The Minnesota State Innovation Model (SIM)

Transcription

1 The Minnesota State Innovation Model (SIM) T E S T I N G A N D I M P L E M E N T I N G T H E M I N N E S O TA A C C O U N TA B L E H E A LT H M O D E L 2014

2 State Innovation Model Initiative (SIM) SIM is a Center for Medicare and Medicaid Innovation initiative to test and implement health care payment and delivery reform ideas Goal: Better quality in health care, improved experience, and lower costs

3 Part of the Affordable Care Act is Testing New Ideas [ACA]... doesn t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. -- Atul Gawande -

4 Minnesota awarded largest testing grant in the country ($45.3 million), February 2013 Five other states also received SIM testing grants from CMMI: Massachusetts., Maine, Vermont, Oregon and Arkansas. 16 states received design grants National SIM Grants

5 Implementing the Minnesota Accountable Health Model The Minnesota Department of Health and the Minnesota Department of Human Services will use SIM funds to implement and test the Minnesota Accountable Health Model Joint MDH, DHS project led by DHS Commissioner Lucinda Jesson and MDH Commissioner Ed Ehlinger

6 Leadership structure

7 Opportunity for Minnesota Testing AND Transforming Strengthening providers and communities to create healthy futures

8 What is the MN Accountable Health Model? A work in progress A framework for driving health reform toward these aims: Most Minnesotans receive care that is patient-centered and coordinated across settings Most providers of care and services are participating in an ACO or similar model that holds them accountable for costs and quality Financial incentives across private and public payers that encourage Triple Aim, coordination, partnership, prevention, value and health promotion Communities, providers and payers collaborate to improve clinical care and population health

9 For Minnesota to get a good grade from CMS in 2016 at the end of this three year grant, the state needs to among other things deliver both useful research findings and savings. CMS Report Card

10 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?

11 Why transformation is needed State budget pressures Medicaid program and other payers of health care. Provider financial incentives do not encourage reducing cost and improving quality of care volume vs. value. Provider innovation to lower cost and improve quality is often penalized, not supported. Health outcomes for Medicaid enrollees and other populations need improvement. Care should be centered around patients and their families.

12 What is the MN Accountable Health Model expected to deliver to CMS by 2016? Here are a few... Savings of $111 million to Medicaid, Medicare and commercial market 1.7 million Minnesotans included in the Minnesota Accountable Health Model. This would be an increase of 500, % of primary clinics providing patient-centered, coordinated care, health care home, behavioral health home or similar model

13 Goals and Vision 60% of fully insured population in ACO/TCOC models 200,000 Medicaid enrollees in ACOs Evidence of better health and lower costs from first round ACO models 67% of primary care clinics are HCH or BHH 15 Accountable Communities for Health Quality measures and payment structures that align across payers ACO/ACHs begin to integrate behavioral health or LTC or social services/public health Providers and communities partner in new and deeper ways ACHs identify health and cost goals and sustainability to continue work beyond grant funding.

14 How will Minnesota achieve targets? Build on existing reforms Expand the number of Minnesota ACOs (broadly defined) and their scope, specifically expanding Minnesota's Medicaid Health Care Delivery System demonstration (HCDS) Invest in e-health (health information technology and exchange) Create up to 15 Accountable Communities for Health

15 Building on a Foundation of Reform Efforts Medicaid ACOs Health Care Homes SHIP Strong Collaborative Partnerships Standardized Quality Measurement E-health Initiative Community Care Teams

16 Cracks in MN s Foundation - Challenges Access to clinical data across providers Real time secure data exchange Data analytic ability Start up costs for communities and small rural providers Disparities Public health and health care silos Payment for procedures not value or health

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

18 Model Drivers Diagram

19 ACOs are Broadly Defined in the Minnesota Accountable Health Model Minnesota is embracing a broad and flexible ACO concept. Most people think of a medical ACO centered around a large health care provider SIM Minnesota is starting with a broad definition: An ACO represents the notion of a group of health care providers with collective responsibility for patient care that helps providers coordinate services delivering high-quality care while holding down costs

20 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 10

21 Build on the MN s Health Care Homes as ACO Foundation Shared Risk/ Benefit Accountable Care Organizations defined by population management and financial risk/benefit sharing with payers Performance Reporting Coordination of Care Quality improvement EMR Communication and Access Health Care Home Components - An organization that cannot do these things is unlikely to succeed as an ACO Integration with Community Services Care Plans Patient Registries, Tracking

22 Minnesota Health Care Homes As of December 31, 2013 there are 322 certified HCHs, representing 43% of Minnesota clinics, and serving 3.33 million people Evaluation of MN HCH: HCHs tend to serve a more diverse population than non-hch clinics Certified HCHs that were part of the evaluation had higher scores than noncertified primary care clinics on a number of quality measures Overall lower Medicaid expenditures than non-hch clinics.

