Transcript We Need P4P
Integrated Care 2.0: Policy Partners to Drive Change GIH ANNUAL MEETING MARCH 6, 2014 Learning Objectives Learn strategies to establish partnerships with policy makers to support complex health initiatives; Identify potential national accrediting, regulatory, funding and other policy organizations that can enhance sustainability of foundations’ initiatives; Explore case studies of policy changing partnerships. Public and Private Collaborations LARRY GRAB, DIRECTOR Behavioral Health Northeast & Medicare Advantage Services WellPoint, Inc. Collaborative Partnerships The private managed care company partnering with: Not-for-profit organizations (Hospitals, CMHCs, FQHCs, etc.) State-based policy-maker workgroups Quasi-state organizations – eligible for grants and public funding Organizational coalitions Why Collaborate and Partner? Ability to pilot and/or study programs that are of mutual interest Lend support and weight for grant funding awards Increase communication of initiatives Enhance community relations and involvement through local partnerships The Maine Experience Anthem’s representation on the Maine Health Access Foundation (MEHAF) Integrated Care Policy workgroup Mutual interest on integrating medical and behavioral health care Anthem initiated the use of Health and Behavior Assessment & Intervention CPT codes as a starting point The Maine Experience (cont) The Anthem work was the foundation to further evaluate this with other payers; influence change; and share the outcome results to demonstrate value Maine Experience Outcomes Partnering outcomes included: Ability to reach a large provider network with significant patient population A multi-constituent workgroup to spread the word of the initiative and provide feedback Maintain momentum and focus thru Program staff Expansion and inclusion of other payers, public and private Results that help influence ongoing support, future policy or redirection of the initiative Upcoming Collaborations Piloting a program with Northeast Business Group on Health (NEBGH) in the NYC metro area The “One Voice” program links primary care providers with a non-MD BH provider and a consulting psychiatrist Upcoming Collaborations Partially grant-funded for the consulting psychiatrist and insurer funded for the face: face work with the patients Insurers and NEBGH will work together to evaluate health outcomes of those individuals that participated in the program Integrated Care 2.0: Policy Partners to Drive Change Sarah Hudson Scholle, Vice President Grantmakers in Health March 6, 2014 Building the PCMH The National Dual Eligibles Summit 12 The Joint Principles of the PCMH Developed by the ACP, AAFP, AAP and AOA • Personal physician • Physician directed medical practice • Whole person orientation • Care is coordinated and/or integrated across all health care system and patient’s community • Quality/safety are hallmarks of medical home • • • • • • Care planning Evidence-based medicine Clinical decision support Continuous quality improvement Patient participation and feedback Appropriate HIT • Enhanced access • Payment reform 13 About NCQA Our mission To improve the quality of health care Our method Measurement We can’t improve what we don’t measure Transparency We show how we measure so measurement will be accepted Accountability Once we measure, we can expect and track progress 14 What is a medical home? PCMH 2011 standards • Care access and continuity • Identify and manage a population • Treatment planning and care management • Provide self-care support and community resources • Track and coordinate • Measure to improve performance 15 PCMH is the fastest-growing delivery system reform 35,000 33,026 30,000 24,544 25,000 20,000 16,191 15,000 10,000 7,676 6,550 5,198 5,000 214 0 3,302 1,976 383 1,506 28 12/31/08 12/31/09 12/31/10 Clinicians 12/31/11 Sites 12/31/12 11/30/13 16 NUMBER OF PCMH CLINICIAN RECOGNITIONS BY STATE *As of 2/28/14 WA ND MT VT NH MN OR WI SD ID MI IA PA NE UT CA IL CO KS OH IN MA NY WY NV ME RI CT NJ DE MD WV MO VA KY NC TN AZ NM OK 0 Recognitions AR SC MS AL 1-20 Recognitions GA LA 21-60 Recognitions TX FL AK 61-200 Recognitions 201+ Recognitions HI 35,677 PCMH CLINICIAN RECOGNITIONS PR 17 Less than 5 percent of practices submit CAHPS PCMH data 18 Role of Philanthropy • Raise awareness • Identify best practices, innovative models • Advocate for policy change • Train and sustain Key Discussion Questions As a local/regional grantmaker, what local groups might fit a policy partner profile? As a national foundation, how does one connect with influential local policy partners? How much of this work can be done locally? What type of issues are best addressed with larger national policy partners? Keep in Touch Irfan Hasan The New York Community Trust 212-686-0010 ext. 573 Larry Grab WellPoint, Inc. 203-654-3305 [email protected] [email protected] Becky Hayes Boober Maine Health Access Foundation 207-620-8266 ext. 114 [email protected] Sarah Scholle NCQA 202-955-3588 [email protected]