advancing the triple aim through integrated care · quality and performance for minnesota health...
TRANSCRIPT
Advancing the Triple Aim Through Integrated Care
June 16, 2016
Liz Cinqueonce, Senior Vice President, Southern Prairie Community Care
Disclosure
• Liz Cinqueonce reports no actual or potential conflicts of interest associated with this presentation
Learning Objectives
• Upon successful completion of this activity, pharmacists should be able to: – Describe the Minnesota Integrated Health Partnership
Program and the IHPs’ role in advancing health care quality and performance for Minnesota Health Care Program Recipients
– Discuss how SPCC is engaging pharmacists in the delivery of comprehensive MTM services as a key strategy to improve quality and outcomes, and to manage Total Cost of Care
Integrated Health Partnerships (IHP) Minnesota’s Medicaid ACO Model
What is an Accountable Care Organization?
• A group of health care providers with collective responsibility for patient care that helps coordinate services – deliver high quality care while holding down cost
• Creates an incentive through a variety of payment structures for providers to efficiently and effectively manage the full spectrum of care a patient receives throughout the care system
• Innovation lies in the flexibility of their structure, payments, and risk assumptions
MN Approach to ACO Development
• Integrated Health Partnership (IHP) Demonstration Authorized in 2010 by MN Stat. 256B.0755
• Builds on history of health reform – wanted to define the “what” (better care, lower costs), rather than the “how”
• Allow for broad flexibility and innovation under a common framework of accountability
• Accountability Framework includes: – Models based on/accountable for, Total Cost of Care (TCOC) – Robust and consistent quality measurement – Models that drive rapidly away from the incentive “to do more”, and
towards increasing levels of integration
Who can be an IHP? Characteristics/Requirements
• Deliver the full scope of primary care services • Coordinate with specialty providers and
hospitals • Demonstrate how they will partner with
community organizations and social service agencies and integrate their services into care delivery
How are IHPs Accountable? Total Cost of Care (TCOC)
• Medicaid recipients in both FFS and managed care organizations – attributed using past encounters/claims
• Defined core set of services included in TCOC calculation; IHPs may elect to add
• Existing provider payment persists through the demo with gain-/loss-sharing payments made annually based on risk adjusted TCOC performance, contingent on quality performance
How are IHPs Accountable? Same Framework, Model Options
• IHPs voluntarily contract with DHS under model options: Integrated or Virtual
– Integrated = Delivery system providing spectrum of care as a common entity; move toward symmetrical “downside” risk; can propose variable risk corridors and distribution (does not have to be 50/50)
– Virtual = collaborative, not affiliated with a hospital or serving <2,000 enrollees; “up-side” only; savings beyond min. threshold shared 50/50.
• Flexibility within the two models to accommodate provider makeup, size and capacity, and risk tolerance with the goal to ensure broadest possible participation.
• TCOC target is measured against actual experience to determine the level of claim cost savings (excess cost) for risk share distribution.
How are IHPs Accountable? TCOC and Quality Measurement
• TCOC target is measured against actual experience to determine the level of claim cost savings (excess cost) for risk share distribution.
• Quality Performance impacts shared savings amounts an IHP can receive – Year 1 – 25% based on reporting only – Year 2 – 25% based on performance – Year 3 – 50% based on performance
• Individual measures scored based on either achievement or year-to-year improvement
Collaboration of 12 Counties CHIPPEWA COTTONWOOD JACKSON KANDIYOHI LINCOLN LYON MURRAY NOBLES REDWOOD ROCK SWIFT YELLOW MEDICINE
MartinFaribaultJackson Fillmore HoustonMower
FreebornNoblesRock
Watonwan WinonaCottonwood OlmstedWaseca Dodge
SteeleMurray
PipestoneBlue Earth
WabashaNicollet
BrownRice
Le SueurLyon
LincolnRedwood Goodhue
SibleyScott
Renville
DakotaYellow Medicine
CarverMcLeod
RamseyChippewa HennepinLac qui
Parle
WashingtonMeekerSwift Kandiyohi
Anoka
Wright
SherburneBig StoneChisago
IsantiPopeStevens Stearns
BentonTraverse
DouglasGrant Kanabec
Mille Lacs
Morrison
Todd
Pine
WilkinOtter Tail
CarltonCrow Wing
WadenaAitkin
Clay Becker
Hubbard
Cass
NormanMahnomen
Itasca
Red Lake
Clearwater
Pennington
Polk Lake
CookBeltrami
Marshall
Saint Louis
Koochiching
RoseauKittson
Lake of the Woods
Two Organizations, One Mission Enhancing the life and health of people in our communities and across our region.
