Health Transformation in Colorado

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1 Health Transformation in Colorado How SIM Can Support and Leverage Colorado s Can-Do Spirit Presented By: Vatsala Pathy Office of Governor John Hickenlooper January 26,

2 TODAY S OBJECTIVES Learn about the SIM grant and how it affects you Learn how SIM ties into The State of Health initiative 2

3 WHAT IS SIM? SIM = State Innovation Models Initiative Initiative of the Center for Medicare & Medicaid Innovation (CMMI) Encourages states to develop & test models for transforming health care payment & delivery systems Colorado awarded $2 million planning grant + $65 million implementation funding to strengthen our strategy to achieve Triple Aim* *Better health, better patient experiences, lower costs 3

4 COLORADO SIM: OUR OBJECTIVES Move healthcare organizations along the continuum to greater clinical, financial and operational alignment Incent the system to align with the needs of individuals and the capabilities of communities. 4

5 COLORADO SIM : OUR GOAL Improve the health of Coloradans by providing access to integrated primary care and behavioral health services in coordinated community systems, with valuebased payment structures, for 80% of state residents by

6 COLORADO S PATH TO HEALTH TRANSFORMATION 6

7 KEY INITIATIVES The State of Health: administration-wide commitment to making Colorado healthiest state in the nation 2 years of SIM foundation work: engaged 100s of stakeholders around integrating Behavioral Health & Primary Care Senate Bill 208 Commission & Commission on Affordable Health Care: bipartisan and public/private commitments to keeping Colorado health policy on cutting edge Comprehensive Primary Care Initiative (CPCI): Convened public/private payers in competitive market to engage in jointdecision making & lead in developing data aggregation solution Accountable Care Collaborative (ACC), Regional Care Collaborative Organizations (RCCOs) & Behavioral Health Organizations (BHOs): Colorado Medicaid is advancing public sector delivery & payment reform 7

8 THE STATE OF HEALTH FRAMEWORK Promoting prevention & wellness Helping individuals stay healthy or become healthier Improving health system integration & quality Eliminating barriers & working effectively within & across systems to ensure personcentered care Expanding coverage, access & capacity Ensuring individuals can access care at the right time & place Enhancing value & strengthening sustainability Redesigning financial incentives & infrastructure to focus on quality & value, not volume 8 STATE INNOVATION MODEL

9 THE STATE OF HEALTH FRAMEWORK Colorado Winnable Battles: central to many of our initiatives and foundation for SIM work Legislation passed: central to many of our initiatives and foundation for SIM work Promoting prevention & wellness Helping individuals stay healthy or become healthier 9 Strengthened Mental Health System: initiative to expand community & crisis capacity Drug prevention & education: national leader on combating prescription drug abuse & marijuana prevention/education Medicaid State Plan Amendment (SPA): SPAs allow us to make changes to program policies/operational approach Colorado Prevention Alliance (CPA): Central to many of our initiatives and foundation for SIM work Community Health Alliance Model: Public health transformation collaborative

10 THE STATE OF HEALTH FRAMEWORK Legislation & beyond: well into full, multi-year implementation Cornerstones of work: 2 years of SIM progress & our State Health Improvement Plan Improving health system integration & quality Eliminating barriers & working effectively within & across systems to ensure personcentered care Accountability for improvement: RCCOs responsible for meeting key quality of care indicators Office of Community Living: reformed our system of long-term services & supports Partnership with Colorado foundations & advocates: Beginning to integrate dental into primary care RCCO/BHO alignment: Outset of process to ensure longterm alignment with Medicaid 10

11 THE STATE OF HEALTH FRAMEWORK Eligibility & benefit expansions: Substance use & mental health benefits; adult dental; 133% Federal Poverty Level (FPL) Successful state-based Exchange: First state to pass bipartisan Exchange legislation Expanding coverage, access & capacity Ensuring individuals can access care at the right time & place Alignment with Federal Law: Reformed Colorado s health insurance statutes Implementation of workforce data initiative: To improve workforce planning & investment strategy Simultaneous enrollment issue: Leading State working to fix this structural Affordable Care Act (ACA) problem 11

