Transcript Document

The Minnesota Accountable Health
Model
(SIM Minnesota)
S U P P O R T I N G T H E I N T E G R AT I O N O F
E M E R G I N G P R O F E S S I O N S I N T O T H E H E A LT H C A R E
WORKFORCE
FEBRUARY 6, 2015
Outline
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SIM Background
Emerging Professions Work
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Definitions
Data Collection
Integration Grants
Toolkit Contracts
Emerging Professions Workgroups
Website Development
Overall Goals for Emerging Professions
State Innovation Model (SIM)Initiative
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SIM is a Center for
Medicare and Medicaid
Innovation (CMMI)
initiative to test and
implement health care
payment and delivery
reform ideas
Goal: Better quality in
health care, improved
experience, and lower
costs (Triple Aim)
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:
Massachusetts., Maine,
Vermont, Oregon and
Arkansas.
16 states received design
grants
Minnesota SIM
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“Minnesota Accountable Health Model”
• Joint MDH/DHS project
• 3 years, $45 million
• Multiple grants, contracts, workgroups (internal and external)
already underway
• Collaborative Agreement with CMMI
• Testing Grant
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?
Q:
What is an Accountable Care Organization?
A:
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Accountable Care Organizations (ACOs) are groups of
doctors, hospitals, and other health care providers, who
come together voluntarily to give coordinated high quality
care to their patients.
The goal of coordinated care is to ensure that patients –
especially the chronically ill – get the right care at the right
time, while avoiding unnecessary duplication of services and
preventing medical errors.
When an ACO succeeds in both delivering high quality care
and spending health care dollars more wisely, it will share in
the savings it achieves.
Impetus for Accountable Care Organizations
Impetus for ACOs
Desired Outcomes
• Develop payment approaches to
create incentives for value not
volume
• Shift risk and rewards closer to
point of care to foster local
accountability
• Realize return on federal and
state investments
• Improve access to
care, outcomes and information
for the beneficiary
• Value = Better Quality + Lower
Cost/“The Triple Aim”
• Integrated prevention, wellness,
screening and disease
management
• Coordinate care across care cycle
• Data to monitor utilization,
compare and share across states
• New reimbursement structures,
including incentives that
encourage integrated practice
models
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Minnesota Accountable Health Model- SIM Five
Drivers of Better Health
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Emerging Professions
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Definitions
• Emerging professions:
• Community Health Worker (CHW)
• Community Paramedic (CP)
• Dental Therapist (DT)/Advanced Dental Therapist (ADT)
• Future may also include Doula, Certified Peer Support Specialist
Emerging Professions Work
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What is the current state of the CHW, CP, and DT/ADT Professions?
• Data Collection
• Available or Potential Data Sources:
• # of graduates, and work locations
• # of current students, and projected pipeline
• # of CHWs and DT/ADTs enrolled with DHS (CP work billed under
ambulance medical director).
• # of Medicaid claims submitted to DHS on behalf of CHWs, CPs and
DT/ADTs
• Data from Health Plans
• Clinical or other non-claims data from employers
• Data from CHW-related grants and projects
Emerging Professions Work:
Integration Grants
• Grant Program to supplement the salary of Emerging Professions
practitioners in new positions
• New hires or existing staff moving into new roles
• Credentialed
• Licensed DT and Certified ADT
• Certified CP
• CHW with certificate from one of the 7 approved MNSCU programs
• Who can apply?
• Any potential employer of a CHW, CP or DT/ADT
• Medical clinic, public health agency, hospital, county social service
agency, dental clinic, nursing home, inpatient mental health facility, etc,
etc, etc.
Emerging Professions Work:
Integration Grants
What kinds of applications are most likely to get funded?
• Projects that best align with the goals of the SIM grant
• Priority will be given to projects that build connections between:
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Mental health
Long-term care
Public health
Social services
• Projects that serve a clearly defined population
• Projects that plan for sustainability after the grant
Emerging Professions Work:
Integration Grants
3 Rounds of Grant Funding
• Total of 12 grants from all 3 rounds
• $30,000 in start up funding per grant for salary and fringe only.
• 12 month grant term
Round 1
• 5 grants funded: 2 CHWs, 1 CP, and 1 DT and 1 ADT
• Projects started July 2014.
Round 2
• 4 grants funded: 1 CHW, 2 CPs, 1 ADT
• Projects started November 2014
Round 3
• Up to 5 grants
• RFP to be published in spring 2015. Projects start summer 2015.
Emerging Professions Work:
Integration Grant Projects
Community Health Worker (CHW):
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Hennepin County -- CHW works in Hennepin County Jail clinic
coordinating care for behavioral health clients while in the jail, during
discharge planning, and up to 90 days following release.
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MVNA -- CHW works in home care and community-based palliative care
in north metro suburbs providing follow-up care to prevent hospital readmissions.
