Connecticut State Innovation Model

Population Health Council

Webinar 3:00 PMDial in #: 1-800-593-9940

passcode: 9502934Thursday, November 30th, 2017

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1. Overall SIM direction

2. Population Health Planning Pathway

3. Prevention Service Initiative – procurement update/next steps

4. CT Health Collaboratives Survey

5. Identification of reference communities – Considerations for participation

HEC definition/ Core Elements / Opportunities/ Challenges

6. Ad Hoc committee (SIM steering committee and population health council)

7. Timelines – Technical Assistance and implementation

Agenda

Prevention Service Initiative

Health Enhancement Community

PCMH+ Medicaid (value-based payment)

Quality Measure Alignment

Community & Clinical

Integration Program

Advanced Medical Home

Program

Value-based insurance

design (VBID)

Public scorecard

Health Information Exchange

Core Data Analytics Solution

SIM Initiatives

Population Health Payment Reform Transform Care Delivery Empower Consumers

Health Information Technology

Healthier People, Better Care, Smarter Spending, and Health Equity

SIM Stages of Transformation

1 2 3

•HEC will foster community-wide multi-sector collaboration and accountability to promote healthier people, better care, smarter spending, and health equity.

•SIM will partner with communities to address root causes, behavior, and social determinants of health.

•Create the conditions that promote and sustain cross-sector community-led strategies focused on prevention.

Health Enhancement

Community

Population Health Planning Pathway

Prevention Service Initiative

•Enhance business capabilities of CBOs so that they can enter into at least one contractual relationship with a healthcare provider that is participating in value-based payment.

•Increase the number of individuals with unmet prevention needs who complete community-placed, evidence-based prevention services and maintain or improve wellness.

•Improve Advanced Network/FQHC performance on quality measures related to asthma or diabetes and associated ED utilization or admissions/readmissions for an attributed population.

Technical Assistance

Select a TA Vendor for CBOs/ healthcare

organizations

Select CBOs who are ready and willing

to receive TA and pursue a written

agreement

Launch TA to CBOs and healthcare organizations to facilitate written

agreements

Process to Launch the PSI Demonstration

Contract negotiation with selected bidder is underway.

Consulting firm brings expertise, national experience, and a “deep bench” to address CT SIM objectives for CBO linkage model.

TA Provider will participate in recruitment and selection of CBOs and AN/FQHCs.

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Prevention Service InitiativeTechnical Assistance – Vendor Selection

TA Project Plan emphasizes peer-to-peer activities and includes:

On-site Learnings Sessions

Individual Site Visits

Webinars and Partner Calls

Tools and Templates

Evidence-based Prevention Models

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Prevention Service InitiativeTechnical Assistance – Proposed Elements

Questions or Comments?

Prevention Service Initiative

“Common components of a community health collaborative include developing partnerships, identifying priorities, developing a vision and scope, identifying common community assets, implementing intervention and evaluation plans, planning for sustainability, and celebrating success.”

• Purpose: To determine the basic structure, leadership, and operational characteristics of existing health collaboratives in the state.

• Findings used to:

1. Inform DPH’s exploration of and planning for Health Enhancement Communities (HECs)

2. Create points of contact to further engage and build on the strengths of existing community partnerships

Community Health Collaboratives SurveyConnecticut, 9/2017

Statewide Collaboratives:17 respondents indicated that their collaborative serves the entire state of Connecticut.Collaboratives Serving Counties:9 respondents indicated that their collaborative serves one or two Counties.3 respondents indicated that their collaborative serves a portion of a County.Collaboratives Serving Cities and Towns:32 respondents indicated that their collaborative serves specific cities or towns.In total 71 cities/towns were reported as served by at least one collaborative. Other Geographic Areas:17 respondents specified other types of geographic areas served (regions, etc.).

Geographic Areas Served

Survey Respondents’ Role in Collaborative

Half of survey respondents and organizations reported had leadership roles in the Collaboratives.

15.0%

0.0%

0.9%

54.0%

15.9%

18.6%

8.8%

Other (n=17)

Treasurer (n=0)

Secretary (n=1)

General Member (n=61)

Executive Committee Member (n=18)

Coordinator (n=21)

Chair/Co-Chair (n=19)

2.7%

5.3%

4.4%

46.0%

17.7%

23.9%

Other (n=3)

Funder (n=6)

Workgroup Leader (n=5)

Member Organization (n=52)

Coordinating Organization (n=20)

Lead/Backbone Organization (n=27)

Individual Role in Collaborative (n=113) Organization/Agency Role in Collaborative (n=113)

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

70.6% of respondents (n=201) were part of an existing health collaborative.

Engagement and Meeting Frequency

15.0%

2.5%

27.5%

52.5%

2.5%

0.0%

Other (n=12)

Does meet regurlarly (n=2)

Quarterly (n=22)

Monthly (n=42)

Biweekly (n=2)

Weekly (n=0)

Meeting Frequency During Past Calendar Year (n=71)

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

•Approximately half of collaboratives met monthly during the past calendar yet

•85.1% of respondents indicated that their organization was “engaged” or “very engaged” in the collaborative (data not shown)

9.2%

16.1%

33.3%

19.5%21.8%

Less than 5members (n=8)

5-10 members(n=14)

11-20 members(n=29)

21-30 members(n=17)

More than 30members (n=19)

Collaborative Structure

Number of Participating Agencies in Collaborative (n=87)

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

• Most respondents indicated that their collaboratives had between 11-20 participating agencies

