the minnesota accountable health model•steering team formation (january 2017) •data collection...

WEDNESDAY, JANUARY 18, 20179:00 AM - 12:00 PM

S H O R E V I E W C O M M U N I T Y C E N T E R | 4 5 8 0 V I C TO R I A S T. N . , S H O R E V I E W, M N 5 5 1 2 6

The Minnesota Accountable

Health Model

Joint Community Advisory and Multi-

Payer Alignment Task Force Meeting

Information: SIM MN Website, www.mn.gov/sim

Contact: SIM MN Email, sim@state.mn.us

• Welcome and Overview of Agenda

• Updates

• Sustainability and Evolution of SIM-Related Initiatives

• Next Steps / Future Meetings

• Public Comment

Agenda

Minnesota SIM Driver Diagram3

Infographic

UPDATES

Updates (slide 1 of 2)

• CMMI Request for Information (RFI) Results

• Evaluation

• Resources – Roadmaps & Toolkits

o E- Health podcast

o E- Health Roadmap

o Emerging Professions Toolkit

Updates (slide 2 of 2)

• 2017 SIM Funded Grant Opportunities

• Save the Date: 2017 MN e-Health Summit

o Connectivity. Equity. Health.

o June 15, 2017

o Earl Brown Heritage Center, Brooklyn Center

SUSTAINABILITY AND EVOLUTION OF SIM-RELATED

INITIATIVES

COMMUNITY ENGAGEMENT

Sustainability and Evolution of SIM-related Initiatives:

Sustainability and Evolution of SIM-related Initiatives: Community Engagement

• Outcomes from Health Equity Summit

o Visual Meeting Summary

o Call to Action Pledge Form

• Recent Findings from Evaluation

• Upcoming Opportunities

Topics:

• Community Engagement

• eHealth Use and Data Exchange

• Payment & Care Delivery Reform

• National Perspective

Questions for Each Topic:

• What are member organizations focusing on in 2017 and beyond in this arena?

• Are there specific topics, within this arena, that are of interest for future panel speakers or networking opportunities?

Sustainability and Evolution of SIM-related Initiatives– DISCUSSION (1)

eHEALTH USE AND DATA EXCHANGE

Sustainability and Evolution of SIM-related Initiatives: eHealth Use and Data Exchange

• Consent RFI

• HIE Study

• HIO Connectivity

Consent RFI - Overview

• Assessment of the costs and patient impact associated with the Minnesota consent requirements for treatment, payment, and healthcare operations (Minnesota Health Records Act)

• Due February 2017 to legislature

Consent RFI – Patient Themes

Patients:• Do not agree on the positive or negative impact of the

Minnesota Health Records Act

• Have varied experiences relating to the “cost” of providing consent for sharing their health information

• Have varied opinions on how their personal health information should be controlled and used

Consent RFI – Provider Themes

Providers report:

• Negative impact on patient care

• Patient burden

• Patients frustrated; providers confused

• Requirements run contrary to patient expectations

• Processes to obtain consent vary widely

• Most patients do provide consent

• Preference to align with HIPAA

Consent RFI – Considerations and Implications

• It will be difficult for Minnesota to achieve its health reform goals due to varied interpretations of the MHRA

• Some clarifications to operationalize the current MHRA are needed

• Education, resources and legal assistance are needed by providers and patients

• Implementing the MHRA often require a manual process for obtaining patient consent outside of the EHR

• The MHRA does not adequately support the majority of patients whose preference is to share their health information

HIE Study - Overview

• Assess Minnesota’s legal, financial, and regulatory framework for HIE, including the requirements of the MN Health Records Act

• Make recommendations for modifications that would strengthen the ability of MN health care providers to:o securely exchange data

o in compliance with patient preferences, and

o in a way that is efficient and financially sustainable

• Due February 2018

HIE Study – High Level Timeline

• Steering Team formation (January 2017)

• Data collection (March – June 2017)o Focus groups, interviews, environmental scan, workgroups

• Recommendations development (June – August 2017)

• Recommendations validation (August – October 2017)

• Report finalization (December 2017)

• Report submission (February 2018)

Health Information Organization (HIO): an organization that oversees, governs, and facilitates HIE among health care providers that are not related health care entities to improve coordination of patient care and the efficiency of health care delivery.