23 23 Expanding ACOs through Medicaid Integrated Health Partnerships (formerly HCDS) -- Minnesota s Medicaid program has already been contracting with some ACOs to provide care for Medicaid beneficiaries. Minnesota Medicaid and the ACOs share in any savings that come about from keeping Medicaid beneficiaries healthy and out of the hospital. Medicaid will fully implement and test ACO contracts with nine organizations: CentraCare, Children s Hospital, Essentia Health, Fairview, FQHC Urban Health (a network of 10 community clinics), Mayo Clinic, North Memorial and the Northwest Metro Alliance. Between July 2013 and June 2014, Minnesota Medicaid will also award a second round of ACO contracts, specifically focused on expanding services ACOs are accountable for to include mental health and long-term supports and services, and providers that serve complex populations Integrated Health Partnerships will also provide an ACO contracting option for primary care providers and/or multi-specialty provider groups that have between 1,000 and 2,000 beneficiaries in Minnesota Health Care Programs and are not formally integrated with a hospital or integrated system via aligned financial arrangements and common clinical and information systems.

24 Leveraging Community Involvement Accountable Communities for Health Incentives for communities and care providers to partner and work together. Up to 15 Accountable Communities for Health (ACH) a A community may be a county, a reservation, a city housing project, or the patients in a health care system ACHs build on existing work Community Care Teams, Statewide Health Improvement Program, Community Transformation Grants

25 Accountable Communities for Health ACH implementation starts in year 2 October 2014 to October 2015 ACH Activities Establish community advisory teams/partnerships Identify priority population health goals and improvement activities Ensure community involvement Develop sustainability plans

26 Community Health MN Accountable Health Model 6/18/

27 Accountable Communities for Health Environment Prevention Transportation Community Based Governance Structure Local Public Health Community Care Team Community Partners Workplace Food Systems Service Coordination Team Referral Coordinator Local Public Health High Need Person or Family Primary Care Care Coordination Medication Mgt Housing Specialists Shopping CHW, Case Manager Behavioral Health PCP Coaching Hospital Services Finances Physical Therapy Heat Faith Community Health Plans Schools Education Health Literacy Adapted from Maine Quality Counts 27

28 Community Care Teams Community Care Teams are interdisciplinary, crosssetting, community-focused partnerships that bring together health care providers, patients, community support services, schools, faith-based organizations, and other key partners to coordinate care for the whole patient and improve the health of a population.

29 ACH Foundation: Community Care Teams Three existing CCT s in Minnesota: Pilots for ACH Initially funded through Health Care Homes program Multi-disciplinary care teams: clinic/hch, hospital, community & social services Focus on coordinating care for whole patient, engaging all sectors Developing new relationships, approaches 6/18/2014 MN Accountable Health Model 29

30 MN Pilot Community Care Teams Mayo Wrap-- around team approach, focusing on the development of the core team structure for senior population. HCMC, Brooklyn Park/Brooklyn Center Focus on diabetes and community/parish linkages Essentia, Ely Began with pediatric mental health, extended to broader population through community partnerships 6/18/2014 MN Accountable Health Model 30

31 E-Health Investment Giving health care providers additional support to collect, use and exchange clinical data using electronic medical records and patient registries. Enhancing the State s ability to provide meaningful data about the cost and quality of care to providers and ACOs. This information will allow providers to better manage the care of a population of people, and improve the quality and cost of their care.

32 Health Information Exchange in Minnesota Minnesota Approach to HIE Statewide Shared Services Collaborative Government Role through Provision of HIE Oversight Market-based to Encourage Innovation and Allow Choice

33 Purpose HIE Oversight Program in Facilitating Exchange Allows market-based approach for provision of HIE services; multiple HIE service providers (HIO/HDI) may be certified and operate in the state Establishes oversight by Commissioner of Health to protect the public interest on matters pertaining to health information exchange Requires State Certificate of Authority to operate Health Information Organizations (HIO) and Health Data Intermediaries (HDI) Minnesota Statute 62J J.4982

34 Exchange Mechanisms Used by Minnesota Hospitals, 2013 State-Certified HIE Service Provider Exchange with providers that use the same EHR vendor/system as our hospital Exchange with providers that use a different EHR vendor/system Peer-to-peer exchange 14% 14% 20% 47% Interstate HIE and HealtheWay Other/Do not know 1% 2% Do not electronically exchange health information 33% 0% 20% 40% 60% 80% 100% Percent of Hospitals with EHRs (N=139) Source: Minnesota Department of Health, Office of Health Information Technology, 2014

35 Electronic Exchange of Health Information Among Sharing Partners Rural/CAH Urban/Non-CAH Hospitals exchanging with any setting Hospitals exchanging with unaffiliated settings Clinics exchanging with any setting 46% 72% 75% 66% 61% 61% Clinics exchanging with unaffiliated settings Nursing homes able to exchange 36% 36% 35% 40% 0% 20% 40% 60% 80% 100% Percent of Minnesota Provider Settings Exchanging Health Information Source: Minnesota Department of Health, Office of Health Information Technology, 2014

36 The Work Continues: Identification of 15 ACHs through RFP process begins this summer Connectivity Grants are under Review for Communities that are early adopters and need additional assistance to implement HIE RFP released for contractor(s) to develop HIE roadmaps for local public health, behavioral health, long-term and post-acute care, and social services settings RFP in review for Privacy, Security and Consent TA and education for ACHs Learning Collaboratives are beginning on key topics that support the transformation of health care delivery

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