• 37.7% of respondents indicated that their collaboratives have Memorandums of Understanding (MOUs) in place (data not shown)

16.5%

76.9%

71.8%

83.3%

49.4%

7.7%

15.4%

9.0%

34.2%

15.4%

12.8%

7.7%

The collaborative currently has written bylaws(n=79)

The collaborative has a written vision and/ormission statement (n=78)

The collaborative has a written strategic plan oraction plan (n=78)

Members actively participate in committees,subcommittees, or task forces (n=78)

Yes No I don't know

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

• Most respondents indicated that their collaboratives had committees, subcommittees, or task forces, had written strategic or action plans, and had a written vision and/or mission statement

• Almost half of respondents indicated that their collaboratives did not have written bylaws

Collaborative Structure

18.2%

20.5%

28.4%

31.8%

37.5%

42.0%

45.5%

46.6%

53.4%

61.4%

76.1%

88.6%

90.9%

Other (n=16)

Business (n=18)

Housing (n=25)

Public safety/Legal services (n=28)

Private and community foundations (n=33)

Family support (n=37)

Advocacy (n=40)

Colleges and universities (n=41)

Community health centers (n=47)

FQHCs (n=54)

Community, human, and social service providers (n=67)

Governmental agencies (n=78)

Health care providers (n=80)

• Health care providers, governmental agencies, and community, human, and social service providers were the most frequently selected sectors that are represented in collaboratives

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

Sectors Represented (n=88)

27.6%

0.0%

3.9%

18.4%

21.1%

27.6%

28.9%

48.7%

53.9%

59.2%

60.5%

Other (n=21)

Healthcare purchasing (n=0)

Business practices (n=3)

Hospital accountability/quality measures (n=14)

Data governance and/or data sharing (n=16)

Priority areas in a non-profit hospital community health plan…

Consumer health (n=22)

Priority areas in a CHIP (n=37)

Social determinants of health (n=41)

Access to healthcare (n=45)

Priority areas in a CHNA (n=46)

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

Issues Addressed by Collaboratives (n=76)

• Respondents indicated that collaboratives were formed to address a wide range of issues, including priority areas in a community health needs assessment, access to healthcare, and the social determinants of health

Priority Issues

54.4%45.6%

Yes (n=37) No (n=31)

DATA SOURCE: Connecticut Department of Public Health, State Innovation Model Survey, 2017

Collaborative has Financial Resources Associated with Strategic Priorities (n=68)

• When asked to specify their collaborative’sstrategic priorities, respondents described: Addressing specific health issues General community health / well-being Decreasing health disparities Priority populations Cross-sector collaboration and relationship-

building Data-sharing / data use Decreasing preventable readmissions Community health needs assessments

• Slightly more than half of respondents indicated their collaborative has financial resources allocated for their strategic priorities

Priority Issues

Questions or Comments?

Community Health Collaboratives SurveyConnecticut, 9/2017

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Health Enhancement Community (HEC)Working Definition

A Health Enhancement Community is accountable for health,

health equity, and related costs for all residents in a geographic

area; uses data, community engagement and cross sector

activities to identify and address root causes; and operates in an

economic environment that sustainably funds and rewards such

activities by capturing the economic value of improved health.

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Individual patients Attributed population Total population

Clinical settings

Community interventions

Policy/environmental

Strategies tailored to

attributed pop.

Clinical-community

referrals

Population-wide strategies

Traditional policy and

environmental strategies

Eligibility or payment

policies, etc.

Operational Space of Accountable Communities

Core Elements For CT Health Enhancement Communities (in construction)

Opportunities for Collaborative Partnerships

Section 501(r) of the tax code provides that a hospital organization will not be treated as a tax-exempt organization unless the hospital organization meets the requirements to conduct a communityhealth needs assessment (CHNA) and to adopt an implementation strategy to meet the community health needs identified through the CHNA.

The IRS code requires the CHNA to include the communities served by the hospital facility and to obtain input from persons representing the broad interests of the community.

Regulations require hospital facilities to solicit and take into account input from public health department and also urge them to undertake a joint CHNA process.

The regulation also requires the hospital facility to develop an implementation strategy describing how a hospital plans to address priorities identified in the CHNA.

Requires a comprehensive community health assessment (CHNA) and efforts to improve the health of the population (CHIP).

Setting priorities, planning, program development, funding applications, policy changes, coordination of community resources, and new ways to collaboratively use community assets to improve the health of the population.

Requires to engage with the public health system and community members

Identify and address health problems through collaborative processes.

Build partnerships to leverage resources, coordinate activities, and employ community assets.

Community engagement to strengthen social engagement, building social capital, establishing trust, ensuring accountability, and building community resilience.

Public Health Accreditation Hospital Systems Community Benefits

HEC Planning Challenges

Discussion / Recommendations

What should we look for when identifying reference communities for HEC planning?

What challenges should we consider for HEC planning?

HEC Planning Challenges

Accountability: Define the appropriate expectation for an HECs

Boundaries: Define the best criteria to set geographic limits.

Indicators: Define appropriate measures of health improvement.

State Role: Define the level of planning flexibility.

Health Disparities: Define approaches to address disparities across communities.

Sustainability: Define financial solution for long term impact.

Regulations: Define regulatory levers to advance HECs.

Engagement: Define how to gain buy-in and participation from stakeholders.

HEC Planning Challenges: Discussion

What other challenges should HEC planning prioritize?

Are there other challenges to consider?

Joint discussion with HISC AdHoc committee

Timelines