An Introduction to the Community Medicaid...
Transcript of An Introduction to the Community Medicaid...
AnIntroductiontotheCommunityMedicaidCollaborative
AnnMonroe
President,CommunityHealthFoundation
November12,2010
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presented at the P2 Quarterly Meeting
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Health Status of Western New Yorkers
Risk Factor Erie County
Niagara County
Other 6 WNY Counties
State
% unemployed (March 2010) 8.2% 8.6% 8.4% - 11% 8.7%
% of population at or below poverty level (2007) 13.7% 11.9% 9.6% - 15.8% 13.8%
CV Disease Crude Mortality Rate per 100,000 372.3 437.2 312.1 – 423.1 313.4
CV Disease Crude Hospitalization Rate /10,000 202.6 266.6 143.6 – 235.0 194.6
Diabetes Mortality Rate per 100,000 26.4 24.2 14.7 – 35.2 20.0
ED Visits per 100 residents 36.1 40.5 30.0% - 41.5% 34.6
ED Visit for Illness (% of ED visits) 68.4% 66.6% 63.1% - 67.3% 74.7%
• High rates of cardiovascular disease mortality and hospitalization rates
• Higher diabetes mortality compared to the State average • Emergency department utilization greater than State average
Sources:NYS DOH, County Health Assessment Indicators, 2005-2007 SPARCS Annual Reports, Emergency Departments of NYS, Table 8: 2006 Emergency Department Visits by County of Residence and Reason for Visit NYS DOH, County Health Indicator Profiles (2003 - 2007) Bureau of Labor Statistics, March 2010
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TheStatePerspective
• 2006NYSMedicaidspendingwas$2,316percapita– 128%abovethenationalaverageof$1,015– 257%abovethemedianspendingof$899
• Higherspendinghasnotresultedinbetterquality
• MedicaidinNYS– Poorhealthindicatorsandlowqualityscores– Financiallimitationstohospitalsandhealthplans(increasing
netlosses)– Insufficientphysicianreimbursement– CurrentfinancialcrisisofNewYorkState
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MedicaidManagedCareinWNY
• MedicaidManagedCareenrollmentgrowing• Allhealthplansincreasingmembership• Economictimesandhealthcarereformforecastcontinuedgrowth
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Medicaid Managed Care and Health Plan Share in WNY
Source: NYS Department of Health, Monthly Medicaid Managed Care reports, data as of January of each year
Health Plan Share by County
BCBS/ Health Now Fidelis
Indepndnt Health Univera
Allegany 63% 0% 0% 37%
Cattaragus 45% 34% 0% 21%
Chatauqua 24% 73% 0% 3%
Erie 17% 25% 28% 31%
Genesee 91% 9% 0% 0%
Niagara 32% 35% 33% 0%
Orleans 42% 58% 0% 0%
MomentofOpportunity
• NewYorkStateDepartmentofHealth– enhancedpaymenttoprimarycarephysicianstosupportdevelopmentofpatientcenteredmedicalhomemodels
– physiciansreceive$2,$4,or$6pmpmforeachManagedMedicaidPatientiftheymeetNCQAPCMHLevel1,2or3,respectively
• Opportunitytoimprovequalitymetricsandthefinancialstabilityofthehealthsystemsservingthispopulation
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RegionalReadiness
Priorities Young children in poverty
Deferring frailty among elders Building community health capacity
Strengthening safety net (SNAPCAP)
Neighborhood Action Initiative Collaborative for Improved Transitions Early childhood emotional/social health
quality improvement collab.
750+ providers & 2000+ users 25 million results (labs, radiology,
transcribed reports, 1.7M new monthly 75,000 community-wide consents, 3000
added weekly Payor EMR adoption program
Regional quality improvement Consumer engagement
Performance measurement/public reporting
Reduce health disparities
1 of 17 communities funded by RWJF for Aligning Forces for Quality
Community Health Planning & Reporting Capability
Western New York organizations recognized for leadership in developing regional collaboration for health improvements.
