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The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute June 14, 2013 Fourth Annual National ACO Summit Follow us on Twitter at @ACO_LN and use #ACOsummit.
The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
June 14, 2013
Fourth Annual National ACO Summit
Follow us on Twitter at @ACO_LN
and use #ACOsummit.
Closing Plenary Session
Keynote Address
Cindy Mann, JDDirector of the Center for Medicaid and CHIP Services (CMCS),
Centers for Medicare and Medicaid Services (CMS), US
Department of Health and Human Services,
Closing Plenary Session
Health Care Reform 2013 and Beyond
Moderator:
Mark McClellan, MD, PhD, Director, Engelberg
Center for Health Care Reform, Leonard D. Schaeffer Chair in
Health Policy Studies, The Brookings InstitutionMark Chassay, MD, Deputy Executive Commissioner for Health
Policy and Clinical Services, Texas Health and Human Services
CommissionJudy Mohr‐Peterson, PhD, Medicaid Director, Oregon Health
Authority
Judy Mohr Peterson, Director, Medical Assistance Programs
Oregon Health Authority
Health System Transformation: Coordinated Care Organizations
Health System Transformation
www.health.oregon.gov
Sick care – not health care UnsustainablePoor outcomes for the dollars that we spendNon‐integrated or coordinated care.Focus on acute care, not promotion of health and preventitive care
Traditional state budget balancingCut people from careCut provider ratesCut services
The Fourth Path
www.health.oregon.gov
Change how care is delivered to:Reduce wasteImprove healthCreate local accountabilityAlign financial incentivesPay for performance and outcomesCreate fiscal sustainability
Oregon’s Strategic ApproachCreate Coordinated Care Organizations: A local network of all kinds of health care providers working together to deliver care for Oregon Health Plan members
Changing care model AND business model
Key Elements of Coordinated Care Organizations
Community‐based, strong consumer involvement in governance that bring together the various providers of servicesResponsible for full integration of physical, behavioral and oral healthGlobal budgetRevenue flexibility to allow innovative approaches to prevention, team‐based careOpportunities for shared savings
Accountability through measures of health outcomes
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Status Today
www.health.oregon.gov
February 2012: Bipartisan legislation passed March – July: 1115 Waiver and statewide procurement for CCOs16 CCOs certified;
15 operational as of today.~90% of Medicaid recipients get care through a CCO“Proof of concept” in Medicaid, then to extend the care
model.Early work: Community health workers in housing; single clinic
for addressing all needs for foster children; better integration of physical & behavioral health; hire public health nurses for tobacco cessation
Some Key Attributes of Care Models
Best practices in managing and coordinating care
Shared responsibility among providers and consumers
Accountability for quality, cost and access – Measuring performance
Paying for outcomes and health
Enhanced transparency and sharing of information (readily available cost and quality information)
Sustainable rates of growth
Key Levers for System Transformation
Care coordination throughout the system
Alternative payment methodologies
Integration of physical, behavioral, oral health
Community‐based focus – local innovation
Flexible services
Testing, accelerating and spreading innovations
Supports for Transformation
Transformation Center and Innovator Agents
Learning collaboratives
Peer‐to‐peer and rapid‐cycle learning systems
Community health assessments and community improvement plan
Non‐traditional healthcare workers
Transformation plans
Primary care home support
Technical assistance in addressing health equity
Just Some of the Current and Future Challenges We Are Working to Address
Change is hard
Change is very hard
Time, resources and expectations
No time, limited resources and large expectations
Operating in both an old and new paradigm
Just Some of the Current and Future Challenges We Are Working to Address
Increasing consumer engagement and personal responsibility for health
Training and using new health care workers
Health information exchange
Robustly transforming care and paying for outcomes
Accounting for “flexible” services
To learn more….
www.health.oregon.gov
Promoting Accountable, Efficient Care:
The Texas Approach
Mark Chassay, MDDeputy Executive Commissioner
Health Policy and Clinical Services
June 14, 2013
Texas Approach
• Texas approach includes: • Fostering local innovation• Avoiding unnecessary costs• Addressing regional needs
• Major initiatives include:• 1115 Medicaid Waiver• State Innovation Models (SIM)
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1115 Waiver: Background
• Allows expansion of managed care while protecting hospital supplemental payments.• Previously funded through upper payment limit (UPL)
program.• Creates new payment methodology through two pools.
