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Health Care Reform Update


Health Care Reform Update Jeff Schiff, MD, Medical Director, DHS Pat Adams, Assistant Commissioner, MDH Scott Leitz, Assistant Commissioner, MDH – PowerPoint PPT presentation

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Title: Health Care Reform Update

Health Care Reform Update
  • Jeff Schiff, MD, Medical Director, DHS
  • Pat Adams, Assistant Commissioner, MDH
  • Scott Leitz, Assistant Commissioner, MDH
  • Presentation to Health Care Access Commission
  • December 1, 2008

Health Reform Bill Key Elements
  • Health reform bill passed in May contains a
    number of key elements
  • Public health improvement (SHIP)
  • Health care coverage/affordability
  • Chronic care management/health care home
  • Payment reform and price/quality transparency
  • Administrative efficiency
  • Health care cost measurement

Vision and Framework for Implementation
  • Create meaningful, transformative health reform
    based on the Institute for Healthcare
    Improvements Triple Aim. The goals of the
    Triple Aim are to simultaneously
  • Improve population health
  • Improve patient/consumer experience and
  • Improve affordability of health care.

Health Reform Implementation Principles
  • Purpose of reform is to improve health of
    Minnesotans and redesign care to improve value
  • We must start with end in mind and always
    remain focused on what we want to accomplish and
    what success looks like.
  • To ensure all Minnesotans benefit, we will aim
    for market-wide implementation of health reforms
    not just reforms for government programs.
  • We will seekand expectunprecedented
    collaboration among public and private partners
    as we implement comprehensive health reform

Overview of presentation
  • Quality Incentive Payment System (QIPS)
  • Provider Peer Grouping
  • Baskets of Care
  • Other Activities
  • SHIP
  • Health Care Homes

Article FourUpdate on Implementation of
Quality, Transparency, and Payment Reform
  • Scott Leitz
  • Assistant Commissioner
  • Minnesota Department of Health
  • Health Care Access Commission
  • December 1, 2008

Quality and Incentive Payment System
  • Minnesota Statutes, section 62U.02
  • MDH contracted with local organizations to
    implement the QIPS
  • Minnesota Community Measurement contract lead
  • Minnesota Hospital Association
  • Minnesota Medical Association
  • StratisHealth
  • University of Minnesota
  • 3 million contract over 4 years

Quality and Incentive Payment System
  • Key Tasks
  • Task One Quality measures identification and
    documentation to be used for public reporting
  • Task Two Development of an incentive payment
  • Task Three Collection and public reporting of
    standardized quality measures
  • Important Dates
  • July 1, 2009 MDH specifies quality measures and
    quality incentive payment system
  • Jan. 1, 2010 Providers submit standard quality
  • July 1, 2010 Standard quality
  • measures reported publicly

Quality and Incentive Payment System
  • Project Status
  • On schedule to meet statutory timelines
  • Met all key milestones to date (e.g., RFP,
    contract, etc.)

General Timeline General Timeline
Dec. 5, 2008 Inventory of existing quality measures completed
Dec. 2008 thru Jan. 2009 Contractor holds public meetings with stakeholders to develop recommendations on a set of quality measures for public reporting
Feb. 1, 2009 Inventory of existing quality incentive payment and pay-for-performance systems complete
Quality and Incentive Payment System
General Timeline General Timeline
Feb. 2009 thru Mar. 2009 Contractor holds public meetings with stakeholders to develop recommendations on quality measures and specific methodology for quality-based incentive payment system
Apr. 2009 thru June 2009 MDH adopts administrative rules to implement the quality measures and incentive-based payment system
July 2009 Contractor begins education and training of providers about QIPS requirements
Jan. 1, 2010 Contractor begins collecting data
July 1, 2010 MDH publishes first public report on quality measures
July 1, 2010 SEGIP begins using the quality incentive payment system
Provider Peer Grouping
  • Collection of encounter data
  • Collection of pricing data
  • Analytical work for peer grouping providers based
  • The quality and outcome data from QIPS
  • The resources used to achieve the outcomes
  • The price of those resources
  • Important Dates
  • July 1, 2009 Health plans TPAs begin
    submitting data
  • Jan. 1, 2010 MDH specifies peer grouping
  • June 1, 2010 MDH disseminates results of peer
    grouping to providers
  • Sept. 1, 2010 MDH publicly publishes
  • the results of peer grouping

Provider Peer Grouping Encounter Data
  • Minnesota Statutes, section 62U.04, subd. 4
  • MDH will execute a data collection contract in
    2-3 weeks
  • Project Status
  • On schedule to meet statutory timelines
  • Met all key milestones to date (e.g., RFP,
    contract, etc.)

