Michigan Cancer Consortium 2013 Annual Meeting · Primary Care Workforce Supplemental Payments ....

Michigan Cancer Consortium 2013 Annual Meeting

State Level Delivery System and Payment Reform Innovation

Tony Rodgers, Principal

November 20, 2013

These slides are the property of the presenter. Do not duplicate without express written consent.

Key Pillars of Comprehensive Health Reform

Health Insurance Reform

Healthcare Delivery

System Design

Value Based Purchasing &

Payment Reform

Affordable Care Act


States can be Laboratories for Delivery System and Payment Reform Innovation

Health System Transformation

Policy Alignment

Delivery System Design Payment

Models

Health IT

Performance Improvement Accountability

P4P Incentives Care

Management Partial Cap Global

Models Medical/Health

Homes ASCs ICO’s MCO

Performance Management Performance

Reporting Provider Profiling QI/PI

Population and Community

Health

Policies GME Policy Primary Care

Workforce Supplemental

Payments


Presenter

Presentation Notes

This slides depict the key inputs into the design planning process and the distilling into a State Health Care Innovation Plan and model design. How stay blend these elements into the model design will determine the scope and reach of the health system transformation. Each

Michigan’s Stakeholder Engaged Model Planning and Design Process

Stakeholders Putting the Pieces Together


“Collaborative adaptive leadership and intelligent

design is critical to successful delivery system redesign and payment reform.”


Presenter

Presentation Notes

This slide introduces the concept of transformative vision and the state as the intelligent designer of the future models of health delivery system and payment models.

Four Key Planning Steps Delivery System and Payment Reform

Vision

•Developing a common vision among stakeholders to define Michigan’s next generation delivery system and payment models

Goals

•Establishing the broad goals and aims of delivery system redesign and target performance improvements

Model Characteristics

•Articulating the key characteristics of the next generation delivery system and payment model

Model Elements

•Developing the detailed elements of the delivery system and payment model

1 2 3 4


Creating a Common Vision of the Next Generation of

Michigan’s Healthcare Delivery System

7

Next Generation Emerging Today

• ACO, Patient Centered Medical Homes, and Pay for Performance Incentives ACO and Patient Centered Medical /Health

Homes Shared Savings Value-Based Payment and Reimbursement Performance Incentives Strengthen Quality Improvement Program Electronic Health Records and Health

Information Exchanges • Provider and Patient Relationship Greater Chronic Disease Management Engage patients / personal responsibility

shared decision making regarding health Care management and coordination Greater cost and quality accountability

• Quality Improvement and Best Practice Knowledge Diffusion

Delivery System and Payment Reforms Community Integrated Health Systems Population Based Payment Model Shared Risk & Reward payment models Long Term Health Outcome Value-Based

Reimbursement Cost Containment Focus Emphasis on Community Health Performance

• Increased Connectivity / Patient Engagement and Responsibility Interactive patient engagement tools to support

self-management & healthy living Seamless coverage continuity management Integrate beneficiary life span care management Broad use of telehealth, mobile, and social media

tools • Continuous Performance Improvement Cross Sector Linkage and Integration Rapid Cycle Evaluation and Improvement

Vision

Person/Family Centered Value Based &

Outcome Oriented

Accountable & Community

Integrated


Presenter

Presentation Notes

Evolving the system requires a common public and private vision and alignment to value based outcomes, health system alignment to outcomes and financial accountability and reward for results. Emerging Accountable Health Care Systems driven by Medicare need to broadly expanded and evolve to the next generation of delivery system model and payment reform. Health system that are effective in using e-health tools, engaging patients and communities in health and wellness, life span care focused, continually improving, and learning organization.

Establishing Broad Goals of Delivery System and Payment Reform

Michigan’s Broad Delivery System and Payment Reform Goals

1 Strengthen the primary care infrastructure to expand access for Michigan residents

2 Provide coordinated care to promote positive health and healthcare outcomes for individuals requiring intensive support services

3 Build capacity within communities to improve population health

4 Improve systems of care to ensure delivery of the right care, by the right provider, at the right time, and at the right place

5 Design system improvements to reduce administrative complexity

6 Design system improvements that keep insurance premiums affordable for individuals and employers


Presenter

Presentation Notes

Table is designed with the Aims and Goals in mind. We bucketed key functions of the system into four broad areas and noted how they correspond to the AC goals. We thought we heard from you that each element of the model has a unique and important role.

