Prescription for Pennsylvania Presentation by Barbara J. Holland Chief Counsel Governor

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Prescription for PennsylvaniaPresentation
byBarbara J. HollandChief CounselGovernors
Office of Health Care Reform
Prescription for Pennsylvania
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
PRESCRIPTION FOR PENNSYLVANIA Right State
Right Plan Right Now
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Prescription for Pennsylvania The Need for Action
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• Pennsylvania businesses suffer a competitive
  disadvantage in the global marketplace against
  companies from countries where health care costs
  less and is universally available.
• Pennsylvania spends 11 percent more per person
  on health care than the U.S. average, and our
  health care costs are increasing twice as fast as
  average wages.

PRESCRIPTION FOR PENNSYLVANIA Right State
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Prescription for Pennsylvania The Cost of
Inaction
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• Pennsylvanias businesses, consumers and
  taxpayers pay at least 7.6 billion a year for
  unnecessary and avoidable health care costs.
• Inaction would not only continue these
  unnecessary and avoidable costs, it would
  jeopardize the health and safety of our residents
  and perhaps even weaken the commonwealth's
  economic competitiveness.

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Prescription for Pennsylvania
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Prescription for Pennsylvania is a set of
integrated practical strategies introduced by
Governor Rendell in January, 2007 to

• Increase access to affordable health care
  coverage for all Pennsylvanians
• Improve the quality of care delivered
  throughout the commonwealth
• Help bring health care costs under control for
  employers and employees

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Prescription for Pennsylvania
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Prescription for PennsylvaniaWill Reduce Health
Insurance Costs

• Putting all Rx for PA initiatives in place,
  including small group and individual insurance
  reforms would
• Lower average insurance cost over the next
  several years by nearly 25 percent
• Slow the erosion of employer-sponsored insurance
  and make insurance rates more affordable and
  predictable for both employers and consumers
• Consumers could realize a 2,000 savings on a
  9000 policy.

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Right Plan Right Now
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Prescription for Pennsylvania Affordability,
Access Quality
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Rx for Affordability Cover All Pennsylvanians Cov
erage for College Students and Young
Adults Community Benefit Requirements Uniform
Admission Criteria Fair Billing and Collection
Practices Capital Expenditures Small Group
Insurance Reform Transparency of Cost and
Quality Data
Rx for Quality Health Care Acquired
Infections Quality Outcomes Technology Pay for
Performance Chronic Care Health
Disparities Child and Adult Wellness Long Term
Living End of Life and Palliative Care

• Rx for Access
• Health Care Workforce
• Removing Practice Barriers
• CRNPs
• Physician Assistants
• Nurse Midwives
• CRNAs
• Pharmacists
• Cost-Effective Sites
• Co-Occurring Disorders

