New Mexico Health System Innovation

Design Phase

Improving health outcomes and population health

“For A Healthier New Mexico”

STATE INNOVATION MODEL (SIM) INITIATIVE

FUNDED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, CMS INNOVATION CENTER

What is the State Innovation Model [SIM] Initiative?

• Created by the Affordable Care Act (ACA); administered by the Centers for Medicare and Medicaid Services (CMS) Innovation Center

• To test innovative health delivery & payment models that reduce spending, enhance the quality of care & improve population health

• Since 2012, more than $1 billion awarded to 34 States, 3 territories and the District of Columbia

• Two phases: Design (1-2 years to develop the design of proposed transformation model); Testing of design (3 years)

New Mexico Health System Innovation

The Design•Based on “The Triple Aim”

• Enhancing the consumer’s experience of care

• Reducing health care costs

• Improving population health and health outcomes.

Examples of Triple Aim Goals

Enhanced experience of care Improved primary care with patient-centered medical homes (PCMH)

model - integration of primary care, behavioral health services and social services

Reduction of costs

Reimbursement of services is value (outcome)-based vs. fee-for-service (volume)

May include reimbursement for “non-traditional” services, i.e., those provided by community health workers, social services, etc.

Improving population health & health outcomesLocal community health workers & paramedics who participate in the

delivery of primary care

Interoperability of health information systems

What does “health system transformation” look like?

What are the Objectives of NM’s Design?

• Alignment and integration of public health, behavioral health and primary care • Reducing costs & slowing the rate of health care inflation• Increasing the number of New Mexicans who have health insurance• Building the healthcare workforce & supporting infrastructure• Expanding the use & integration of health information technology (HIT)

Who will participate?Extensive stakeholder engagement

• State agencies • Local & tribal governments • Health care providers • Public payers (Managed Care Organizations (MCOs) and private

commercial payers • Social service providers • Patient advocacy groups • Local organizations • Business community• Local Community, in collaboration with HCs

Suggestions for Community Representatives

Behavioral health (individual providers/clinics, etc.)Business community/chamber of commerceHealth consumers/general publicEMS/paramedicine/emergency managementEnvironmental/community planning organizationsFood bankHealth professional organizationHigher education health clinicHospitalInsurer (public & private)Local governmentPatient advocacy/consumerPrimary care (individual providers/FQHC/local private clinic, etc.)School-based health clinicTribal health servicesVulnerable population advocacy organization

Stakeholders in the Public Health System

MCO’s

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsCHCs

Laboratory Facilities

Hospitals

EMS Community Centers

Doctors

Health Department

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health

Engagement StructureSix Stakeholder Committees and Local Communities -

• Population Health - to address health issues across the life continuum• Health Care• Health Care Workforce • Payers • Tribal• Health Information System (Health Information Technology; Health Information Exchange; Healthcare System Information; Health Status; Individual Health Info); and,• Ongoing Community Engagement (County & Tribal Health Councils)

Flow of Design Inputs

Input Compiled Input Compiled for Model Designfor Model Design

Stakeholder Stakeholder CommitteesCommittees

Community Engagement led

by Health Councils (HCs)

Work Groups

SIM Management

Team (OPA/HSD Admin. Staff)

Governor’s OfficeGovernor’s Office

Health System Health System Innovation Innovation Committee Committee

(HSIC)(HSIC)

Innovation: Priority Health Issues

•Obesity Prevention and Control •Diabetes Prevention and Control•Tobacco Use Prevention and Control

Important ConsiderationsSocial Determinants of Health

Important Considerations for HCs

Diffusion of Innovation seeks to explain how innovations are taken up in a population. An innovation is an idea, behavior, or object that is perceived as new by its audience. Diffusion of Innovations offers three valuable insights into the process of social change:•What qualities make an innovation spread.•The importance of peer-peer conversations and peer networks.•Understanding the needs of different user segments.

Timeline• May 19: Stakeholder Summit (kick-off),

Albuquerque• May-July: Community orientations & development of

engagement plans for three succeeding community engagement sessions• July – October 5: With DOH Health Promotion Teams,

conduct community engagement sessions to provide input to Design • October 15: Draft Community Stakeholder Design

recommendations by theme provided by NM Alliance of Health Councils

Timeline• Week of October 19: All Stakeholder Committees to meet

in Albuquerque• Week of November 2: Health System Innovation

Committee (HSIC) reviews proposed design from Stakeholder Committees & local communities• Week of November 16: Stakeholder Committees

convene in Albuquerque• December 1: Final design sent to HSIC• December 15: Final Community Stakeholder Design

recommendations by Theme due from NM Alliance of Health Councils• December 15: Stakeholder Summit to occur in

Albuquerque to present final design

Community Engagement Planning

• Health Councils review existing membership & identify additional representation for community input sessions

• DOH Health Promotion Teams collaborate with Health Councils & NM Alliance to gather recommendations for Health System Innovation Design

• Statewide standardized approach that includes flexibility to accommodate local needs

Community Engagement Planning

• Overall Goal: To provide recommendation on proposed innovation design

• Question to consider: “Does the proposed design achieve the Triple Aim in your community?”

• NM Alliance of Health Councils & DOH Health Promotion Teams collaborate to assist HCs with input session format, materials, process, and agenda

• Succeeding sessions to provide recommendation to the design

Get Ready

• Identify three dates & locations for the community engagement sessions during July 1 - October 5, 2015

• Review existing Health Council membership to ensure widest possible input

• Identify list of invitees (Individuals & Organizations) & begin to distribute “save the date” notices

• Materials, templates, and more information will be available in June

Preliminary Community Engagement Plan Outline

GOALS: 

1. Ensure maximum input and engagement in the Health System Innovation planning process by New Mexico counties and tribal communities

 

2. Develop community health planning processes that will benefit communities, resulting in increased understanding of:

• Community assets• Community health needs, gaps, issues• Locally identified health priorities• Stakeholder involvement strategies 

3. Prepare communities for possible participation in a SIM Implementation Phase

Stages of Community Engagement

1. Orientation to the NM Health System Innovation planning process:

• Power Point presentation to health councils and community groups

• Discussions of strategies for involvement of all sectors and stakeholders

• Preliminary discussions of the kinds of input being sought

 

Stages of Community Engagement

2. Development of methods for community/stakeholder engagement:

a)Identification of sectors currently represented on health councilsb)Identification of sectors & stakeholders who should be at the tablec)Methods for reaching & engaging community stakeholders:• Expanded health council meetings• Regional, multi-council meetings• Focus groups• Other community coalitions, networks• Community surveys• Other potential groups: e.g., community coalitions, volunteer

groups, schools, business groups, faith communities, advocacy groups

 

Stages of Community Engagement

3. Community Input: Identify information to be gathered prior to development of design

4. Community Input: Responses to proposed design

 

Community Input Information Framework

Research Questions:

•How can the Triple Aims be achieved in your community?•How do each of the factors below help or hinder achieving the Triple Aim?

Aims & Objectives

1. Improve Population Health:• Integration of population health, prevention, & primary care•Address social determinants of health•Create environments that offer health choices

Aims & Objectives

2. Enhance Patient Experience of Care:•Patient-centered care• Integration of primary care, behavioral health, & oral health•Chronic disease management•Access, health care workforce development

Aims & Objectives

3. Reduce Health Care Costs:•Reform payment systems• Increase health insurance coverage•Expand health information technology

Factors that Help/Hinder Achieving the Triple Aim

•Environmental (Geographic, social & cultural factors)•Current Strengths, Resources•Community Needs/Gaps/Barriers•Health Priority Areas•Potential Solutions

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.

The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.