Michigan’s Key Model Characteristics

Accountability Person- and Family-centeredness Community-centeredness Prevention, Wellness, and Development Focus Community Linkages Community Integration Evidence-based Payment for Value


Presenter

Presentation Notes

If we use this we should do so later

Delivery System Model Elements

Element Role or Function of the Delivery System Element

Person Centered Medical /Health Home

A primary care practitioner or health team that manages the care and coordinates services for panel of patients

Accountable Systems of Care Organized provider network that take responsibility for a population of assigned/enrolled patient.

Payer and Purchaser 1. Medicaid Managed Care Health Plan 2. Health Insurance Exchange Health Plans 3. Medicare Fee for Service Program 4. Medicare Advantage Plan 5. Commercial Health Insurance Health Plan 6. Self funded purchasers

Community Health Innovation Region

An organized community based organization the facilitates development of community health strategies and is an incubator for community health innovation

HUB/Community Resource Management

A organized single access point for patient and community members accessing psycho/social/economic community based resources

Health Information Infrastructure Provider

Organization that provides the infrastructure for the exchange of health information between services providers.


Developing the Detailed Design Specifications for Michigan’s Delivery System and Payment Reforms

Person/Family Centered Care Management

Community Integrated Care Delivery &

Management

Information Technology

Performance Mgmt /

Analytics

Payment Methodology &

Management

• Expanded and strengthened Primary Care

• Assures effective PCP / Specialist coordination

• Accountable Governance

• Learning organizations

• Assures effective health risk management and cost containment

• Person centered networks designs

• Patients & networks affiliation

• Emphasis on patient & family engagement

• Focuses on Population Health Management

• Effective in Prevention & Wellness

• Invests in Community Health Capacity

• Community Accountable

• Partners with Public Health

• Life Span Care Management

• Community Resource Integrated

• Financially Aligned to Community Risk Reduction

• Integrated provider and patient portals

• Broad use of personal health record

• E-Health risk assessment and health management tools

• EHR/HIE connectivity and seamless Information Exchange

• Integrated health record

• Interactive patient care management tools

• PHR integrated patient decision support tools

• Broad use of cost effective Telehealth Remote monitoring

• Payments and reimbursement aligned to patient care and population outcomes

• Equitably shares risks and reward

• Rapid cycle performance based payment

• Payment that dynamically adjust to severity and risk factors

• Prevent fraud and abuse

• Support informed shared decision making between patient and provider

• Reduce administrative burden & cost

• Effective in the use of “big data to improve performance

• Real time performance analytics

• Person centered performance improvement

• Analytics to support effective community risk and population health management

• Computerized learning systems for improving patient management and self care

• Provider & health system public performance reporting

• Integrate performance and financial incentive systems

• Personalized consumer health analytics tools

11


Presenter

Presentation Notes

Health system design planning involves taking into account unique healthcare ecology and developing the specifications of a transform health system model design that can produce the cost, quality, and population health performance improvement results that are critical for keeping health insurance affordable and state resident healthy productive.

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Healthcare Decision

Tools

Person to Population Analytics

Health Outcomes

Improvement

Performance improvement will require access to large scale healthcare data & analytics to support rapid cycle evaluation and knowledge diffuse, and to translate best practice into community practice application

Connecting various Sources of data and health information


Michigan’s Healthcare Delivery System Model


The Patient’s or Caregivers Role in the Next Generation Healthcare Delivery System

1.Communicate with provider or medical team;

2.Self-care management; 3.Shared decision making; 4.The engagement and active

participation in health and wellness;

5.Learned about health condition and raise health literacy.


Levels of Shared Decision Making and Patient Activation and Engagement

Moving from passive

participant to starting to take a

role in key healthcare

decision making related to their health or the health of a

family member.

Proactively seeking to build knowledge of

illness or condition and what treatment

options and personal

responsibility in self care

management is required

Being able to advocate for self

or a family member in a confident and informed way.

Taking personal responsibility for

helping to achieve good outcomes for

care.

Adopting new behaviors and

self care management

that will lead to positive health outcomes and

maximizing quality of life span health.

