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Introduction to State Health Policy:
A Seminar for New State Legislators
A Free Series of Archived
Sessions from the
March 31-April 3, 2005 Seminar in Chicago,
Ilinois |
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Full Agenda
| Print .PDF Agenda |
Session 1:
Dinner, Welcome, Overview,
and Introductions |
| Date/Time: |
Thursday, March 31, 2005, 7:00–8:15 p.m. |
| Presenters: |
Marjorie Shofer, R.N., M.B.A.
Senior Program Analyst
Office of Communications and Knowledge Transfer
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
Rockville, MD Martha King
Director
Health Program
National Conference of State Legislatures (NCSL)
Denver, CO |
| Content: |
During this session, participants will be welcomed
and the mission, goals, and objectives of AHRQ and NCSL will
be described. An overview of the seminar’s objectives and
agenda also will be provided, and participants will have an opportunity
to introduce themselves. |
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(this session was not archived) |
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Session 2:
Roles of State Legislatures
and State Government in Determining Health Policy |
| Date/Time: |
Friday, April 1, 2005, 8:30–10:00 a.m. |
| Presenter: |
John E. McDonough, Dr.P.H.
Executive Director
Health Care for All
Boston, MA
(Former Massachusetts State Legislator)
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| Content: |
State governments, especially State legislatures,
play a major role in setting policy for the regulation, financing,
and delivery of health care in America. With heightened
involvement in health care policy, State legislatures are in
a position to guide their States in effective administration
of the health care delivery system. This introductory session
will review some of the traditional roles States have played
and discuss the variety of new roles States are assuming.
After
this session, participants should be able to:
• List traditional State roles in health policy (e.g.,
regulation of insurance, licensure of facilities and health
professionals,
and financing care for low-income and indigent populations)
• Describe practices States are adopting in response
to the changing health care environment (e.g., value-based
health care purchasing,
quality assurance—including improving patient safety,
health system monitoring and cost containment). |
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Session 3:
State Roles in Regulating
Health Care Markets: Balancing Cost, Access, and Quality |
| Date/Time: |
Friday, April 1, 2005, 10:15 a.m.–12:15 p.m. |
| Presenters: |
Robert E. Hurley, Ph.D.
Associate Professor
Department of Health Administration
Medical College of Virginia
Virginia Commonwealth University
Richmond, VA
Len M. Nichols, Ph.D.
Vice President
Center for Studying Health System Change
Washington, DC
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| Content: |
States share responsibility with the Federal Government
for regulating health care markets. In their role to ensure that
consumers have access to cost-effective high-quality health care
in an ever-changing economic environment, States have established
a variety of regulatory mechanisms over the years. This session
will describe the “health care delivery market” and
discuss the States’ role in its regulation. Programs implemented
over the years to balance cost, quality, and access will be highlighted,
as will program outcomes. This session will also examine increases
in health care expenditures and possible options for maximizing
resources in this challenging environment.
After this session,
participants should be able to:
• Identify the major reasons why the Government regulates the
health care market
• Describe how Federal laws and regulations affect State authority
to regulate health care markets
• Explain trends in the health care delivery system, laws, and
regulations implemented to affect cost, access, and/or quality
• Discuss the current challenge of how to handle increasing health
care costs and possible options for maximizing resources
• Discuss some of the major regulatory challenges State legislatures
are likely to face in the next several years.
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Session 4:
Quality and Cost: Achieving Value in Today’s Health Care
System |
| Date/Time: |
Friday, April 1, 2005, 1:30–3:00 p.m. |
| Presenter: |
Brent James, M.D., M.Stat.
Executive Director
Vice President for Medical Research
Institute for Health Care Delivery Research
Intermountain Health Care
Salt Lake City, UT |
| Content: |
With States battling increased health care costs,
many might ask if they can afford to focus on quality. This session
will explore the current state of health care quality, how quality
and costs are inextricably connected, how focusing on quality
can impact costs, and what States can do to improve quality of
care. Since the release of the Institute of Medicine’s
1999 sentinel report To Err is Human, improving patient safety
and reducing medical errors emerged as key priorities for many
health policymakers. Since that time, much attention has been
focused on the issue. Two additional IOM reports that focused
on whether health care is delivered properly and results in favorable
patient outcomes were released, as were the Department of Health
and Human Services national report cards on quality – the National
Healthcare Quality Report (NHQR) and the National Healthcare
Disparities Report (NHDR).
After this session, participants should
be able to:
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Define “health care quality”
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Define “evidence-based medicine”
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Discuss the “costs” associated with poor quality
• Describe the Hospital Patient Culture Survey as a tool in quality
improvement strategies
• Describe the role of measures for quality improvement contained
in the AHRQ NHQR and NHDR reports
• List several strategies to improve quality in their State. |
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Session 5:
Understanding the Importance of Public Health |
| Date/Time: |
Friday, April 1, 2005, 3:15–4:30 p.m. |
| Presenter: |
Georges C. Benjamin,
M.D.
