Transcript Document
Department of Vermont Health Access
Vermont Blueprint for Health
Building an Integrated System of Health
Innovations in Medicaid: Payment and Delivery Reform Health Action 2014 Beth Tanzman, MSW Assistant Director, Blueprint for Health www.hcr.vermont.gov
Department of Vermont Health Access
Global Commitment to Health
Waiver 1115 Demonstration
Blueprint for Health Payment and Service Delivery Reforms
Medication Assisted Treatment “Hub & Spoke” Reforms
Vermont Chronic Care Initiative
Q & A
Department of Vermont Health Access
Global Commitment to Health
2005 - Present Caps total federal funds Establishes the state XIX Authority as Managed Care Entity Allows use of XIX funds for state fiscal relief and non Medicaid health programs Flexibility to reduce benefits, increase cost sharing, limit enrollment for optional and expansion populations with some limits
Department of Vermont Health Access Managed Care Entity (MCE) Savings
Reduce the rate of uninsured/ underinsured Increase access to quality health care to uninsured, underinsured and Medicaid beneficiaries Provide public health approaches to improve the heath outcomes and quality of life Medicaid-eligible individuals Encourage the formation and maintenance of public-private partnerships in health care
Department of Vermont Health Access
Patient Centered Medical Homes: Joint Principles American Academies of Family & Pediatric Physicians, College of Physicians, Osteopathic Association Personal Physician ongoing relationship for continuous & comprehensive care Physician Directed team who collectively take responsibility for ongoing care Whole Person provide or arrange for all a patient’s health care needs Care is Coordinated & Integrated across all elements of health care system and community. Care is facilitated by registries and health information exchange.
Quality & Safety care planning process based on partnership with patients, evidence-based medicine, accountability for CQI, voluntary recognition process Enhanced Access open scheduling, expanded hours, electronic communication Payment recognizes the added value to patients including for coordination of care
Department of Vermont Health Access $3.00
$2.50
$2.00
$1.50
$1.00
Requires 6 of 6 Must Pass Elements
$0.50
$0.00
0 10 20 30 40 50 60 70 NCQA 2011 PCMH Score 80 90 100
All insurers pay enhanced payment based on a practices score as a patient centered medical home NCQA PCMH standards and scoring methods are used to score practices as a medical home Payment changes with each 5 point change in the NCQA PCMH score (score ranges from 0 – 100 points) Designed to incent ongoing iterative improvement, and to provide a disincentive for moving backwards
Department of Vermont Health Access
Hospitals Specialty Care & Disease Management Programs Social, Economic, & Community Services
Community Health Team
Nurse Coordinator Social Workers Nutrition Specialists Community Health Workers Public Health Specialist Advanced Primary Care Advanced Primary Care Mental Health & Substance Abuse Programs Programs
Extended Community Health Team
Medicaid Care Coordinators SASH Teams Self Management Spoke (MAT) Staff Advanced Care Primary Primary Care Advanced Public Health Programs & Services Health IT Framework Evaluation Framework Multi-Insurer Payment Reform Framework
Department of Vermont Health Access
Multi-insurer Payment Reforms
Insurers
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Medicaid
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Commercial Insurers
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Medicare
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Fee for Service
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Unchanged
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Allows competition
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Promotes volume +
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Patient Centered Medical Home
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Payment to practices
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Consistent across insurers
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Promotes quality +
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Community Health Teams
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Shared costs as core resource
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Consistent across insurers
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Minimizes barriers
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Based on NCQA PPC-PCMH Score
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$1.20 - $2.49 PPPM
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Based on active case load
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5 FTE / 20,000 people
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$ 350,000 per 5 FTE
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Scaled based on population
Department of Vermont Health Access
160 140 120 100 80 60
Patient Centered Medical Homes and Community Health Team Staffing in Vermont CHT FTEs Recognized Practices Patients
279,828 356,341 342,067 84 505,373 483,147 500,000 423,015 458,437 442,175 395,725 114.6
118.5 120.0
100 93 79.6
85.9
104 89.9
105.9
107 113 118 122 400,000 300,000 246,983 79 62.0
58 49.5
200,000 43 36.6
40 20 0 16.6 16.6 15.4
19.3
29 23.9
21.0
8.8
11.1 11.1 11.1 11.1
5.8
18 5 11 11 11 7 7 7 7 7 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 Q4 2012 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 100,000 0 *Since joining the Blueprint, three practices have combined to form a new practice, one practice has joined an existing practice, and one practice has closed.
Department of Vermont Health Access
Self-management Workshops
Healthier Living Workshops (Stanford University Self-management) – Chronic Disease – Pain – Diabetes Tobacco Cessation Wellness Recovery & Action Planning (WRAP) Diabetes Prevention (National YMCA) 4/25/2020 10
Department of Vermont Health Access Patient Centered Medical Homes and Community Health Team Staffing in Vermont Key Components
PCMHs (scored by UVM) PCPs (unique providers) Patients (per PCMHs) CHT FTEs (core staff) SASH provider FTEs (extenders) Spoke Staff FTEs (extenders)
December 2013
122 613 505,373 120 46.5
30 4/25/2020 11
Department of Vermont Health Access
A “Perfect” Storm
Increasing Rates of Opioid Dependence Inadequate Network Capacity High Health Care Expenditures Poor Patient (Client) Outcomes Program & Funding Silos
Department of Vermont Health Access
“ Hub & Spoke” Health Home for Opioid Addiction
Care As Usual
5 Regional Centers Addictions Treatment Methadone OTP 125 Physicians Prescribing Buprenorphine OBOT
Health Home
~ 6 FTE RN, MA / 400 Pts - OTP & OBOT Methadone & Buprenorphine 2 FTE RN, MA / 100 Pts OBOT Buprenorphine Comprehensive Care Management - Care Coordination - Health Promotion - Transitions of Care Individual and Family Support - Referral to Community & Social Supports
Advanced Primary Care Practices and Community Health Teams
HUB SPOKES
Department of Vermont Health Access
Health Homes
Section 2703 Affordable Care Act
6 Core Services
Comprehensive Care Management Care Coordination Health Promotion Comprehensive Transitions of Care Individual and Family Support Services Referral to Community and Social Support Services
Department of Vermont Health Access
Vermont Chronic Care Initiative KEY STATISTICS
Total Number of Medicaid Enrolled (as of October 2013) VCCI Eligible Candidates 187,019 103,058 10,102 Total Number in the top 5% Total Engaged via face-to-face and/or telephonic case management (SFY 2012) Average Episode of Care Duration 3,015 Target Caseload 77 days Field – 25 Embedded – 50 Phone –50 4/25/2020 15
Department of Vermont Health Access Financing Medicaid Medicare BlueCross MVP Cigna Self Insured Medicaid Payment Reform Fee for Service (Volume) $ PPPM - NCQA Score Pay for Performance Shared Capacity Delivery System Reform Patient-Centered Medical Homes $ PPM Capacity $ Quality
(in design)
$ Shared Interest
(proposed)
Community Health Teams Specialized Services
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Vermont Chronic Care Initiative
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Medication Assisted Treatment (Hub & Spoke)
4/25/2020 16