Current State-Certified HIOs

HIO Development – State-Certified HIOs

HIO Development – HIO to HIO Connectivity

Short term

• Confirming HIO participation in ELR and immunization data exchange with MDH

• Discussing priorities for interoperability in 2017

o Patient matching specifications

o Healthcare directory

o Patient directory

o Public health specifications (ELR, immunizations)

Long term - Discussing proposed Shared Services Bus model toward MN statewide HIE strategy; other based on HIE study

Topics:

PAYMENT & CARE DELIVERY REFORM

• Eligible recipients

o Non-dual, under-65, across both FFS and all Medicaid MCO enrollees

o Attributed using past encounters/claims

• Provider requirements

o Voluntary contracts under model options “Virtual” (shared savings only) and “Integrated” (negotiated gain/loss sharing) based on size and structure

o Flexibility in governance structure and care models

• Payment and quality model

o Defined core set of services, IHP may elect to include additional services

o Existing payments persist with gain-/loss-sharing payments made annually based on risk-adjusted TCOC performance, contingent on quality performance (SQRMS)

• Provider supports

o Data analytics and reporting feedback (monthly and quarterly files)

o Learning collaboratives

IHP Model Components

99,107

145,869

204,119

375,924

462,698

$14,825,352

$65,339,161

$76,662,498

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

$90,000,000

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2013 2014 2015 2016 2017

MN Integrated Health Partnerships Growth & Savings

Enrollees Annual Savings

ACOs = 6 ACOs = 9 ACOs = 16 ACOs = 19 ACOs = 21

IHP Successes: Participant Growth and Savings

How’s it going? RFI & Other Stakeholders

Helps accelerate care delivery innovations that had already begun, such as movement towards team-based care, community partnerships, a “super-utilizer” focus, etc.

BUT… Long-term sustainability is an open question.

Data and reports have been essential, providing a “source of truth” and a view of patients not readily available elsewhere.

BUT… Data rich, but sometimes still information poor.

Flexibility of model is key - every population is different; everything is local.

BUT… Not all provider models fit well into the current demonstration.

Partnerships are critical to the success of the model longer term – pushing IHPs to reach out to unaffiliated providers and community partners is important.

BUT… Partnerships tend to be informal in nature, and there isn’t a formal mechanism

to ensure partners are involved in the value arrangement and risk models.

What’s Next? - IHP 2.0 Key Design Elements

• Include a population-based prospective care coordination payment.

• Support exchange of electronic clinical event notifications between IHPs and providers.

• Incorporate IHP contract incentives that strengthen partnerships with community supports and social service organizations.

• Ensure a “no risk” track for IHPs that are not able to take on risk, but are still accountable for patient care.

• Develop an advanced track where higher capacity systems can take on increased accountability for patient population health outcomes.

• Strengthen alignment between HCH and IHP, MACRA, other programs.

Health Care Homes Transform Care and Lives of 3.9 Million Minnesotans

Review:•Brief history of Health Care Homes (HCH)

•HCH best practices

•HCH program outcomes

•Alignment and Future direction

Objectives

• Centerpieces of Minnesota’s 2008 health reform initiative.

• Focus is on redesign of primary care delivery

• Meaningful engagement of patients in their care.

Health Care HomesBackground

• Voluntary program – no cost to certify

• Recertification every 3 years

• 415 clinics certified overall

• 376 currently certified (20 border state clinics)

• 3,660 certified primary care clinicians and their teams

HCH Certification

361376

2011 2012 2013 2014 2015 2016

Certified HCH Totals: 2011 - 2016

Before Health Care Homes•Patients are recipients of health care

•Patients make appointments.

•Care is determined by current problem and time available.

•Patients are responsible to coordinate their own care.

•High quality care is delivered because well trained.

•It’s up to the patient to tell us what happened to them.

•Clinical operations center on meeting the doctor’s needs.

Health Care Homes•Patients and families are partners in their healthcare.

•Care Coordinator works directly with patients.

•Proactive care planning.

•Care is standardized with evidence-based guidelines and planned visits.

•A multidisciplinary team works at the top of their licenses to coordinate care.

•Improved quality outcomes through measurement.

•Visits, tests and follow-up care is tracked.

What’s different

• Inter-professional team.

• Engage patients as part of the quality improvement.

• Expanding partnerships beyond the walls of the clinic (current standards require only 1 community partner).

• Improve structure through certification requirements.

• Transformation to a Health Care Home provides a strong primary care foundation for:o Alternative payment models

o ACH’s

Health Care Homes Best Practices

HCH vs. Non-HCHs:

• Improved quality for Asthma, Vascular Care, Diabetes, Depression and Colorectal measures.

• 9 percent less expensive

• Fewer hospitalizations with lower costs

• Over a five year evaluation period, spending for Medicaid, Medicare and Dual Eligible patients was approximately $1 billion less - did not take into account other initiatives

Five Year HCH Program Evaluation Key Findings

256B.0753 PAYMENT for Care Coordination

•Develop a payment system that provides per-person care coordination payments to certified health care homes under section 256B.0751 for providing care coordination services and directly managing on-site or employing care coordinators

•Care coordination payment system must vary the fees paid by care complexity, with the highest fees being paid for care provided to individuals requiring the most intensive care coordination.

•Health plan companies shall develop payment conditions and terms for the care coordination fee for health care homes participating in their network in a manner that is consistent with the system developed under section 256B.0753 (62U.02)

Payment for Care Coordination

Future Direction

Health Care Homes a Strong Foundation

• Strengthen meaningful partnerships

• Align with emerging state and federal models for value-based or alternative payment

• Support financial sustainability of HCH clinics by moving towards value-based payment and providing support for community/clinic partnerships.

