Transforming Health Insurance through Payment Reform Transparency - PowerPoint PPT Presentation

Department of Financial Services Transforming Health Insurance through Payment Reform Transparency & Consumer Involvement

DFS Payment Reform Initiatives 1. Rate Review 2. Reporting on Payment Reform Baseline 3. Surprise Out-of-Network Billing Reform 4. SHIP | 2

1. Rate Review Achievements • Insurer Rate Applications are Now Public • Enabled Public Input for Consumer Comments • Rate Decisions Publically Available Future Goals • Improved Web Site • Disclosure of Premium Cost Drivers | 3

2. Reporting on Payment Reform Baseline July 2014 Survey -- Key findings : • Many payment reform initiatives -- 76 innovative programs from 19 insurers • Few providers impacted (15%); So, 85% still FFS • Few consumers impacted (12%) • Most programs not impacted • High variability CPR Survey • Follow up to July survey • Working with CPR to standardize data | 4

3. Surprise Out-of-Network Billing Reform Limits consumer liability for ER and Surprise OON bills Transparency Components of Bill Hospitals… • Standard charge list • Participating health plans • Physician groups in contract • Whether employed/contracted doctors likely provide care Doctors… • Whether participates • Reasonably anticipated charges upon request • Which doctor services arranged for scheduled hospital visit Insurers… • Which reasonably anticipated providers are OON • Amount covered • Reasonably anticipated cost of service (UCR) | 5

SHIP/Medicaid: Different Constituencies, Different Funding – Same Goals Same Goals: 1. Reduce preventable hospitalizations by 25% in Medicaid 5 years 1. DSRIP Medicaid- 2. IAAF 2. Transform 80% of Safety Net 3. VAP provider payment to Providers 4. Capital value based (not fee- for-service) 3. Investment in HIT: SHIP • All Payer Database - $10M • SHIN-NY - $55M Commercial/Self Insured Commercial 4. Population Health 1. DFS rate review Self-Insured/ Improvement Projects to: 2. CMMI grant All Providers • Align with 3. NYSHIP Prevention Agenda • Promote an Advanced Primary Care Model 5. Evolve the health care workforce | 7

Possible DFS Rate Review Tools • Promote value based payment models and Advanced Primary Care (APC) -- Set payment reform adoption benchmarks -- Encourage investment in APC • Set annual medical growth targets • Adopt quality of care information for consumers -- CMS Star rating system • Create tiered network incentives | 8

Transforming Health Insurance through Payment Reform Transparency - PowerPoint PPT Presentation

Department of Financial Services Transforming Health Insurance through Payment Reform Transparency & Consumer Involvement DFS Payment Reform Initiatives 1. Rate Review 2. Reporting on Payment Reform Baseline 3. Surprise Out-of-Network

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Health Care Reform and Individual Health Insurance in New York Karen Pollitz, Research Professor

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System: Navigating Changes Under MACRA Overcoming Challenges in Transforming Payment and Care

Primary Care, ACOs, and Payment Reform Mark McClellan, MD, PhD Director, Initiatives on Value

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Transforming Health Insurance through Payment Reform Transparency - PowerPoint PPT Presentation

Department of Financial Services Transforming Health Insurance through Payment Reform Transparency & Consumer Involvement DFS Payment Reform Initiatives 1. Rate Review 2. Reporting on Payment Reform Baseline 3. Surprise Out-of-Network

Payment Reform: Expanding the Playing Field NYS Health Foundation Roles for Government and

Changes in Oncology Practice Models, Payment, and Location: The Impact of Health Reform and

www.drsforamerica.org Q: How will the legislation affect the kind of insurance I can buy? Will it

The Path to Meaningful Health Insurance Coverage in Maryland States with Autism Insurance

Federal Health Care Reform and Health Insurance Exchange Planning in New York Danielle Holahan and

Behavioral Health Payment Reform Workgroup February 27 , 2020 1 Agenda 10:00 10:05

Roles for Government Purchasers in Payment Reform Doug McKeever, Chief CalPERS Health Policy

HEALTH CARE REFORM IN THE NETHERLANDS Gelle Klein Ikkink Director of Health Insurance

First Balkan Forum on: Health Care Reform ALBANIA: AN OVERVIEW of THE HEALTH SYSTEM &amp;

The Impact of Health Care Reform on Pathology Practice and Payment: From Volume to Value Donald

TORT REFORM What does this mean for you ? Insurance Premiums What are you seeing with your

Through Payment Reform Lisa Dulsky Watkins, MD October 30, 2014 www.milbank.org Agenda 1. The

Health Care Reform and Individual Health Insurance in New York Karen Pollitz, Research Professor

Integration: The Need for Delivery System and Payment Reform KENNETH E. THORPE, PH.D. EMORY

System: Navigating Changes Under MACRA Overcoming Challenges in Transforming Payment and Care

Primary Care, ACOs, and Payment Reform Mark McClellan, MD, PhD Director, Initiatives on Value

Synthesizing a Representative Critical Path for Post-Silicon Delay Prediction Qunzeng Liu and

Burns Children burn at much lower temperatures in a shorter amount of time Children are more

Pre-Test Imminent Death: Recognition &amp; Management Robert M. Taylor, MD Medical Director,

Perinatology Care of the mother and fetus during pregnancy, labor, delivery, and early neonatal

R D ( ) Anomaly: A Model-Independent Collider Signature and Possible Hint for R -parity

Genetics 160,000 Bullying Lack of Failure Dopamine Levels &gt; 50% Unhealthy Relationships

Updates in Polymyalgia Rheumatica and Giant Cell Arteritis Sarah Goglin MD Assistant Professor of

Efficacy and Safety of Dalbavancin and Oritavancin in the Treatment of Gram- Positive Infections

First Balkan Forum on: Health Care Reform ALBANIA: AN OVERVIEW of THE HEALTH SYSTEM &

Pre-Test Imminent Death: Recognition & Management Robert M. Taylor, MD Medical Director,

Genetics 160,000 Bullying Lack of Failure Dopamine Levels > 50% Unhealthy Relationships