On September 17, 2021, the U.S. Departments of Health and Human Services and Treasury finalized the 2022 Notice of Benefit and Payment Parameters (NBPP) rule and announced a significant expansion of their oversight of health plans’ provider networks. This expert perspective reviews provisions of the rule of particular import to the state-based marketplaces (SBMs) and state insurance regulators.
About State Health and Value Strategies
State Health and Value Strategies (SHVS) is a program of the Robert Wood Johnson Foundation focused on assisting states with transforming their health care systems to be affordable, equitable and innovative. By connecting states with experts in the field, SHVS is able to provide timely and meaningful technical assistance to states when they need it the most. SHVS assists states in four key domains:
- Affordability – A system of coverage and care that is affordable for consumers and sustainable for states is central to creating a health care system that meets the needs of patients. SHVS provides states with best practices to develop coverage options that are realistic and affordable.
- Coverage – Comprehensive coverage that allows patients to access the care they need is critical to building a Culture of Health, in which everyone in America has a fair and just opportunity for health and well-being. SHVS works with states to expand coverage opportunities and protect coverage gains.
- Integration – Systems of care and government agencies need to coordinate and communicate in order to fully address the goals and needs of the people they serve. SHVS brings together multiple strands of the health and social service systems to share best practices and identify opportunities for alignment to address people’s goals and needs.
- Value – Promoting systems of care that reward health outcomes over volume of services is a mission of SHVS. States can leverage technical assistance to drive payment change and support population health initiatives.
The technical assistance SHVS provides to states is informed by two overarching goals: that every person should have the same opportunities to access the health care system and have a fair and just opportunity to lead the healthiest lives possible; and to support the needs and goals of all patients as they interact with the health care system.
About the Team
Heather leads SHVS and assists states in their efforts to transform health and health care by providing targeted technical assistance to state officials and agencies. She is a Professor of the Practice at Princeton University’s School of Public and International Affairs, where she teaches courses on health policy and administration, and is a faculty affiliate of the Center for Health & Wellbeing. She served as New Jersey’s Commissioner of Health and Senior Services from 2008-2010, overseeing a cabinet-level agency with a budget of $3.5 billion and staff of 1,700, responsible for public health services, regulation of health care institutions, senior services, and health care policy and research. She received her JD, cum laude, from the New York University School of Law, and her BA, cum laude, from Duke University.
Dan assists in managing and coordinating the technical assistance providers serving the states and works with states to identify their assistance needs and policy goals. He was deeply involved in the implementation of the Affordable Care Act at the state level as Deputy Chief of Staff for Rhode Island’s Lieutenant Governor. Dan also served as the principal subject matter expert for the Rhode Island Healthcare Reform Commission on Health Insurance Exchange and project director for the State Innovation Model (SIM). Dan serves as a Lecturer in Public Affairs at the School of Public and International Affairs at Princeton University. He received a MBA from Providence College and his BA from Brown University.
Sally supports the delivery of technical assistance to states and works with subject matter experts to develop and disseminate products to assist states in their efforts to transform their health care systems. Sally oversees the development of technical assistance content to increase access to, and innovation within, state Medicaid programs. She has worked in both state and local government in New Jersey, New York and California. Sally comes to Princeton after serving in the New Jersey Office of Management and Budget with responsibility for the Department of Health and the Department of Children and Families. Sally holds an MPP from the University of California, Berkeley, Goldman School of Public Policy, as well as a BA from Brown University.
Sonia supports the delivery of technical assistance to states and works with subject matter experts to develop and disseminate products to help states transform health and health care. Sonia oversees content related to the regulation of and access to commercial health insurance. She comes to Princeton after working with the Health Division at the National Governors Association Center for Best Practices, where she focused on issues related to payment and delivery system transformation, rural health, the health workforce, and complex care individuals. Sonia holds a master’s degree in public health with a concentration in health policy from The George Washington University and a bachelor’s degree in health promotion and behavior from the University of Georgia.
Stephanie handles day-to-day operations at SHVS, managing the ongoing administration of contracts with the program’s technical assistance providers; tracking and providing reports on the grant program; planning conferences, webinars, and other events; and monitoring program resources. Stephanie has previous financial risk management and operations experience in managerial roles at CLS Bank International and Mizuho Capital Markets Corporation in New York. She received an MS in Foreign Service from Georgetown University and her BA from the University of Pennsylvania.