Payment Modeling Workgroup Breakout Session March 17, 2015

Transcription

1 Payment Modeling Workgroup Breakout Session March 17, 2015

2 Agenda Meeting Objectives Introductions Workgroup Purpose Payment Modeling Transformation Sequence Workflow Deliverables Workflow Timeline Next Steps 2

3 Meeting Objectives Workgroup members get to know each other, members of the SHIP team Become familiar with workgroup specific transformation sequence, initial set of deliverables, and related timelines. o Deeper, and workgroup specific, dive into content reviewed by Julie earlier today Review immediate next steps to begin work 3

4 Introductions Introduce yourself and share your professional experience. Why did you agree to participate in this workgroup? Based on what you heard this morning, identify: o One opportunity we should capitalize on o One barrier we will need to address 4

5 Payment Modeling Workgroup Purpose The purpose of the Payment Modeling Workgroup is to develop approaches to payment, reimbursement, and investment that will support successful implementation of the care delivery system transformation and population health improvement strategies identified by those workgroups. The Payment Modeling team will serve as a resource to all SHIP transformation teams, including designating representatives from the Payment Modeling team to serve as embedded members of the three transformation teams. 5

6 Approach to Completing Workgroup Deliverables Payment Modeling Transformation Sequence Workflow Deliverables Workflow Deliverable Timeline 6

7 Payment Modeling Transformation Sequence Define What a good Paymt Model is/does Inventory Existing Models What needs/attributes describe a good payment model? Note/Clarify Redundancy What are the attributes of the payment models needed by the transformation teams? Transformation Payment Needs Assessment Examples of successful payment/investment models applied to target pop, intervention? What measurement, data issues do they raise? What payment models/experiments are currently active? Build payment model inventory/menu. Are there similar payment models being called different things? Create unique and descriptive names for each basic model. Community Best Practice Identify gaps between current state and goals/identified community best practice. What root causes underlie gaps? How should current models be adapted? Redesigned? Gap/Root Cause Analysis What is the road map for designing and testing new payment/investment models? What is the plan to disseminate and support implementation? Best Practice/ Implementation Road Map Sustainability 7

8 Step Description Purpose What Is A Good Payment Model? Identify realistic, actionable and measurable goals for payment/investment that will advance the health and health care of this population. Consider patient/person/population perspective at center. To establish a set of common/core attributes that all stakeholders agree are appropriate, achievable, actionable and measurable. These attributes will serve to align the efforts of all stakeholders in the transformation of payment/investment for this population Population Boundaries Transformation Teams identify specific population of people/patients to be considered in this transformation study To clearly define the attributes of those included in the study so that team members can focus the transformation effort Discovery Structured gathering of relevant evidence-based information about the population being studied here, payment/investment models currently being applied to this population. Confirm interventions being identified by Transformation Teams. To develop a well founded understanding of the current approaches to payment/investment for populations and interventions identified by Transformation Teams. Determine what kind of inventory of current models, results, etc. would add value. Community Best Practice Identification of actions by stakeholder group, specific to payment/investment, that will positively advance the Shared Goals for this group of people/patients Go and see examples of payment/investment in desired interventions. Can current approaches meet the need, work for WI? Why/why not? Consider connections with Transformation Measurement and HTI workgroups. Gap Analysis/Root Cause Assessment Identify gaps between the current state and future state of the payment/investment models that pertain to the health Define the gaps to permit assessment of whether proposed interventions will and health care of this population. Identify and document address gaps/root causes. Identify circumstances for each stakeholder group root cause(s) associated with the gap(s). Multiple, that adversely impact the identified gap(s) stakeholder based root causes are likely to track to one gap.

