Maryland Health Care Commission: the 2014 Update

Transcription

1 Maryland Health Care Commission: the 2014 Update Ben Steffen Executive Director Maryland Health Care Commission October 8, 2014

2 Speaker Biography Ben Steffen serves as the Executive Director of the Maryland Health Care Commission (MHCC), an independent regulatory agency whose mission is to plan for health system needs, promote informed decision making, increase accountability, and improve access to health care and health care coverage in Maryland. The MHCC administers the certificate of need program, Maryland small group insurance market reforms, the establishment of Maryland s Health Information Exchange, and quality reporting initiatives for hospitals, nursing homes, and health benefit plans. Prior to assuming this position, he served as the Director of the Commission s Center for Information Services and Analysis. This Center has analytic and operational responsibilities for health care practitioner initiatives in the state, including development of an All Payer Claims Database and the Patient Centered Medical Home Program. Mr. Steffen serves as a spokesperson for the Commission at state and national levels on state health care expenditures, physician work force, physician uncompensated care, and information security. development of an All Payer Data Base and the Patient Centered Medical Home Program. Mr. Steffen is board member for the Maryland Health Benefit Exchange, the organization established in 2011 by the Maryland Legislature to implement the insurance coverage expansion under the Patient Protection and Affordable Care Act (ACA). He also serves on the Board of the Maryland Health Insurance Program, Maryland s highly successful high risk insurance pool, that serves individuals that are unable to purchase insurance in the current Maryland individual market Earlier in his career, he served as a budget analyst in the Health, Housing, and Income Security Division of the Congressional Budget Office, where he worked on the modeling that produced the estimates of reforms that ultimately led to the Medicare Prospective Payment System. Before joining MHCC, he served as program manager with Computer Science Corporation where he consulted on health policy modeling applications with ProPAC (later MedPAC), the Congressional Research Services, and several large national hospital systems. Mr. Steffen holds a Master s Degree from American University and has completed post graduate work at the University Of Michigan.

3 Maryland Health Care Commission Craig Tanio, MD, MBA, Chair, is the Chief Medical Officer at ChenMed, and a former principal of McKinsey & Co. Garret A. Falcone, Vice Chair, is the Executive Director of Heron Point of Chestertown Michael S. Barr, MD, MBA, FACP is a board certified internist and Executive Vice President at the National Center for Quality Assurance (NCQA) John E. Fleig is Chief Operating Officer for Mid Atlantic Health Plan for United Healthcare Paul Fronstin, PhD is the Director of the Employee Health Benefit Research Institute s Health Research and Education Program Kenny W. Kan CPA is Senior Vice President and Chief Actuary of CareFirst. Michael S. McHale, MHA is the President and CEO of Hospice of the Chesapeake Barbara Gill McLean, MA retired as a Senior Policy Fellow at the University of Maryland School of Medicine and is the former Executive Director of the MHCC Kathryn Montgomery, PhD, RN, NEA BC is the Associate Dean of Strategic Partnerships & Initiatives and Assistant Professor at the University of Maryland School of Nursing Ligia Peralta, MD, FAAP, FSAHM, AAHIVM is a clinician with special expertise in the areas of adolescent health, HIV, sexually transmitted infections and health disparities Frances B. Phillips, RN, MHC, is a community health improvement and population health innovation consultant and is the former Deputy Secretary for Public Health Services Glenn Schneider, MPH is the Chief Program Officer for the Horizon Foundation Diane Stollenwerk is a health care quality consultant and a former Vice President at the National Quality Forum Stephen Thomas, PhD is the Director of the Center for Health Equity and a professor in the School of Public Health at Univ. Of Maryland at College Park Adam Weinstein., M.D. is a kidney specialist and the medical director for Nephrology and Transplant Services for the Shore Health System.

