Care Coordination, Provider Alignment and Infrastructure:

Laying the Foundation for Health Care Transformation

Nicole StallingsVice President

Maryland Hospital Association

August 21, 2015

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Objectives

• Provide overview of key HSCRC and DHMH incentives and activities to promote care coordination and provider alignment

• Outline reporting requirements

• Describe timeline of key initiatives

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State-Level Infrastructure (leverages many other large investments)

Create and Use, Meaningful, Actionable Data

Develop Shared Tools (Patient Profiles, Enhanced Notifications, Care Needs, Others)

Connect Providers

Alignment

Medicare Chronic Care Management Codes/Medical Homes

Gainsharing & Pay for Performance

Integrated Care Networks & ACOs Including Dual Eligibles

Accelerating All-Payer Opportunities Moving Away From Volume

Care coordination & integration (locally-led)

Implement Provider-Driven Regional & Local Organizations & Resources (Requires Large Investments And Ongoing Costs)

Support Provider-Driven Regional/Local Planning

Technical Assistance

Consumer Engagement

State & Local Outreach Efforts

Develop Shared Tools For Engaging Consumers

Maryland’s Strategic Transformation Roadmap

Source: HSCRC Public Meeting. May 13, 2015

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Implementation Focus Areas

Year 1

• Global Budgets• Meeting test metrics• Monitoring infrastructure• Potentially avoidable utilization concepts and data• Stakeholder input

Year 2

• Payment Alignment: Gainsharing, pay-for-performance, Medicare Chronic Care fees, Dual eligible & integrated care networks

• Clinical improvement: care coordination, chronic disease management

Year 3

• Implementation of models developed in year 2• Focus on additional alignment opportunities• Patient, family and community engagement

Source: Modified from HSCRC presentation.

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Implementation Focus Areas

Year 1

• Global Budgets• Meeting test metrics• Monitoring infrastructure• Potentially avoidable utilization concepts and data• Stakeholder input

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Accomplishments to Date

• Financial targets were exceeded and quality was improved

• Nearly all hospital revenues are under global budgets

• Hospitals are engaging with physicians, long-term care providers, and community partners to plan and implement changes to the delivery system

• Medical home and Accountable Care Organizations (ACOs) continue to develop

• Starting to see expansion in MCO efforts beyond Medicaid to address Medicare patients

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Implementation Focus Areas

Year 2

• Payment Alignment: Gainsharing, pay-for-performance, Medicare Chronic Care fees, Dual eligible & integrated care networks

• Clinical improvement: care coordination, chronic disease management

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Physician Alignment & Engagement Workgroup Report

• Focused on what State and Commission could do as regulator, facilitator and catalyst to promote alignment of strategies among hospitals and other health care providers

• Considered strategies that are both: – Non-Compensatory:

• Shared infrastructure, analytics and other resources • Better health care quality and cost reporting • Investment to improve ease of practice such as care management support

– Compensatory:• Pay for performance • Gainsharing • Shared Savings

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Status Update• MHA’s Gainsharing program methodology finalized and phase

1 recruitment complete• HSCRC, on behalf of MHA, MedChi and others, seeking

enhanced Medicare data and federal waivers to facilitate various alignment activities– Expected approval Q2 of 2016, if not sooner– MHA exploring alternative vehicles to accelerate gainsharing

implementation

• HSCRC initiating discussions on additional alignment models with stakeholders; expect to establish a workgroup for additional input

Source: HSCRC Executive Director’s Report. August 12, 2015

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Care Coordination Workgroup Report

• Consensus that improved care coordination and alignment among providers (particularly for high needs patients) is key to meeting the goals of the All-payer model and improving population health

• Partnerships at the regional and local levels are critical to effective care coordination

• Statewide infrastructure is needed to support these efforts

Who is High Risk?

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Regional and Local Efforts to Focus on…

• Delivery system changes, including:– Chronic disease supports– Integration and coordination across care continuum– Case management and other supports for high needs and complex

patients– Episode improvements, including quality and efficiency improvements– Clinical consolidation and modernization to improve quality and

efficiency

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Regional and Local Efforts (cont.)

• Increased focus on integration with community needs and supports– Increased focus on community needs assessments– Focus on transportation and other social needs– Focus on population health– Patient and family engagement

• Technical assistance– Provided via State Budget Reconciliation and Financing Act of 2014

(BRFA) funds through CRISP

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REGIONAL PARTNERSHIPS FOR HEALTH SYSTEM TRANSFORMATION

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Regional Partnership for Health System Transformation Planning Grants

• 2014 Budget authorized up to $15 million to fund the planning of regional partnerships and statewide infrastructure to facilitate care management and coordination in support of waiver goals

• Department of Health and Mental Hygiene and HSCRC released RFP in February; 11 applications received

• Eight grantees awarded total of $2.5 million in May• Technical assistance provided to all grantees• Resources and webinars available to all hospitals

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Regional Partnerships• Hospital-led partnerships to develop regional plans to do the

following:– Collaborate on analytics– Target services based on patient/population needs, and – Plan and develop care coordination and population health improvement

approaches

• Plans must:– Propose delivery and financing model– Identify infrastructure and staffing to support the model– Target outcomes for reducing utilization/costs and improving quality