Level 1 Level 2 Level 3 Level 4

Increasing Level of Patient Activation and Engagement


Role of Patient Centered Medical Homes

Patient-provider partnership

Patient registry

Performance reporting

Individual care management

Extended access

Test results tracking & follow-up

Preventive services

Linkage to community services

Self-management support

Patient web portal and e-health connectivity

Coordination of care

Specialist pre-consultation & referral process


Presenter

Presentation Notes

CHAP Patient Center Medical Home

Role of Patient Center Medical Homes in Prevention, Screening, and Early Detection

Prevention, Screening, Early Detection, and Referral: Develop effective screening strategies to increase screening (e.g. cancer) of high risk patient and early detection of disease and illness. Effective methods to increase screening in primary care settings include : Implementation of specific days devoted to prevention activities, Planned care visits should be used e-learning tools prevention, Designated non-physician staff to work with high risk patients and complete specific

prevention activities. Use a team-based model of care that includes non-provider staff such as nurses,

community health workers, and patient navigators in connecting with patients. Electronic medical records systems should have patient registries to identify at-risk

patients and generate reminders to both staff and patients of the need for preventive services and appointments.

Integrate clinical decision support functionality with EMR that provides evidence-based clinical guidelines and best practices references for screening and referral.

PCMH will address both intrapersonal (for example, fear) and systems-level barriers (for example, appointment navigation & us of community health workers) to achieving follow-up care for screening abnormalities, especially for minorities and low-income populations.


Accountable Systems of Care Accountable Systems of Care are one of the major delivery system reform component in Michigan’s SIM delivery system model.

Provide clinical direction and administrative support for provider network

– Contracting

– Reporting

– Credentialing

– Clinical guidelines and medical direction

Train and develop staff

Quality reporting, provider performance profiling, and improvement

Provides support for population health management

Care management and coordination system support

Data collection, analysis and data management

EMR and HIE interface implementation a continuous support

Provide and train care managers

Contract with or arrange for specialists referrals, diagnostic services, community based services, and other services required to support the full continuum of care.


Presenter

Presentation Notes

Physician Organizations capabilities Role they play in ACS Care Manager deployment

The Delivery System Must Support the Health Information Infrastructure for EMR/HIE

Accountable Systems of Care must support: 1. Electronic medical record (EMR) system that are

electronically connected or integrated with the broader delivery health information system via a health information exchange or as part of an integrated EMR platform.

2. Integrated patient disease registries, 3. Medication management and e-prescribing capability 4. Integrated clinical decision support , 5. Patient portal and support the patients electronic

personal health record, 6. Quality reporting and analysis capability.


Beneficiary /Person

Centered Impact

Organized System of

Care

Clinical Leadership

Community Integrated

Continuous Performance and Outcome Improvement

Meaningful Use of Health

Information Technologies

Knowledge Management & Dissemination

Adaptive Learning

Organization

Accountable System of Care Design Characteristics

Results In

Beneficiary/Person Centered Accountable Systems of Care Healthcare Networks

Better Care and Patient Experience

Clinical Integration and Evidence-Based Care

Patient Activation and Increased Health Literacy

Efficient Cost Effective Care and Cost Contaiment

Reduction in Health Care Cost Trends

Population Health Improvement

Expected Outcomes


H

H

CAH

Hospital

Critical Access Hospital

PCMH

Non-PCMH

Physician

FQHC

CMHSP

Specialist

H

CAH

ASC’s


H

H

CAH

Hospital

Critical Access Hospital

PCMH

Non-PCMH

Physician

FQHC

CMHSP

Specialist

H

CAH

HUB

HUB Community Services System


Linking Patient/Person Centered Performance Measures with Community and Population Health Performance

Measures

Michigan’s Quality &

Performance Measures

Patient Centered

Based Outcomes

Performance Screen

Community Health Performance

Measures

• Adult Mortality Reduction •Violence Reduction •Safety •Suicide Prevention •Heart Health •Increase Activities of Daily Living •Adolescent Health •Child Health & Development