Executive Director
American Public Health Association
Washington, DC |
| Content: |
Public health activities, such as the immunization
of children, have proven effective over time at preventing disease,
protecting health, and saving health care resources. Indeed,
public health services can be the most cost-effective way to
promote health among large populations. Recent bioterrorism threats,
SARS, West Nile Virus, and the flu vaccine shortage have highlighted
public health issues and raised awareness about gaps in local
and State government programs that are supposed to respond to
such threats. Rising trends in obesity and chronic disease have
increased concentration on prevention. Understanding and supporting
activities in public health is an important role of State policymakers.
This session will outline the key public health activities undertaken
by States and the role legislatures play in regulating these
services.
After this session, participants should be able to:
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Define “public health” and describe its effect
on the factors that contribute to disease and death in the
United States
• Discuss the importance of public health in the context of broader
State efforts to improve the health and welfare of their residents
• Describe the role of the State legislature in supporting public
health activities. |
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Session 6:
A Roundtable Discussion |
| Date/Time: |
Friday, April 1, 2005 4:30–5:00 p.m. |
| Facilitator: |
Martha King
NCSL
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| Content: |
Building on the earlier discussions, this roundtable
discussion will provide an opportunity for participants to identify
and discuss their “take-aways” and explore issues
and challenges faced by States as they work to improve the health
of their constituents. |
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(this session was not archived) |
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Session 7:
Providing Access to Care, Part I: The Uninsured and the Health Care Safety
Net |
| Date/Time: |
Saturday, April 2, 2005, 8:30–10:30 a.m. |
| Presenters: |
Kenneth E. Thorpe, Ph.D.
Robert W. Woodruff Professor and Chair
Department of Health Policy and Management
Rollins School of Public Health
Emory University
Atlanta, GA
Grace-Marie Turner, Ph.D.
President
Galen Institute, Inc.
Alexandria, VA |
| Content: |
Many States are confronted with a growing number
of people who lack health insurance or a regular source of care.
This situation presents difficulties for both the individual
and the community where they live. Because they cannot afford
care, the uninsured tend to wait too long and seek services when
their conditions become acute and/or require more extensive care.
This contributes to overall health care costs because providers
must either absorb the cost of providing these services or pass
the cost to others. Some States and local communities have established
a “safety net” of providers—public or nonprofit
hospitals and clinics that provide a high volume of charity care
to serve this population. However, traditional safety net providers
are struggling to remain financially viable. This session will
provide a descriptive analysis of the uninsured and discuss Federal,
State, local government, and private efforts to strengthen the
safety net and/or establish programs to increase insurance coverage
for vulnerable populations.
After this session, participants should
be able to:
• List some characteristics of the uninsured population and describe
potential outcomes of lacking health insurance
• Define the term safety net, list major safety net providers,
and describe how the current marketplace impacts the safety
net
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Identify and describe some Federal, State, local government,
and private sector strategies for expanding insurance coverage
to the underserved. |
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Session 8:
Hot Issues in Health Care: Focus on Medicaid and SCHIP |
| Date/Time: |
Saturday, April 2, 2005, 10:45 a.m.–12:15 p.m. |
| Presenters: |
Martha King
NCSL
Rachel B. Morgan, R.N., B.S.N.
Senior Policy Specialist
State Federal Relations
National Conference of State Legislatures
Washington, DC |
| Content: |
State governments play many key roles in providing
access to health care for populations that lack adequate private
health coverage. Perhaps the most central of these roles is the
oversight of Medicaid, a Federal/State financed health care program
for low-income populations (including women and children, the
elderly, and people with disabilities). Issues regarding Medicaid
are of critical importance to State legislatures, especially
because Medicaid accounts for 20 percent of the average State’s
budget and is the fastest growing line item in most States. This
session will provide an overview of Medicaid, and the State Children’s
Health Program (SCHIP) a program to provide health care services
to underserved children—and discuss State roles in administering
these programs.
After this session, participants should be able
to:
• Explain the structure and major functions of the Medicaid program
• Describe the options States have for tailoring Medicaid to
meet local needs
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Explain the structure and goals of SCHIP
• Describe factors contributing to rising health care costs under
Medicaid and SCHIP and explain what approaches States have
taken to control costs. |
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Session 9:
Health Care Workforce Issues |
| Date/Time: |
Saturday, April 2, 2005, 1:30–3:00 p.m. |
| Presenter: |
Bram B. Briggance,
Ph.D.
Program Director
Center for the Health Professions
University of California
San Francisco, CA |
| Content: |
Many health professionals are licensed by State
boards, regulated by State authorities, and trained in State
institutions subsidized with State funds. As such, State legislatures
play a major role in regulating the health professions and ensuring
that there are enough health care workers to meet their State’s
health care needs. Currently, many States are facing worker shortages,
especially in nursing and other paraprofessional settings. This
session will discuss the most pressing health workforce issues
and how State legislators can respond strategically to meet the
needs of their constituents.
