SB616 HFA White 3-11

    Delegate White moved to amend the bill on page 5, section 3, line 17, by striking subsection (d) in its entirety and inserting in lieu thereof the following:

    “(d) The Director should make every effort to evaluate and administer programs to improve quality, improve health status of members, develop innovative payment methodologies, manage health care delivery costs, evaluate effective benefit designs, evaluate cost sharing and benefit based programs, and adopt effective industry programs that can manage the long term effectiveness and costs for the programs at the Public Employees Insurance Agency to include, but not be limited to:

    (1) Increasing generic fill rates;

    (2) Managing specialty pharmacy costs;

    (3) Implementing and evaluating medical home models and health care delivery;

    (4) Coordinating with providers, Medicaid and private insurance carriers to encourage the establishment of cost effective accountable care organizations;

    (5) Exploring and developing advanced payment methodologies for care delivery such as case rates, capitation, and other potential risk sharing models and partial risk sharing models for accountable care organizations and/or medical homes;

    (6) Adopting in a timely manner measures identified by the Centers for Medicare and Medicaid Services to reduce cost and enhance quality;

    (7) Evaluating the expenditures to reduce excessive use of emergency room visits, imaging services and other drivers of the agency’s medical rate of inflation;

    (8) Recommending cutting edge benefit designs to the Finance Board to drive behavior and control costs for the plans;

    (9) Implementing programs to encourage the use of the most efficient and high quality providers by employees and retired employees;

    (10) Identifying employees and retired employees who have multiple chronic illnesses and initiating programs to coordinate the care of these patients;

    (11) Initiating steps by the agency to limit or eliminate the payment by the agency for treating hospital acquired infections; and

    (12) Initiating steps by the agency to limit or eliminate the number of employees and retired employees who are re-admitted to a hospital for the same diagnosis related group illness within thirty days of being discharged by a hospital in this state or another state.

    (e) On July 1, 2011, and every year thereafter until and including July 1, 2016, the Director shall issue a progress report to the Joint Committee on Government and Finance on the implementation of the reforms in this section. The report shall include, but not be limited to, the following:

    (1) The status of implementation of accountable care organizations, medical homes, including the number of employees or retired employees who are enrolled in accountable care organizations or medical homes, the methodology used by the agency to reimburse accountable care organizations, and any cost savings or cost increases or quality improvement for employees or retired employees who use accountable care organizations or medical homes;

    (2) The cost of implementing any of the reforms listed in this section and projected cost savings and/or quality improvements from the implementation of these initiatives; and

    (3) Any additional cost containment measures that he or she believes are warranted.”; and

    Relettering the remaining subsection.