Social Determinants: The Next Phase of Value-Based Innovation

Size: px
Start display at page:

Download "Social Determinants: The Next Phase of Value-Based Innovation"

Transcription

1 Social Determinants: The Next Phase of Value-Based Innovation UNDERSTANDING AND INFLUENCING KEY PREDICTORS OF HEALTH OUTCOMES Presented by RAM Technologies, Inc. Social determinants: The next phase of value-based innovation 1

2 INTRODUCTION At first glance, the social determinants of health (SDOH) seem beyond the purview of healthcare providers and payers, but it has become increasingly clear that these factors are important to health outcomes, and they must be addressed if stakeholders are to improve the health of vulnerable populations. Identifying SDOH, integrating data into health records and models, and using that information to guide interventions are the keys to improving health and bending the cost curve, but barriers such as data and stakeholder silos remain. Payers, with repositories of claims and demographic data as well as advanced analytic capabilities, are strongly positioned to forge partnerships with healthcare providers and community groups to surmount these barriers, address SDOH and unlock value in healthcare. NATIONAL AND REGIONAL STAKEHOLDERS TARGET THE SDOH 1-4 SDOH are central to the CDC s Healthy People 2020 initiative a list of 1,200 objectives in 42 categories meant to improve public health nationwide. Meanwhile, coalitions are forming across the nation to address SDOH. The Camden Coalition of Healthcare Providers citywide care management system, Harlem Children s Zone Project, the Colorado Health Foundation s Healthy Places initiative and the Healthy Food Financing Initiative are among the efforts developed to pursue neighborhood-level interventions by targeting poverty, physical activity, nutrition and more. Payers are also getting involved. Through the Center for Medicare and Medicaid Innovation s State Innovation Models Initiative, health plans are working with states on population health improvement models that include a social determinants component. Other Medicaid payment and delivery reforms also encourage organizations to consider and address SDOH, and in some cases, Medicaid reimburses for housing.

3 TECHNOLOGY CAN HELP 2, 5-11 INTEGRATE SDOH INTO CARE PATIENT-LEVEL INSIGHTS SDOH cannot be adequately addressed until they are identified and quantified. Because SDOH vary between and within patient populations, interventions must be personalized based on reliable data capture, sharing and analysis. GENERALLY, THE SOCIAL DETERMINANTS OF HEALTH ARE THE CONDITIONS IN WHICH PEOPLE ARE BORN, GROW, WORK, LIVE AND AGE. THEY INCLUDE: 16 LIFESTYLE FACTORS tobacco use illicit drug use diet exercise isolation ENVIRONMENTAL FACTORS pollution noise SOCIOECONOMIC FACTORS financial stress education level housing quality access to transportation access to healthful food access to recreation neighborhood safety The basic electronic health record (EHR) is a foundation, but to be useful for developing and evaluating targeted interventions, the EHR must be expanded to include new types of data. Sources include patient questionnaires, activity trackers and other medical devices, as well as demographic data. In addition, data silos must be brought down to allow data to flow freely to where it can be most effective. For example, payers already house key demographic information, and when they share it with providers, clinicians gain a more robust understanding of patients and may go on to collect additional data. The result is a more informative EHR that when analyzed yields insights for addressing SDOH at the patient, community and population levels. Indeed, HHS envisions a future where clinicians in a multi-payer environment obtain actionable, reliable, and comprehensive feedback data regardless of who pays for their patients care. Social determinants: The next phase of value-based innovation 3

4 COMMUNITY-LEVEL INSIGHTS Geographic information systems can be used to identify communities and neighborhoods with high rates of poverty and unemployment, low education levels, exposure to pollution, a lack of transportation, food deserts and other factors that contribute to poor health. Mapping and analyzing data enables the development of a community health needs assessment to guide interventions. The CDC offers resources for completing such an assessment. POPULATION-LEVEL INSIGHTS Payer claims data also holds clues to SDOH. For example, cardiovascular disease and depression may be linked to stress caused by insecure housing; environmental factors contribute to asthma; obesity and diabetes may be tied to poor access to healthful food; and transportation problems may result in missed appointments. Claims analyses tease out these and other associations that might otherwise be missed. Payers that share this and other data with clinicians and other partners arm them with the insights needed to truly make a difference. STANDARDIZATION IS KEY Clinical SDOH assessment tools have come to the market, but the field lacks standards, guidance and best practices for multisector data sharing and systematically capturing, documenting and prioritizing SDOH. Various efforts are underway to fill the gaps, and some stakeholders have introduced tools for measuring SDOH. In addition, the National Association of Community Health Centers, Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association and the Institute for Alternative Futures have joined forces to implement, test and promote a standardized risk assessment protocol to assess and address patients social determinants of health. 4 Social determinants: The next phase of value-based innovation 4

5 HOW PAYERS ARE LEADING THE WAY 1,4,5,12-15 In addition to data sharing and analytics, payers are strongly positioned to take SDOH to the next level in other ways indirectly through provider and patient incentives and directly through philanthropy. Value-based insurance design is one framework for encouraging providers to collect and use SDOH data, and many payers have already launched pilot programs in this area. Identifying SDOH allows health plans to not only waive cost-sharing for key services but also to cover food as medicine and provide housing and transportation assistance, for example. Major health plans also continue to leverage partnerships with community organizations to identify and address SDOH. These payers are investing directly or through community groups in interventions that improve housing, transportation, employment, nutrition, education and health behaviors in the patient populations they serve, and in at least one case, adopting a whole patient perspective for high-cost, high-need patients that accounts for social determinants. In addition, Association for Community Affiliated Plans members are testing myriad programs and initiatives to improve housing, economic stability, education and food security in the patient populations they serve. Payers are strongly positioned to take SDOH to the next level indirectly through provider and patient incentives and directly through philanthropy. Social determinants: The next phase of value-based innovation 5

