MDH ACH Powerpoint.pdf - Minnesota Public Health Association

12 Pages·2014·1.21 MB·English

1/10/2014
Minnesota’s Accountable Health
Model: a Framework to Improve
Outcomes, Engage Communities, and
Reduce Expenditures
WHAT IS THE MN ACCOUNTABLE
HEALTH MODEL?
1/10/2M01N4 Accountable Health Model 2
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CMS Innovation Center State Innovation Model
(SIM) program
Supporting comprehensive approaches to transform a
state’s health system
through innovative payment and service
delivery models that will
lower costs while maintaining or
improving quality of care
State Innovation Model
Testing States
Model Testing Grant awarded to Minnesota –
(cid:1)
Partnership between MDH and DHS
(cid:1)
States could apply for Model Design grants ($1-$3 million, one
year) or Model Testing grants (up to $60 million, three years)
– and five other states: AR, ME, MA, OR, VT
Minnesota’s Model Testing grant: $45.2M
(cid:1)
Planning/Implementation period: 4/1/13 –9/30/13 (6
months)
(cid:1)
Testing period: 10/1/13 –9/30/16 (3 years)
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Foundation
Strong
Medicaid Health Care
SHIP Collaborative
ACOs Homes
Partnerships
Standardized
E-health Community
Quality
Initiative Care Teams
Measurement
Cracks in Foundation
Access to real-time Start up costs for
clinical data across Care coordination Data analytic communities and Disparities
providers skills ability small rural
providers
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Vision
• Every patient receives coordinated, patient-centered primary care.
• Providers are held accountable for the care provided to Medicaid enrollees and
other populations, based on quality, patient experience and cost performance
measures.
• Financial incentives are fully aligned across payers and the interests of patients,
through payment arrangements that reward providers for keeping patients
healthy and improving quality of care; and
• Provider organizations effectively and sustainably partner with community
organizations, engage consumers, and take responsibility for a population’s
health through accountable Communities for Health that integrate medicare
care, mental/chemical health, community health, public health, social services,
schools and long term supports and services.
What are we testing?
Can we improve health and lower costs if more people are covered
by Accountable Care Organizations (ACO) models?
If we invest in data analytics, health information technology,
practice facilitation, and quality improvement, can we accelerate
adoption of ACO models and remove barriers to integration of care
(including behavioral health, social services, public health and long-
term services and supports), especially among smaller, rural and
safety net providers?
How are health outcomes and costs improved when ACOs adopt
Community Care Team and Accountable Communities for Health
models to support integration of health care with non-medical
services, compared to those who do not adopt these models?
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PROGRESS TOWARD A NEW MODEL
•Medicaid ACOs payment models based on quality,
Payment models patient experience and cost performance measure
•Practice facilitation support, learning collaboratives
Coordinated care & funding for coordinated care transformation M
•Support to integrate new provider types
u
l
•Data analytics and HIT/HIE support to accelerate t
HIT & data adoption and remove barriers to integrate care.
i
-
p
•Within ACOs, integrate with long term care,
a
Accountable Care behavioral health, public health and social services
y
e
r
Community •Community partnerships through Accountable
Communities for Health that identify health and
Partnerships cost goals and strategies to meet goals
Building Toward the Vision
Evidence of better
60% of fully insured
200,000 Medicaid health and lower costs
population in
enrollees in ACOs from first round ACO
ACO/TCOC models
models
67% of primary care 15 Accountable Quality measures and
clinics are HCH or BHH Communities for payment structures
Health that align across payers
ACHs identify health
ACO/ACHs begin to
Providers and and cost goals and
integrate behavioral
communities partner in sustainability to
health or LTC or social
new and deeper ways continue work beyond
services/public health
grant funding.
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DRIVER 4: PROVIDER ORGANIZATIONS
PARTNER WITH COMMUNITIES AND
ENGAGE CONSUMERS, TO IDENTIFY
HEALTH AND COST GOALS AND TAKE
ON ACCOUNTABILITY FOR POPULATION
HEALTH
Total funding: $6.8M (16%)
Goals
(cid:1)
Create new, sustainable venues through which
providers engage with communities in more
meaningful ways to improve individual and
community and population health.
(cid:1)
Ensure selected ACH communities have identified
their own health and cost goals and their own
measurement tools, and they have a solid plan to be
sustainable in the future.
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Activities
Select up to 15 Accountable Communities for
Health (Year 2) and provide financial support to:
(cid:1)
Establish community advisory teams/partnerships
(cid:1)
Identify priority population health goals and
improvement activities
(cid:1)
Ensure community leadership/ownership
(cid:1)
Provider technical assistance and development of
payment model integration
(cid:1)
Develop sustainability plans
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Foundation: Community Care Teams
• Three existing CCT’s in Minnesota: Pilots for
ACH
• Initially funded through HCH program
• Multi-disciplinary care teams: clinic/HCH,
hospital, community & social services
• Focus on coordinating care for whole patient,
engaging all sectors
• Developing new relationships, approaches
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Community Care Teams
• Mayo: Wrap---around team approach,
focusing on the development of the core team
structure for senior population.
• HCMC (Brooklyn Park/Brooklyn Center): Focus
on diabetes and community/parish linkages
• Essentia Ely: Began with pediatric mental
health, extended to broader population
through community partnerships
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Similar Models
• VT, NC Community Care Teams
• Oregon: Coordinated Care Organizations
– Unified local budgets
– Governed by provider/community partnerships
• MD: Community Integrated Medical Home (SIM)
– Regional community health hubs
– Local health improvement coalitions
– Hotspotting based on utilization data
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Lessons to Build On…..
• Engage trusted community leaders – and primary
care providers - early on
• Start with small projects to get off the ground,
establish roles & trust
• Build on existing relationships & work
• Need designated/supported time for work
• Build in LOTS of time to develop partnerships,
agree on goals
• Sustainability/payment is key
• Culture change/paradigm shift
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General ACH criteria
• Not one-size-fits-all
• Proposals may be initiated by providers,
community orgs, non-profits, tribes, etc.
• Include at least one ACO that provides
primary care to a threshold % of population
and has financial accountability for outcomes
• Community-led oversight body that
represents population & needs: includes
providers from across spectrum
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