rural coalition strategy for value-based...

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Rural Coalition Strategy for Value-Based Healthcare Bill Mize - Director – Upper Mid TN Rural Health Network Richard Taylor – Director of Business Development – eTransX Inc. DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. April 13, 2015

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Page 1: Rural Coalition Strategy for Value-Based Healthcares3.amazonaws.com/rdcms-himss/files/production/... · Rural Coalition Strategy for Value-Based Healthcare Bill Mize - Director –

Rural Coalition Strategy for Value-Based Healthcare

Bill Mize - Director – Upper Mid TN Rural Health Network

Richard Taylor – Director of Business Development – eTransX Inc.

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

April 13, 2015

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Conflict of Interest Bill Mize Executive Director Upper Mid TN Rural Health Network Richard Taylor Director of Business Development eTransX Inc. Have no real or apparent conflicts of interest to report.

© HIMSS 2015

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Learning Objectives

Analyze shared coalition strategies for implementing value-based healthcare in a rural region.

Explain how to partner with strategic technology vendors to develop an affordable and sustainable technology solution for supporting value based healthcare.

Discuss how to work with statewide associations and state government agencies in leveraging resources and expertise for forming a rural healthcare coalition.

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Presentation Overview Coalition Challenge:

• How can our healthcare providers in rural upper middle Tennessee successfully cross the “shaky bridge” from pay-for-volume to pay- for-value?

Potential Options: • Consolidate • Collaborate • Close

Presentation focus: • How a rural coalition of hospitals and clinics in Tennessee

selected the collaboration option to cross the “shaky bridge”? • The lessons we learned along the way

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HIMSS Value STEPS Model The Health IT Value Suite creates a taxonomy and framework to quantify and discuss the impact of IT in health settings

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Value STEPS addressed

Satisfaction: Developed a strategy to enhance patient satisfaction with local healthcare quality, convenience and continuity of care.

Electronic Information: Developed a strategy to build and fund a regional data sharing interoperability platform.

Savings: Developed a strategy to reduce costs of value based healthcare infrastructure and generate initial $1.25 million in annual shared savings for participating healthcare providers.

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• Founded in August 2006

• Mission: To share knowledge and resources to address health care challenges in a six county region

• Voting members - Five local hospitals and two local clinics

• Associate members: Urban hospitals (Vanderbilt and HCA TriStar), TN Hospital Association, TN Dept of Health, technology companies (eTransX, CivicHealth), emergency medical services (EMS), North Central Telephone Co., area state legislators

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Upper Middle TN Rural Health Coalition

Upper Mid TN Rural Health Network

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What were the prerequisites for action? • Obtaining funding for transformation to Value Based healthcare

delivery • Find external sources to supplement limited funding from

individual local healthcare providers Note: 66 percent of the nation’s 2,323 rural hospitals are operating at a financial loss, according to iVantage Health Analytics.

• Obtaining external expertise to build an operational and technical strategy and roadmap to value based healthcare delivery

• Rural healthcare providers individually have limited internal expertise for building a value based operational and technical healthcare roadmap

• Obtaining political support • Finding political support in and outside of the region

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Coalition Vision

for Value Based Healthcare

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What were the key critical success factors? • Deciding on an appropriate coalition structure for value based

healthcare

• Engaging area physicians

• Selecting appropriate technology for value based healthcare delivery

• Finding sustainable funding and pursuing grant opportunities

• Working with statewide healthcare associations

• Working with state and local government agencies

• Engaging local school systems

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What were the organization options? • Establish a Managed Services Organization (MSO)

• Pool resources to purchase shared resources (e.g. information technology, coordinators)

• Charge service fees to members • Function as a Clinically Integrated Network (CIN)

• Work together as a virtual integrated system • Contract with payers for value based payments • Share patient information • Support patient centered medical home model

• Establish an Accountable Care Organization (ACO) • Medicare shared savings ACO

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Selection -- The Clinically Integrated Network Option • Enabled resource sharing for smaller physician practices

• Provided a way to share care coordinators • Provided a way to share cost of technology • Enabled a stronger negotiating position with payers

• Less resources required compared to forming an Accountable Care Organization • Did not require as much funding up front • Did not require ACO shared savings risks

• Provided a way to contract with payers vs MSO option • Allows for contracting with payers

• Disadvantages • More complex to operate than Managed Services

Organization • Does not have the legal benefits of an ACO

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CIN Organizational Connections

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What is the primary focus of the Clinically Integrated Network? • Utilize the CIN model to support a patient centered medical

home model (PCMH) and Medicaid Health Home model.

