“Alignment” for Transformation
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“Alignment” for Transformation. NGA: Learning from Each Other January 14, 2014. Rhode Island Structure for Alignment. Executive Committee of Health Care Reform Commission. Lieutenant Governor (Chair). Secretary of Health and Human Services. Health Insurance Commissioner.

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Alignment for transformation

“Alignment” for Transformation

NGA: Learning from Each Other

January 14, 2014

Rhode island structure for alignment
Rhode Island Structure for Alignment

Executive Committee of Health Care Reform Commission

Lieutenant Governor


Secretary of Health and Human Services

Health Insurance Commissioner

Director of Administration

Governor’s Policy Director


Public Health

Behavioral Health

Facilities Regulation

State Employees

Health Benefits





Examples of alignment in rhode island
Examples of Alignment in Rhode Island

QHP Standards and Certification

Eligibility IT System

Patient-Centered Medical Homes

  • Exchange Develops Standards

  • Health Insurance Commissioner certifies Insurers

  • Jointly developed, overseen and paid for by Medicaid, Exchange and Department of Administration

  • Health Insurance Commissioner initiated provider collaborative; “strongly encouraged” insurer participation

  • Medicaid engaged in payments after 2 years

  • State employees plan to begin payments after legislation

Lessons learned in alignment
Lessons learned in alignment

Bureaucracy has outlived previous administrations and will outlive this one

Tone from the top and commitment of cabinet officials will define opportunity for success

Governor leadership critical

How official talk, formally and informally

Competing priorities must be resolved ASAP

Alignment is not just policy-based

Lt. Governor is RI has no administrative authority or oversight

Served as facilitator for alignment (social workers)

Neutral party very valuable

Lobbyists and interest groups will test the limits and exploit any weaknesses in the fronts

“Invisible Fence” Theory

Interacting with the market
Interacting with the market

  • Widespread appreciation of the talent and commitment of State staff – but recognition that the system places great constraints on them

  • Several stakeholders in private market lamented State’s inability to “speak with a singular voice” – frustration that the agendas of different agencies/branches are often in conflict with each other

  • Frustration due to perception that State continually subjects providers to change; some of which is unnecessary and burdensome

  • Concern that State leadership does not adequately understand healthcare marketplace

Trustworthiness of Government Questioned

Interviews with 36 external stakeholders

Strategies for multi payer alignment
Strategies for Multi-Payer Alignment

Give CEOs a single person to discuss strategy and policy

Provides a place for venting and problem solving

Single point of contact

Creative development of things that keep people happy

Aligned quality measures, rather than just a requirement to move to an outcome-based system

Give marketplace carrots first

When alignment causes strife, call it out and work it out

There will be times when agencies don’t line up. Don’t force it, fix it.

Admit to internal speedbumps

Legislative initiatives can be detrimental to marketplace – executive branch can play a critical role in understanding the viewpoints of the market

Fight for some of their interests