4 MHCC Mission Control health system costs through effective and efficient planning Drive quality improvement through public reporting and oversight Serve as a health policy think tank and incubator for Maryland by analyzing policy alternatives and testing policy options alone and in collaboration with executive and legislative branch partners Accelerate delivery system reform and diffuse information technology to improve quality and reduce costs

5 MHCC Organizational Structure Executive Direction Center for Health Facilities Planning and Development Center for Quality Measurement and Reporting Center for Analysis and Information Services Center for Health Information Technology and Innovative Care Delivery Streamline CON Align health planning with new waiver & ACA Modernize oversight of specialized services` Integrate quality domains in hospital reimbursement Expand Hospital Performance Guide Measuring practitioner performance Increasing price transparency Monitoring population health Accelerate EHR adoption Expand advanced primary care initiatives

6 Center for Health Care Facilities Planning & Development Align health planning with requirements of new waiver and health care reform Modernize approach to oversight of specialized services 5

7 Key Initiatives Health Planning Rethinking approach to health planning and certificate of need (CON) under the new hospital waiver Short term applications are not docketed until hospitals have a budget agreement with MHCC Applications must align with assumptions in the budget agreement Applies to projects where letter of intent was submitted before 1/1/2014 Mid term Aligning levels of demand with new payment model Update State Health Plan to link planning/con regulation within spending limits environment Need (including priority ranking of need), impact and cost effectiveness will primarily be addressed in Phase 1 review Long term 2017 Further adapt regulation as necessary based on initial experience with two phase process and next phase of HSCRC waiver (targeting overall per capita spending for health care services)

8 Key Initiatives Cardiac Services MHCC adopts final regulations on new oversight of cardiac services that established Ongoing oversight of services via a certificate of ongoing performance Angioplasty in hospitals with and without cardiac surgery Cardiac surgery programs awarded before and after 1998 External and independent peer review established for all angioplasty programs Voluntary relinquishment when programs have failed even after implementing a corrective action plan Establishes a process for awarding certificates of conformance for existing programs that perform only primary angioplasty or for new angioplasty programs Establishes a process for considering applications from hospitals wishing to perform cardiac surgery Creates a clinical advisory committee to advise MHCC on implementation of program More fully aligns Maryland with most recent clinical guidelines established by the ACC and STS

9 Center for Quality Measurement & Reporting Integrate quality domains across health plans, hospitals, and long term care facilities Quality Hospital Performance Guide and Designate Patient Safety Center

10 Key Initiatives Maryland Health Care Reports

11 Key Initiatives Hospital Performance 8 New Public Reporting Hospital Guide will launch in this month Price Transparency Initiative Top 20 DRGs and most commonly performed outpatient procedures presented by hospital Plan to include physician payments in 2015 January 2014 Full Implementation Expanded Data Collection Outpatient Measures Claims Based & Chart Abstracted New HAI measures (CAUTI, MRSA, Colon, SSIs added) Use of CDC HCW Flu Vaccination Module for national comparison

12 Key Initiatives Maryland Patient Safety Center Activities of Maryland Patient Safety Center, Inc., the current designee Develop a culture of patient safety within health care facilities Approach emphasizes non punitive educational initiatives that encourage full reporting that will contribute to the prevention of future errors. AHRQ designated Patient Safety Organization Key activities directly related to adverse events Safe from Falls Educational programs aimed at reducing errors, including adverse events Root Cause Analysis and Failure Mode Effect Analysis 2015 initiatives Sepsis prevention and Adverse event reporting MHCC process for redesignation MPSC presents to MHCC in September MHCC requests public comment on redesignation MHCC considers staff recommendation at the November meeting

13 Center for Analysis & Information Systems APCD expands as a tool for Monitoring population health Increasing price transparency Measuring practitioner performance

14 Key Initiatives Expanding the All Payer Claims Data Base (APCD) Historical uses legislatively required analyses, MHCC programs (medical home), and Commission originated studies All commercial carriers are required to submit under State law TPAs, Behavioral Health, PBMs, QHPs added in 2014 Quarterly collection of information from payers launched on 10/1/2014 Complete 2014 claims available late spring 2015 Greater data sharing with Medicaid and Medicare data (under a federal data use agreement) New APCD Use Cases Foundation of a practitioner performance measurement system Source for measuring spending per capita (enhanced waiver) Monitoring the impact of health reforms on population health