6 LOOKING TO THE FUTURE 2,4,16 The transition to value-based care is well underway, but continued progress is needed to optimize healthcare and outcomes if stakeholders are to build a more sustainable system. Research has shown that SDOH are at least as important to patient outcomes as medical care itself, and for Medicare, Medicaid and dual-eligible populations, SDOH are particularly important. As value-based care places new emphasis on prevention and outcomes, stakeholders have realized they must find a way to account for SDOH, and many have pursued efforts to influence social determinants as a result. This is the next phase of value-based care. To effectively identify and influence SDOH, data silos must be eliminated, partnerships formed and tools for integrating SDOH interventions into clinical care must be developed. These efforts will require stakeholder support, investment, incentives and new ways of thinking about healthcare. Payers have the perspective, resources and tools to ensure SDOH are fully recognized and addressed as an integral component of healthcare. These efforts will require stakeholder support, investment, incentives and new ways of thinking about healthcare.

7 References 1. Dixon-Fyle, S. and Kowallik, T. (2010) Engaging consumers to manage health care demand. McKinsey & Company. Retrieved Sept. 1, 2017 from engaging-consumers-to-manage-health-care-demand 2. Heiman, H. and Artiga, S. (2015) Beyond health care: The role of social determinants in promoting health and health equity. Kaiser Family Foundation. Retrieved Sept. 1, 2017 from 3. US Department of Health and Human Services. (2017) Social determinants of health. Healthy People Retrieved Sept. 1, 2017 from 4. Levi, J. and DeSalvo, K. (2017) Funding for local public health: A renewed path for critical infrastructure. Health Affairs Blog. Retrieved Sept. 1, 2017 from 5. America s Health Insurance Plans. (2017) Beyond the boundaries of health care: Addressing social issues. Retrieved Sept. 1, 2017 from 6. Centers for Disease Control and Prevention. (2015) Community health assessments & health improvement plans. Retrieved Sept. 1, 2017 from 7. Data Across Sectors for Health. (2017) Exploring the intersection of clinical data, claims and social determinants of health. Retrieved Sept. 1, 2017 from 8. Gold, R., Cottrell, E., Bunce, A., Middenorf, M., Hollcombe, C. et al. (2017) Developing electronic health record (EHR) strategies related to health center patients social determinants of health. Journal of the American Board of Family Medicine. 30(4), Ready, T. (2017) Data on social needs may redefine precision healthcare. Health Leaders Media. Retrieved Sept. 1, 2017 from Washington, V. and Slavitt, A. (2017) Building the value-based health care system of the future depends on meeting clinicians data needs. Health Affairs Blog. Retrieved Sept. 1, 2017 from blog/2017/01/17/building-the-value-based-health-care-system-of-the-future-depends-on-meeting-clinicians-data-needs/ 11. Centers for Disease Control and Prevention. (2015) Community health assessments & health improvement plans. Retrieved Sept. 1, 2017 from Association for Community Affiliated Plans. (2014) Positively impacting social determinants of health. Retrieved Sept. 1, 2017 from Beaton, T. (2017) How payer philanthropy can address social determinants of health. HealthPayer Intelligence. Retrieved Sept. 1, 2017 from Shah, N.R., Rogers, A.J. and Kanter, M.H. (2016) Health care that targets unmet social needs. New England Journal of Medicine Catalyst. Retrieved Sept. 1, 2017 from catalyst.nejm.org/health-care-that-targets-unmet-social-needs/ 15. University of Michigan Center for Value-based Insurance Design. (2016) V-BID in action: The role of cost-sharing in health disparities. Retrieved Sept. 1, 2017 from World Health Organization. (2017) Social determinants of health. Retrieved Sept. 1, 2017 from int/social_determinants/en/ 7

8 ABOUT RAM TECHNOLOGIES RAM Technologies is a leading provider of enterprise software solutions for healthcare payers. For over 36 years, RAM Technologies has led the way in the creation of superior software solutions for health plans serving governmentsponsored healthcare programs (Managed Medicaid, Medicare Advantage, Federal Employee Health Programs, etc.). RAM Technologies has merited a top spot in the Philadelphia Business Journal s List of Top Software Developers for eight consecutive years, has been featured in Inc. Magazine s List of Fastest Growing Private Companies for five years and has been named Most Promising Insurance Technology Solution Provider by CIOReview. To learn more about RAM Technologies, call (877) or visit

Navigating an Enhanced Rural Health Model for Maryland

Navigating an Enhanced Rural Health Model for Maryland Executive Summary HEALTH MATTERS: Navigating an Enhanced Rural Health Model for Maryland LESSONS LEARNED FROM THE MID-SHORE COUNTIES To access the Report and Accompanied Technical Reports go to: go.umd.edu/ruralhealth

More information

PRAPARE Social Determinants of Health in the EHR OCHIN Epic Tools for Data Collection, Screening, and Referral

PRAPARE Social Determinants of Health in the EHR OCHIN Epic Tools for Data Collection, Screening, and Referral PRAPARE Social Determinants of Health in the EHR OCHIN Epic Tools for Data Collection, Screening, and Referral What are Social Determinants of Health (SDH)? Nonmedical factors influencing health (Braveman