• Incentivizes delivery system improvements and improves access and system coordination.
• Establishes Regional Healthcare Partnerships (RHPs).
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1115 Waiver: Payment Pools
• Uncompensated Care (UC)• Covers costs for care provided to those without coverage. • Supplements Medicaid underpayment.• Adds physician, clinic and pharmacy to allowable costs.
• Delivery System Reform Incentive Payments (DSRIP)
• Encourages regional collaboration.• Transforms delivery systems to:
• Improve care through enhanced access, quality, and health outcomes,
• Improve population health, and • Lower costs through efficiencies and improvements.
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1115 Waiver: RHPs
• Texas is divided into 20 RHPs.• Based on stakeholder preferences.• Each anchored by public hospital or other public entity.
• Hospitals and other providers must participate in an RHP to access UC and DSRIP funds.
• Each RHP developed a Regional Plan: • Demonstrating regional collaboration.• Outlining priority community needs.• Proposing DSRIP projects to improve regional health
care delivery by 2016. 20
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1115 Waiver: DSRIP Projects• Category 1 – Infrastructure Development
• Investments in people, places, processes and technology. • Pay for performance.
• Category 2 – Program Innovation and Redesign • Pilots, tests and replicates innovative care models. • Pay for performance.
• Category 3 – Quality Improvements• Healthcare delivery outcomes improvement targets tied to
Category 1 and 2 projects. • Pay for outcomes.
• Category 4 – Population-Based Improvements• Requires all hospitals to report on the same measures. • Pay for reporting. 22
1115 Waiver: Timeline
• October 2011: Demonstration year (DY)1 begins (retroactively).
• December 2011: Federal Centers for Medicare & Medicaid Services (CMS) approves waiver.
• May 2012: HHSC establishes 20 RHPs.• December 2012: Each RHP submits regional
plan.• April 2013: HHSC submitted over 1,300 to
DSRIP projects for CMS approval.23
1115 Waiver: Timeline
• May 2013: Most DSRIP projects approved for DYs 1-3.
• September 2013: Anticipated approval date for DYs 4-5 projects.
• October 2013: RHPs develop learning collaborative plans.
• September 2016: End of 5-year demonstration.
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SIM: Background
• In July 2012, the federal Centers for Medicare & Medicaid Services (CMS) announced the State Innovation Models (SIM) initiative.
• This opportunity was available for up to 30 states to: • design or test an innovative multi-payer delivery and
payment models.• organize and improve public health infrastructure.• lower health care costs while improving quality.
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SIM: Potential Models
• All SIM models must base payment on quality outcomes rather than fee-for- service.
• Examples include:• Accountable care organizations (ACOs) or
integrated care systems.• Shared savings arrangements.• Bundled or episodic payments. • Medical or health homes. 26
SIM: Potential Models
27Adapted from S. Delbanco, Commonwealth Fund, 2011
SIM: Background
• In September 2012, HHSC submitted a proposal for a Model Design initiative to:• Convene payers, providers and other stakeholders to
build consensus on needs concerning:– Health information technology infrastructure.– Billing and claims data.– Quality measures.
• Research actuarial models and policy options.• Over the course of six months, design innovative
payment and delivery models specific to the needs of Texans.