12 THE STATE OF HEALTH FRAMEWORK Leading the pack: Colorado leads in Electronic Health Record (EHR) & Health Information Exchange (HIE) adoption Successful legislation: Passed legislation supporting payment reform pilots Enhancing value & strengthening sustainability Redesigning financial incentives & infrastructure to focus on quality & value, not volume Reforming HIE structure: Ensuring continued progress & integration with non-hie initiatives Partnership with Brookings Institute: Integrating measures & programs across health/human services & providing education to help all Coloradans achieve middleclass income by middle age 12

13 COLORADO SIM: WHY IT MATTERS of the time, 14 most common physical complaints have no identifiable organic cause 84% 80% of people with a behavioral health disorder will visit primary care at least once a year >50% of referrals from primary care to an outpatient behavioral health clinic do not make the 1 st appointment 50% of behavioral health disorders are treated in primary care 67% of people with a behavioral health disorder do not get behavioral health treatment 13

14 COLORADO S STRUGGLES High rates of suicide (3 per day) Drug abuse deaths > car accident or firearm deaths Higher rate of illicit drug use Marijuana-related hospital admissions 14

15 COLORADO SIM: OUR PATH FORWARD 1. Service delivery and practice transformation 2. Population health and consumer engagement 3. Payers, purchasers and payment reform 4. HIT, data and quality measures 15

16 SERVICE DELIVERY & PRACTICE TRANSFORMATION RIGHT CARE, RIGHT TIME, RIGHT PLACE Traditional model does not address community needs Our model: supports, strengthens & reaches 400 practices Ramp-up, including practice assessment tool & IT infrastructure Additional 150 practices on-boarded Initial 100 practices on-boarded Additional 150 practices on-boarded 16

17 POPULATION HEALTH & CONSUMER ENGAGEMENT ALL HEALTH IS LOCAL Building from Winnable Battles framework We will: identify, review, engage & facilitate Regional planning; review community assessments Launch collaboratives; align funding with regional needs; bi-annual convening of collaboratives

18 PAYERS, PURCHASERS & PAYMENT REFORM YOU GET WHAT YOU PAY FOR OBSERVATION PHASE Identify current spending & future spending benchmarks Understand needs to transform practice, delivery & payment Identify outcome & quality baselines SHARED RISK & SAVINGS Increased provider responsibility Extra payment built into cost of care Support in practice transformation Performance, cost & quality measurement 18 CARE COORDINATION & SAVINGS Increased coordination thru additional payments Support in practice transformation Performance, quality & cost measurement PAYMENTS & BUDGETING FOR COMPREHENSIVE PRIMARY CARE Learning collaborative Payment based on total cost of care & coordination Performance, quality & cost measurement

19 PAYERS, PURCHASERS & PAYMENT REFORM YOU GET WHAT YOU PAY FOR Colorado s major carriers actively collaborate around Triple Aim We recognize challenges providers face in addressing patients mental health & substance abuse issues Plans are providing needed technological assistance in areas such as telehealth, tele-therapy & tele-psychiatric consults 19

20 HIT, DATA & QUALITY MEASURES IF YOU CAN T MEASURE IT, YOU CAN T IMPROVE IT Clinical IT support for practices Provide HIT assessments at the practice, community & state level Support clinicians in HIT adoption & integrating HIT tools into workflow to improve quality of care & reduce cost A strong & effective governance structure with data policies in place will support data driven planning & implementation via: Centralized data repository providing consolidated reporting and benchmarking Collecting, merging & analyzing clinical & claims data to leverage data supporting improvements in population health 20

21 HIT, DATA & QUALITY MEASURES IF YOU CAN T MEASURE IT, YOU CAN T IMPROVE IT Quality measures: Hypertension Obesity Tobacco Prevention Asthma Diabetes IVD Safety Depression Anxiety Substance Use Child Development Evaluation measures: Population Health Health Care Systems Quality of Care Quality Outcomes Costs Statewide Costs Region-wide Costs Populationwide Program Monitoring 21 Rapid-cycle Evaluation Cost Reduction Return on Investment

22 LABORATORY FOR HEALTH TRANSFORMATION 22

23 23 QUESTIONS?

24 CONTACT INFORMATION Vatsala Pathy SIM Director Office of the Governor

25 THANK YOU! January 24,

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