More information

Tomorrow s Healthcare: Better Quality, More Affordable, More Accessible

Tomorrow s Healthcare: Better Quality, More Affordable, More Accessible Tomorrow s Healthcare: Better Quality, More Affordable, More Accessible Victor J Dzau, MD President, National Academy of Medicine September 23, 2016 Fung Healthcare Leadership Summit Global Challenges

More information

Care Collaboration Success: How Payers, Providers and Local Resources Innovate and Collaborate for Effective Care Management

Care Collaboration Success: How Payers, Providers and Local Resources Innovate and Collaborate for Effective Care Management Care Collaboration Success: How Payers, Providers and Local Resources Innovate and Collaborate for Effective Care Management Introduction The nature of our healthcare ecosystem has been that of care provided

More information

Financing of Community Health Workers: Issues and Options for State Health Departments

Financing of Community Health Workers: Issues and Options for State Health Departments Financing of Community Health Workers: Issues and Options for State Health Departments ASTHO Technical Assistance Presentation Terry Mason, PhD Carl Rush, MRP Geoff Wilkinson, MSW This webinar is supported

More information

Accountable Care: Clinical Integration is the Foundation

Accountable Care: Clinical Integration is the Foundation Solutions for Value-Based Care Accountable Care: Clinical Integration is the Foundation CLINICAL INTEGRATION CARE COORDINATION ACO INFORMATION TECHNOLOGY FINANCIAL MANAGEMENT The Accountable Care Organization

More information

Caring for the Whole Patient Predictive Analytics Technology, Socio-demographic Insights, and Improved Patient Outcomes Randy K.

Caring for the Whole Patient Predictive Analytics Technology, Socio-demographic Insights, and Improved Patient Outcomes Randy K. WHITE PAPER Caring for the Whole Patient Randy K. Hawkins, MD Caring for the Whole Patient Socio-demographic data, not normally present in the electronic health record, and not routinely found in the hands

More information

Implementation Strategy For the 2016 Community Health Needs Assessment North Texas Zone 2

Implementation Strategy For the 2016 Community Health Needs Assessment North Texas Zone 2 For the 2016 Community Health Needs Assessment North Texas Zone 2 Baylor Emergency Medical Center at Murphy Baylor Emergency Medical Center at Aubrey Baylor Emergency Medical Center at Colleyville Baylor

More information

Opportunities for Medicaid-Public Health Collaboration to Achieve Mutual Prevention Goals: Lessons from CDC s 6 18 Initiative

Opportunities for Medicaid-Public Health Collaboration to Achieve Mutual Prevention Goals: Lessons from CDC s 6 18 Initiative Advancing innovations in health care delivery for low-income Americans Opportunities for Medicaid-Public Health Collaboration to Achieve Mutual Prevention Goals: Lessons from CDC s 6 18 Initiative June

More information

Smarter Care: The Impact of Social Determinants on Health

Smarter Care: The Impact of Social Determinants on Health Smarter Care: The Impact of Social Determinants on Health Ljubisav Matejevic Global Market Development Executive IBM Curam Smarter Care Founder of the Global E-Health Forum Member of the IBM Cúram Research

More information

Connecticut SIM: Enabling Accountable Care and Accountable Communities

Connecticut SIM: Enabling Accountable Care and Accountable Communities Connecticut SIM: Enabling Accountable Care and Accountable Communities SIM SYMPOSIUM FROM ACCOUNTABLE CARE TO ACCOUNTABLE COMMUNITIES: HOW CONNECTICUT S STATE INNOVATION MODEL INITIATIVE IS DRIVING REFORM

More information

NATIONAL ASSOCIATION OF CHRONIC DISEASE DIRECTORS 2200 Century Parkway, Suite 250 Atlanta, GA

NATIONAL ASSOCIATION OF CHRONIC DISEASE DIRECTORS 2200 Century Parkway, Suite 250 Atlanta, GA NATIONAL ASSOCIATION OF CHRONIC DISEASE DIRECTORS 2200 Century Parkway, Suite 250 Atlanta, GA 30345 770.458.7400 1. Agencies and organizations providing training to state staff working on 1305/SPHA should

More information

Financing SBIRT in Primary Care: The Alphabet Soup and Making Sense of it

Financing SBIRT in Primary Care: The Alphabet Soup and Making Sense of it Financing SBIRT in Primary Care: The Alphabet Soup and Making Sense of it CAPT Hernan Reyes, MD Deputy Regional Administrator, HRSA Region 6 July 13, 2016 Objectives Understand the role of HRSA within

More information

MEDICAL-LEGAL PARTNERSHIPS

MEDICAL-LEGAL PARTNERSHIPS HEALTH CENTER-BASED MEDICAL-LEGAL PARTNERSHIPS Where They Are, How They Work, and How They Are Funded January 2018 National Center for Medical Legal Partnership AT THE GEORGE WASHINGTON UNIVERSITY AUTHORS

More information

Strategy for Quality Improvement in Health Care

Strategy for Quality Improvement in Health Care Strategy for Quality Improvement in Health Care Neal D. Kohatsu, MD, MPH, DHCS Medical Director Desiree Backman, DrPH, RD, UC Davis Institute for Population Heath Improvement & DHCS Chief Prevention Officer

More information

Sustainable Funding for Healthy Communities Local Health Trusts: Structures to Support Local Coordination of Funds

Sustainable Funding for Healthy Communities Local Health Trusts: Structures to Support Local Coordination of Funds Sustainable Funding for Healthy Communities Local Health Trusts: Structures to Support Local Coordination of Funds Executive Summary In the wake of enactment of the Affordable Care Act, the Trust for America