Health Care Homes Request For Information Ideas for Program Enhancements

•Support the secure exchange of clinical information with a wide range of partners.

•Simplify administrative processes for certification and recertification and requirements for learning collaborative participation.

•Establish health disparity reduction and health equity goals

Health Care Homes Request For Information

We are on the right path!• Value based payment

• Community partnerships

• Health equity

• Learning support and technical assistance

Key challenges• Reimbursement and financial sustainability

• Data exchange and health information management

• Incentives for community partnerships

Request For Information: Key Findings

Feedback indicates top barrier to successful implementation of the HCH model are challenges around billing and reimbursement.

• Clinic level changes necessary to meet certification standards, and maintaining those changes, requires adequate reimbursement and other means of support.

• Enhancements to HCH standards - promoting clinic-community partnerships and addressing social determinants of health will need effective strategies for long-term viability.

Financial Sustainability

Resources

Background/Reports/Statutes:• http://www.health.state.mn.us/healthreform/homes/background/index.ht

Certification Resources:• http://www.health.state.mn.us/healthreform/homes/certification/index.ht

Evaluation Reports: • http://www.health.state.mn.us/healthreform/homes/outcomes/eval

uationreport.html

Request for Information:• http://www.health.state.mn.us/healthreform/homes/newsannounce

ments.html

Bonnie LaPlanteDirector, Health Care Homes

651-201-3744Bonnie.LaPlante@state.mn.us

Contact Information

• What are the best approaches to promoting and providing alignment between payers?

• What key points would need to be addressed to make a compelling case for “payment alignment”?

• What would the steps be to make it happen?

Questions for Taskforce

Topics:

Sources of information: https://qpp.cms.gov/ ; https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-Quality-Payment-Program-webinar-slides-10-26-16.pdf; https://www.advisory.com/research/physician-practice-roundtable/members/expert-insights/2016/nine-faqs-on-provider-payment-under-macra; and http://healthaffairs.org/blog/2016/12/12/building-a-system-that-works-the-future-of-health-care/

NATIONAL PERSPECTIVE FOR TRANSFORMING HEALTH CARE

• Millions uninsured

• Avoidable errors

• Health care costs outpacing the rest of the economy

• Payment system that rewards volume

http://healthaffairs.org/blog/2016/12/12/building-a-system-that-works-the-future-of-health-care/

National Framework for Transforming Health Care: The Challenge

http://healthaffairs.org/blog/2016/12/12/building-a-system-that-works-the-future-of-health-care/

Change the Way We Pay

• Reward the value of care and patient outcomes rather than the quantity of services

Improve Care Delivery

• Promote coordination

• Prioritize wellness and prevention

• Give health care leaders the flexibility to innovate

Unlock Health Care Date and Information

• Use common standards to ensure portability

• Allow patients to access their own electronic health information

• Ensure that rules allow data to move simply and securely

National Framework for Transforming Health Care: The Strategy

Medicare Access and CHIP Re-Authorization Act (MACRA)

Repealed the Sustainable Growth Rate (SGR)

• SGR was used by CMS to control Medicare spending on clinician services and is based on the growth of federal spending for Medicare services

• However, SGR exceeded the sustainable growth rate target nearly every year since 2002

Changes the approach to Medicare clinician payment

• Locks in provider payment rates at near zero growth

Creates the Quality Payment Program (QPP) with two payment tracks

• Merit-Based Incentive Payment System (MIPS)

• Advanced Alternative Payment Models (APM)

• Starting in 2019, yearly payment adjustments differ for each payment track

• 2017 is the performance year CMS will use to determine clinician payment adjustments in 2019

• Clinician payment will not be impacted until January 1, 2019

MACRA Timeline

Topics:

NEXT STEPS / FUTURE MEETINGS

The Next Meeting

Final Community Advisory and

Multi-Payer Alignment

Joint Task Force Meeting

Wednesday, April 19, 2017 | 9:00 a.m. – 12:00 p.m.

Wilder Center | 451 Lexington Pkwy N, St Paul, MN 55104

PUBLIC COMMENT

Task Forces• Jennifer Lundblad (JLundblad@stratishealth.org), CATF Chair

• Garrett Black (Garrett.Black@bluecrossmn.com), MPTF Chair

• Diane Rydrych (Diane.Rydrych@state.mn.us), MDH

• Jennifer Blanchard (Jennifer.Blanchard@state.mn.us), DHS

• Krista O’Connor (Krista.Oconnor@state.mn.us), DHS

Facilitation Team• Greg Howe (ghowe@chcs.org)

• Diane Stollenwerk (diane@stollenwerks.com)

Task Force Contact Information

Minnesota Accountable Health Model

Public Website

www.mn.gov/sim

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