General Timeline General Timeline
Jan. 2009 Contractor holds public meetings with stakeholders to develop recommendations on data elements
Feb. 2009 thru May 2009 MDH adopts administrative rules to collect encounter data
July 1, 2009 Contractor begins working with health plans and TPAs to collect encounter data
Provider Peer Grouping Analytical Work
  • Minnesota Statutes, section 62U.04
  • RFP currently open for bid
  • Key contractor tasks
  • Issue a request for information (RFI) on peer
    grouping systems
  • Collect and synthesize available research and
    data on peer grouping systems
  • Participate in public meetings to discuss the
    results of the RFI and research efforts
  • Stakeholders will have an opportunity to respond
    to the RFI
  • Public meetings to discuss peer grouping
    methodologies will begin Summer 09

Baskets of Care
  • Minnesota Statutes, section 62U.05
  • MD will execute a contract to facilitate a
    steering committee and seven work groups in 1-2
  • Steering Committee will
  • Identify conditions/episodes of care to include
    in the seven baskets, using
  • Prevalence, Cost of treatment, Potential for
  • Identify issues related to implementing baskets
  • General oversight of the work groups
  • Work groups will
  • Identify the health care services and/or outcomes
    to include in each basket
  • Identify/define quality measures for the baskets
    of care
  • Incorporate patient-directed, decision-making
  • support in baskets

Baskets of Care
  • Steering Committee Chairs
  • Dr. George Isham, HealthPartners
  • Dr. Doug Wood, Mayo
  • Steering Committee Members
  • MMA (2 primary and specialist)
  • MHA (2 rural/critical access hospital and urban
  • Council of Health Plans (2)
  • Mayo
  • Insurance Federation
  • Employer (1)
  • Organization with market experience with baskets
    of care
  • Consumers (2)
  • Work Groups Members All Interested Parties

Baskets of Care
  • Project Status
  • On schedule to meet statutory timelines
  • Met all key milestones to date (e.g., RFP,
    contract, etc.)

General Timeline General Timeline
Jan. 2009 thru April 2009 Steering committee and work groups meet to define baskets
July 2009 MDH writes rules defining baskets of care
July 2009 Contractor begins outreach effort to educate providers on defined baskets of care
July 2009 thru Oct. 2009 Steering committee and work groups develop plans to address 1) quality measures for baskets 2) administrative challenges in implementing baskets
Other Activities
  • All activities prioritized by due date of
  • Anticipated starting dates of public
  • Essential Benefit Sets
  • Due DatesOctober 15, 2009 - Work group submits
    initial recommendationsJanuary 15, 2010 MDH
    submits a report to the Legislature
  • Work Group Meetings Late Spring 2009
  • Uniform Claim Study
  • Due DatesJanuary 1, 2010 MDH submits report
    to Legislature
  • Work Group Meetings Late Winter 2009

State Health Improvement Program SHIP
  • Pat Adams
  • Assistant Commissioner
  • Minnesota Department of Health
  • Health Care Access Commission
  • December 1, 2008

Description of SHIP
  • Signed into law as integral public health
    component of Health Reform Initiative
  • SHIP intended to reduce obesity and tobacco use
    in Minnesota through policy, systems, and
    environmental changes
  • 47 million appropriated for fiscal years 2010
    and 2011
  • Competitive grants to Community Health Boards and
    tribal governments rolled out beginning July 1,

SHIP Model for Achieving Success
  • Community input into planning, implementation and
  • Adherence to socio-ecological model
  • Health promotion in four settings community,
    schools, worksites, health care
  • Local program advocates
  • Informed by evidence-based interventions
  • Focus on common risk factors
  • Extensive and comprehensive evaluation linked to
    program planning
  • Policy, systems, and environmental change that
    supports healthy behavior
  • Accountability and oversight

SHIP Development Structure- Internal and External
Work Group Accomplishments
  • Intervention
  • Drafting a Menu of Interventions for potential
    grantees to assist in implementation of policy,
    systems, and environmental change
  • Evaluation
  • Drafting an evaluation plan to address community
    and tribe assessment, process and outcome
    evaluation, and surveillance
  • Developing linked evaluation options for Menu of
  • Technical Assistance
  • Providing three major pre-implementation
  • Developing statewide, regional, and
    grantee-focused support
  • Communications
  • Developing consistent messaging, branding, and
    market-wide coordination
  • Chronic Disease Integration
  • Developing strategies to better coordinate
    systems throughout Minnesota to promote chronic
    disease reduction
  • RFP
  • Drafting Request for Proposals to be released in
    February 2009

