Total Cost of Care Phase III Expansion. Request for Proposals Information Webinar November 17, 2016

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1 Total Cost of Care Phase III Expansion Request for Proposals Information Webinar November 17,

2 Presentation Overview Format for Webinar NRHI Background Getting to Affordability - Total Cost of Care Original Pilot Phase II Overview Phase III RFP Requirements RFP Review and Selection Process

3 Presentation Format Lines will be muted to ensure high quality recording Webinar will be recorded and posted to our website at for later viewing You may send questions at any time during the live webinar Click on Questions and Answers at the top left of your screen Type your question in the dialogue box that appears If you prefer, you can send your question anonymously by checking the box at the bottom left Click Send Questions will be answered live as much as possible. All questions and responses will be posted in the FAQ document Additional questions following the webinar can be submitted via the web form

4 Who is the Network for Regional Healthcare Improvement (NRHI)? A national organization of more than 35 regional health improvement collaboratives (RHICs). RHICs are non-profit, multi-stakeholder organizations working in and collaborating across regions to achieve better care at lower cost. RHICs work together through NRHI to accelerate and spread regional innovation across the U.S. We re stronger and more effective together. NRHI

5 NRHI s Guiding Principles The status quo of our healthcare system is unacceptable in terms of its quality, safety or cost. We strive for win-win solutions recognizing that change is required by all. We promote and actively pursue transparency of healthcare cost, quality, patient experience, and outcomes. We believe the best solutions come from a multi-stakeholder approach. We work collaboratively to accelerate and scale innovation. NRHI

6 6 November 18, 2016 NRHI

7 Getting to Affordability NRHI brings together regional partners to: Produce standardized, high-quality data analyses and reporting of healthcare costs Share both information and experiences Use the resulting information to compel fundamental change 7

8 November 18,

9 Original Pilot Goals and Achievements Original Pilot Goal To develop and produce information to enable communities to reduce the total cost of care in multiple regions with replicable, multi-stakeholder driven strategies. Goals Achieved Five regions produced and distributed attributed practice level reports Developed and tested a regional benchmarking approach Community reports highlighted variation across practices Engaged and empowered physician champions to lead change both locally and nationally 9 November 18, 2016

10 Phase II Project Goal Evolve TCoC pilot and show preparedness for national scalability for standardized reporting. Deepen stakeholder engagement and broaden the local activation and dissemination of Total Cost of Care measurement. 22

11 Getting to Affordability: A Total Cost of Care Initiative 11

12 Phase II Wins Improved data collection and analysis Advised on the expansion to Medicare and Medicaid Deepened stakeholder engagement Demonstrated nationally scalability Expansion regions Maryland Utah Development Sites APCD Technical Guide

13 Resources & Issue Briefs 13 November 18, 2016

14 G2A Community Learning Modules Discussions Resources Tech Talk Tuesdays 14 November 18, 2016

15 Questions? Use the Q&A Feature 15 November 18, 2016

16 TCoC Phase III Effective November 1, 2016 October 31, 2018 Key Themes Dissemination G2A Learning Modules & Community National Multi-Stakeholder Summit Acceleration Data Quality Assessment & Improvement Program Sustainability Data, Reporting & Use Business Products & Services Physician & Multi-Stakeholders Seminar Playbooks Innovation Team 16

17 Funded Participation Opportunities Standardized Regions Opportunity for two new regions Year 1 - Each region eligible for up to $70,000/year Year 2 - Each region eligible for up to $60,000/year Alignment and Development Sites Nine to thirteen regions over grant period $10,000 - $25,000/region/year Varying lengths of proposals accepted 17

18 Participation Requirements All Funding Levels Strive toward Standardization, Alignment & Transparency Familiar with the value of TCOC reporting Obtain Board of Directors support Comply with the Robert Wood Johnson Foundation lobbying rules NRHI Member Letter of Recommendation Execute a formal Letter of Commitment 18 November 18, 2016

19 Standardized Regions Deliverables & Support 19 November 18, 2016

20 Benefits of Standardization Adds local credibility reporting same measures in a standardized manner Ability to benchmark across regions for vision of what is possible to achieve Allows for some local customization (e.g. attribution) while preserving critical centralized elements (e.g. risk adjustment) Centralized quality checks reveal hidden, underlying data quality issues and guidance for resolution Share solutions to common issues 20

21 Standardized Regions Requirements of Participation Current access to all of the commercial data elements required to produce the HealthPartners NQF endorsed TCOC measure framework; Data use agreements that allow cost reporting; Commitment to data analysis resources and tools necessary to meet deliverables outlined below; Knowledge of Total Cost of Care and Resource Use reporting methodologies; Capacity to collect and analyze the integrity of essential data to produce Total Cost of Care reporting; Ability to attribute and risk adjust consistently in accordance with the project technical specifications; 21

22 Standardized Region Requirements of Participation (cont.) Access to both the analytic resources and tools necessary to ensure the completeness and integrity of the required data set; Ability to submit aggregated data to benchmarks; Established and engaged multi-stakeholder platform and experience collaborating with local stakeholders; and Ability to meet all of the deliverables outlined in more detail below. 22

