S U P P O R T I N G T H E I N T E G R AT I O N O F C O M M U N I T Y H E A LT H W O R K E R S I N M I N N E S O TA

J U N E 5 , 2 0 1 4

The Minnesota Accountable Health Model

(SIM Minnesota)

Outline

• SIM Background• Emerging Professions Work• Definitions• Data Collection• Integration Grants• Toolkit Contracts• Emerging Professions Workgroups• Best Practices

• Overall Goals, specific to CHWs

State Innovation Model (SIM)Initiative• SIM is a Center for

Medicare and Medicaid Innovation (CMMI) initiative to test and implement health care payment and delivery reform ideas

• Goal: Better quality in health care, improved experience, and lower costs (Triple Aim)

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: Massachusetts., Maine, Vermont, Oregon and Arkansas.

• 16 states received design grants

SIM Background

• “Minnesota Accountable Health Model”• Joint MDH/DHS project• 3 years, $45 million

• Staff coming on board• Multiple grants, contracts, workgroups (internal and external)

already underway• Collaborative Agreement with CMMI • Testing Grant

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?

Q: What is an Accountable Care Organization?

A: • Accountable Care Organizations (ACOs) are groups of doctors,

hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their patients.

• The goal of coordinated care is to ensure that patients – especially the chronically ill – get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

• When an ACO succeeds in both delivering high quality care and spending health care dollars more wisely, it will share in the savings it achieves.

Impetus for Accountable Care Organizations

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Impetus for ACOs• Develop payment approaches to

create incentives for value not volume

• Shift risk and rewards closer to point of care to foster local accountability

• Realize return on federal and state investments

• Improve access to care, outcomes and information for the beneficiary

Desired Outcomes• Value = Better Quality + Lower

Cost/“The Triple Aim”• Integrated prevention, wellness,

screening and disease management

• Coordinate care across care cycle• Data to monitor utilization,

compare and share across states• New reimbursement structures,

including incentives that encourage integrated practice models

Leadership structure

Model

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Emerging Professions Work

• Definitions• Emerging professions:• Community Health Worker• Community Paramedic• Dental Therapist/Advanced Dental Therapist

• Future may also include Doula, Certified Peer Support Specialist

• MDH is hiring a full-time Emerging Professions Coordinator• Three-year position, funded by the SIM grant

Emerging Professions Work

• What is the current state of the Community Health Worker Profession?• Data Collection• Available or Potential Data Sources:• # of graduates, and work location• # of current students, and projected pipeline• # of CHWs enrolled with DHS• # of Medicaid claims submitted to DHS on behalf of CHWs• Data from Health Plans• Clinical or other non-claims data from CHW employers

• E.g., encounters with uninsured patients, public health encounters• Data from CHW-related grants and projects

Emerging Professions Work:Integration Grants

• Grant Program to supplement the salary of Emerging Professions practitioners in new positions

• CHW Grants are intended to fund salaries of• New hires• MnSCU-approved curriculum graduates

• Who can apply? • Any potential employer of a CHW• Medical clinic, public health agency, hospital, county social service

agency, dental clinic, nursing home, inpatient mental health facility, etc, etc, etc.

Emerging Professions Work:Integration Grants

• What kinds of application are most likely to get funded? • Projects that best align with the goals of the SIM grant

• Priority will be given to projects that build connections between:• Mental health• Long-term care• Public health• Social services

• Projects that serve a clearly defined population • Projects that plan for sustainability after the grant

Emerging Professions Work:Integration Grants

• 3 annual rounds• Round 1: funding for two CHW positions, $30,000 each• Applications due TODAY

• Round 2: funding for one CHW position, $25,000• RFP to be published in July (est.)

• Round 3: funding for one CHW position, $20,000

• Round 1 contracts begin in July.

Emerging Professions Work:Integration Grants

• What does the state get in exchange for the grant?• We want to evaluate “Practice Transformation”

• What services does the CHW provide?• Who does the CHW care for?• What does having a CHW mean for other team members?• What new services can an employer take on with the addition of a

CHW?• What is the return on investment?• What best practices are developed that can be shared with others?• What additional training should be in the CHW curriculum?

Emerging Professions Work:Toolkits

• MDH will contract for development of a CHW Toolkit• Designed for potential employers, to answer:• What is a CHW trained to do?• What is the core skill set? • What are the potential benefits of hiring a CHW?• What CHW services are covered by insurance?• Who can supervise a CHW?• What information is available for return on investment?• What are examples of work currently being done by CHWs?

• RFP will be published in July (est.) • Contracts will be for around $100,000 each, over two years.

Emerging Professions Work:Workgroups

• MDH has convened an informal SIM CHW Workgroup• The advisory workgroup will help• Monitor progress of the Grants• Develop evaluation criteria for the Grants• Collect and analyze data • Share information about current CHW projects and future trends

Emerging Professions Work:Best Practices

• MDH will ask current CHW programs and employers about specific examples:• What services CHWs are providing?• What populations are CHWs serving?• What settings are they working in? • How are CHWs working in team-based environments?• What part of CHW training is most valuable?• What have CHWs learned on the job?• What barriers are CHWs encountering?• What structures are in place to ensure CHWs can reach their potential?

• What we learn will be shared widely

Emerging Professions:Overall Goals

• Better data about the CHW profession• Better understanding of current best practices• Integration of best practices with curriculum

development• Policy changes• Information about Return On Investment

• Not just about money

Emerging Professions:Overall Goals

• Greater “Uptake” of CHWs• More CHWs working and using the full breadth of their training

• Greater CHW participation in ACO models• Change of payment away from fee-for-service

• Understanding of “Practice Transformation”• What does hiring a CHW mean for the employer?• For the patient?• For the care team?• For the community?

Emerging Professions

Questions?

Will Wilson, SupervisorMinnesota Department of Health

Office of Rural Health and Primary Carewill.wilson@state.mn.us

(651) 201-3842