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

M P H A C O N F E R E N C E J U N E 5 , 2 0 1 4

The Minnesota Accountable Health ModelSIM Minnesota

National SIM Grants• Minnesota awarded

largest testing grant in the country ($45.3 million), February 2013

• Five other states also received SIM testing grants from CMMI: MA, ME, VT, OR and AR.

• 16 states received design grants

Vision

• Every patient receives coordinated, patient-centered primary care.• Providers are held accountable for the care provided to Medicaid enrollees and

other populations, based on quality, patient experience and cost performance measures.

• Financial incentives are fully aligned across payers and the interests of patients, through payment arrangements that reward providers for keeping patients healthy and improving quality of care; and

• Provider organizations effectively and sustainably partner with community organizations, engage consumers, and take responsibility for a population’s health through accountable Communities for Health that integrate Medicare care, mental/chemical health, community health, public health, social services, schools and long term supports and services.

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?

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

ACO/ACHs begin to integrate behavioral

health or LTC or social services/public health

15 Accountable Communities for

Health

Quality measures and payment structures

that align across payers

Providers and communities partner

in new and deeper ways

$111 M in savings to Medicaid, Medicare

and commercial payers

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67% of primary care clinics are HCH

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

MN Drivers of Better Health

• Medicaid ACOs payment models based on quality, patient experience and cost performance measurePayment models

• Practice facilitation support, learning collaboratives & funding for coordinated care transformation

• Support to integrate new provider typesCoordinated care

• Data analytics and HIT/HIE support to accelerate adoption and remove barriers to integrate care.HIT & data

• Within ACOs, integrate with long term care, behavioral health, public health and social servicesAccountable Care

• Community partnerships through Accountable Communities for Health that identify health and cost goals and strategies to meet goals

Community Partnerships

Multi-payer

Driver Four, Accountable Communities for Health (ACH)

Provider organizations partner with communities and engage consumers, to identify health and cost goals and take on accountability for population health

• Select up to 15 Accountable Communities for Health and provide financial support to

• Create new, sustainable venues through which providers engage with communities in more meaningful ways to improve individual and community and population health.

Total funding: $6.8M (16%)

Accountable Communities for Health

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Accountable Communities for Health

Adapted from Maine Quality Counts

Community Based Governance Structure

General ACH Criteria

• Broad populations may apply for ACH grants.• Priorities on advancing health equity• Community-led leadership team that represents community and

broad section of providers• Develops a community based care coordination service delivery

team or system • Population based prevention component• No longer use the percentage threshold. An “ACO partner”

should be a provider participating in an ACO, the ACO needs to be an active partner.

• Participates in Measurement / Testing / Evaluation

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ACH Advisory Subgroup

Convene 12 members in February – April, 2014 to:• Provide guidance and advice in setting strategies to raise awareness of the ACH vision

across Minnesota that will create community readiness for innovation in health and health care system redesign.

• Provide advice on soliciting and receiving input from diverse stakeholders and communities regarding the ACH approach and applying that input to program planning as appropriate;

• Develop recommendations for selection criteria and recommendation of ACHs in

collaboration with existing advisory groups and the SIM leadership team by the end of March

• At a later date the State in collaboration with the Community Advisory Subgroup will re-evaluate the work of the advisory subgroup to determine the needs for ongoing support and advice throughout ACH implementation.

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Alex Alexander MPA, MBA -- Beacon Group, SE MN, Project Management Office, Mayo Clinic

Catherine Brunkow, RN -- HCMC, Community Care Team, Hennepin County Human Services & Public Health Dept.

Catherine Vanderboon, RN, PhD -- Community Care Team, Mayo Clinic,

Gina Nolte -- Partnership for Health and CTG, Clay County Public Health

Heidi Favet, CHW -- Essentia Health Ely Community Care Team

Jan Malcolm -- Courage Kenny Center, Allina Health

Jennifer DeCubellis and Ross Owen -- Hennepin Health

Joanne Foreman, RN, BAN -- Institute For Clinical Systems Improvement, Accountable Health Community

Kathy Gregersen -- Mental Health Resources Center

Kevin A. Peterson MD, MPH, FRCS, FAAFP – Dept of Family Medicine & Community Health, Univ of MN, Minnesota Academy of Family Physicians

Kristin Godfrey, MPH -- HCMC, Community Care Team, MPHA

Roxanne King, CHW -- NorthPoint Health and Wellness

Sarah Keenan RN, BSN -- Bluestone

Susan Severson -- Stratis Health

Accountable Communities for Health (ACH) Subgroup Members

Accountable Communities for Health (ACH) Subgroup Activities

ACH Advisory Subgroup met three times: • February 28• March 14• March 28

• Executive and Detailed Summary of Meetings on SIM website www.mn.gov/sim

• Presentation to SIM Community and Multipayer taskforce on SIM website.

Revised ACH Grant Timeline

• ACH Advisory Subgroup Meetings thru April, 2014 • Contract with Community Care Teams Late Summer

2014• Statewide Community Engagement through Summer,

2014 and ongoing• Post competitive RFP September 1, 2014• Finalize RFP process and grants by November, 2014• Implementation begins in January 1, 2015

The ACH Grants Will Cover Up to 15 ACHs

• ACH leadership team, recruit ACH members including local citizens, facilitate and coordinate ACH meetings with community partners, manage ACH grant dollars.

• Implement Community Service Delivery Teams / System• Implement small grants to support community participation.• Develop infrastructure to support implementation of the ACH. • Implementation of sustainability plan, and participation in

rapid-cycle evaluation of the model.