More information

How an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics

How an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics Success Story How an ACO Provides and Arranges for the Best Patient Care Using Clinical and Operational Analytics HEALTHCARE ORGANIZATION Accountable Care Organization (ACO) TOP RESULTS Clinical and operational

More information

Artificial Intelligence Changes Evidence Based Medicine A Scalable Health White Paper

Artificial Intelligence Changes Evidence Based Medicine A Scalable Health White Paper Artificial Intelligence Changes Evidence Based Medicine A Scalable Health White Paper TABLE OF CONTENT EXECUTIVE SUMMARY...3 UNDERSTANDING EVIDENCE BASED MEDICINE 3 WHY EBM?.....4 EBM IN CLINICAL PRACTICE.....6

More information

Providence Hood River Memorial Hospital 2010 Community Assets and Needs Assessment Report

Providence Hood River Memorial Hospital 2010 Community Assets and Needs Assessment Report Providence Hood River Memorial Hospital 2010 Community Assets and Needs Assessment Report Produced by Lauren M. Fein, M.P.H. How the study was conducted Every three years, Providence Hood River Memorial

More information

Executive Summary 1. Better Health. Better Care. Lower Cost

Executive Summary 1. Better Health. Better Care. Lower Cost Executive Summary 1 To build a stronger Michigan, we must build a healthier Michigan. My vision is for Michiganders to be healthy, productive individuals, living in communities that support health and

More information

January 04, Submitted Electronically

January 04, Submitted Electronically January 04, 2016 Submitted Electronically Mr. Andy Slavitt Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G, Hubert H. Humphrey Building

More information

UC HEALTH. 8/15/16 Working Document

UC HEALTH. 8/15/16 Working Document 1) UC Health Mission Our mission is to make health care better. Each UC health system works to advance this mission in its community and as a system of health systems, we work together to catalyze innovation

More information

WHITE PAPER. Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice

WHITE PAPER. Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice WHITE PAPER Maximizing Pay-for-Performance Opportunities Proven Steps to Making P4P a Proactive, Successful and Sustainable Part of Your Practice Maximizing Pay-for-Performance Opportunities In today s

More information

Rural Health Disparities 5/22/2012. Rural is often defined by what it is not urban. May 3, The Rural Health Landscape

Rural Health Disparities 5/22/2012. Rural is often defined by what it is not urban. May 3, The Rural Health Landscape 5/22/2012 May 3, 2012 The Rural Health Landscape Alan Morgan Chief Executive Officer National Rural Health Association National Rural Health Association Membership 2012 NRHA Mission The National Rural

More information

1875 Connecticut Avenue, NW, Suite 650 P Washington, DC F

1875 Connecticut Avenue, NW, Suite 650 P Washington, DC F June 27, 2016 The Honorable Sylvia Matthews Burwell Secretary, U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 Mr. Andy Slavitt Acting Administrator, Centers

More information

What is a Pathways HUB?

What is a Pathways HUB? What is a Pathways HUB? Q: What is a Community Pathways HUB? A: The Pathways HUB model is an evidence-based community care coordination approach that uses 20 standardized care plans (Pathways) as tools

More information

Jumpstarting population health management

Jumpstarting population health management Jumpstarting population health management Issue Brief April 2016 kpmg.com Table of contents Taking small, tangible steps towards PHM for scalable achievements 2 The power of PHM: Five steps 3 Case study

More information

Oregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority

Oregon s Health System Transformation: The Coordinated Care Model. March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority Oregon s Health System Transformation: The Coordinated Care Model March 2014 Jeanene Smith MD, MPH Chief Medical Officer- Oregon Health Authority The Challenges Oregon Faced Rising healthcare costs outpacing

More information

NextGen Population Health TEN TEN TEN TEN TE. Prevent Patients from Falling Through the Cracks in 10 Easy Steps

NextGen Population Health TEN TEN TEN TEN TE. Prevent Patients from Falling Through the Cracks in 10 Easy Steps NextGen Population Health TEN TEN TEN TEN TE Prevent Patients from Falling Through the Cracks in 10 Easy Steps Proactive, automated patient engagement anytime, anywhere. Automate care management to improve

More information

Addressing Social Determinants of Health: Connecting People with Complex Needs to Community Resources

Addressing Social Determinants of Health: Connecting People with Complex Needs to Community Resources Advancing innovations in health care delivery for low-income Americans Enhancing Complex Care Beyond the Walls of a Clinical Setting Series: Addressing Social Determinants of Health: Connecting People

More information

Midmark White Paper Building Your Connected Point of Care Ecosystem. Point Of Care Ecosystem Series Part Four

Midmark White Paper Building Your Connected Point of Care Ecosystem. Point Of Care Ecosystem Series Part Four Midmark White Paper Introduction Before embarking on any construction project, it is always a good idea to have a set of blueprints or a detailed plan to guide progress and ensure alignment with objectives.

More information

Re: Health Care Innovation Caucus RFI on value-based provider payment reform, value-based arrangements, and technology integration.

