KANSAS CITY, MO - More than 600 health policy workers from around the country convened here this week for a conference aimed at tackling some of the most pressing issues facing states, particularly in light of the federal health reform law.

The three-day conference — hosted by the National Academy for State Health Policy in the Westin Hotel at Crown Center — drew several top officials from the U.S. Department of Health and Human Services, a dozen or more ranking state Medicaid officers and health officials representing all states except South Carolina.

Topics of discussion ranged from where states stand on developing new health insurance exchanges, enrollment in public health programs the digital age, reducing avoidable re-hospitalizations, medical liability reform and new approaches for dealing with people dually eligible for Medicaid and Medicare.

Cross-border cooperation
During Tuesday's lunchtime plenary discussion called "Show Me How to Work Across State Lines" participants heard from Kansas City (Kan.) Mayor Joe Reardon, Kansas City (Mo.) Director of Health Rex Archer, and Marcia Nielsen, a policy expert from the University of Kansas Medical Center and former executive director of the now-defunct Kansas Health Policy Authority.

Focus of the discussion was on the work begun by Reardon's administration to improve the city's health given recent County Health Rankings by the Kansas Health Institute and the Robert Wood Johnson Foundation. That report ranked his county — Wyandotte — as the least healthy in the state.

Reardon told the capacity crowd that the ranking had spurred his city to action. And he said that Google Fiber's selection of Kansas City for its pilot deployment of ultra-high-speed Internet created an opening for the greater metro area to work together to improve community health.

"The true potential of that is to form this web that crosses the state line and jurisdictional boundaries and allows us to work together," Reardon said. "Highest on the list of things we think will play out through this partnership is health care and delivery of health care services. Sometimes it takes unique opportunities like this Google Fiber initiative to bring the right people to the table to focus in the right way."

Among the challenges described was the difference in Medicaid reimbursement rates from one state to the next. Kansas reimburses providers at 94 percent of Medicare, Missouri at 65 percent. That inevitably affects access to care in the region near the state line, Reardon said.

He told the crowd that the Mid-America Regional Council is a cross-state collaborative that is beginning to tackle such issues.

"To go from good to great is going to require institutions and capacity to reach beyond jurisdictional boundaries and really start to develop programs and authority to execute plans. That kind of apparatus doesn't exist in the most robust way that it could in a place like this Kansas City region and I suspect in other regions as well," Reardon said.

Health Homes
Also discussed at the conference was the concept of "health homes," as it is emerging from the federal health reform law.

The Centers for Medicare and Medicaid Services is taking applications for state initiatives to improve health care delivery for chronically ill, high-cost Medicaid beneficiaries.

The patients targeted are those with a substance abuse or mental health condition and at least one chronic health condition, such as obesity, diabetes, asthma or a developmental disability.

To qualify for enhanced federal funding, health homes must ultimately demonstrate improved efficiency and reduced costs.

How states go about making them work is almost entirely up to them, said Mike Hall, director of the newly created Division of Integrated Health Services at CMS. Hall said CMS would not issue regulations for health homes because it does not want to stifle innovation in program designs.

"This is a concept that we are, with states, designing on the fly," Hall said. "This is Congress trying out an idea and then asking us to report back in 2014 and 2017 whether or not the idea works...and which strategies appear to work the best."

Missouri is one of three states (along with Rhode Island and Oregon) to have formally submitted a health homes plan to CMS.

Joseph Parks — a Missouri Department of Mental Health officer — said at least 21 percent of the state's Medicaid population should be eligible for treatment in health homes simply by virtue of being overweight (68 percent of his Medicaid patients) and being addicted to cigarettes (30 percent).

Parks said Missouri's plan relies heavily on data collection to shape and guide its implementation.

"Our key principle is 'What gets measured is what gets done.' It's more important to spend a lot of time measuring than to spend a lot of time planning," Parks said. "Measuring is more useful, because a lot of what you might spend time planning for never happens."