Utilization Review & related programsReview & related programs

State Employee Health State Employee Health InsuranceInsurance

State Workers State Workers CompensationCompensation

Health Care Data Health Care Data Governing BoardGoverning Board

Business Health Business Health Partnership ProgramPartnership Program

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Where is KPHA going in Where is KPHA going in the future?the future?

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Vision PrinciplesVision Principles

Adopted by the Board last monthAdopted by the Board last month Will provide direction to the Board as Will provide direction to the Board as

they and this agency develops and they and this agency develops and maintains a coordinated health policy maintains a coordinated health policy agendaagenda

Guiding framework of the Board and Guiding framework of the Board and the work the Agency intends to the work the Agency intends to accomplishaccomplish

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Access to CareAccess to Care

Kansans should have access to patient centered Kansans should have access to patient centered health care and public health services which health care and public health services which ensure the right care, at the right time, and at the ensure the right care, at the right time, and at the right place.right place.

Indicators:Indicators:• (1) Health insurance status;(1) Health insurance status;• (2) Health professions workforce;(2) Health professions workforce;• (3) Safety net stability;(3) Safety net stability;• (4) Medicaid eligibility;(4) Medicaid eligibility;• (5) Health disparities(5) Health disparities

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Quality and EfficiencyQuality and Efficiency

The delivery of care in Kansas should emphasize The delivery of care in Kansas should emphasize positive outcomes, safety and efficiency and be positive outcomes, safety and efficiency and be based on best practices and evidence-based based on best practices and evidence-based medicine.medicine.

IndicatorsIndicators• (1) Use of Health Information Technology/Health (1) Use of Health Information Technology/Health

Information Exchange;Information Exchange;• (2) Patient Safety;(2) Patient Safety;• (3) Evidence based care;(3) Evidence based care;• (4) Quality of care;(4) Quality of care;• (5) Transparency (of cost and quality of health (5) Transparency (of cost and quality of health

information).information).

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Affordable & Sustainable Health CareAffordable & Sustainable Health Care

The financing of health care and health promotion The financing of health care and health promotion in Kansas should be equitable, seamless, and in Kansas should be equitable, seamless, and sustainable for consumers, providers, purchasers, sustainable for consumers, providers, purchasers, and government.and government.

IndicatorsIndicators• (1) Health insurance premiums;(1) Health insurance premiums;• (2) Cost sharing by consumers;(2) Cost sharing by consumers;• (3) Uncompensated care;(3) Uncompensated care;• (4) Medicaid and SCHIP enrollment;(4) Medicaid and SCHIP enrollment;• (5) Health and health care spending.(5) Health and health care spending.

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Health and WellnessHealth and Wellness

Kansans should pursue healthy lifestyles with a Kansans should pursue healthy lifestyles with a focus on wellness as well as a focus on the focus on wellness as well as a focus on the informed use of health services over their life informed use of health services over their life course.course.

IndicatorsIndicators• (1) Physical fitness;(1) Physical fitness;• (2) Nutrition;(2) Nutrition;• (3) Age appropriate screening;(3) Age appropriate screening;• (4) Tobacco control;(4) Tobacco control;• (5) Injury control.(5) Injury control.

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Responsible StewardshipResponsible Stewardship

The KHPA will administer the resources entrusted to The KHPA will administer the resources entrusted to us by the citizens and the State with the highest us by the citizens and the State with the highest level of integrity, responsibility and transparency.level of integrity, responsibility and transparency.

IndicatorsIndicators• (1) Open decision making;(1) Open decision making;• (2) Responsible spending;(2) Responsible spending;• (3) Financial reporting;(3) Financial reporting;• (4) Accessibility of information;(4) Accessibility of information;• (5) Cooperation with the Centers for Medicare and (5) Cooperation with the Centers for Medicare and

Medicaid Services—our federal partners for the Medicaid Medicaid Services—our federal partners for the Medicaid and SCHIP programs.and SCHIP programs.

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Education & Engagement of the PublicEducation & Engagement of the Public

Kansans should be educated about health and Kansans should be educated about health and health care delivery to encourage public health care delivery to encourage public engagement in developing an improved health engagement in developing an improved health system for all.system for all.

IndicatorsIndicators• (1) Advisory Council Participation;(1) Advisory Council Participation;• (2) Data Consortium Participation;(2) Data Consortium Participation;• (3) Public communication;(3) Public communication;• (4) Community/Stakeholder/Advocacy Partnership;(4) Community/Stakeholder/Advocacy Partnership;• (5) Foundation Engagement.(5) Foundation Engagement.

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