Health Care Cabinet: Delivery System Innovation Work Group February 6, 2012

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Health Care Cabinet Delivery System Innovation
Work GroupFebruary 6, 2012

• Mark Borton, Staff to the Work Group
• MBorton_at_snet.net
• 860-938-2991

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Agenda

• Mark Bortons new role as Staff to Work Group
• Review Operating Principles
• Preliminary list of Healthcare Reform Projects in
  CT
• Review form for presenting suggested
  Recommendations to HCC
• Members get 5 minutes to present their policy and
  priority suggestions and rationale
• Review and rank suggestions
• Next Steps and meeting schedule

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Healthcare Reform ProjectsState Comptrollers
Office

• Patient-Centered Medical Home (PCMH)
• Focus on Provider Practice transformation and
  Payment Reform
• July 2010 with ProHealth, July 2011 with Hartford
  Medical Group
• NCQA-PCMH Level 3 certified Practices
• 35,000 State employees, retirees, and dependents
• Prospective population-based payment plus
  performance bonus
• Early results are good Quality improvement.
  Cost Too soon to tell.
• Health Enhancement Program
• Focus on Patient behavior change in lifestyles
  and service choices
• Began 1/1/2012. 51,500 Patient enrolled (97 of
  eligible)
• Required screenings optional programs (smoking,
  weight loss)
• Financial incentives for participation, reduced
  copays and Rx cost.
• Targeted savings 20 million/year

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Healthcare Reform ProjectsConnecticut Medicaid

• New Administrative Services Organization (ASO)
• Focus on more efficient administration and
  improved care management
• Community Health Network (CHN) contractorlive as
  of 1/1/2012
• Includes Medicaid medical programs for 600,000
  Patients
• Support for emerging Medical Homes, ACO/ICO,
  Health Neighborhoods
• Patient-Centered Medical Home (PCMH)
• Focus on Provider Practice transformation and
  Payment Reform
• NCQA-PCMH Level 3 certification Glide Path
  support to achieve
• Up-front payments, monthly fees, performance
  bonuses
• Small scale in 2012but available state-wide as
  Providers are certified.
• Medicare-Medicaid Dual-Eligible (MME)
• Focus on care coordination, whole-person
  orientation, Value
• In planningapplication to CMS in April for
  multi-year demonstration
• Initially focus on frail elderly, then all
  75,000 Average cost 2x national
• ACO-like Integrated Care Organizations
  Incorporates Mental Health, etc.
• Risk-adjusted global payments in addition to
  Fee-for-Service

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Healthcare Reform ProjectsOther

• Medicare Comprehensive Primary Care Initiative
  (CPCI)
• Goal Multi-Payer critical mass adoption of
  PCMH-like programs
• Grants of 25 to 50 million each to 5-7
  communities nationally
• Funds paid directly to PCPs as 20 pmpm average
  (risk-adjusted)
• Requires 75 Practices with NCQA-PCMH Level 3, and
  use of HER (CT has)
• Office of Health Care Reform lead collaborative
  application process with help from Connecticut
  Business Group on Health and others
• Private Payers Aetna, Anthem, Cigna,
  ConnectiCare, United
• Public Payers Comptrollers Office, Connecticut
  Medicaid
• Expect to hear in March if CT won grant.
• Other Healthcare Reform Projects
• See spreadsheet---Please send additions, updates,
  and corrections to Mark Borton, Mborton_at_snet.net
  

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Characteristics of High-Performing Healthcare
Systems

• Focus on Primary Care and Prevention
• Two-thirds Primary Care One-third
  Specialty/Hospital Care
• vs. the reverse in the US
• Foundational elements of Primary Care
• Access to Care (both timeliness and insurance
  coverage)
• Coordination of Care
• Continuity of Care with PCP
• Comprehensive Care (most performed by PCP)
• Research by Barbara Starfield/Johns Hopkins
  University

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Cost and Quality Issue Areas

• Disparities
• Social determinants
• Chronic Diseases
• Diabetes, Heart Disease, Obesity, Asthma
• Frail and Elderly
• Medicare-Medicaid Eligible (MME, or
  Dual-Eligible)
• Avoidable Utilization
• Emergency Room (ER) use, and Re-Admissions
• Medication Management
• Adverse reactions, adherence, generics
• Legal
• Fraud Abuse, Malpractice Reform
• Nursing Homes
• Quality and cost issues, Alternatives
• End-of-Live Care

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Delivery System Focus AreasAHRQ, CMMI, RWJF,
CWF, IHI

• Hospitals
• Hospital-acquired infection, adverse events
• Re-Admissions discharge and coordination
• Emergency Room utilization, internal process,
  out-patient coordination
• Primary Care
• Patient-Centered Medical Homes, Medical
  Neighborhoods
• Culturally-sensitive Care
• Mental Health integration
• Information Technology
• Electronic Health Records (EHR, EMR)i.e. nodes
• Health Information Exchanges (a.k.a. RHIOs)i.e.
  connections
• Measurement
• Process and Outcomes, Nodes and Connections (i.e.
  systemness)
• Learning
• Collecting and disseminating Best Practices

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Delivery System Focus AreasAHRQ, CMMI, RWJF,
CWF, IHI

• Payment Reform
• Pay-for-Performance
• Shared Savings
• Medical Homes
• Accountable Care Organizations
• Bundled or partially-capitated payments
• Insurance Reform
• Exchanges
• Cooperatives
• Medical Loss Ratio (MLR)
• Cost-Effectiveness Research
• Patient-Centered Outcomes Research Institute
  (PCORI)

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Other Issues and Ideas

• State Convener authority (overcome anti-trust
  issues)
• Community-based Care Coordination Services (e.g
  NCCC)
• Focus on applying for and winning national grants
• Workforce development New curriculum, new roles
• No wrong door to Care Retail, workplace,
  school clinics, Rx
• SecondaryTertiary facility balance (arms race)
• Malpractice Reform

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Delivery System Innovation Work Group

• Next Steps
• Next Meeting