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Well Being Development -- CHW works with adult MH clubhouse in Ely
providing outreach and follow-up services to connect behavioral health
clients to team-based, coordinated, patient-centered care.
Emerging Professions Work:
Integration Grant Projects
Community Paramedic (CP)
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Essentia Health Ada -- CP acts a primary care extender providing non-emergency,
out of hospital, in-home services to patients with complex medical conditions to
prevent avoidable ambulance calls, ER visits, and hospital readmissions.
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HealthEast -- Four CPs share 1 FTE providing follow-up and home visiting services to
high-risk behavioral health clients within 48-72 hours of St. Joseph’s hospital
discharge to prevent hospital readmissions and avoidable ER visits.
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Ringdahl Ambulance -- Private, independent, ambulance service using a CP to
connect with an ACH project, doing post-discharge follow-up with high-risk patients
in Fergus Falls and Pelican Rapids.
Emerging Professions Work:
Integration Grant Projects
Dental Therapist/Advanced Dental Therapist (DT/ADT)
• Children’s Dental Services -- ADT treating low-income children and pregnant
women in North Mpls. and St. Cloud. Collaborating with primary care clinics,
Head Start, schools, and other community partners.
• Northern Dental Access Center -- ADT working in a community dental clinic in
Bemidji, under a collaborative management agreement with a contract dentist,
providing preventive and restorative type dental care.
• West Side Community Health Services -- (FQHC Urban Health Network or
FUHN). DT treating children from East St. Paul, in a FQHC which is integrating
dental and primary care services internally through referral and care
coordination.
Emerging Professions Work:
Integration Grants
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What does the state get in exchange for the grant?
• We want to evaluate “Practice Transformation”
• What services does the CHW, CP or DT/ADT provide?
• Who does the CHW, CP, or DT/ADT care for?
• What does having a CHW, CP, or DT/ADT mean for other team
members?
• What new services can an employer take on with the addition of a
CHW, CP, or DT/ADT?
• What is the return on investment?
• What best practices are developed that can be shared with others?
• What additional training should be in the curriculum?
Emerging Professions Work:
Integration Grants - Outcomes
Grant Outcome Example:
HealthEast (St. Joseph’s Hospital)
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88.2% of patients working with a CP have mental health visit within 7 days of
discharge
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71.0% of patients working with a CP have a primary care visit within in 21 days of
discharge.
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100% of patients are taking their medications, 91.2% are taking their medications as
prescribed and 8.8% of patients were taking their medication, but incorrectly.
Emerging Professions Work:
Toolkits
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Through SIM-MN, MDH will contract for development of a
CHW, CP and DT/ADT Toolkit (3 Toolkits/3 Contracts)
• Designed for potential employers, to answer:
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What is a CHW/CP/DT/ADT trained to do?
What is the core skill set?
What are the potential benefits of hiring a CHW/CP/DT/ADT?
What services are covered by insurance?
Who can supervise a CHW/CP/DT/ADT?
What information is available for return on investment?
What are examples of work currently being done by CHWs/CPs/DTs/ADTs?
Contracts will be approx. $100,000 each, for 12 months.
RFP was published in Oct. 2014. Currently in contract negotiations.
Work anticipated to start April 2015.
Emerging Professions Work:
Workgroups
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MDH has convened an informal SIM CHW Workgroup to
help:
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Monitor progress of the Grants
Develop evaluation criteria for the Grants
Collect and analyze data
Share information about current emerging professions projects and
future trends.
Emerging Professions Work:
Best Practices
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MDH will ask current CHW, CP, and DT/ADT programs and
employers about specific examples:
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What services are they providing?
What populations are they serving?
What settings are they working in?
How are they working in team-based environments?
What part of their training is most valuable?
What have they learned on the job?
What barriers are they encountering?
What structures are in place to ensure they can reach their potential?
What we learn will be shared widely
CHW Work:
Website Development
CHW Website in Development
• Current Website is on Grant and Contract Program Only
• Information to Include:
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Definition or Description of the Profession
Data
Scope of Practice
Education and Training
Payment and Reimbursement
Funding (SIM Grant Work)
Additional resources such as reports, articles, partners, etc.
Emerging Professions:
Overall Goals
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Better data about the CHW, CP and DT/ADT profession
Better understanding of current best practices
Integration of best practices with curriculum
development
Policy changes
Information about Return On Investment
• Not just about money
Emerging Professions:
Overall Goals
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Greater “Uptake” of CHWs, CPs, and DTs/ADTs
• More of these practitioners working and using the full breadth of their
training
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Greater participation of these practitioners in ACO
models
• Change of payment away from fee-for-service
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Understanding of “Practice Transformation”
• What does hiring a CHW, CP, or DT/ADT mean for the employer?
• For the patient?
• For the care team?
• For the community?
Emerging Professions
Questions?
Kay Herzfeld
Emerging Professions Coordinator
Minnesota Department of Health
Office of Rural Health and Primary Care
[email protected]
(651) 201-3846