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, 2015 1
TODAY S OBJECTIVES Learn about the SIM grant and how it affects you Learn how SIM ties into The State of Health initiative 2
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
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
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 2019 5
COLORADO S PATH TO HEALTH TRANSFORMATION 6
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
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
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
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
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
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
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
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
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
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 2015 2016 2017 2018 Initial 100 practices on-boarded Additional 150 practices on-boarded 16
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 2015 2016 2017 2018 17
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
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
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
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
LABORATORY FOR HEALTH TRANSFORMATION 22
23 QUESTIONS?
CONTACT INFORMATION Vatsala Pathy SIM Director Office of the Governor Vatsala.pathy@state.co.us 303.512.3330 24
THANK YOU! January 24, 2015 25