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Prescription for Pennsylvania Rx for
Affordability
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Rx for Affordability
Cover All Pennsylvanians Legislation
introduced in both houses. (HB 1870 SB 1117)
Meetings ongoing with CMS to obtain federal
matching funds Coverage for College Students and
Young Adults Legislation introduced in the
House (HB 1556 HB 2005) Community Benefit
Requirements In draft regulations Uniform
Admission Criteria In draft regulations. Fair
Billing and Collection Practices In draft
regulations. Capital Expenditures Draft
Executive Order prepared. Small Group Insurance
Reform Legislation introduced in the
House. Transparency of Cost and Quality Data
Website with prices of the 200 most commonly
prescribed drugs available in PA pharmacies in
the final stage of development.
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Prescription for Pennsylvania Rx for Access
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Rx for Access
Health Care Workforce Legislation introduced in
the House to institutionalize the PA Center for
Health Care Careers, which has been effective in
increasing the number of nursing graduates from
PA nursing schools. Removing Practice
Barriers Scope of practice bills passed, for
CRNPs, nurse midwives and dental hygienists.
Scope of practice legislation introduced in the
House for pharmacists, physical therapists, nurse
anesthetists and physician assistants. Working
with insurers to credential and include
non-physician practitioners in all
networks. Cost-Effective Sites Requirement that
hospitals have cost effective primary care
available for those presenting at hospital
emergency rooms who do not need emergency room
care is in draft regulations. Funding obtained
to start up additional Federally Qualified Health
Centers, nurse managed centers and mobile
wellness vans for medically underserved areas.
RFPs issued and grants will soon be awarded.
Working with insurers to include all
cost-effective sites in networks where
geographically appropriate. Co-Occurring
Disorders DPW and DOH are jointly credentialing
mental health and substance abuse treatment
providers who treat patients with co-occurring
disorders.
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Prescription for Pennsylvania Rx for Quality
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Rx for Quality
Health Care Associated Infections Legislation
passed to require infection prevention procedures
and reporting of health-care associated
infections by hospitals. Implementation is
ongoing. Quality Outcomes Included in
legislation for hospitals for hospital-acquired
infections and in draft hospital regulations for
other hospital quality measures.
Technology Hired Director of Technology.
Developed architecture for statewide
interoperability and electronic health
records. Pay for Performance DPW has
implemented performance based contracting
features in both Health Choices and ACCESS Plus
contracts for primary care providers. In
addition, some hospital disproportionate share
funding has been used to reward quality-related
activities for hospitals since 2006. Enhancements
are planned for 2008-09. A 2 million grant
program is also set up for hospitals to access
for quality-related projects. ACCESS Plus has
already demonstrated cost savings and better
outcomes for patients for patients with chronic
diseases. Chronic Care Executive Order created
a Commission to make recommendations on
establishing the infrastructure to change how
chronic care is delivered across Pennsylvania.
Strategic plan was presented to the Governor and
Legislative Leadership in February.
Implementation of the chronic care model will
begin in Philadelphia in May, and in other
regions of the state in September.
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Prescription for Pennsylvania Rx for Quality
(cont.)
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
Rx for Quality (continued)
Health Disparities Executive Order
established Office of Health Equity. Funding
received to provide grants to increase
minority health care providers. Child
Wellness Increased funding for subsidized school
breakfasts and improved health curriculums.
Adult Wellness Smoking ban has passed both
Houses and is being considered by conference
committee. Long Term Living Assisted Living
Residence licensure law passed, barriers to
timely receipt of home and community waiver
services eliminated, nursing home transition
program established, regular meeting of the Long
Term Living Cabinet and joint Deputy reporting to
Aging and DPW. End of Life and Palliative
Care Advanced Directive bill enacted. DOH
working on hospice regulations to include small
residential hospices. Cost /benefit analysis of
mandating provision of palliative and hospice
services planned.
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Prescription for Pennsylvania
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com
2008-09 Budget Initiatives
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Prescription for Pennsylvania 08-09 New Budget
Initiatives
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• 25.1 Million in State and Federal Funds
• 5 million- to start Pennsylvania Health
  Information Exchange (PHIX), a 5-year project to
  create platform to share patient health care
  information, with investment from health care
  providers and insurers. Statewide implementation
  of e-Prescribing and Electronic Medical Records,
  are necessary steps for building PHIX.
• 1.8 million - to increase access to primary
  medical and dental care in underserved areas
  through a new nurse loan repayment program, an
  enhanced primary care practitioner loan repayment
  program and an expanded community challenge grant
  program.
• 100,000 to assess the opportunities for
  increasing the availability of hospice and
  palliative care services for children

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Prescription for Pennsylvania Ongoing
Initiatives
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• 6.5 million to provide financial incentives
  for local education agencies to increase the
  availability of nutritious foods for students.
• Status More than 500 local education agencies
  are currently participating in the School
  Nutrition Incentive program.
• 4.6 million to develop standardized
  identification and reporting of
  health-care-associated infections by hospitals
  and provide training in infection-control best
  practices.
• Status The Governors Office of Health Care
  Reform is coordinating the activities of the
  Department of Health and the Patient Safety
  Authority to implement the provisions of Act 52
  of 2007.

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Prescription for Pennsylvania Ongoing
Initiatives
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• 2.9 million to increase access to primary
  health care in underserved rural areas
• Status Providers have been selected to
  establish a new community health center to serve
  the Gettysburg area and two mobile health clinics
  to serve Forest, Venango and Greene counties.
• 2.2 million to implement a comprehensive,
  evidence-based chronic-care management model for
  persons with chronic disease.
• Status The Chronic Care Management,
  Reimbursement and Cost Containment Commission
  presented the Governor with a strategic plan to
  improve the delivery of health care to
  Pennsylvanians who require chronic-care. Report
  issued February 13 pilots to start in May, with
  statewide rollout by September.

PRESCRIPTION FOR PENNSYLVANIA Right State
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Prescription for Pennsylvania Ongoing Initiatives
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• 700,000 to manage and coordinate Prescription
  for Pennsylvania implementation
• 515,000 to enhance the delivery of health
  messages through an integrated and coordinated
  approach to health literacy
• 500,000 to increase the number of health
  professionals equipped to address the needs of
  racial and ethnic minorities
• 266,000 to expand premium rate review
  authority to all insurers providing coverage in
  the small employer market
• 30,000 to assist elementary school teachers
  with integrating healthy living concepts into
  lesson plans

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Prescription for Pennsylvania Pending Initiatives
Edward G. Rendell, Governor Rosemarie B. Greco,
Director, Office of Health Care Reform
www.RxforPA.com

• Critical Legislative Action Still Needed
• Provide uninsured adults access to affordable
  health care coverage through the new Cover All
  Pennsylvanians program
• Make all Pennsylvania workplaces, restaurants and
  bars smoke free
• Reduce cost and stabilize health insurance
  premiums for small employers with small group
  reforms, including modified community rating

PRESCRIPTION FOR PENNSYLVANIA Right State
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