Re: Health Care Innovation Caucus RFI on value-based provider payment reform, value-based arrangements, and technology integration. August 15, 2018 The Honorable Mike Kelly The Honorable Ron Kind U.S. House of Representatives U.S. House of Representatives 1707 Longworth House Office Building 1502 Longworth House Office Building Washington,

More information

IMPROVING AND TEACHING POPULATION HEALTH

IMPROVING AND TEACHING POPULATION HEALTH IMPROVING AND TEACHING POPULATION HEALTH J. Lloyd Michener, MD Professor and Chair Department of Community and Family Medicine Director, Duke Center for Community Research Duke University Health System

More information

COLLABORATING FOR VALUE. A Winning Strategy for Health Plans and Providers in a Shared Risk Environment

COLLABORATING FOR VALUE. A Winning Strategy for Health Plans and Providers in a Shared Risk Environment COLLABORATING FOR VALUE A Winning Strategy for Health Plans and Providers in a Shared Risk Environment Collaborating for Value Executive Summary The shared-risk payment models central to health reform

More information

Effective Care for High-Need, High-Cost Patients: How to Maximize Prevention and Population Health Efforts

Effective Care for High-Need, High-Cost Patients: How to Maximize Prevention and Population Health Efforts Effective Care for High-Need, High-Cost Patients: How to Maximize Prevention and Population Health Efforts May 9, 2018 www.hcttf.org 1 Speakers Jeff Micklos Executive Director HCTTF Kelly McCracken National

More information

Washington County Public Health

Washington County Public Health Washington County Public Health Strategic Plan 2012-2016 Message from the Division Manager I am pleased to present the Washington County Public Health Division s strategic plan for fiscal years 2012 to

More information

PCA/HCCN Health Center Program Update

PCA/HCCN Health Center Program Update PCA/HCCN Health Center Program Update National Association of Community Health Centers Community Health Institute August 30, 2016 Tonya Bowers, MHS Acting Associate Administrator Bureau of Primary Health

More information

Leverage Information and Technology, Now and in the Future

Leverage Information and Technology, Now and in the Future June 25, 2018 Ms. Seema Verma Administrator Centers for Medicare & Medicaid Services US Department of Health and Human Services Baltimore, MD 21244-1850 Donald Rucker, MD National Coordinator for Health

More information

Integrating Public Health and Social Services with Delivery System Reform

Integrating Public Health and Social Services with Delivery System Reform Integrating Public Health and Social Services with Delivery System Reform New York State Department of Health Office of Health Insurance Programs Greg, Policy Director October 2015 1 Agenda 1. DSRIP &

More information

Move the Needle on Difficult Quality Measures: How Health Plans Can Control High Blood Pressure

Move the Needle on Difficult Quality Measures: How Health Plans Can Control High Blood Pressure Move the Needle on Difficult Quality Measures: How Health Plans Can Control High Blood Pressure A Centauri Health Solutions Sm White Paper By melanie Richey 2016 by Centauri Health Solutions, Inc. All

More information

1. Standard Contract Provisions [ 438.3(s)(3)]: Ensuring access to the 340B prescription drug program

1. Standard Contract Provisions [ 438.3(s)(3)]: Ensuring access to the 340B prescription drug program July 27, 2015 Centers for Medicare and Medicaid Services Department of Health and Human Services Attn: CMS-2390-P P.O. Box 8016 Baltimore, MD 21244-8016 RE: Proposed Rule for Medicaid and Children s Health

More information

Methodist McKinney Hospital Community Health Needs Assessment Overview:

Methodist McKinney Hospital Community Health Needs Assessment Overview: Methodist McKinney Hospital Community Health Needs Assessment Overview: 2017-2019 October 26, 2016 Prepared by MHS Planning CHNA Requirement: Overview In order to maintain tax exempt status, the Affordable

More information

W. Douglas Weaver, MD, MACC. American College of Cardiology SENATE FINANCE COMMITTEE

W. Douglas Weaver, MD, MACC. American College of Cardiology SENATE FINANCE COMMITTEE Statement of W. Douglas Weaver, MD, MACC On behalf of the American College of Cardiology Presented to the SENATE FINANCE COMMITTEE Roundtable on Medicare Physician Payments: Perspectives from Physicians

More information

Working Together for a Healthier Washington

Working Together for a Healthier Washington Working Together for a Healthier Washington Dorothy Teeter, HCA Director Nathan Johnson, HCA Chief Policy Officer All Alliance Meeting June 9, 2015 By 2019, we will have a Healthier Washington. Here s

More information

Healthy People in a Healthy Economy: A Blueprint for Action in Massachusetts

Healthy People in a Healthy Economy: A Blueprint for Action in Massachusetts U N D E R S T A N D I N G B O S T O N Healthy People in a Healthy Economy: A Blueprint for Action in Massachusetts The Boston Foundation and The New England Healthcare Institute June 2009 About the Boston

More information

COMMUNITY DEVELOPMENT AS A PARTNER FOR HEALTH EQUITY 870 MARKET STREET, SUITE 1255 SAN FRANCISCO, CA

COMMUNITY DEVELOPMENT AS A PARTNER FOR HEALTH EQUITY 870 MARKET STREET, SUITE 1255 SAN FRANCISCO, CA COMMUNITY DEVELOPMENT AS A PARTNER FOR HEALTH EQUITY 870 MARKET STREET, SUITE 1255 SAN FRANCISCO, CA 94102 415.590.3034 PRESENTATION OUTLINE 1. Health Happens in Neighborhoods 2. What is Community Development?

