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3 Who We Are We re a coalition of concerned Kentuckians, over 250 organizations and individuals, who believe that the best health care solutions are found when everyone works together to build them. Right now, families and businesses in every county are facing rising costs, and too many of us go without needed health care. Healthy families create healthy economies. And a healthy Kentucky is something we all want. So we re working step by step to build a healthier Kentucky for everyone.

4 What We Do KY Voices for Health fosters collaboration among organizations and individuals around common areas for improvement, bringing together a broad sector of advocates to speak with one voice and have a greater impact. Advocated for increasing the tobacco tax, and smoking cessation Advocated to remove barriers to the enrollment of children eligible for KCHIP Received the MediStar Seven Counties Services Health Advocacy Award in 2011

5 Our Key Priorities Assuring that all Kentuckians have access to high quality, affordable healthcare Making prevention a priority for Kentucky s health policies and programs Improving the efficiency and effectiveness of health care for Kentuckians Improving the health of Kentucky s children

6 The Changing Landscape of Healthcare in Kentucky Kentucky s Move to Medicaid Managed Care Implementation of Healthcare Reform Transparency in the World of Healthcare Maintaining a Focus on Prevention

7 Implementation of Healthcare Reform As the Affordable Care Act is implemented across the nation, it is important that the public is educated and engaged and that access to care, efficiency and effectiveness in the system and covering the uninsured remain a priority.

8 Ensuring Access to Care New insurance rules will promote fairness and provide security to families New health insurance exchanges will allow consumers and small businesses to buy affordable coverage and compare health plans Medicare will improve for seniors Primary care providers practicing in underserved areas will receive a 10% increase in Medicare payments

9 Ensuring Efficiency and Effectiveness Health insurers will have to spend at least 80% of the premiums they collect on medical services Medicare payments will be linked to quality outcomes through a hospital value-based purchasing program New Medicare/Medicaid payment incentives will encourage hospitals to reduce preventable readmissions

10 Covering the Uninsured Families will be given subsidies based on income to buy insurance through the exchanges, substantially reducing costs Small businesses will receive tax credits, ranging from 35% to 50%, to provide health coverage to employees Medicaid MAY be expanded to cover additional Kentuckians with incomes up to 133% of the federal poverty level

11 Need for Coverage Over 650,000 uninsured Kentuckians KY Health Report Card - opportunity for improvement! 45 - Outcomes Rank 43 - Overall Rank 49 - Smoking Rank 46 - Obesity Rank Nearly $600 million is spent on uncompensated care each year. (A KHA report estimated it is far higher: $1.67 billion in 2010.) 11

12 ACA s Prevention and Public Health Fund: Kentucky The Prevention and Public Health Fund offers an unprecedented investment in promoting wellness, preventing disease, and protecting against public health emergencies. Much of this work is done in partnership with States and communities. States and communities are using Prevention Fund dollars to: help control the obesity epidemic fight health disparities detect and quickly respond to health threats reduce tobacco use train the nation's public health workforce modernize vaccine systems prevent the spread of HIV/AIDS increase public health programs effectiveness and efficiency improve access to behavioral health services

13 Preventive Services Covered Under the ACA If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider. Covered Preventive Services for Adults Depression screening for adults Covered Preventive Services for Women, Including Pregnant Women Domestic and interpersonal violence screening and counseling for all women Covered Preventive Services for Children Behavioral assessments for children of all ages Depression screening for adolescents

14 Health Homes Under the ACA Sec & Sec (e) States may apply for grants build a personcentered health home that results in improved outcomes for beneficiaries and better services and value for State Medicaid and other programs, including mental health and substance abuse agencies. SAMHSA developed a Guidance Document for States as they consider taking advantage of the Section 2703 provision for people with behavioral health (i.e., mental health and substance abuse, MH/SA) disorders. The document serves as a checklist of key behavioral health questions. By providing States this structured background regarding the core elements of the Section 2703 health home, SAMHSA aims to ensure that key behavioral health topics are considered as States develop health home proposals.

15 SAMHSA - HRSA Center for Integrated Health Solutions The SAMHSA-HRSA Center for Integrated Health Solutions, run by the National Council for Community Behavioral Healthcare under a cooperative agreement from the U.S. Department of Health and Human Services, is funded jointly by SAMHSA and HRSA. The Center promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. For more information about the Center for Integrated Health Solutions, go to thcare_collaboration/overview/about_the_center.

16 Accountable Care Organizations An ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve with traditional Medicare (not Medicare Advantage). The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries. The ACO would be a patient-centered organization where the patient and providers are true partners in care decisions.

17 Accountable Care Organizations The Affordable Care Act specifies that an ACO may include the following types of groups of providers and suppliers of Medicare-covered services: ACO professionals (i.e., physicians and hospitals meeting the statutory definition) in group practice arrangements, Networks of individual practices of ACO professionals, Partnerships or joint ventures arrangements between hospitals and ACO professionals, or Hospitals employing ACO professionals, and Other Medicare providers and suppliers (e.g. retail clinics).

18 Accountable Care Organizations Certain critical access hospitals are eligible to participate in the Shared Savings Program. The law requires each ACO to include health care providers, suppliers, and Medicare beneficiaries on its governing board. The ACO must take responsibility for at least 5,000 beneficiaries for a period of three years. Payments are global payments based on episode of care. Payments are negotiated through contracts with ACOs.

19 Accountable Care Organizations Current ACO partnerships in Kentucky: Humana and Norton Anthem and Community Health System (CHS) Bluegrass Family Health and Baptist

20 Kentucky Health Benefit Exchange Executive Order signed by Governor Beshear July 17, 2012 created the Exchange and administrative structure Housed in CHFS, 4 divisions with up to 30 employees Establishment of an Advisory Board with 11 members Advisory Board may create sub-committees

21 A health benefit exchange is an organized marketplace for individuals and employees of small businesses to shop for health insurance based on price and quality. Individuals will also be able to apply for Medicaid coverage through the Exchange. Like 21

22 How will buying insurance be different under the Exchange? Online web portal with shop and compare tools Call center for assistance with eligibility and subsidies Navigators and Agents offer face-to-face customer support Shop and Compare Tools 22

23 When will the Exchange be operational? Open Enrollment - October 1, 2013 Fully Operational - January 1,

24 Why is the Exchange good for Kentuckians? 24

25 Why is the Exchange good for Kentuckians? Offer coverage choices for all, regardless of place of work (Create a safety net for job loss) Subsidies to help families Tax credits to help small businesses Tax Calculator: State-based Exchange can better respond to Kentucky s needs High low income population Poor health rankings 25

26 Why is the Exchange good for Kentuckians? 26

27 Join our collaborative advocacy efforts We need your voice to build a healthier Kentucky [email protected]

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