Leveraging e-health to Achieve Coordinated Care and Accountable Health Plenary Session II

Transcription

1 Leveraging e-health to Achieve Coordinated Care and Accountable Health Plenary Session II Moderators: Jennifer Lundblad, PhD, MBA President and CEO Stratis Health Garrett Black, MBA, MHA Senior Vice President, Provider Collaboration Blue Cross and Blue Shield of Minnesota

2 Leveraging e-health to Achieve Coordinated Care and Accountable Health Mary Fischer, MSW Executive Director Southern Prairie Community Care Jaeson Fournier, DC, MPH Chief Executive Officer West Side Community Health Services 2

3 Leveraging e-health to Achieve Coordinated Care and Accountable Health Susan Heichert Senior Vice President, CIO Chief Information Officer Allina Health John Smylie, MPH Chief Operating Officer, Essentia Health 3

4 Leveraging e-health to Achieve Coordinated Care and Accountable Health Diane Rydrych Director of Health Policy Minnesota Department of Health 4

5 The Accountable Health Landscape in Minnesota Diane Rydrych Director of Health Policy Minnesota Department of Health 10 TH ANNIVERSARY MINNESOTA E- HEALTH SUMMIT JUNE 11, 2014

6 Overview Minnesota Accountable Health Model Vision/goals Accountable care/accountable health Accountable Care Organizations (ACOs) Medicare ACOs Medicaid ACOs (Minnesota-Integrated Health Partnerships) Health Plan/Payer/County Based Purchaser ACOs

7 What is SIM? Part of the CMS Innovation Center State Innovation Model (SIM) program Supporting comprehensive approaches to transform a state s health system through innovative payment and service delivery models that will lower costs while maintaining or improving quality of care

8 Every patient receives coordinated, patient-centered primary care. Providers are held accountable for the care provided to Medicaid enrollees and other populations, based on quality, patient experience and cost performance measures. Financial incentives are fully aligned across payers and the interests of patients, through payment arrangements that reward providers for keeping patients healthy and improving quality of care; and Provider organizations effectively and sustainably partner with community organizations, engage consumers, and take responsibility for a population s health through Accountable Communities for Health that integrate medical care, mental/chemical health, community health, public health, social services, schools and long term supports and services.

9 What are we testing? Can we improve health and lower costs if more people are covered by Accountable Care Organizations (ACO) models? If we invest in data analytics, health information technology, practice facilitation, and quality improvement, can we accelerate adoption of ACO models and remove barriers to integration of care (including behavioral health, social services, public health and long-term services and supports), especially among smaller, rural and safety net providers? How are health outcomes and costs improved when ACOs adopt Community Care Team and Accountable Communities for Health models to support integration of health care with non-medical services, compared to those who do not adopt these models?

10 SIM Strategy: Expand and Accelerate Adoption of ACOs The State Innovation Model (SIM) grant will achieve the Minnesota Accountable Health Model vision and support Triple Aim goals by providing investments in infrastructure and supporting providers and communities to begin to participate in, or expand their participation in, a range of accountable care models. MN SIM Targets: 200,000 Medicaid enrollees in ACOs 60% of fully insured population (1.7 million people) in ACO/TCOC arrangements $111M savings (Medicaid, Medicare and Commercial)

11 Impetus for Accountable Care Organizations Impetus for ACOs Develop payment approaches to create incentives for value not volume Shift risk and rewards closer to point of care to foster local accountability Realize return on federal and state investments Improve access to care, outcomes and information for the beneficiary Desired Outcomes Value = Better Quality + Lower Cost/ The Triple Aim Integrated prevention, wellness, screening and disease management Coordinate care across care cycle Data to monitor utilization, compare and share across states New reimbursement structures, including Incentives that encourage integrated practice models