After this session, participants
should be able to:
• Understand the trends and factors that affect the supply and
demand of health professionals both now and in the future
• Identify and discuss the most critical challenges our health
system will face regarding its workforce
• Respond in a meaningful and strategic way to these complex
health workforce issues. |
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Session 10:
A Roundtable Discussion |
| Date/Time: |
Saturday, April 2, 2005, 3:15–4:15 p.m. |
| Facilitator: |
Marjorie Shofer, R.N., M.B.A.
AHRQ
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| Content: |
This roundtable discussion will provide an opportunity
for participants to identify and discuss their “take-aways” from
the seminar and explore approaches for addressing their State’s
unique issues and challenges. |
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(this session was not archived) |
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Session 11:
The Crisis in Medical Malpractice Insurance |
| Date/Time: |
Sunday, April 3, 2005, 8:30–10:00 a.m. |
| Presenter: |
Randall R. Bovbjerg,
J.D.
Principal Research Associate
Center for Health Care Studies
The Urban Institute
Washington, DC |
| Content: |
Over the past several years the cost of obtaining
medical malpractice insurance has risen dramatically. This has
left some physicians with difficult choices with respect to their
chosen profession—including paying very high malpractice
insurance premiums, moving to a State or area where premiums
are lower in comparison, discontinuing care and leaving the profession
completely. Finding solutions for this problem is complicated
by the players involved. Physicians, lawyers, consumers, and
insurers each have a different point of view regarding why the
problem exists and are far apart on possible “fixes.” This
session will provide an overview of the factors leading to a
rise in malpractice premiums and will discuss options State legislators
have to address this situation, including making changes to the
legal system and/or the insurance system.
After this session,
participants should be able to:
• Discuss the history of malpractice insurance in the United
States
• Identify the factors underlying the most recent increase in
malpractice insurance
• Outline how States have historically regulated this product
• List options States have to address this issue and the possible
ramifications associated with each option. |
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Session 12:
Prescription Drugs |
| Date/Time: |
Sunday, April 3, 2005, 10:15–11:45 a.m. |
| Presenter: |
Jonathan Blum, M.P.P.
Director
Medicaid Practice
The Health Strategies Consultancy LLC
Washington, DC |
| Content: |
A major issue in both Congress and State legislatures
has been the high cost of prescription drugs, especially for
seniors without coverage. High drug costs also impact Medicaid
and other State programs that offer a prescription drug benefit.
This session will explore recent trends in prescription drug
costs and the factors responsible for rising costs, the impact
of rising drug costs on the health care delivery system, the
impact of recent Federal legislation on State prescription drug
programs,
and State strategies for addressing issues related to prescription
drug coverage.
After this session, participants should be able
to:
• Understand what factors are driving increased pharmaceutical
costs
• Describe the State and Federal programs that play a role in
providing prescription drug coverage
• Discuss strategies to address prescription drug issues, including
rising costs, access to prescription drugs, and the quality
of pharmaceutical care
• Describe what research says about the impact of various drug
benefit designs on access, costs, utilization, and health outcomes. |
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Session 13:
Closing Comments and Seminar Evaluation |
| Date/Time: |
Sunday, April 3, 2005, 11:45 a.m.–12:00 p.m. |
| Facilitator: |
Marjorie Shofer, R.N.,
M.B.A.
AHRQ
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| Content: |
Participants will be invited to make concluding
comments about the workshop and fill out an evaluation form. |
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(this session was not archived) |
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Note: Session 14 was originally scheduled as an
agenda item for the conference, but had to
be cancelled. It was recorded post-conference, and is available
as an archived session.
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Session 14:
Cost, Quality, and Access: Providing Long-Term Care Services to an Increasingly
Elderly and Chronically Ill Population |
| Date/Time: |
Sunday, April 3, 2005, 10:15–11:45 a.m. |
| Presenter: |
Christine G. Williams,
M.Ed.
Director
Office of Communications and Knowledge Transfer
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
Rockville, MD |
| Content: |
As more baby boomers retire and the cost of long-term
care (LTC) services continues to escalate, State policymakers
are exploring methods for controlling costs while still meeting
constituent demands for quality and access to services. Although
most States spend a significantly greater share of their LTC
dollars on nursing homes, most are working to improve the balance
toward home- and community-based alternatives to institutional
care. This session will address the “rebalancing” issue
as well as other key policy issues in the debate over LTC ,
including the increasing cost of services and the difficulty
of ensuring quality.
After this session, participants should be
able to:
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List the major demographic groups who receive LTC and describe
how demand for LTC will change in the future
• Name the major public and private funding streams that
finance LTC and describe how public resources are allocated
to pay
for LTC
• Discuss State roles in LTC reform and in ensuring quality
care in LTC settings
• Understand the framework for a comprehensive LTC. |
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