Transcript Recertification Year Three and Subsequent Years

The Minnesota Accountable Health
Model
SIM Minnesota
T E S T I N G A N D I M P L E M E N T I N G T H E M I N N E S O TA
A C C O U N TA B L E H E A LT H M O D E L
MPHA CONFERENCE JUNE 5, 2014
National SIM Grants
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Minnesota awarded
largest testing grant in
the country ($45.3
million), February 2013
Five other states also
received SIM testing
grants from CMMI: MA,
ME, VT, OR and AR.
16 states received
design grants
Vision
• Every patient receives coordinated, patient-centered primary care.
• Providers are held accountable for the care provided to Medicaid enrollees and
other populations, based on quality, patient experience and cost performance
measures.
• Financial incentives are fully aligned across payers and the interests of patients,
through payment arrangements that reward providers for keeping patients
healthy and improving quality of care; and
• Provider organizations effectively and sustainably partner with community
organizations, engage consumers, and take responsibility for a population’s
health through accountable Communities for Health that integrate Medicare
care, mental/chemical health, community health, public health, social services,
schools and long term supports and services.
What are We testing?
Can we improve health and lower costs if more people are covered by
Accountable Care Organizations (ACO) models?
If we invest in data analytics, health information technology, practice facilitation,
and quality improvement, can we accelerate adoption of ACO models and
remove barriers to integration of care (including behavioral health, social
services, public health and long-term services and supports), especially among
smaller, rural and safety net providers?
How are health outcomes and costs improved when ACOs adopt Community
Care Team and Accountable Communities for Health models to support
integration of health care with non-medical services, compared to those who do
not adopt these models?
Goals and Vision
60% of fully insured
population in
ACO/TCOC models
200,000 Medicaid
enrollees in ACOs
Evidence of better
health and lower
costs from first round
ACO models
67% of primary care
clinics are HCH
15 Accountable
Communities for
Health
Quality measures and
payment structures
that align across
payers
Providers and
communities partner
in new and deeper
ways
$111 M in savings to
Medicaid, Medicare
and commercial
payers
ACO/ACHs begin to
integrate behavioral
health or LTC or social
services/public health
Building on a Foundation of Reform Efforts
Medicaid
ACOs
Health Care
Homes
Standardized
Quality
Measurement
E-health
Initiative
SHIP
Strong
Collaborative
Partnerships
Community
Care Teams
MN Drivers of Better Health
Payment models
• Medicaid ACOs payment models based on quality,
patient experience and cost performance measure
Coordinated care
• Practice facilitation support, learning collaboratives &
funding for coordinated care transformation
• Support to integrate new provider types
HIT & data
Accountable Care
Community Partnerships
• Data analytics and HIT/HIE support to accelerate
adoption and remove barriers to integrate care.
• Within ACOs, integrate with long term care, behavioral
health, public health and social services
• Community partnerships through Accountable
Communities for Health that identify health and cost
goals and strategies to meet goals
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Driver Four, Accountable Communities
for Health (ACH)
Provider organizations
partner with communities
and engage consumers, to
identify health and cost
goals and take on
accountability for
population health
Total funding: $6.8M (16%)
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Select up to 15 Accountable
Communities for Health and
provide financial support to
Create new, sustainable
venues through which
providers engage with
communities in more
meaningful ways to improve
individual and community
and population health.
Accountable
Communities
for Health
Adapted from Maine
Quality Counts
Accountable Communities for Health
Community
Based
Governance
Structure
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General ACH Criteria
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Broad populations may apply for ACH grants.
Priorities on advancing health equity
Community-led leadership team that represents community
and broad section of providers
Develops a community based care coordination service
delivery team or system
Population based prevention component
No longer use the percentage threshold. An “ACO partner”
should be a provider participating in an ACO, the ACO needs
to be an active partner.
Participates in Measurement / Testing / Evaluation
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ACH Advisory Subgroup
Convene 12 members in February – April, 2014 to:
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Provide guidance and advice in setting strategies to raise awareness of the
ACH vision across Minnesota that will create community readiness for
innovation in health and health care system redesign.
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Provide advice on soliciting and receiving input from diverse stakeholders
and communities regarding the ACH approach and applying that input to
program planning as appropriate;
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Develop recommendations for selection criteria and recommendation of
ACHs in collaboration with existing advisory groups and the SIM leadership
team by the end of March
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At a later date the State in collaboration with the Community Advisory
Subgroup will re-evaluate the work of the advisory subgroup to determine
the needs for ongoing support and advice throughout ACH implementation.
