States gain traction in ACA rollout

Some states have found practical success in establishing the Affordable Care Act, but what distinguishes their efforts are their unique fit within each state’s distinctive political and business climates.

Most well-reported may be Kentucky‘s success with its Kynect state-based health insurance exchange, which was working smoothly before exchanges in many other states and the federal Healthcare.gov. A key factor in Kynect’s was that it was organized within the state agency that includes Medicaid, community services, and performs much of the exchange eligibility, intake and administrative technology services.

“From the beginning all these services were able to work together and assure that the exchange would operate smoothly,” said Emily Whelan Parento, executive director in the Office of Health Policy, Kentucky Cabinet for Health and Family Services under Democratic Gov. Steve Beshear.

Kentucky also created an “approachable” brand, Parento said. “Friendly innovation was the theme, and people have responded to that,” she explained,  during  a March 5 conference sponsored by America’s Health Insurance Plans (AHIP).

As of Feb. 28, Kentucky had enrolled 264,000 people in health coverage through the exchange, about 210,000 of those in Medicaid and about 54,000 in private insurance. Approximately 580 small businesses have signed up for the SHOP program.

Next door in Ohio, the state government has taken a pragmatic approach. It built constructive working relationships with health plans in order to rein in Medicaid costs preparation for program expansion, as well as clearing a path to plan performance, said Greg Moody, director of the Governor’s Office of Health Transformation under Ohio Republican Gov. John Kasich.

Ohio has consolidated the various healthcare regions in the state and slashed the number of managed care contracts from 36 to five.

“We carved in more services among more populations, and the greater scale has allowed us to cut administrative costs and hold all Medicaid cost growth to 3 percent last year,” Moody said, with Ohio’s health plans “critical partners in turning that around.”

Kentucky also moved quickly to Medicaid managed care but there were snafus early on, like bumps in provider payment, Parento said. “We meet monthly with the seven managed care plans letting concerns be known so we can act,” she said.

With more people insured, Kentucky is pursuing efforts to identify healthcare workforce needs and developing a centralized database to target gaps. Beshear recently signed a law that expands the prescribing authority of advanced practice registered nurses (APRN).

Ohio has a state innovation design grant from the Center for Medicare and Medicaid Innovation to pay for value and is ready to test it, Moody said. The goal is broad access to a patient-centered medical home and when high-cost episodes occur, the provider is paid to keep costs down and quality up.

Although the approach is  similar to what other states are doing, “Ohio may matter as a testing ground. We have always been a bellwether for the nation,” he said. Additionally, no single health plan dominates the state. Nine plans cover 90 percent of Ohio’s residents and are participating as healthcare payment innovation partners.

Initially, Ohio assembled a diverse group of stakeholders to help advocate for Medicaid expansion. Kasich ultimately used a board authority to accomplish it, but those coalitions are still in place. “We are using [the coalitions] to help support the next piece of reform for medical home and enhanced primary care,” Moody said