HEAL 10 PCMH Grant support
Federal Regional Extension Center to support meaningful use of EMR WNY Health Equity Coalition
Improving Quality Improvement across the region
Beacon Community
Partners
• Initialpartners– Fidelis– HealthNow– IndependentHealth– Univera– CommunityHealthFoundationofWesternandCentralNewYork
• Localproviders(e.g.physicianoffices,hospitals,FQHCs)
• HomeforthisprojectisP2CollaborativeofWesternNewYork
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CommunityMedicaidCollaborativeOverallGoal
Population:UrbanBuffaloandNiagaraFalls
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• Improveoutcomes(measuredviaIHITripleAimframeworkofquality,experience,costandoverallhealthstatus)
• ImprovetheCareCoordinationModeltoachieveOutcomes.• PersonCenteredMedicalHome• PCMH/HealthPlan/Providerintegrationandalignment• NeighborhoodCommunities
• DevelopBusinessSustainabilityModeltoSupportCareCoordinationModelandOutcomes
• Ensureavailablecommunityresourcesareutilizedasnewandrecurringresourcesaredefinedandpiloted
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Community Coordination
Critical Components to Improve Quality and Affordability
Com
pone
nts
Care Coordination Physician Office
Community Based EMR Meaningful Use
Fund
ing
Sour
ces
• Practice to evolve from limited to fully integrated electronic capability with connectivity/interoperability to support
• Patient-population data • Searchable clinical patient
information • Use of patient registries • Clinical condition / risk
management • Population health
management
• Improving quality, safety, efficiency, and reducing health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Ensure adequate privacy and security protections for personal health information
• Provide care coordination support within the physician practice aligning and maximizing each team members level of training and expertise (i.e. RN, social worker, health coach, care coordinator) to:
• Address barriers at point of care
• Assess social / environmental needs
• Liaison between physician practice and community resources
• Support patient self management
• Intertwining socio-environmental issues and medical needs require collaboration with community partners and organization to:
• Promote and support health prevention, early diagnosis and treatment
• Coordinate, navigate and access community services
• Develop and support community awareness, education and engagement
• Empower and promote individual responsibility
• To be determined based upon scope and approach
• To be determined based upon scope and approach
• Beacon Community • HEAL 10 • Primary Care (Payor) EMR in kind allocation within HEAL 10 • Regional Extension Centers (REC) • NYS PCMH funding based upon achieving NCQA accreditation level 1, 2, or 3 ($2/ $4/ $6) • Potential funding may be available from individual health plan or hospital programs, government grants, and/or foundations
Patient Centered Medical Home (Physician/practice to achieve NCQA Accreditation)
Use of Technology
CommunityMedicaidCollaborativeCareCoordinationModel
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NeighborhoodCommunity
PCMHHealthplanw/hospital/other
providerintegration
INTERVENTIONS INTERVENTIONS INTERVENTIONS
PersonCenteredHealthCoordinationModel
• Innovativethoughtandcommitmenttodevelopthenewmodel• Alignmenttooutcomemeasuresrepresentativeofquality,experienceandcost• Maximizingcurrentresources,identifyingefficienciesandcreatingvalue
WNY Regional Medicaid Collaborative Coordination of Care – Conceptual Framework
Hospitals / Health Delivery System
Discharge Planner / Case
Manager
Community
Community Health Worker
Care Coordination Health Plan
Health Coach, Disease / Case Manager
Patient Centered Medical Home
(PCMH)
Care Coordinator
Supported by Health Information Exchange
Individual
WNYCommunityMedicaidCollaborativePerformanceMeasurement
initialdrafttobedeveloped
FinancialCost HealthStatus
Experience Quality
• Medicalpmpm–reducetrend
• Adminpmpm–reducetrend
• Prevalence:–Cardiac–Diabetes–Obesity–Cancer
• QARR/HEDIS• Utilization(ER,Admits)
• VariationinCare
• CAHPS• PCAHPS• IHI
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CommunityMedicaidCollaborativeSummit(Nov2,2010)“PromisingModelsforAccountableHealthyCommunity”
• Speakersfromothercommunitiesacrossthenation– CenterforHealthCareStrategiesinNewJersey– InstituteforHealthCareStudiesatMichiganStateUniversity
– RhodeIslandChronicCareSustainabilityInitiative– NeighborhoodHealthPlanofRhodeIsland– CommunityHealthWorkerNetworkofNewYorkCity– HudsonHealthPlan(NY)– VermontBluePrint– AdirondackPlan(NY)
• PresentationsavailableontheP2website(www.p2wny.org)
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KeyLearnings• InvestmentintheEMRandClinical/PracticeTransformation
inclusiveofPCMHcertificationandmeaningfuluse– requiresorganizationalchangemanagement,– resources(qualityimprovementandcarecoordinators),– enhancedfinancialreimbursement
• Practicemustseeitisintheirbestinteresttotransformwhichneedstobecommunicatedbothintermsofqualityandeconomics
• Timeframetoimplementcanrangefrom2to5years
• Physicianproviderswhotransformareseekingcommonreimbursement/revenuestreamswithsamequalityoutcomemeasures
• Abilitytodesignreimbursementmodelsacrosspayershasrequiredsomelevelofstateauthority
Thankyou!