Transcript CLINIC LEADERSHIP INSTITUTE ALUMNI SESSION

UPCOMING STATE INITIATIVES
WHAT IS ON THE HORIZON?
MERCED COUNTY HEALTH CARE CONSORTIUM
Thursday, October 23, 2014
Pacific Health Consulting Group
INITIATIVES ON THE HORIZON
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WHOLE PERSON CARE
1115 WAIVER RENEWAL
PAYMENT REFORM
SECTION 2703 – HEALTH HOMES
CalSIM
WHOLE PERSON CARE: What is it?
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Approach to addressing vulnerable individuals’
health, behavioral health and social needs together
Coordination of health, behavioral health and social
services in a patient-centered manner with the goals
of improved health outcomes and more efficient
and effective use of resources
Stems from social determinants of health
COMPONENTS OF WHOLE PERSON CARE
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Collaborative leadership
Target population
Financial flexibility
Shared data
Coordination of services across sectors
Patient- centered care
WHOLE PERSON CARE: Why now?
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Medi-Cal expansion under ACA
Expanded substance use disorder coverage
Realignment: restructured financing for counties
Expanded role of Medi-Cal managed care health
plans in provision of mental health services
Coordinated Care Initiative (CCI) for dual eligibles
1115 Waiver renewal focus
State Innovation Model (CalSIM)
SECTION 1115 WAIVER RENEWAL
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Allow states flexibility to design demonstration
projects that promote objectives of Medicaid
program
Typically approved for 5 years
Must be budget neutral
Current waiver ends October 31, 2015
Need to submit new proposal 6 months in advance
BRIDGE TO REFORM WAIVER 2010-2015
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Strengthen safety net
Maximize opportunities to reduce number of uninsured
Optimize opportunities to increase federal financing to
address uncompensated care
Promote long term, efficient use of state funds
Improve health care quality and outcomes
Promote home and community-based care
Included the Low Income Health Program, DSRIP, SPD
transition to managed care, rural managed care
transition, Healthy Families transition and other
components
NEW 1115 WAIVER RENEWAL
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Strengthen primary care delivery and access
Avoid unnecessary institutionalization and services through
an integrated delivery system
Address social determinants of health
Use Medi-Cal program as incubator to test innovative
approaches to whole person care
Find synergy with CalSIM and other state initiatives
“The focus of the Waiver Renewal will be on improving and
reforming our Medi-Cal payment and delivery systems and
ensuring ongoing support for the safety net”
- DHCS Concept Paper (July 2014)
INITIAL WAIVER RENEWAL CONCEPTS
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Federal/State Shared Savings
Payment and Delivery Reform Incentives
Safety Net Payment Reforms
FQHC Payment Reform
DSRIP Successor Program
CCS Program Redesign
Shelter for Vulnerable Populations
Workforce Development
PAYMENT REFORM – FQHC Alternative
Payment Methodology (APM)
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Pilot program proposed (urban areas only)
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Community health center FQHCs and County FQHCs
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Transition to Medi-Cal managed care plans as payor of
FQHC services
No risk = FQHCs assured reimbursment at no less than the
PPS rate and plans protected from risk
Purpose: transition delivery of care at FQHCs from
current volume-based system to one that better aligns
financing and delivery of services
NEXT STEPS
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Legislative authority to operate APM
Administrative approval beyond DHCS
Populations to be determined
System and operational readiness at health plans
and FQHCs
Timing and duration of pilots
Choice of counties and FQHCs to participate
DATA
Rate setting
ACA SECTION 2703
HEALTH HOMES
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Health Home optional Medicaid benefit
For intensive care coordination for people with
chronic conditions
New benefit includes package of 6 care
coordination services and does NOT fund direct
medical or social services
90% federal match for 8 quarters (2 years) and
50% thereafter
2703 SERVICES
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Comprehensive care management
Care coordination and health promotion
Comprehensive transitional care
Individual and family supports
Referral to community and social services
Use of health IT, data and evaluation
AB 361 – enacted in 2013
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Authorizes implementation of ACA Section 2703 in
California – requires that DHCS implement only if no
additional General Fund moneys used
Requires inclusion of specific target population of
frequent users and those experiencing homelessness
For target population, program must include providers
with experience serving frequent hospital/ED users and
homeless members
CALIFORNIA STATE INNOVATON
MODEL - CalSIM
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California received SIM Design Grant March 2013, which supported
development of State Health Care Innovation Plan
Draft Plan submitted to CMS March 2014 (often called Let’s Get Healthy
California)
Up to 12 State Innovation Model (SIM) Testing Grants from $20 million to
$100 million, for a total of $700 million
4 year grants (including a year of planning)
Projected start date is January 1, 2015, and grants will run through
December 31, 2018
CMS Innovations Center: “The purpose of the [Center] is to test innovative
payment and service delivery models to reduce program expenditures…while
preserving or enhancing the quality of care furnished to individuals under such
titles.”
CalSIM PROPOSAL OVERVIEW
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Plan for Population Health
4 Initiatives
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Maternity Care
Health Homes for Patients with Complex Needs
Palliative Care
Accountable Communities for Health
Building Blocks
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Workforce
Health Information Technology and Exchange
Enabling Authorities
Cost and Quality Transparency Database
Public Reporting
Payment Reform Incubator
TIMES ARE CHANGING…..
INTEGRATED AND CONNECTED
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The future is about population health and
integration!
Time to look ahead not in the past
What are the common characteristics of these
efforts?
MORE INFORMATION
CalSIM:
http://www.cchs.ca.gov/pages/pritab.aspx
Whole Person Care:
http://www.blueshieldcafoundation.org/sites/default/files/publications/downl
oadable/Opportunities_for_Whole-Person_Care_9_2014.pdf
1115 Waiver:
http://www.dhcs.ca.gov/PROVGOVPART/Pages/waiverrenewal.aspx
Section 2703- Health Homes:
http://www.medicaid.gov/State-Resource-Center/Medicaid-State-TechnicalAssistance/Health-Homes-Technical-Assistance/Downloads/Health-HomesFAQ-5-3-12_2.pdf
Payment Reform: CPCA Pilot Projects
http://www.cpca.org/index.cfm/policy-advocacy/policy/payment-reform/