• Rural providers will be accountable to each other and to payers to deliver high-quality care in an efficient manner

• Key components • Collectively define and enforce standards of care • Coordinate patient care • Manage population health • Collect and report quality metrics

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How was the technology infrastructure strategy developed? • Partnered with eTransX and CivicHealth – healthcare technology

companies - to help design infrastructure strategy and roadmap

• Addressed components of the technical infrastructure strategy • Regional health information exchange solution • Shared patient information repository and portal • Tele-health and Tele-medicine integration • Community Care Coordination system for referral management

and tracking compliance with care plans

• The partners provided technology expertise • Donated expertise for defining technology requirements • Helped coalition write the technology section of grant

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Coalition Technology Roadmap

Patient Health

Outcomes

Population Health

Analytics Gap Analysis

Provider EMR Systems/

Claims Data

Health Information

Exchange

Community Care

Coordination System

White = Existing systems in place Yellow = New Rural Coalition Technology

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Primary Physician Hospitals Labs

Specialists

Pharmacy/ Retail Clinic Rehab

Long Term Care

Community Social Agencies

Home Health

EMS

Schools Payers

Rural Coalition Network

Goal: Connect Key Community Stakeholders

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Planned Rural Coalition IT Infrastructure

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Working with Associations • Tennessee Hospital Association

• Provided expertise and insight • Rural Health Association of Tennessee

• Provided insights on relevant legislative rural issues

• Tennessee Primary Care Association • Provided insight on patient centered medical

homes • TNREC (State Regional Extension Center)

• Assistance with meaningful use related expertise

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Working with Government Agencies

• State of Tennessee Healthcare Finance (Medicaid) • Provided expertise and insight on state directions for

Medicaid and value based healthcare • State of Tennessee Department of Health

• Provided insights on rural health grants and working with local health departments

• State of Tennessee Office of eHealth Initiatives • Provided assistance with health information exchange

options and potential funding • State of Tennessee Office of Emergency Medical Services

• Engaged with mobile integrated healthcare initiative (community paramedics)

• Veterans Administration • Explored options for veterans care in the community

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Working with School Systems • Diabetes Education Program

• Worked with schools to improve diabetes awareness and prevention

• Community Wellness Initiatives • Integrated with school systems

• Engage School Nurses and Faculty

• Engaged schools with improving awareness of school age health challenges such as asthma

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Coalition Directions Current

• Pursuing value based payments from Medicaid Managed Care Organizations to help fund coalition operations

• Pursuing 2015 CMS Clinical Transformation Grant • Exploring opportunities to provide local healthcare to Veterans • Exploring use of EMS paramedics for care coordination

Future

• Explore additional integration with school systems and senior citizen centers

• Pursue Medicare Chronic Care Management revenue • Explore opportunities for supporting long term services and

support (aging in place) in the region • Help other rural regions in Tennessee form coalitions

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Key Coalition Accomplishments To Date

Received positive feedback from selected physicians in the region

• Using a state grant, met with selected physicians and received supportive feedback on the proposal model

Received Positive Feedback on CIN Model from Tennessee Medicaid (Tenncare) Managed Care Organizations (MCOs)

• Positive responses have been received from two of the TennCare MCOs for supporting this model to improve Medicaid patient outcomes in a cost effective manner

Received support from State of Tennessee Health Information Exchange oversight division for potential funding for establishing regional HIE infrastructure

Applied for a CMS Clinical Transformation Grant

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Goals in State Health Innovation Plan

• Over the next five years, reach 80% of the state’s population with value-based payment and delivery models

• Utilize an all payer approach • Utilize three primary strategies:

– Patient Centered Health Homes (Medical Homes) – Retrospective Episodes of Care (Bundles) – Long Term Care and Support Payment and Delivery System

Reform Source: Tennessee Health Care Innovation Plan – Dec 9, 2013

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Well Positioned to Support State of TN Value Based Health Home Initiative

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Addressing Social, Economic, Behavioral, Mental Needs

Connecting All Patient Encounters

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Current Proposal for Medicaid Funding

• Contract with TN Medicaid Managed Care Organizations (MCOs) for value based payments

• Pilot Project Scope – 12,000 Medicaid Beneficiaries

• Pilot Project ROI – $2,500,000 savings per year – $ 995,000 1st year costs ($750,000 2nd year) – $ 1,505,000 net savings ($1,750,000 2nd year)

• Shared savings split with CIN and MCOs – $752,500 - first year – $875,000 - for each subsequent year

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Coalition Lessons Learned

• Don’t delay - start now with developing a regional value based healthcare solution (to help control your future destiny)

• Emphasize coalition based strategy and local deployment • Involve physicians in the community (find champions) • Do your homework on coalition structure options (ACO, Clinically

Integrated Network, Managed Services Organization) • Form technology partnership to develop IT infrastructure roadmap • Engage relevant community organizations (churches, schools) • Get input from statewide associations and government agencies • Explore all funding options (payers, grants, government) • Approach improves continuity of care and convenience for the

patients which also helps improve patient satisfaction

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Value STEPS Recap

Satisfaction: Developed strategy to enhance patient satisfaction with local healthcare quality and convenience Electronic Information: Developed strategy to build and fund a regional data sharing interoperability platform Savings: Developed strategy to reduce costs of value based healthcare infrastructure and generate initial $1.25 million in annual shared savings for participating healthcare providers

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Value to the Rural Region

Enhanced patient satisfaction and continuity of care for the citizens. Enhanced financial stability of local health care providers. Enhanced bargaining and negotiating power with payers through the coalition. Enhanced awareness of healthcare issues and challenges with elected officials and community leaders.

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Questions Speaker contact information:

Bill Mize Executive Director Upper Mid TN Rural Health Network [email protected] Phone: 615-210-0045

Richard Taylor Director of Business Development eTransX Inc. Phone: 615-620-7524 Cell: 615 482-3600 [email protected] www.etransx.com

Upper Mid TN Rural Health Network

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