Health Care Cabinet: Health Care Cabinet: Delivery System Innovation Work Delivery System Innovation Work

GroupGroup

February 6, 2012February 6, 2012

Mark Borton, Staff to the Work GroupMBorton@snet.net

860-938-2991

AgendaAgenda• Mark Borton’s 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

Healthcare Reform Projects—Healthcare Reform Projects—

State Comptroller’s Office:State Comptroller’s Office:

• Patient-Centered Medical Home (PCMH)o Focus on Provider Practice transformation and Payment Reformo July 2010 with ProHealth, July 2011 with Hartford Medical Groupo NCQA-PCMH Level 3 certified Practiceso 35,000 State employees, retirees, and dependentso Prospective population-based payment plus performance bonuso Early results are good: Quality improvement. Cost: Too soon to tell.

• Health Enhancement Programo Focus on Patient behavior change in lifestyles and service choiceso Began 1/1/2012. 51,500 Patient enrolled (97% of eligible)o Required screenings; optional programs (smoking, weight loss)o Financial incentives for participation, reduced co—pays and Rx cost.o Targeted savings: $20 million/year

Healthcare Reform Projects—Healthcare Reform Projects—

Connecticut Medicaid:Connecticut Medicaid:

• New Administrative Services Organization (ASO)o Focus on more efficient administration and improved care managemento Community Health Network (CHN) contractor—live as of 1/1/2012o Includes Medicaid medical programs for 600,000+ Patientso Support for emerging Medical Homes, ACO/ICO, Health Neighborhoods

• Patient-Centered Medical Home (PCMH)o Focus on Provider Practice transformation and Payment Reformo NCQA-PCMH Level 3 certification; “Glide Path” support to achieveo Up-front payments, monthly fees, performance bonuseso Small scale in 2012—but available state-wide as Providers are certified.

• Medicare-Medicaid Dual-Eligible (MME) o Focus on care coordination, whole-person orientation, Value o In planning—application to CMS in April for multi-year demonstrationo Initially focus on frail elderly, then all 75,000; Average cost 2x nationalo ACO-like Integrated Care Organizations Incorporates Mental Health, etc.o Risk-adjusted global payments in addition to Fee-for-Service

Healthcare Reform Projects—Healthcare Reform Projects—

Other:Other:

• Medicare: Comprehensive Primary Care Initiative (CPCI)

o Goal: Multi-Payer “critical mass” adoption of PCMH-like programso Grants of $25 to $50 million each to 5-7 communities nationallyo Funds paid directly to PCPs as $20 pmpm average (risk-adjusted)o Requires 75 Practices with NCQA-PCMH Level 3, and use of HER (CT has)o Office of Health Care Reform lead collaborative application process with

help from Connecticut Business Group on Health and otherso Private Payers: Aetna, Anthem, Cigna, ConnectiCare, Unitedo Public Payers: Comptroller’s Office, Connecticut Medicaido Expect to hear in March if CT won grant.

• Other Healthcare Reform Projectso See spreadsheet---Please send additions, updates, and corrections to: Mark

Borton, Mborton@snet.net

Characteristics of High-Characteristics of High-

Performing Healthcare Performing Healthcare

SystemsSystems

• Focus on Primary Care and Prevention*o Two-thirds Primary Care – One-third Specialty/Hospital Careo vs. the reverse in the US

• Foundational elements of Primary Care*o Access to Care (both timeliness and insurance coverage)o Coordination of Careo Continuity of Care with PCPo Comprehensive Care (most performed by PCP)

* Research by Barbara Starfield/Johns Hopkins University

Cost and Quality Issue Areas:Cost and Quality Issue Areas:• Disparities

o Social determinants

• Chronic Diseaseso Diabetes, Heart Disease, Obesity, Asthma

• Frail and Elderlyo Medicare-Medicaid Eligible (MME, or “Dual-Eligible”)

• Avoidable Utilizationo Emergency Room (ER) use, and Re-Admissions

• Medication Managemento Adverse reactions, adherence, generics

• Legalo Fraud & Abuse, Malpractice Reform

• Nursing Homeso Quality and cost issues, Alternatives

• End-of-Live Care

Delivery System Focus Areas:Delivery System Focus Areas:

AHRQ, CMMI, RWJF, CWF, AHRQ, CMMI, RWJF, CWF,

IHIIHI

• Hospitalso Hospital-acquired infection, adverse eventso Re-Admissions; discharge and coordinationo Emergency Room utilization, internal process, out-patient coordination

• Primary Careo Patient-Centered Medical Homes, Medical Neighborhoodso Culturally-sensitive Careo Mental Health integration

• Information Technologyo Electronic Health Records (EHR, EMR)—i.e. “nodes”o Health Information Exchanges (a.k.a. RHIOs)—i.e. “connections”

• Measuremento Process and Outcomes, Nodes and Connections (i.e. “systemness”)

• Learningo Collecting and disseminating Best Practices

Delivery System Focus Areas:Delivery System Focus Areas:

AHRQ, CMMI, RWJF, CWF, AHRQ, CMMI, RWJF, CWF,

IHIIHI

• Payment Reformo Pay-for-Performanceo Shared Savingso Medical Homeso Accountable Care Organizationso Bundled or partially-capitated payments

• Insurance Reformo Exchangeso Cooperativeso Medical Loss Ratio (MLR)

• Cost-Effectiveness Researcho Patient-Centered Outcomes Research Institute (PCORI)

Other Issues and Ideas: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• Secondary—Tertiary facility balance (“arms race”)• Malpractice Reform

Delivery System Innovation Delivery System Innovation

Work GroupWork Group

• Next Steps

• Next Meeting