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SIM: Timeline
• April 1, 2013: Initiative officially began.• May – June 2013: Public stakeholder
meetings in 14 cities across the state.• June 2013: Statewide survey• August 2013:
• Conference in Austin• Public comment period on draft models
• September 30, 2013: Initiative will conclude.29
Challenges / Lessons Learned
• Standardization vs. flexibility• Pros and cons of aggressive timelines• Same players, new relationships• Determining value of projects
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HHSC Communications
• 1115 waiver webpage:hhsc.state.tx.us/1115-waiver.shtml
• SIM webpage:hhsc.state.tx.us/hhsc_projects/innovation/sim.shtml
QUESTIONS?
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Closing Plenary Session Health Care Reform 2013 and Beyond
Moderator: Mark McClellan, MD, PhD, Director, Engelberg Center for Health Care Reform, Leonard D. Schaeffer Chair in Health Policy Studies, The Brookings InstitutionMark Chassay, MD, Deputy Executive Commissioner for Health Policy and Clinical Services, Texas Health and Human Services CommissionJudy Mohr-Peterson, PhD, Medicaid Director, Oregon Health Authority
Summit Closing Comments
Mark McClellan, MD, PhDDirector, Engelberg Center for Health Care Reform, Leonard D.
Schaeffer Chair in Health Policy Studies, The Brookings
Institution; Former CMS Administrator and FDA Commissioner
Closing Plenary Session
The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
June 14, 2013
ACO Summit Closing Comments
3
Mark McClellan, MD, PhDDirector, Engelberg Center for Health Care Reform, Leonard D. Schaeffer Chair in Health Policy Studies, The Brookings Institution; Former CMS Administrator and FDA Commissioner
The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
Major Themes and Next Steps
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The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
Some Key Challenges Discussed
•
Communicating and internalizing ACO mission, organization‐wide
•
Legal and operational barriers of ACO formation while addressing
potential
anticompetitive concerns
•
Timely data sharing and IT connectivity that supports providers at the point
of care in real time
•
Effective platform and methods for data analytics
•
Management and governance with physician leadership and community
engagement
•
Aligned performance goals and performance measures, including
alignment across payers
•
Transition strategies for hospital business model as care is increasingly
delivered in lower‐cost settings
•
Managing individual and population health simultaneously
•
Effective strategies for states to adopt new payment and delivery models
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The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
Collaborating on Effective Health Reform Implementation Moving Forward
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The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
ACO Learning Network Workgroups
ACO Learning Network In‐Person Workshop
October 10th
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Accountable Care Payment
Strategy Identify essential
pathways to successful
payment reform
Implementing Performance Measurement
Identify and create advanced
performance measures
Optimizing the Impact of
Pharmaceuticals Create value-
based pharmaceutical
delivery environment
Clinical Transformation
Create care delivery model that
offers value and improves quality
High-Risk and Vulnerable
Populations Effectively manage
care of high-risk and vulnerable
individuals
The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
Thank you…
•
To all of you for attending, contributing and participating in the ACO Summit
making it a truly collaborative event
•
To the dozens of speakers that graciously volunteered their time
and have been
leading ACO implementation across the country
•
To the sponsors that made this event possible and are actively supporting ACO
implementation
•
Thanks to the MANY people behind the scenes that made the Summit
possible:–
Brookings: Ross White, Andy Cohen, Kavita
Patel, Sarah Bleiberg, Mallory West,
Barbara Gage, Judy Tobin, Christine Dang‐Vu, Andrea Thoumi, Erica Socker,
Sara Bencic, Anna Marcus, Lisa Tran, Alex Morin
–
Dartmouth: Will Schpero, Greg Kotzbauer, Aleen
Saunders, Savannah
Bergquist, Anu
Kaul–
Conference Administrators: Peter Grant and his team, including Suzanne Tyler,
Kathryn Plumb, Justin Sorensen, Scott DeMoss
and his team at PRG, Dave
Dunham and his team at ICV Media
The Engelberg Center for Health Care Reform at Brookings | The Dartmouth Institute
June 14, 2013
Fourth Annual National ACO Summit
Follow us on Twitter at @ACO_LN
and use #ACOsummit.