  • Planning is fully underway
  • Involving key stakeholders in planning (local
    public health and tribal governments)
  • Working closely with other stakeholders to ensure
    SHIP adds value and builds on existing efforts
  • Using evidence- and practice-based interventions
    to maximize program impact
  • Utilizing and modifying existing data collection,
    assessment, and reporting systems
  • RFP is on track to be released February 2009 and
    will be due May 1, 2009

  • Building on existing prevention efforts to expand
    and not duplicate work that is already being done
  • Enhancing capacity of local public health and
    tribal governments to implement policy, systems,
    and environmental changes
  • Integrating with other Health Reform Initiative
    components to support overall health reform
  • Developing an statewide system to demonstrate
    that reductions in risk factors ? decreases in
    chronic disease ? substantial health care

SHIP Next Steps
  • Continue planning with our partners
  • Award funds to roll out July 1, 2009
  • Provide technical assistance to grantees to
    ensure successful implementation
  • Secure future funding to achieve goals of
    reducing obesity and tobacco use and exposure in
  • Reduce the burden of chronic disease to generate
    future health care-related cost savings

Health Care Homes
  • Dr. Jeff Schiff, Medical Director, DHS
  • Pat Adams, Assistant Commissioner, MDH
  • Health Care Access Commission
  • December 1, 2008

Health Care Homes (HCH)
  • A model of delivering care that is
  • comprehensive
  • coordinated
  • culturally-competent
  • continuous
  • accessible
  • family-centered
  • compassionate

HCH Program Development Tasks
  • Criteria for participation
  • Verification process
  • Common payment methodology
  • Incorporation of collaborative learning
  • Measurement of results

Assumptions for Development and Implementation of
  • Learning from and building on local and national
    experiences with HCH models
  • Collaborative process with broad stakeholder
  • Flexibility within the parameters of the
    legislation creating opportunity to test
    different models
  • Meaningful measures that focus on desired
    outcomes more than process
  • Refinement of model over time

HCH Development process
  • Collaboratively organized in state government
    between the Departments of Human Services and
    Health with emphasis on public-private
  • A combination of grant contracts and state
    organized processes
  • Integration with all of the other parts of the
    Health Care Reform legislation

HCH Activities
  • Active current work
  • Foundational
  • Outcome recommendations
  • Capacity Assessment
  • Consumer and Family Council
  • Criteria development workgroup

HCH Activities
  • Program components in development
  • Verification
  • Collaborative learning model development and
  • Payment system development
  • Development of specific evaluation measures

HCH Activities to Date
  • Outcomes Start with the end in mind.
  • RFP issued October 2008 to develop
    recommendations for broad outcomes or goals to be
    used to guide the evaluation of health care
  • Contract awarded in November 2008 to Institute
    for Clinical Systems Improvement (ICSI). Work
    product due 12/31/08.
  • Draft outcomes were sent out for public input on

HCH Activities to Date (cont.)
  • Capacity Assessment.
  • RFP issued October 2008 seeking an entity to
    conduct an assessment of 1) the readiness of the
    primary health care delivery system to implement
    health care homes 2) consumer understanding and
    readiness for the implementation of health care
    homes and 3) to make recommendations that will
    guide capacity building efforts in establishing a
    statewide health care home system.

HCH Activities to Date (cont.)
  • Consumer/Family Council
  • Opportunity for consumer and public engagement
    and input
  • First meeting November 21st
  • Representatives to serve on other work groups,
    including criteria/standards work group

HCH Activities to Date (cont.)
  • Creation of criteria/standards.
  • Process will include facilitated group processes
    for broad input from a variety of stakeholder
  • HCH Community Meeting Dec. 12, 2008 (will be
    archived for later viewing).
  • Work groups will convene beginning Dec. 18 to
    develop standards.
  • Collaboration with leading national
    criteria/standards organizations
  • Development process will include opportunity for
    public input.
  • Recommendations to Commissioners of Health and
    Human Services in late Jan. 2009

HCH Opportunities and Challenges
  • Transformational change in care delivery
  • Changes in infrastructure and culture
  • Creation of a patient and family centered health
    care system
  • Measurement must evaluate all three goals of the
    IHI Triple Aim
  • Measures will be developed concurrent with the
    program and refined over time
  • Measures must evaluate progress to decreasing
  • Payment must blend payments for services,
    coordination of care, and improved outcomes
  • Payment mechanisms will evolve over time

Contact Information
  • Jeff Schiff, MD, DHS
  • Pat Adams, MDH
  • Scott Leitz, MDH
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