More information

Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs

Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs Organization: Solution Title: Calvert Memorial Hospital Calvert CARES: Collaborative Activation of Resources and Empowerment Services Building Programs to Fit Patients vs. Bending Patients to Fit Programs

More information

Population Health Management Tools and Strategies to Support Care Coordination An InfoMC White Paper April 2016

Population Health Management Tools and Strategies to Support Care Coordination An InfoMC White Paper April 2016 Population Health Management Tools and Strategies to Support Care Coordination An InfoMC White Paper April 2016 Norris, Susan, Ph.D., Chief Clinical Officer, InfoMC Daniels, Allen S., Ed.D., Clinical Director,

More information

Lessons from the States: Oregon s APM Model

Lessons from the States: Oregon s APM Model Lessons from the States: Oregon s APM Model F R I D AY, N O V E M B E R 6, 2 0 1 5 2 : 0 0 P M E T C R A I G H O S T E T L E R, E X E C U T I V E D I R E C T O R, O P C A K E R S T E N B U R N S L A U

More information

Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19

Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19 Patient Protection and Affordable Care Act Selected Prevention Provisions 11/19 Coverage of Preventive Health Services (Sec. 2708) Stipulates that a group health plan and a health insurance issuer offering

More information

Measure Applications Partnership (MAP)

Measure Applications Partnership (MAP) Measure Applications Partnership (MAP) Uniform Data System for Medical Rehabilitation Annual Conference Aisha Pittman, MPH Senior Program Director National Quality Forum August 9, 2012 Overview MAP Background

More information

WHITE PAPER. The Shift to Value-Based Care: 9 Steps to Readiness.

WHITE PAPER. The Shift to Value-Based Care: 9 Steps to Readiness. The Shift to Value-Based Care: Table of Contents Overview 1 Value Based Care Is it here to stay? 1 1. Determine your risk tolerance 2 2. Know your cost structure 3 3. Establish your care delivery network

More information

2016 BEHAVIORAL HEALTH GRANT OPPORTUNITY

2016 BEHAVIORAL HEALTH GRANT OPPORTUNITY 2016 BEHAVIORAL HEALTH GRANT OPPORTUNITY A. MICHIGAN HEALTH ENDOWMENT FUND OVERVIEW The Michigan Health Endowment Fund was established to improve the health of Michigan residents and reduce the cost of

More information

Sierra Health Foundation s Responsive Grants Program Proposers Conference Round One

Sierra Health Foundation s Responsive Grants Program Proposers Conference Round One Welcome to Sierra Health Foundation s Responsive Grants Program Proposers Conference 2012 Round One Diane Littlefield Vice President of Programs and Partnerships Matt Cervantes Program Officer 2 Agenda

More information

Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees

Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees TECHNICAL ASSISTANCE BRIEF J UNE 2 0 1 2 Low-Cost, Low-Administrative Burden Ways to Better Integrate Care for Medicare-Medicaid Enrollees I ndividuals eligible for both Medicare and Medicaid (Medicare-Medicaid

More information

Community Development and Health: Alignment Opportunities for CDFIs and Hospitals

Community Development and Health: Alignment Opportunities for CDFIs and Hospitals Community Development and Health: Alignment Opportunities for CDFIs and Hospitals Summary of Chicago Convening: October 21 22, 2015 Overview Expansion in coverage and a shift in payment models from volume

More information

producing an ROI with a PCMH

producing an ROI with a PCMH REPRINT April 2016 Emma Mandell Gray Rachel Aronovich healthcare financial management association hfma.org producing an ROI with a PCMH Patient-centered medical homes can deliver high-quality care and

More information

Highline Health Connections: Care Navigation for Vulnerable Populations

Highline Health Connections: Care Navigation for Vulnerable Populations Highline Health Connections: Care Navigation for Vulnerable Populations WSHA Readmissions Safe Table - Feb 14, 2017 Carolyn Bonner, Director Home Health, Health Connections, Cancer Center, Sleep Center

More information

Draft. Public Health Strategic Plan. Douglas County, Oregon

Draft. Public Health Strategic Plan. Douglas County, Oregon Public Health Strategic Plan Douglas County, Oregon Douglas County 2014 Letter from the Director Dear Colleagues It is with great enthusiasm that I present the Public Health Strategic Plan for 2014-2015.

More information

Oregon s Health System Transformation: Coordinated Care Model. November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer

Oregon s Health System Transformation: Coordinated Care Model. November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer Oregon s Health System Transformation: Coordinated Care Model November 2013 Jeanene Smith MD, MPH OHA Chief Medical Officer The Challenges Oregon Faced Rising healthcare costs outpacing state budget in

More information

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010

The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 The Patient Protection and Affordable Care Act Summary of Key Health Information Technology Provisions June 1, 2010 This document is a summary of the key health information technology (IT) related provisions

More information

Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act

Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act Ashby Wolfe, MD, MPP, MPH Chief Medical Officer, Region IX Centers for Medicare and Medicaid Services

More information

USAID/Philippines Health Project

USAID/Philippines Health Project USAID/Philippines Health Project 2017-2021 Redacted Concept Paper As of January 24, 2017 A. Introduction This Concept Paper is a key step in the process for designing a sector-wide USAID/Philippines Project

More information

POSITION DESCRIPTION

POSITION DESCRIPTION State of Michigan Civil Service Commission Capitol Commons Center, P.O. Box 30002 Lansing, MI 48909 Position Code 1. DEPTALTEZ98N POSITION DESCRIPTION This position description serves as the official classification

More information

Health Centers Overview. Health Centers Overview. Health Care Safety-Net Toolkit for Legislators

Health Centers Overview. Health Centers Overview. Health Care Safety-Net Toolkit for Legislators Health Centers Overview Health Centers Overview Health Care Safety-Net Toolkit for Legislators Health Centers Overview Introduction Federally Qualified Health Centers (FQHCs), also known as health centers,

More information

40,000 Covered Lives: Improving Performance on ACO MSSP Metrics

40,000 Covered Lives: Improving Performance on ACO MSSP Metrics Success Story 40,000 Covered Lives: Improving Performance on ACO MSSP Metrics EXECUTIVE SUMMARY The United States healthcare system is the most expensive in the world, but data consistently shows the U.S.