12 Accountable Care Organization** A group of health care providers, with collective responsibility for patient care that helps coordinate services delivering high quality care while holding down costs* Innovation lies in the flexibility of their structure, payments and risk assumption (i.e., how much skin in the game they have in terms of controlling costs and improving quality) Likely to include PCPs, specialists, and likely a hospital, and other provider and community agreements/partnerships. May need the ability to administer payments, set benchmarks, measure performance, and distribute savings *Robert Wood Johnson Foundation, **Accountable Care Organizations: A new model for sustainable innovation, Deloitte Center for Health Solutions Slide provided by Center for Health Care Strategies (CHCS)

13 National ACO models Medicare Shared Savings Program (CMS) Eligible providers, hospitals, and suppliers participate in ACOs to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries and reduce unnecessary costs. Advance Payment ACO Model provides supplemental support from CMMI to physician-owned and rural providers for start-up resources to build the infrastructure (e.g., staff, improving information technology systems, etc.) Minnesota MSSP sites: Essentia, Community Health Network, Integrity Health Network, North Collaborative Care Pioneer ACO Model (CMMI) For early adopters of ACOs Designed to support organizations with experience operating as ACOs or in similar arrangements in providing coordinated care to beneficiaries at a lower cost to Medicare. The Pioneer ACO Model will test the impact of different payment arrangements in helping these organizations achieve the goals of providing better care to patients and reducing costs. Minnesota Pioneer ACO sites: Fairview, Park Nicollet, and Allina Slide provided by Center for Health Care Strategies (CHCS)

14 Minnesota s ACO Models Minnesota Medicaid ACOs Integrated Health Partnerships (IHP) Previously Health Care Delivery System (HCDS) demonstration Hennepin Health: a Safety Net ACO Integrated Care System Partnerships (ICSPs) Commercial ACO/TCOC Agreements Health care providers and systems participate in a range of different delivery and payment arrangements aimed at improving the Triple Aim May include performance based on outcomes/quality and cost; varying levels of financial risk from shared savings to sub-capitation Many use MN Community Measurement TCOC metric Arrangements can be across multiple population (self-insured, commercial and government) for some health plans

15 ACOs are Broadly Defined in the Minnesota Accountable Health Model Broad and flexible ACO concept Most think of medical ACOs centered around a large health care providers or systems Minnesota is starting with a broad definition of provider (health care, behavioral health, LTC, LPH, social service): An ACO represents a group of providers and partner organizations with collective responsibility for patient care that helps providers coordinate services delivering highquality care while holding down costs

16 How will SIM drive change? Define the what we seek, rather than the how Allow for local flexibility and innovation under a common framework of accountability Framework of accountability includes: Models based on/accountable for total cost of care Robust and consistent quality measurement Models that drive rapidly away from the incentive to do more Models that drive rapidly towards increasing levels of integration Demonstrate a clear plan to be, or partner with, an ACO or ACO-like entity

17 Minnesota Drivers of Better Health Payment models Medicaid ACOs payment models based on quality, patient experience and cost performance measure Coordinated care Practice facilitation support, learning collaboratives & funding for coordinated care transformation Support to integrate new provider types HIT & data Data analytics and HIT/HIE support to accelerate adoption and remove barriers to integrate care. Accountable Care Within ACOs, integrate with long term care, behavioral health, public health and social services Community Partnerships Community partnerships through Accountable Communities for Health that identify health and cost goals and strategies to meet goals

18 More Information Visit Sign up for alerts at the website Request speakers at

19 Panel Questions What has been the biggest success in your organization s use of e-health? What are the lessons learned from implementing an ACO type model?

20 Additional Panel Questions What are the greatest e-health needs in your organization? What are your organization s population health (community health) goals and how is the ACO or similar model helping achieve those goals? What is your organization s approach or strategies for engaging consumers? What are your organization s next priorities or future goals?

21 Audience Questions Please step to a microphone to ask a question. Introduce yourself, your organization and direct your question to one or more panelists. Thank you.

22 Thank you Please join us for the Networking Reception from 5:00-6:00 in the Ballroom Lobby