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Foundation: Community Care Teams

• Three existing CCT’s in Minnesota: Early Implementer ACHs.• Meet same ACH criteria as competitive applicants.• Provide learning peer support (tools, guidance, small tests)Background:• Initially funded through HCH program• Multi-disciplinary care teams: clinic/HCH, LPH, hospital, community &

social services• Focus on coordinating care for whole patient, engaging all sectors • Developing new relationships, approaches to coordinated care.• Olmsted County / Mayo, Brooklyn Center / Brooklyn Park / HCMC, Ely /

Essentia.

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How to Get StartedEngage Community Members, “Reach Out”

Goal: ACH’s will engage community members and stakeholders to establish priorities to impact health goals, build partnerships that will integrate and coordinate care within their communities.• Engage community members (citizens).• Engage providers, community / local public health, community or

cultural organizations, schools, tribes, faith based organizations, patient advocacy groups, worksites, employers, housing, social services, behavioral health and other medical or non-medical groups who care for or provide services for all aspects of an individuals health.

• Local Public Health is Required to Participate.• Clinics / ACOs.

How to Get Started, Identify and Define Your Population

• Population is broadly defined such as, geographical, defined by patient population, or health needs of the community, high resource use in a smaller segment of the communities population, or a specific population such as a high rise or a virtual population of members.

• Intentional efforts should be made to reach marginalized and underserved communities.

How to Get Started to Identify Population, Build On Community Based Data

• Build on local public health and/or hospital community assessment.

• Check out your local public health agency. Each public health agency needs to complete their community health assessment by February of next year.

• Use SHIP Community Assessment data.• Consider health systems utilization data or health plan

data or workforce or other community collected data.

ACH Community Engagement

• The primary goals of the community engagement process are to: • Raise awareness of the ACH vision and opportunities for

patient centered, coordinated integrated approach;

• Create community readiness for innovation in health and health care system redesign, delivery and payment; and

• Receive input from diverse stakeholders and communities regarding the ACH approach, including ACH structure and governance.

Community Engagement, Next Steps

• Communication through a variety of methods, webinars, newsletter, and website.

• Regional presentations will be scheduled for this summer.• Events already scheduled.• Do you have an event already planned with community

members? Let us know.• Connect on our website at http://mn.gov/sim and Select Request a Speaker

More Information

• Visit• www.mn.gov/sim

• Sign up for email alerts at the website

• Request speakers at www.mn.gov/sim

• Email sim@state.mn.us

Local Public Health and Accountable Communities for Health

Renee S. Frauendienst, Public Health Division Director/CHS Administrator, Stearns County

Disclaimer

All comments are mine, mine, mine!!However, they may be borrowed free-of-chargeat your own risk for up to 2 weeks.$0.25/day after that!

Light travels faster than sound. This is why some people appear bright until you hear them speak.

Accountable Communities for Health

Quickly unfolding Great flexibility Broad structure Driven by communities “learning collaborative” atmosphere Conceptually based

Goal of SIM

System change that is: Innovative Replicable Sustainable Measurable Broad-based

Fits perfectly Local Public Health role

Role of Public Health3 Core Functions10 Essential ServicesStatutory Responsibilities

Essential Services and Core FunctionsSystem Nurture:AssessmentPolicy developmentAssurance

Provider of Services:Assurance-Link to/provide care

Accountable Communities for Health System Nurture role

of Public Health Chapter 145A

Community Health Assessment

Community Health Improvement Plan

Top Community Priorities

Grounded in Public input

Accountable Communities for Health Policy Development

Partnerships around policy/system/environmental changes

Health in All Policy Social Determinants

of Health Health Equity

Accountable Communities for Health Assurance Structural Support

Competent Workforce Adequate Workforce Culturally appropriate

CHW

Accountable Communities for Health System Nurture

Outcomes Short-term Long-term

Sub-populations Whole population

Accountable Communities for Health Lesser Degree Providing care/linking

care

Accountable Communities for Health 1. LPH will have

available their assessment results

2. LPH will have established community priorities

3. LPH should have linked to other community assessments-Hospital, United Way, other community initiatives

4. LPH may not be the lead but rather the “behind the scene” nurturer.

5. Approach LPH to partner and connect you with other partners

6. If LPH is not at the table-get them there!

7. LPH may have direct services that may help or may be the provider to develop

Southern Prairie Community Care• In 2006, the 12 Counties began discussions on how to

build local partnerships and increase local control around service delivery for the population. A focus on early intervention and prevention was discussed.

• In 2010, the Department of Human Services under Minn. Stat. 256B.0755 was allowed to create alternate and innovative health care delivery systems, organized by providers, to provide services to groups of patients for an agreed upon total cost of care or risk/gain sharing arrangement.

Southern Prairie Community Care• In 2012, a Joint Powers Agreement was finalized

among the 12 Counties and Southern Prairie Community Care (SPCC) was formed.

• The purpose for formation of SPCC is building a service delivery network- a care coordination model built upon the concept of an Accountable Care Organization (ACO).

• DHS receives $43 million SIM grant for statewide project and begins the planning phase.

Southern Prairie Community Care• The work has begun at SPCC to create a Accountable

Care Organization. • There are many partners in this project but today I will

focus on where Public Health fits into this puzzle!• Two Operations Mangers have been hired bringing the

public health and human service expertise to the model.

• Four tracks have been developed and public health has a role in all four tracks. The four tracks identified are:

Southern Prairie Community Care• Track I Focus: People With Chemical Dependency and Adult

Mental Health, and significant use of Emergency Department/Hospital or Community Based Crisis Care.

• Track II Focus: Adults with Multiple Chronic Concerns with some focus on Diabetes

• Track III Focus: Adolescents health screening for chlamydia and/or broad spectrum STD screening, mental health screening and chemical dependency screening

• Track IV Focus: Increasing Well Child Visits at age 15 months that will lead to increased opportunities to address family system deficits.