15 New information needs required regulatory and technology changes in Directed payers to provide Master Patient Index (MPI) for enrollees CRISP will supply MPI to submitters, submitters will append MPI to eligibility files on the APCD MPI will be unique to resident Potential to link with hospital discharge and outpatient records New information sources defined 3 new submissions files Dental claims (carriers in HBE) in 2014 Plan benefit design Non claims based payments to providers 2016

16 Key Initiatives Using the All Payer Claims Data Base (APCD) 15 Make APCD information available for examining population health develop a resident summary file Mirrors Medicare beneficiary level cost and utilization file Demographics of the patient/resident Summarized information on spending by broad service buckets Resident summary file starts with privately insured, would also include Medicare and eventually Medicaid Further Price Transparency (CCIIO will provide some funding) MHCC and MIA will work together to use APCD for MIA s rate review processes MHCC will accelerate data collection to align data with information reported by carriers in rate applications MHCC and MIA will work together to build analytic tools that will enable APCD to be used in dynamic rate review environment

17 Center for Health Information Technology & Innovative Care Delivery Accelerate HIE adoption Expand advanced primary care initiatives

18 Key Initiatives Health IT Adoption Advance health information technology (health IT) statewide to achieve the goals of health care reform Plan for health IT adoption and integration that balances the need for information sharing with the need for strong privacy and security policies Promote and facilitate the adoption and optimal use of health IT for the purposes of improving the quality and safety of health care Identify challenges to health IT adoption and use and formulate solutions that address these challenges Increase the availability and use of standards based health IT through stakeholder engagement Harmonize community based HIE efforts throughout the State Foster appropriate use case development to increase availability of electronic health information through the statewide health information exchange (HIE) Designate management service organizations to promote the adoption and advanced use of electronic health records

19 Key Initiatives Advanced Primary Care ACA and new waiver envision closer integration between hospital and community care Practices organized around PCMH programs are best equipped to keep patients out of the hospital and to manage patients transition back into the community 5 large commercial carriers, Medicaid, some self funded employers participate in the current plan Authority to create PCMH programs ends 12/2015 MHCC working with stakeholders to determine approaches for continuing PCMH programs Practice transformation important Monitoring single carrier programs is critical for identifying success factors To fully engage practices, the state can work with carriers to align quality metrics and performance methodologies Data analytics need enhancement

20 New Information and New Challenges All MHCC initiatives make extensive use of information More accurate, timely, and more comprehensive data are essential to the new care models, payment systems, and health care entities that have arisen from the ACA New hospital payment model adds another dimension and opportunity for reform in Maryland

21 Health care reform will increase the need for timely, accurate, and detailed data (appropriately secured) Presentation based on hospital administrative data Contains simulated data

22 Health care reform will increase the need for timely, accurate, and detailed data (appropriately secured) Presentation based on hospital administrative data Contains simulated data

23 New systems and better integration are needed Clinical Operations Electronic Health Record Patient registries & practice level analytics Medical Mgmt Population Health Analytics Decision support Provider Performance Measure Health Information Exchange Real time clinical data Speed Claim data from payers Completeness Data Governance

24 An Infrastructure to Support New Health System Source Systems Clinical and Business Decision Makers Clinical ADT feeds Inpatient EHRs Ambulatory EHRs Labs Results Radiology Results Pharmacy Fills Info for Care Management HIE Reporting Services Performance and Population Health Measures Clinical Domain Care Management Domain Detailed Performance Domain Administrative & Financial Payer Claim Systems Hospital & NH Registry/Admin Data Patient Satisfaction Trusted Entities (Govt) MHCC & Others Maryland Cost and Quality Reports Portal Consumers & Patients

25 The Human Component To meet the needs of the ACA and the new hospital waiver, highly motivated people committed to lowering costs and improving care will be needed New occupations population health director and health data scientist Skills that will be needed health economics, epidemiology, biostatistics, actuarial science, computer science Capable of explaining what the new information is telling us (in a compelling way)