• Initial target populations: high utilizers such as Medicare patients with multiple chronic conditions and high resource use, frail elders with support requirements, and dual eligibles with high resource needs

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Regional Transformation GranteesRegional Group Name Award Amount Lead Hospital

Trivergent Health Alliance $ 133,334 Western Maryland Health System

$ 133,333 Frederick Regional Health System

$ 133,333 Meritus Medical Center

Bay Area Transformation Partnership $ 400,000 Anne Arundel Medical Center

Howard County Regional Partnership for Health System Transformation $ 200,000 Howard County General Hospital

University of Maryland Upper Chesapeake Health and Hospital of Cecil County Partnership $ 200,000

University of Maryland Upper Chesapeake

Regional Planning Community Health Partnership $ 400,000 Johns Hopkins Hospital(s)

Baltimore Health System Transformation Partnership $ 300,000 University of Maryland Medical Center

NexusMontgomery $ 200,000 Holy Cross Hospital

Southern Maryland Regional Coalition for Health System Transformation $ 200,000 Doctors Community Hospital

Total $ 2,500,000

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HSCRC INFRASTRUCTURE FUNDING & MONITORING REQUIREMENTS

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FY 2016 Balanced Update• 0.4% adjustment to FY 2016 GBR budgets to provide new

infrastructure funding• Require all hospitals to submit multi-year plans for improving

care coordination, chronic care, and provider alignment by December 1, 2015

• Require specialty hospitals to begin submitting admission and discharge data to CRISP by April 1, 2016 to facilitate tracking of readmissions

• Up to an additional 0.25% available through competitive awards to hospitals implementing or expanding innovative care coordination, physician alignment, and population health strategies

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Competitive Implementation RFP

** Based on Draft RFP released August 5• Eligible applicant:

– An individual hospital– Multiple hospitals as lead applicants– A hospital applying on behalf of a regional partnership

• All applicants must include collaborating partners• Broad and meaningful networks preferred• Hospitals may participate in multiple applications

Source: HSCRC Webinar. August 6, 2015

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Funding Limits

• A maximum of 0.25% of aggregate rates could be awarded (approximately $40M)

• Total dollars awarded to a hospital acting as a single entity are capped at 0.5% of the hospital’s FY 2015 net patient revenue plus markup

• If named in multiple applications, total combined awards to a hospital are capped at 0.75% of the individual hospital’s FY 2015 net patient revenue plus markup

• Awarded funds will be collected by the hospital through permanent rate increases beginning Rate Year 2016

Source: HSCRC Webinar. August 6, 2015

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Selection Criteria of Note• Consistency with Strategic Plans, and GBR infrastructure, and

other appropriate investments • Efficacy of investments to date • Do investments complement state and regional resources and

policies• Demonstration of how care coordination efforts flow among

providers for high risk patients using different hospitals and the extent to which it addresses patient and family preferences

• Feasibility of ROI and sustainability over time, the apportionment of ROI to payers, the potential to reduce total cost of care

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Timeline of RFP

• Mid to late August – RFP to be released • Mid-September – Webinar for Questions to be posted to the

Website • December 1 – Applications/Proposals Due • January 2016 – Awardees Announced

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HSCRC Infrastructure Monitoring

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Implementation Focus Areas

Year 3

• Implementation of models developed in year 2• Focus on additional alignment opportunities• Patient, family and community engagement

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Alignment: Future Work

• Models that support integration beyond hospitals need to be developed– Hospitals, SNFs and post-acute care facilities – Episodes of care that include providers beyond the hospital– Other payment models that include costs beyond hospital costs

• Development of statewide framework to facilitate approval of models necessary to address total cost of care; includes appropriate federal waivers– Stark– Anti-Kickback– Civil Monetary Penalties– SNF 3-day Stay

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Patient, Family and Community Engagement

• Including patients, caregivers and community organizations as partners in this work

• Addressing risk factors upstream• Understanding and honoring care

preferences• Explaining how our system is

changing

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THANK YOU

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Speaker Biography

Nicole Dempsey Stallings is Vice President for Policy & Data Analytics at the Maryland Hospital Association (MHA), the trade association for Maryland’s 66 hospitals and health systems. In this role she manages advocacy for quality-related regulatory activities and is charged with the development and implementation of care coordination and physician alignment strategies to support the goals of Maryland’s unique Medicare waiver, which allows the state to set the rates hospitals can charge.

Prior to joining MHA, Nicole served as Senior Policy Advisor to the Secretary of the Maryland Department of Health and Mental Hygiene and the Director of the Maryland Health Quality and Cost Council. Ms. Stallings was charged with coordinating and facilitating collaboration on health care quality improvement and cost containment initiatives for the state. Ms. Stallings also staffed the Maryland Health Benefit Exchange Board and the Health Care Reform Coordinating Council, established by Governor O’Malley to coordinate implementation of the Affordable Care Act. Ms. Stallings held previous roles as Chief of Government Relations and Special Projects at the Maryland Health Care Commission and was a registered lobbyist and the Director of Policy for the New Jersey Hospital Association. Nicole holds degrees from Virginia Tech and Rutgers University.