More information

State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013

State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 The National Association of Medicaid Directors (NAMD) is engaging states in shared learning on how Medicaid

More information

Community Health Needs Assessment & Implementation Strategy

Community Health Needs Assessment & Implementation Strategy Community Health Needs Assessment & Implementation Strategy Fiscal Years 2014 2016 for Beth Israel Deaconess Hospital - Milton This report was prepared by: 95 Berkeley Street, Suite 208 Boston, MA 02116

More information

Definition of Meaningful Use of Certified EHR Technology for Hospitals Approved by the HIMSS Board of Directors April 24, 2009

Definition of Meaningful Use of Certified EHR Technology for Hospitals Approved by the HIMSS Board of Directors April 24, 2009 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Definition of Meaningful Use of Certified EHR Technology for Hospitals Approved by

More information

A strategy for building a value-based care program

A strategy for building a value-based care program 3M Health Information Systems A strategy for building a value-based care program How data can help you shift to value from fee-for-service payment What is value-based care? Value-based care is any structure

More information

Draft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged

Draft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged TO: FROM: RE: State Based Marketplaces State Medicaid Directors Delivery Reform/Value Promoting Colleagues Peter V. Lee, Executive Director Draft Covered California Delivery Reform Contract Provisions

More information

LegalNotes. Disparities Reduction and Minority Health Improvement under the ACA. Introduction. Highlights. Volume3 Issue1

LegalNotes. Disparities Reduction and Minority Health Improvement under the ACA. Introduction. Highlights. Volume3 Issue1 Volume3 Issue1 is a regular online Aligning Forces for Quality (AF4Q) publication that provides readers with short, readable summaries of developments in the law that collectively shape the broader legal

More information

Welcome to. Primary Care and Public Health: Linking Public Health and Advanced Primary Care to Improve Outcomes

Welcome to. Primary Care and Public Health: Linking Public Health and Advanced Primary Care to Improve Outcomes Welcome to ASTHO s Delivery and Payment Reform Technical Assistance Call Series Primary Care and Public Health: Linking Public Health and Advanced Primary Care to Improve Outcomes Presented by ASTHO and

More information

Opportunity Knocks: Population Health in State Innovation Models

Opportunity Knocks: Population Health in State Innovation Models Opportunity Knocks: Population Health in State Innovation Models John Auerbach, Debbie I. Chang, James A. Hester, Sanne Magnan* August 21, 2013 *Participants in the activities of the IOM Roundtable on

More information

Kaiser Permanente Research A Very Brief Introduction

Kaiser Permanente Research A Very Brief Introduction Kaiser Permanente Research A Very Brief Introduction Michael Horberg, MD MAS FACP FIDSA Executive Director Research, Community Benefit, and Medicaid Strategy; Mid- Atlantic Permanente Medical Group Kaiser

More information

Building Wellness Communities for Chronic Diseases

Building Wellness Communities for Chronic Diseases A Saviance Technologies Whitepaper Building Wellness Communities for Chronic Diseases The Growing Crisis of Chronic Diseases in the US In the US today, an estimated number of people who are suffering from

More information

WHITE PAPER. Taking Meaningful Use to the Next Level: What You Need to Know about the MACRA Advancing Care Information Component

WHITE PAPER. Taking Meaningful Use to the Next Level: What You Need to Know about the MACRA Advancing Care Information Component Taking Meaningful Use to the Next Level: What You Need to Know Table of Contents Introduction 1 1. ACI Versus Meaningful Use 2 EHR Certification 2 Reporting Periods 2 Reporting Methods 3 Group Reporting

More information

Executive Summary: Innovative Medicaid Payment Strategies for Upstream Prevention and Population Health

Executive Summary: Innovative Medicaid Payment Strategies for Upstream Prevention and Population Health Executive Summary: Innovative Medicaid Payment Strategies for Upstream Prevention and Population Health B C Executive Summary: Innovative Medicaid Payment Strategies for Upstream Prevention and Population

More information

State Levers to Advance Accountable Communities for Health

State Levers to Advance Accountable Communities for Health A PUBLICATION OF THE NATIONAL ACADEMY FOR STATE HEALTH POLICY May 2016 State Levers to Advance Accountable Communities for Health Felicia Heider, Taylor Kniffin, and Jill Rosenthal Introduction In an era

More information

Healthcare Executive JULY/AUG 2016

Healthcare Executive JULY/AUG 2016 10 Imperatives for Population Health Management by Laura Ramos Hegwer Taking an organization s population health management capabilities to the next level requires healthcare leaders to boldly rethink

More information

March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program

March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health CMS Change Package: Primary and Secondary

More information

Promoting Interoperability Measures

Promoting Interoperability Measures Promoting Interoperability Measures Previously known as Advancing Care Information for 2017 and Meaningful Use from 2011-2016 Participants: In 2018, promoting interoperability measure reporting (PI) is

More information

Big Data NLP for improved healthcare outcomes

Big Data NLP for improved healthcare outcomes Big Data NLP for improved healthcare outcomes A white paper Big Data NLP for improved healthcare outcomes Executive summary Shifting payment models based on quality and value are fueling the demand for

More information

2012 Community Health Needs Assessment

2012 Community Health Needs Assessment 2012 Community Health Needs Assessment University Hospitals (UH) long-standing commitment to the community spans more than 145 years. This commitment has grown and evolved through significant thought and

More information

Malnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum. May 2015 avalere.com

Malnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum. May 2015 avalere.com Malnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum May 2015 avalere.com Malnutrition Has a Significant Impact on Patient Outcomes MALNUTRITION IS ASSOCIATED WITH