Accountable Systems of Care

Public Reporting Community Scorecards

Community Health Innovation

Region Performance

Priorities

Managing Community and

Population Health Risk Factors

Cost, Health and Population

Health

Community Based

Performance Outcomes

Innovation in Reducing Community Risk Factors

Provider Performance Reporting


Preventive Care

Acute Care

Chronic Care

Screening Services

Community Integrated Accountable Care System of Care Model

Integrating Patient Centered Care with Primary, and Secondary Prevention

Community Health Surveillance

Community Engagement and Governance

Assessment & Referral

Resources

Community Health Innovation Region

Governance

Assessment & Referral

Process

Community Trust

Programs

Community Services and

Well Care Resources

Other Specialized

Services

Community Healthy Living Support and

Environmental Services

ACO Network

Medical Home

Public Health


Delivery System Redesign and E-Health Connectivity


State Innovation Model Initiative Will Spark a Revolution in the Use of Connect Technologies

E-Health Information •Electronic Personal Health Records •Electronic Health Records •Health Information Exchange

E-Health •E-Health Coaching and Support Groups •E-Learning Health and Self Care Management •Social Media and Social Marketing of Health

Telehealth and Use of Mobile Technologies •Telemedicine •In-home and on-person remote monitoring •E-Consults


Apple’s new “i-Watch” will reportedly track heart rate and other basic metrics, is likely to be the first product and be a platform for other health-focused developers. Reports say the watch will include a 1.5-inch display and run a full version biometric tools.

Apple has staffed up with software and hardware engineers, plus medical sensor, manufacturing and fitness experts.

Apple is investing in tackling tackle sensor technologies and remote patient monitoring, wearable devices and potentially weight management.

Explosion in Development of Mobile Products for the Personal Healthcare Market


New Provider to Patient Connectivity Tools for Patient Care Management

Partners Healthcare, in Massachusetts has a dedicated “Center “ to exploit uses mobile and other remote technologies to improve patient care and patient connectivity with their health team.


Next Generation Technology

Accountable systems of care responsible for innovative adoption, application, and deployment the next generation of health information, telemedicine, telecommunication, and mobile technologies:

Integrated patient e-learning systems and patient portal web-based interfaces;

Support social media and social marketing functionality to link patients important health information;

Remote biometric interface capability and other remote monitoring capability;

Electronic Personal Health Record with integrated patient decision support system,

Web based community resources databases and referral tools.


The Connected Accountable Healthcare Eco-System

Health Analytics

Acute Care

Specialty Care

Community Resources

Pharmacies Other Care

Settings

Diagnostic Services

HIT Infrastructure

Health Analytics

Shared Decision

Making Tools Care

Management

Care Coordination

E-Health

Self-Care Support

Connected Patients and Families

Person Centered Medical Home

Accountable System of Care


SIM Model Testing


SIM Health Care Delivery System Planning & Design, Model Testing, and Deployment

• Quality, Population Health, and Cost Performance Analysis

• Stakeholder Engaged Collaborative Planning

• State Healthcare Innovation Plan & Roadmap

• Model Test Proposal Planning and Design

Stage 1

•Model Test Implementation

•Performance Analysis and Reporting

•Rapid Cycle Evaluation and Improvement

•Ramp up to bring the test to scale

•Model Test Evaluation and Summation Report

Model Testing Stage 2

• Evaluate Deployment Strategy

• Program and Policy Recommendations

• Legislation and Regulation

• Policy Execution and Deployment

Program Deployment &

Policy Translation Stage 3


SIM Stakeholders

& Payers

Michigan SIM Project Team

Health Data &

Analytics

2

Delivery System Design Person, Population, and

Community Centric

Outcome Driven Performance

Value Based Risk and Reward

Continuous Improvement

Behavior

Establish Model Tests Target Outcome Measures (better care, better health, lower cost)

Collect Data & Evaluate

Performance Outcomes

Determine Improvement

Strategy

1 2 3 4

Implement Improvement

Evaluate Outcomes against Target Performance Metrics

Value Based Payment

Communities

3

Michigan SIM Model Performance Analysis Feedback

Beneficiaries, Populations, Community Health Information

ASCs & Providers

PCMH and Accountable Systems of Care Innovation

Participants: Patients,

Populations, & Community

1

Michigan’s Model Testing & Continuous Improvement Cycle

Rapid Cycle

Evaluation & Improvement

Populations Patients

Major SIM Model Test Design Elements

C D

4

Rapid Cycle Evaluation and Improvement Process

B A

SIM Testing Award

$

$ $

Innovation &

Improvement

Continuous Learning


Questions?


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