Ohio Healthcare Efficiencies Study Committee

Richard Shonk, MD, PhD

Chief Medical Officer

Who We Are

Neutral forum for all stakeholders

concerned with health and health care

Those paying for health care

Those providing health care

Those receiving health care

Those improving community health

Our Mission

To positively affect health status, experience, outcomes, and affordability by fostering a connected system of health care and community health through innovation, integration and informatics

What’s the Triple Aim?

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1 2

BETT

ER C

ARE

LOW

ER O

VERALL C

OST

BETTER HEALTH

Collective Impact on Health

Health Care Costs Continue to Rise

And overall health is not improving 2013 State of American Well-Being; Gallup – Healthways Well-Being Index

42nd

49thKENTUCKY

OHIO

142 of 189:Community Well-Being

Where Did We Begin:Bold Goals For Our Region

Today 52% Today 82%

The Story of Our Top Scenarios…

• Initiatives with Impact • Income and Education

improvement• Healthy Behaviors• Continued Improvement in

Patient Centered Medical Home & Care Coordination

• Payment Reform

Action Teams & Steering Committee 2.0Proposed Action Teams:

Action Team StructureCo-Chairs: to reflect diversity, ideally members of current Steering Committee or Leadership Forum

Members: Additional Steering Comm. and Leadership Forum volunteers, subject experts, reps of current programs. Others to assure diversity of perspective, geography, race, and knowledge of current work in that area

Accountable to the Steering Comm. 2.0 to research strategies and recommend action plans

Healthy Behaviors

Care Delivery Bundle

Payment Reform and Financing

Other (TBD)

Other (TBD)

Steering Committee 2.0Chair: Sue McPartlinCo-Chairs: Sr. Sally Duffy, Dr. Lynne SaddlerMembers:

• Existing Steering Committee members • Action team co-chairs

Accountable to the community to assure action plans are sound, aligned, leveraged, address equity and mental health, and match agreed-upon decision criteria

The Comprehensive Primary Care (CPC) Initiative

Primary Care Payment Model Shared Savings(2014-2016)

Care management pmpm; private health plans for commercial, MA, medicaid lines of

business

Care management

pmpm; “fee for service”

Medicare and Ohio Medicaid beneficiaries

Fee for Service + PMPM + Shared Savings = Total Reimbursement

CPCi Markets

Cincinnati/Dayton/Northern Kentucky Market

• 75 Practices• 1/3 Independent• 2/3 System

• 250 Physicians• 220,000 lives• 9 Payers

• Aetna• Anthem• Caresource• Centene/Buckeye• CMS• Humana• Medical Mutual• Ohio Medicaid• UnitedHealthcare

An Initiative of the Center for Medicare & Medicaid InnovationProject Timeline: 2013-2016

National Leaders in Primary Care Transformation

Regional Data Transparency

84,000 Patients

Received Care Management

42,000Shared Decisions

on Smoking Cessation Treatment

Patient Experienc

e

24/7 Access

to Medical Record

Shared Decision Making

Clinical Quality

Improvement

Care Managem

ent

220,000 Beneficiaries 250 Providers 9 Health Plans

Medicare Outcomes to Date:

Measure % decrease

Overall Hospital Admissions-8%

Primary-Care-Treatable Admissions-10%

Readmissions-3%

Overall Expenditures-3.4%

Patient-centered medical homes Episode-based payments

Goal 80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years

Year 1▪ In 2015 focus on Comprehensive Primary

Care Initiative (CPCi)

▪ Payers agree to participate in design for elements where standardization and/or alignment is critical

▪ Multi-payer group begins enrollment strategy for one additional market

Year 3

Year 5

▪ State leads design of five episodes: asthma

(acute exacerbation), perinatal, COPD

exacerbation, PCI, and joint replacement

▪ Payers agree to participate in design

process, launch reporting on at least

3 of 5 episodes in 2014 and tie to payment

within year

▪ Model rolled out to all major markets

▪ 50% of patients are enrolled

▪ 20 episodes defined and launched across payers

▪ Scale achieved state-wide

▪ 80% of patients are enrolled

▪ 50+ episodes defined and launched across payers

State’s Role▪ Shift rapidly to PCMH and episode model in Medicaid fee-for-service▪ Require Medicaid MCO partners to participate and implement▪ Incorporate into contracts of MCOs for state employee benefit program

5-Year Goal for Payment Innovation

Already Local Support for Public Reporting & Transparency

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Primary Care Providers • Cardiovascular Health

• Colon Cancer Screening Rates

• Diabetes Management

• Patient Experience

Hospital • Effectiveness• Patient Experience• Emergency Department

PROMOTE TRANSPARENCY

What gets measured, gets improved

Collaborative Community Health Needs Assessment

Collaborative CHNA: Community stakeholder meetings

Regional Data Aggregation;A Comprehensive View to

Support Comprehensive Care

Why an Aggregated Claims Database?

Need for a neutral, trusted, local source of truth- no one Payor or Provider has the whole picture

Payment is proceeding to “payment for value” from “fee for service” Community-wide view of cost and utilization for decision support and benchmarking

Consistent and Continuous methodology is needed to monitor progress year over year

CPC Data High Level

Those Providing Healthcare

Labs

Primary Care

Hospital

EMSSpecialists

Pharmacy

ShareCommunity wide view of patient data

IntegrateEHR data insertion and extraction

NotifyTimely delivery ofpatient events

AnalyzeProvide actionable measurements of data

Government Insurance

Employers

Patients

Private Insurance

Those Paying for Healthcare

SUMMARY

Models like PCMH are changing the way care is delivered and paid for

We have an opportunity to use data to guide and inform health care decision

We offer tools for employers to drive high quality care

Our region’s Collective Impact strategy on Health unites the community

RECOMMENDATIONS1: Support health improvement organizations that meet the following criteria:

a.) multi-stakeholderb.) neutral convenersc.) data capable

2: Recognize the importance of regional data utilities that ensure health care information is readily available and trusted.

3: Support efforts of State Innovation Model to transition to greater emphasis on Payment for Value and less emphasis on Fee For Service.

4: Seek to align goals, measures and incentives with those of CMS and the private sector to increase signal strength across Ohio.

Thank you!

Richard Shonk, MD, PhDRshonk@Healthcollab.org

Who are the members?

Who are the members?

• 120+ Care Partners

• 100+ Business Partners

The ReThink Health Model

• Shared Understanding of • Possible initiatives• Outcomes over time• Cost of effort

CPCi Overview

• The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering

collaboration between public and private health care payers to strengthen primary care.

Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients.

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Project Timeline

OH-KY Health Collaborative Project Timeline (September 2015)

Define data speci-fications; publish

DSG

Test secure file transmission

Update tHC & Onpoint systems for OH-KY CPCi

Receive test & historical files from data con-

tributors

tHC & Onpoint as-sign Enterprise IDs

Aggregate histori-cal data from data

contributors

Define, build, produce, & test

measures set

Build & deliver pivot tables to

include identified measures

17 MAR 9 MAY 8 JUNE 15 SEPT 20 OCT 9 NOV 19 NOV 8 DEC

Data Strategy

Analytic Services

Clinical/Claims Measures

Exchange ServicesHL7 Exchange Results Delivery, State Reported Meaningful Use

Innovation ServicesED/IP Alerts, Identity Management,

Meaningful Use Continuity of Care Document (CCD) Exchange, Health Information Service Provider (HISP)

HIE Evolution

Connectivity

Message Delivery

Online Repository

Information/Insight

“The goal is to turn data into information, and information into insight.”

-Carly Fiorina

Transactional Research