More information

NATIONAL HEALTH INTERVIEW SURVEY QUESTIONNAIRE REDESIGN

NATIONAL HEALTH INTERVIEW SURVEY QUESTIONNAIRE REDESIGN National Center for Health Statistics NATIONAL HEALTH INTERVIEW SURVEY QUESTIONNAIRE REDESIGN Marcie Cynamon, Director Stephen Blumberg, Associate Director for Science Division of Health Interview Statistics

More information

Covered California s Core Building Blocks for Improving Quality and Lowering Costs

Covered California s Core Building Blocks for Improving Quality and Lowering Costs Covered California s Core Building Blocks for Improving Quality and Lowering Costs Strengthen valuebased, patientcentered benefit design to improve access to primary care. Require providers to meet quality

More information

June 27, Dear Secretary Burwell and Acting Administrator Slavitt,

June 27, Dear Secretary Burwell and Acting Administrator Slavitt, June 27, 2016 The Honorable Sylvia Matthews Burwell Secretary, U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 Mr. Andy Slavitt Acting Administrator, Centers

More information

Introduction Patient-Centered Outcomes Research Institute (PCORI)

Introduction Patient-Centered Outcomes Research Institute (PCORI) 2 Introduction The Patient-Centered Outcomes Research Institute (PCORI) is an independent, nonprofit health research organization authorized by the Patient Protection and Affordable Care Act of 2010. Its

More information

LEGISLATIVE REPORT NORTH CAROLINA HEALTH TRANSFORMATION CENTER (TRANSFORMATION INNOVATIONS CENTER) PROGRAM DESIGN AND BUDGET PROPOSAL

LEGISLATIVE REPORT NORTH CAROLINA HEALTH TRANSFORMATION CENTER (TRANSFORMATION INNOVATIONS CENTER) PROGRAM DESIGN AND BUDGET PROPOSAL LEGISLATIVE REPORT NORTH CAROLINA HEALTH TRANSFORMATION CENTER (TRANSFORMATION INNOVATIONS CENTER) PROGRAM DESIGN AND BUDGET PROPOSAL SESSION LAW 2015-245, SECTION 8 FINAL REPORT State of North Carolina

More information

Health System Leadership to Address Population Health & Reducing Disparities

Health System Leadership to Address Population Health & Reducing Disparities Health System Leadership to Address Population Health & Reducing Disparities Andrew Shin, JD, MPH Chief Operating Officer Health Research & Educational Trust American Hospital Association 1 Changes in

More information

Fact Sheet: Stratifying Quality Measures BY RACE, ETHNICITY, PREFERRED LANGUAGE, AND COUNTRY OF ORIGIN

Fact Sheet: Stratifying Quality Measures BY RACE, ETHNICITY, PREFERRED LANGUAGE, AND COUNTRY OF ORIGIN MINNESOTA STATEWIDE QUALITY REPORTING AND MEASUREMENT SYSTEM Fact Sheet: Stratifying Quality Measures BY RACE, ETHNICITY, PREFERRED LANGUAGE, AND COUNTRY OF ORIGIN Overview Minnesota s 2008 Health Reform

More information

21 st Century Health Care: The Promise and Potential of a Learning Health System

21 st Century Health Care: The Promise and Potential of a Learning Health System 21 st Century Health Care: The Promise and Potential of a Learning Health System Carolyn M. Clancy, MD Director Agency for Healthcare Research and Quality National Science Foundation Learning Health System

More information

States of Change: Expanding the Health Care Workforce and Creating Community-Clinical Partnerships

States of Change: Expanding the Health Care Workforce and Creating Community-Clinical Partnerships States of Change: Expanding the Health Care Workforce and Creating Community-Clinical Partnerships Thursday, November 7, 2013 12:00 1:30 pm ET Sponsored by Merck Foundation www.alliancefordiabetes.org

More information

Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care

Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care Value-Based Payments 101: Moving from Volume to Value in Behavioral Health Care Nina Marshall, MSW Senior Director, Policy and Practice Improvement NinaM@TheNationalCouncil.org Bill Hudock Senior Public

More information

Integration of Clinical Care and Public Health Systems: The need as reflected in the work of the Alliance to Reduce Disparities in Diabetes

Integration of Clinical Care and Public Health Systems: The need as reflected in the work of the Alliance to Reduce Disparities in Diabetes Integration of Clinical Care and Public Health Systems: The need as reflected in the work of the Alliance to Reduce Disparities in Diabetes Moderator and Presenter Belinda W. Nelson, PhD Center for Managing

More information

Population Health: Physician Perspective. Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015

Population Health: Physician Perspective. Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015 Population Health: Physician Perspective Kallanna Manjunath MD, FAAP, CPE Medical Director AMCH DSRIP September 24, 2015 Population Health: Physician Perspective Presentation objectives: Brief Bio Population

More information

Aligning Forces for Quality in Albuquerque

Aligning Forces for Quality in Albuquerque Aligning Forces for Quality in Albuquerque A Community Snapshot Albuquerque s diverse culture can be attributed to its long history. The area had been populated and cultivated by Native Americans for thousands

More information

BUSINESS CASE STUDY: Johnson & Johnson

BUSINESS CASE STUDY: Johnson & Johnson BUSINESS CASE STUDY: Johnson & Johnson Company Overview Sector: Manufacturing (Pharmaceuticals, medical devices, and other products) Number of Employees: 126,500 Headquarters: New Brunswick, New Jersey

More information

Health Information Technology

Health Information Technology ACO Congress Oct 25, 2010 Los Angeles, CA Patient Centered Medical Home and Accountable Care Organizations Health Information Technology David K. Nace MD, Medical Director, McKesson Corporation Co-Chair,

More information