9 Step Description Purpose Wisconsin Best Practice Identify approaches to payment/investment that meet identified attributes of successful model and build on current/known community best practice. Provide frameworks, other support as needed by those who will implement. To develop a menu of approaches to designing/implementing approaches to payment/investment that advance the health/healthcare needs of target population and engage all relevant stakeholders Implementation Road Map Establish sequence of events, key actors, dependencies, needs for implementation support, etc. To support successful, sustainable, scalable implementation of Wisconsin best practice approaches to payment/investment by wide array of necessary stakeholders. 9

10 Population Boundaries Sources of Potential Priority Areas SIM FOA and Plan for Improving Population Health, including Metrics Care Redesign, Behavioral Health, and Population Health Workgroups 10

11 Population Boundaries Suggested Criteria for Choosing Sub-Populations Big enough to matter Small enough to manage get reports, digest, understand the data and the improvement opportunities Data is available to understand the problem and the opportunity, and the data supports the choice Some degree of homogeneity within the sub-population In the line of sight of stakeholders they are already interested Connect to clinical environment in some way Pick to win successful application of transformation model from top to bottom Experienced "transformation leaders" and can apply and improve the model the first time through Not necessary to look first at biggest cost, highest variation Private and public sector relevance 11

12 Population Boundaries Early Thinking Hypertension Obesity Tobacco Diabetes 12

13 Population Boundaries Why Hypertension? Prevalent Root cause/driver of poor health Gaps in outcomes Costly to healthcare, to employers, to families and communities Amenable both to clinical and also community interventions Existing momentum nationally, in the state DHS/CDC Million Hearts CHNA/CHIP Top 8 (Root Causes Nutrition/PA/Obesity/Tobacco) 13

14 Population Boundaries Many Questions to be Answered Adults? Working age 18 64? Seniors 65+? Kids? Geographic focus area urban, suburban, rural? Focus by socioeconomic status or educational attainment? Focus by racial or ethnic group? Focus on greatest gaps, by any of these definitions of the population? 14

15 Payment Models, Measures, Data Community Conditions that Facilitate Healthy Choices Population Health Workgroup Begins Here Best Clinical Practice Including Patient Population Health Management Strategies, Registries, Etc. Care Redesign Workgroup Begins Here Patients Health Needs and Goals 15

16 Our goal will be to ground the SHIP Plan for Improving Population Health in health care improvement priorities, while planning to act at the intersection of health care and community, as well as plan for community level changes that are connected back to the clinical transformation priorities. Health Care Transformation Clinic-Community Linkages P/S/E* Changes to Support Healthier Choices, Reduced Risks Clinical improvement priority with clinical redesign recommendations including population medicine/clinical population health activities Clinic- community linkage strategies, including other partners (collective impact model) Clinic- community linkage strategies, including other partners (collective impact model) Community P/S/E that supports optimal health, reduced risk factors, makes aligned activities possible Community P/S/E that supports optimal health, reduced risk factors, makes aligned activities possible Community P/S/E that supports optimal health, reduced risk factors, makes aligned activities possible *P/S/E = Policy, Systems, and Environmental 16

17 What is a Good Payment Model? Successful Payment Models Will Create incentives for healthcare providers and (as appropriate) community partners to deliver optimal care to patients/consumers while minimizing waste. Support staff and infrastructure necessary to deliver identified best practice Require financial participation by all those with a stake in the outcome Be risk adjusted and sized to the target right payment for right patients/consumers, right services 17

18 What is a Good Payment Model? Successful Payment Models Will Be Supported by a demonstrated ROI we are paying for what works, and we can measure positive ROI on agreed-upon terms [may not all be financial, in same time frame, savings may not accrue directly to the payer/funder/investor] Supported and viewed as feasible by majority of relevant public and private payers/purchasers/funders resulting in aligned approaches and incentives Developed and implemented in a context, with an understanding of how this strategy contributes to the goal of better health with less disparity 18

