Michigan Department of Community Health Director James K. Haveman Strategic Use of the Rear-View...
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Michigan Department of Community Health Director James K. Haveman Strategic Use of the Rear-View Mirror on the Integration Highway Lessons Learned: Benefits, Exchanges, Enrollment July 29, 2014 Lynda Zeller, Senior Deputy Director Behavioral Health & Developmental Disabilities Administration
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Transcript of Michigan Department of Community Health Director James K. Haveman Strategic Use of the Rear-View...
Michigan Department of Community Health
Director James K. Haveman
Strategic Use of the Rear-View Mirror on the Integration Highway
Lessons Learned: Benefits, Exchanges, Enrollment
July 29, 2014Lynda Zeller, Senior Deputy Director
Behavioral Health & Developmental Disabilities Administration
Where We Are TodayBenefits & Funding StructuresPhysical Health and Behavioral Health General Population(Mild-Moderate BH)
Specialty Behavioral Health & Developmental Disabilities
Managed Care-Medicaid
(Majority in managed care plans=except NH-LTC)
-Competitively Bid-13 Medicaid Health Plans-Multiple plans within regions-Includes Mild/Moderate BH-Model consistent for 17 years
-CMH First Opportunity through regional PIHP-PIHP Sole Sourced-10 Regions-Shared Risk, A-87 -1915 (b)(c) concurrent-CMH SMI, SUD, DD, SED Services
Healthy Michigan Plan (Medicaid Expansion)ABP-SPA & 1115
-Repeat items above-Added: Savings Acct, Personal Incentives, Contributions
-Repeat items above-Added: Broader addiction & recovery services
Non Medicaid Funds -Michigan Marketplace (Exchange-EHB include BH)
-SUD federal, state, local (SUD Coordinating Agency merging with PIHP)-CMH state, local, federal SMI, DD, SED
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Where We Are Today Exchanges, Expansion
• Michigan Health Insurance Marketplace (Exchange) www.michigan.gov/difs – 4 Plan Levels, as many as 12 companies
• Healthy Michigan Plan (Expansion)– Began April 1, 2014– Unique model (incentives for healthy behaviors,
health account contributions, etc.)– Enrollment April to early July – 322,000– September 30 goal met in July– www.michigan.gov/healthymichiganplan
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Where We Are TodayInformation Exchange & Analytics
• Health Information Currently– Electronic Health Records
• All 46 CMH use EHR for clinical record real time• All 46 submit claims data to statewide data warehouse
– Care Connect 360 Analytics • Analyzes claims/encounters both physical and
behavioral health – individual and population level
– Health Information Networks & Exchange• www.mihin.org • Behavioral Health – Physical Health Meaningful Use
Cases
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• Provide access to available data in order to:– Improve care coordination and case management– Report chronic conditions– Measure results statewide
• Outcomes• Effectiveness of care• Quality• Performance• Population health
– Improve risk and outcome management– Support forecasting 5
“Care Connect360”Claims Analytics - Physical & CMH
SCREEN SHOT- CARE CONNECT 360- Demographic Information and Chronic Conditions
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Federal
MDCH Data Hub
Medicaid
MSSS
State LABS
Doctors & Community Providers
HIE QOs(Qualified sub-state HIEs)
MI HIN Network of Networks:
Data Warehouse
Copyright 2012-2014 Michigan Health Information Network
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Health Plan QOs (more coming)
Single point of
entry/exit for state
Pharmacies (more coming)
State-wide Shared Services
Virtual QOs
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Checking the Rear View MirrorWhy & How Did We Get Here?
• Looking Back and Learning– Pre Specialty Carve Out Through CMH
• Medical Model-HMOs – Lacking Specialty Service• Large Institutions – State & Community• Narrow Community Service Continuum (SMI, DD, SED)
– Pre Marketplace (Exchange), Parity• CMH only provider for both SMI and
Mild-Moderate/general uninsured population• Indigent funding (state, local, federal) grant structured,
& limited for CMH and SUD Coordinating Agency Services
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Our Next Stop on the Highway(2014-2015)
• MI Health Link (Medicare-Medicaid Dual Demo)– Integrated Care “Model 4” –Build on Carve Out– http://www.michigan.gov/mdch/0,4612,7-132-2939__293
9__2939-259203--,00.html
• Health Information Networks & HI Exchanges– Uniform Consent Format (Paper and Electronic)– Behavioral Health CCD (FIRST!)– Behavioral Health & DD Use Cases (ADT, Autism)
• Health Homes (2703) SMI, Co-Location• State Innovation Model Implementation
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Intended Use of the Rear View Mirror2014-2015
– Looking back, is there now more or less:• Recovery systems and orientation?• Trauma informed systems?• Access to physical health care (SMI, SUD)?• Inpatient recidivism (physical and behavioral health)?• Dollars getting to service? (medical loss)• Gaps between PIHP and Medicaid Health Plans?• Integration between CMH and PH providers?• Gaps between SUD and MH services?• Success managing chronic illness (diabetes, etc.)?
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Our Next Big Destination 2018-2019Michigan’s Blueprint For Health Innovation
(State Innovation Model Product)
Better
Health
Better
Care
Lower
Cost
• Fewer early deaths• Less chronic disease and obesity• Improved mental health and reduced substance abuse• Healthy babies• Healthy child development• Adequate nutrition and exercise• Reduced health disparities
• Access to a patient-centered medical home• Person-centered care• Coordinated care• Fewer hospitalizations and emergency department visits• Reduced administrative complexity
• Constraining the rise in health insurance premiums• Reduced expenditures by payers due to a healthier
population and reduced administrative complexity• Slowing the rate of spending increase through better
utilization and efficiency
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Planning The Trip
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Plan
(2013- 2014)
Test
(2015-2018)
Disseminate
(2018-2019)
• Establish transformation governance
• Engage stakeholders
• Select pilots• Refine testing
strategies
• Execute plan in pilot sites
• Engage stakeholders• Create state
level infrastructure
• Evaluation
• Scale up and disseminate model successes
• Engage stakeholders
• Evaluation
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Accountable Systems Of Care• Provider network – comprehensive medical, behavioral, social for defined population• Share financial risk and rewards – performance based• Support primary care transformation & infrastructure development• Create systems that coordinate complex care• Share resources for greater efficiency• Link with Community Health Innovation Regions for better performance outcomes
Destination Highlights
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Community Health Innovation Regions• Engage all relevant stakeholders for a collective impact of
improved health outcomes, including public health, business, payers, providers, community members, community development, philanthropy
• Address strategic priorities of the community/prosperity region
• Link to Accountable Systems of Care to integrate healthcare delivery, social care, and prevention and wellness activities
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Destination Highlights
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Intended Use of the Rear View Mirror
– Looking back, is (are) there now more or less:• Disparity in health status from social determinants?• Incentives and payment structures that encourage
cross system accountability for population health?• Consumer satisfaction?• Positive trends in morbidity statistics for special
populations (SMI, SUD)?• Administrative complexity within and across system
components?• Of all 2014-2015 Rear View Check Items (Slide 10)?
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Vision & Mission Our Guide On The Integration Highway
Our vision is to improve the experience of care, improve the health of populations, and reduce per capita costs of health care.Our Mission is to protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations.
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Lessons LearnedBenefits, Exchange, Expansion
• Service-Funder Grids are a great first step• Learn the differences: EHR, HIE, Analytics• Model, model, model to anticipate how new
services interface, duplicate, impact others• After the new benefit begins:
– Expect gaps and confusion and address quickly– Use personal stories as your “flashlight”– Balance detail and big picture measures– Celebrate improved access and health status!