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Accountable Communities for Health (ACH)
Subgroup Members
Alex Alexander MPA, MBA -- Beacon Group, SE MN, Project Management Office, Mayo Clinic
Catherine Brunkow, RN -- HCMC, Community Care Team, Hennepin County Human Services & Public Health Dept.
Catherine Vanderboon, RN, PhD -- Community Care Team, Mayo Clinic,
Gina Nolte -- Partnership for Health and CTG, Clay County Public Health
Heidi Favet, CHW -- Essentia Health Ely Community Care Team
Jan Malcolm -- Courage Kenny Center, Allina Health
Jennifer DeCubellis and Ross Owen -- Hennepin Health
Joanne Foreman, RN, BAN -- Institute For Clinical Systems Improvement, Accountable Health Community
Kathy Gregersen -- Mental Health Resources Center
Kevin A. Peterson MD, MPH, FRCS, FAAFP – Dept of Family Medicine & Community Health, Univ of MN, Minnesota
Academy of Family Physicians
Kristin Godfrey, MPH -- HCMC, Community Care Team, MPHA
Roxanne King, CHW -- NorthPoint Health and Wellness
Sarah Keenan RN, BSN -- Bluestone
Susan Severson -- Stratis Health
Accountable Communities for Health (ACH)
Subgroup Activities
ACH Advisory Subgroup met three times:
• February 28
• March 14
• March 28
• Executive and Detailed Summary of Meetings on SIM website
www.mn.gov/sim
• Presentation to SIM Community and Multipayer taskforce on
SIM website.
Revised ACH Grant Timeline
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ACH Advisory Subgroup Meetings thru April, 2014
Contract with Community Care Teams Late Summer
2014
Statewide Community Engagement through Summer,
2014 and ongoing
Post competitive RFP September 1, 2014
Finalize RFP process and grants by November, 2014
Implementation begins in January 1, 2015
The ACH Grants Will Cover Up to 15 ACHs
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ACH leadership team, recruit ACH members including local
citizens, facilitate and coordinate ACH meetings with
community partners, manage ACH grant dollars.
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Implement Community Service Delivery Teams / System
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Implement small grants to support community participation.
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Develop infrastructure to support implementation of the ACH.
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Implementation of sustainability plan, and participation in
rapid-cycle evaluation of the model.
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Foundation: Community Care Teams
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Three existing CCT’s in Minnesota: Early Implementer ACHs.
• Meet same ACH criteria as competitive applicants.
• Provide learning peer support (tools, guidance, small tests)
Background:
• Initially funded through HCH program
• Multi-disciplinary care teams: clinic/HCH, LPH, hospital, community &
social services
• Focus on coordinating care for whole patient, engaging all sectors
• Developing new relationships, approaches to coordinated care.
• Olmsted County / Mayo, Brooklyn Center / Brooklyn Park / HCMC, Ely /
Essentia.
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How to Get Started
Engage Community Members, “Reach Out”
Goal: ACH’s will engage community members and stakeholders
to establish priorities to impact health goals, build partnerships
that will integrate and coordinate care within their communities.
• Engage community members (citizens).
• Engage providers, community / local public health,
community or cultural organizations, schools, tribes, faith
based organizations, patient advocacy groups, worksites,
employers, housing, social services, behavioral health and
other medical or non-medical groups who care for or provide
services for all aspects of an individuals health.
• Local Public Health is Required to Participate.
• Clinics / ACOs.
How to Get Started,
Identify and Define Your Population
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Population is broadly defined such as, geographical,
defined by patient population, or health needs of the
community, high resource use in a smaller segment of
the communities population, or a specific population
such as a high rise or a virtual population of members.
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Intentional efforts should be made to reach
marginalized and underserved communities.
How to Get Started to Identify Population,
Build On Community Based Data
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Build on local public health and/or hospital community
assessment.
Check out your local public health agency. Each public
health agency needs to complete their community
health assessment by February of next year.
Use SHIP Community Assessment data.
Consider health systems utilization data or health plan
data or workforce or other community collected data.