! Joint Powers Organization
! Governed by County Commissioners
! Contracted Entity for IHP
! State Certified HIO
! 501c-3 Non-Profit Organization ! Governed by Stakeholders,
Partners ! Advise SPCC ! Partner to Advance Mission ! Governance for HIE (SPCLink)
13
Southern Prairie Community Care
! SPCC is a virtual network focused on the Triple Aim ! Identified as an Accountable Community for Health ! 27 Provider Members
Clinics, Hospitals, Public Health, Mental Health, Human Services ! Focused on improving health of people in our communities ! Strength is efficiently mobilizing “the community” around those with
highest need ! Ability to leverage connections in governance of SPCC and area HHS
agencies, MHCs, hospitals
SPCC Partners
! Minnesota Department of Human Services • Integrated Health Partnership • Minnesota SIM IHP Data Analytics Grant
! Minnesota Department of Health • State Certified Health Information Organization • Minnesota SIM E-Health Grant (Health Information Exchange) • Minnesota SIM Accountable Community for Health Grant (Diabetes Initiative)
! Blue Cross Blue Shield • 3 Year Agreement (through 2016) • Sustainability Plan In Progress (2017 and beyond)
The Four Pillars of SPCC
INTEGRATED COMMUNITY CARE
HEALTH INFORMATION SERVICES
POPULATION HEALTH IMPROVEMENT
HEALTH EQUITY AND ACCESS
Integrated Community
Care
Health equity - access to care and services
Information Strategies for Accountable
Health
Improved population
health in our 12-county region
Southern Prairie Community
Care
Person and Population
Quality of Life
PILLAR I: Integrated Community Care
17
Reduce IP stays
Reduce ED visits
Improve Primary Care relationships
Increase RX compliance
Reduce inappropriate RX use
Coordinate appropriate MH access
Improve coordination with County based services
Integrated Community Care
! Community based, multidisciplinary health care system ! Takes collective responsibility for the health of individuals and the total
population ! Addresses physical, emotional, and social factors with a patient centered
approach ! Provides assessment for individual needs and issues contributing to poor
health ! Integrates health care services with appropriate community resources ! Goal is to function as a team with the patient to achieve better health
and lower cost
Integrated Community Care Program (ICCP)
! Integrated Community Care Teams ! Connecting Integration Coordinators with Key Providers ! Data Driven Outreach ! Health Care System Partnerships in Three Communities ! CD / MH Case Manager Pilot – Willmar, MN ! Community Health Worker – Worthington, MN ! Initiating Hospital Integration at Point of Discharge ! Mental Health / Primary Care Integration Projects
ICCP Patient Identification
- Poor Health - High risk health status - Complex medical
conditions - High utilization - Mental health issues - Significant social needs - Poor chronic disease
control - Social determinant
issues - Polypharmacy
Pharmacist Engagement in Integrated Community Care
• Development/refinement of approach to engage MTM pharmacists • Workshops for other partners/providers on MTM services; • Workshops for pharmacists to prepare for engagement • Implementation of tools to support information sharing • Refinement of Data Driven Intervention Strategies
– Criteria for patient selection
– Development of operational procedures to facilitate coordination – Development of documentation resources
• Participation in Outreach to Targeted Members • Delivery of MTM Services • Documentation and evaluation of impact on cost, quality, outcomes
DDIS: High ED Use
ED Count >/= 4 during 12 month observation period. Started June 1, 2015. Baseline: 299 members identified that met criteria and were consistently attributed to SPCC during observation period. DDIS Enrolled in ICCP = 27 members. Outreach to baseline group by IC staff, community partners.
DDIS: High Rx Use
Goals: 1. Meaningful connection with 50% of individuals 2. Provide education to 100% of those contacted 3. Assess for physical, social, emotional contributing
factors 4. Offer medication therapy management for 100% of
those contacted 5. Obtain a current accurate medication list Measurements: 1. Total cost of care 2. ED counts 3. Inpatient counts 4. Pharmacy costs 5. Active medication count
Medication count >/= 10 active medications Purpose is to improve medication adherence, safety, and effectiveness
Year 1: $5.8 Million Saved
Attributed Population 22,900 Medicaid Patients
Total Cost Avoidance $5.8 million in CY 2014
Average Cost Avoidance $255.09 per person
Southern Prairie Dollars To Reinvest $1.39 million paid in CY2015
Quality Bonus and Impact of Final Settlement Calculation1
$808,000 additional paid in CY2016
Savings Portion Retained by DHS $3.5 million
1. Final performance calculation for 2014 occurred in May 2016 and indicated 2014 performance was 1% better than the “Interim” calculation from 2015. Change resulted in additional savings distributed to SPCC, beyond the quality bonus
Year 2: $10.3 Million Saved
Attributed Population 25,300 Medicaid Patients
Total Cost Avoidance $10.3 million in FY 2015
Average Cost Avoidance $406.68 per person
Southern Prairie Dollars To Reinvest $3.50 million paid in CY 2016
Quality Bonus Available To Southern Prairie $1.16 additional to be paid in CY2017
Savings Portion Retained by DHS $5.0-5.5 million (pending quality bonus)