23 Reporting & Benchmark Cycles Round 1 Measurement on Calendar Year 2015 Round 2 Measurement on Calendar Year 2016 Estimated grant period: 1/ /2017 Estimated grant period: 12/ / November 18, 2016

24 Standardized Region Deliverables Produce TCOC Reporting Share TCOC Reports Use TCOC Reports Accelerate & Sustain Data Quality Assessment & Improvement Program G2A Community Engagement Market Analysis & Product Development 24 November 18, 2016

25 Standardized Region Deliverables Produce TCOC Reporting Compliant with Technical Resource and Benchmark specifications (HealthPartners NQF endorsed foundation) Multi-payer commercial, attributed practice level reports Medicare FFS (optional) Community level variation Year to year trend analyses Aggregated data for regional benchmarks Public reporting by 10/31/

26 Standardized Region Deliverables (cont.) Share TCOC Reporting Practices & Health Care Systems Community reporting Multi-stakeholder forums Public reporting by 10/31/2018 Nationally through regional comparisons 26

27 Standardized Region Deliverables (cont.) Use TCOC Reporting Regional Annual Forum Multi-Stakeholder Community discussion about healthcare costs Multi-Stakeholder Seminar* Fall 2017 Ten Regions Stakeholder representation from Consumer, Provider, Health Plan & Payer perspective * If selected 27

28 Standardized Region Deliverables (cont.) Accelerate & Sustain Representation on Innovation Team Annual in-person Bi-monthly virtual Contribute to data quality assessment & improvement program development Actively engage in G2A Community Contribute to market analysis & product development 28 November 18, 2016

29 Standardized Regions Funding Round 1 Each region eligible for up to $70,000 $50K for commercial $20K for Medicare FFS Round 2 Each region eligible for up to $60,000 $45K for commercial $15K for Medicare FFS 29 November 18, 2016

30 Support for Standardization Regions Technical Resource and benchmark specifications G2A Learning Modules Access to a Technical Advisor for quality data assessment and improvement for contribution to benchmark Access to limited, non-commercial license of ACG grouper for purposes of benchmarking All travel arrangements handled and expenses paid for the following: Innovation Team meetings (1 site representative each year) Multi-Stakeholder Summit (6 attendees from each region must have a representative from each stakeholder group) 30 November 18, 2016

31 Questions? Use the Q&A Feature 31 November 18, 2016

32 Alignment & Development Sites Deliverables & Support 32 November 18, 2016

33 Alignment & Development Requirements Share the vision of cost transparency Complete G2A Readiness Assessment (part of application process) Work with G2A Navigator to develop a customized training program Complete customized training program Actively engage in G2A learning platform Review and comment on draft Data Quality Assessment & Training Program 33 November 18, 2016

34 Alignment Site Deliverables (Option A) Produce a module for the G2A Learning Community Leverage work completed related to total cost of care Document your story Record your learning module with help from the G2A team Possible topics: Non-standardized TCOC reporting Using cost performance for benefit designs Total cost of care reporting in support of population health management 34 November 18, 2016

35 Alignment Site Deliverables (Option B) Regional Benchmarks Submit a standardized, aggregated data set for inclusion in regional benchmarks Round 1 Measurement on CY2015 Estimated grant period: 1/ /2017 Round 2 Measurement on CY2016 Estimated grant period: 12/ / November 18, 2016

36 Development Site Deliverables Identify a barrier and work to overcome it utilizing the resources available through the G2A learning modules and community Write and share a case study for the G2A learning community Facilitate a Tech Talk or Virtual Classroom on the G2A community to share lessons learned and/or best practices 36 November 18, 2016

37 Alignment & Development Site Funding Nine to thirteen regions selected over grant period Varying lengths of proposals accepted Grants range from $10,000 - $25,000/region/year Amount awarded will vary depending on scope, resources and expenses Indirect expenses allowed 37 November 18, 2016

38 Questions? Use the Q&A Feature 38 November 18, 2016

39 Review & Selection Process Timelines, Review Process & Resources 39 November 18, 2016

40 Submission Timeline Proposals due by noon ET Monday, December 12,2016 Follow up interviews may be requested Respondents shall be notified of the final decision no later than January 6, 2017 All applicants will be notified before public announcement are made

41 Request for Proposal Review Process All responses will be reviewed against requirements and scored by a team representing: Technical/Data Analysis expert Project Team Member Member of NRHI Board of Directors NRHI Staff Scoring based on submitters responses using the following criteria: Alignment with Project Goals Readiness Assessment Ability to meet minimum requirements and deliverables Geographic Distribution Diversity of Topics

42 Budget Budget template provided in RFP 42 November 18, 2016

43 Resources Visit the TCOC page at Technical Resource Word Version of RFP Questions Link to Readiness Assessment Submit questions f74711a3f85ceaa114f494 FAQs updated regularly Join the Getting to Affordability (G2A) Community Click on the following link:

44 For More Information Ellen Gagnon, Executive Director TCoC Mary Isabel Aromando, Project Manger 44

45 Thank you!