19 What is a Good Payment Model? What Do We Want to Finance? 19

20 What is a Good Payment Model? Discussion What attributes would you add to or subtract from the straw model? Does the healthcare 1.0/2.0/3.0 construct help to advance the dialogue? Why or why not? What Is A Good Payment Model? Identify realistic, actionable and measurable goals for payment/investment that will advance the health and health care of this population. Consider patient/person/population perspective at center. To establish a set of common/core attributes that all stakeholders agree are appropriate, achievable, actionable and measurable. These attributes will serve to align the efforts of all stakeholders in the transformation of payment/investment for this population 20

21 Discovery Healthcare Payment - Current Conditions Pluralistic insurance marketplace commercial and Medicaid Majority of $$ still paid on a FFS basis Pay for value picking up steam, but not coordinated, not at scale in the commercial market Medicare moving (effectively?) into value based payment What else do we need to know to understand the current state? 21

22 Discovery Investments in Health - Current Conditions Health outcomes are heavily influenced by non-clinical factors, particularly education and income Investments in these determinants come not just from healthcare payers, but also from federal, state, and local government, business, philanthropy 22

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25 Community Best Practice Approaches to Consider 25

26 Community Best Practice Approaches to Consider 26

27 Discovery Discussion How can we quickly arrive at a clear and relevant picture of the current state? o What aspects of the current payment/investment environment do we need to better understand? o What can we get started on now vs. waiting for the Transformation Workgroups to refine their thinking? Implementation will be among our biggest challenges how can we start thinking now re: how best to test feasibility, build engagement? Discovery Structured gathering of relevant evidence-based information about the population being studied here, payment/investment models currently being applied to this population. Confirm interventions being identified by Transformation Teams. To develop a well founded understanding of the current approaches to payment/investment for populations and interventions identified by Transformation Teams. Determine what kind of inventory of current models, results, etc. would add value.

28 SHIP Workflow Deliverable Timeline Define What a good Paymt Model is/does Inventory Existing Models April 2015 May 2015 Note/Clarify Redundancy May 2015 Transformation Payment Needs Assessment Community Best Practice June 2015 Gap/Root Cause Analysis August/September 2015 June 2015 July 2015 Best Practice/ Implementation Road Map Sustainability 28

29 Next Steps Engaging advisory panel members Monthly workgroup meetings Using Google Drive Workgroup support 29

30 Engaging Advisory Panel Members Workgroup will engage advisory panel members as needed to solicit input on the development of identified deliverables. Examples might include. o When evidence based research is not available and/or specific expertise is needed. o To identify best practices. o To confirm current environment, attributes, and characteristics of population, models, and infrastructure. o Obtain input on ideal state goals, objectives, and outcomes. Recommend coordinating outreach to Advisory Panel members by discussing/assigning at workgroup meetings Based on these desired contributions, who is missing from the Payment Modeling Advisory Panel? 30

31 Monthly Workgroup Meetings Goal is to have one in-person and one teleconference meeting each month. In-person meetings will be approximately 4 hours. Teleconference meetings will be approximately 2 hours. Potential for off-meeting research to contribute to deliverables. Project staff will begin contacting workgroup members immediately following workgroup meetings to schedule monthly meetings for April. Workgroup substitutes are not allowed. Facilitators and project staff will follow-up with workgroup members that cannot attend a meeting. Consistent participation is required given the short-time frame to develop the SHIP. 31

32 Using Google Drive Facilitate workgroup member access to resources, documentation, and deliverables. Access from any internet connection Provides efficient and consistent approach to maintenance of project documentation. Version control Project staff will provide tutorial webinar and support to assist workgroup members. 32

33 Workgroup Support During the SHIP development process please direct questions, comments, or issues appropriately. Administrative/General Questions Contact Lacey Jafolla or Craig Steele Send s to Workgroup Specific Questions Contact Workgroup Facilitator, Sarah Orth, or Joelle Espinosa Escalating Questions/Issues Contact Workgroup Facilitator or Julie Bartels Contact list included in meeting folder 33

34 Questions? 34

35 Thank You! (desk) (cell) 35