ACH Community Engagement
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The primary goals of the community engagement
process are to:
• Raise awareness of the ACH vision and opportunities for
patient centered, coordinated integrated approach;
• Create community readiness for innovation in health and
health care system redesign, delivery and payment; and
• Receive input from diverse stakeholders and communities
regarding the ACH approach, including ACH structure and
governance.
Community Engagement, Next Steps
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Communication through a variety of methods, webinars,
newsletter, and website.
Regional presentations will be scheduled for this summer.
Events already scheduled.
Do you have an event already planned with community
members? Let us know.
Connect on our website at http://mn.gov/sim and
Select Request a Speaker
More Information
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Visit
www.mn.gov/sim
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Sign up for email
alerts at the website
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Request speakers at
www.mn.gov/sim
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Email
[email protected]
Local Public Health and Accountable
Communities for Health
Renee S. Frauendienst, Public Health Division Director/CHS
Administrator, Stearns County
Disclaimer
All comments are mine, mine, mine!!
However, they may be borrowed free-of-charge
at your own risk for up to 2 weeks.
$0.25/day after that!
Light travels faster than sound. This
is why some people appear bright
until you hear them speak.
Accountable Communities for Health
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Quickly unfolding
Great flexibility
Broad structure
Driven by communities
“learning collaborative” atmosphere
Conceptually based
Goal of SIM
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System change that is:
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Innovative
Replicable
Sustainable
Measurable
Broad-based
Fits perfectly Local Public Health role
Role of Public Health
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Core Functions
 10 Essential Services
 Statutory Responsibilities
Essential Services and Core Functions
System Nurture:
Assessment
Policy development
Assurance
Provider of Services:
Assurance-Link to/provide
care
Accountable Communities for Health
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System Nurture role of
Public Health
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Chapter 145A
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Community Health
Assessment
Community Health
Improvement Plan
Top Community Priorities
Grounded in Public input
Accountable Communities for Health
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Policy Development
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Partnerships around
policy/system/environmental
changes
Health in All Policy
Social Determinants of
Health
Health Equity
Accountable Communities for Health
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Assurance
Structural Support
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Competent Workforce
Adequate Workforce
Culturally appropriate
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CHW
Accountable Communities for Health
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System Nurture
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Outcomes
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Short-term
Long-term
Sub-populations
Whole population
Accountable Communities for Health
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Lesser Degree
Providing care/linking care
Accountable Communities for Health
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1. LPH will have available
their assessment results
2. LPH will have established
community priorities
3. LPH should have linked to
other community
assessments-Hospital, United
Way, other community
initiatives
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4. LPH may not be the lead
but rather the “behind the
scene” nurturer.
5. Approach LPH to partner
and connect you with other
partners
6. If LPH is not at the tableget them there!
7. LPH may have direct
services that may help or
may be the provider to
develop
• In 2006, the 12 Counties began discussions on how to
build local partnerships and increase local control
around service delivery for the population. A focus on
early intervention and prevention was discussed.
• In 2010, the Department of Human Services under
Minn. Stat. 256B.0755 was allowed to create
alternate and innovative health care delivery systems,
organized by providers, to provide services to groups
of patients for an agreed upon total cost of care or
risk/gain sharing arrangement.
• In 2012, a Joint Powers Agreement was finalized
among the 12 Counties and Southern Prairie
Community Care (SPCC) was formed.
• The purpose for formation of SPCC is building a
service delivery network- a care coordination model
built upon the concept of an Accountable Care
Organization (ACO).
• DHS receives $43 million SIM grant for statewide
project and begins the planning phase.
• The work has begun at SPCC to create a Accountable
Care Organization.
• There are many partners in this project but today I
will focus on where Public Health fits into this puzzle!
• Two Operations Mangers have been hired bringing
the public health and human service expertise to the
model.
• Four tracks have been developed and public health
has a role in all four tracks. The four tracks identified
are:
• Track I Focus: People With Chemical Dependency and
Adult Mental Health, and significant use of Emergency
Department/Hospital or Community Based Crisis Care.
• Track II Focus: Adults with Multiple Chronic Concerns with
some focus on Diabetes
• Track III Focus: Adolescents health screening for
chlamydia and/or broad spectrum STD screening, mental
health screening and chemical dependency screening
• Track IV Focus: Increasing Well Child Visits at age 15
months that will lead to increased opportunities to
address family system deficits.