June 16, 2016 Liz Cinqueonce, Senior Vice President, Southern Prairie Community Care

Transcription

1 Advancing the Triple Aim Through Integrated Care June 16, 2016 Liz Cinqueonce, Senior Vice President, Southern Prairie Community Care

2 Disclosure Liz Cinqueonce reports no actual or potential conflicts of interest associated with this presentation

3 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

4 Integrated Health Partnerships (IHP) Minnesota s Medicaid ACO Model

5 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

6 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

7 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

8 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

9 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; upside 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.

10 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-toyear improvement

11

12 Collaboration of 12 Counties Kittson Marshall Roseau Lake of the Woods Koochiching CHIPPEWA COTTONWOOD JACKSON KANDIYOHI LINCOLN LYON MURRAY NOBLES REDWOOD ROCK SWIFT YELLOW MEDICINE Polk Norman Clay Wilkin Traverse Pipestone Pennington Red Lake Lincoln Rock Grant Stevens Big Stone Lac qui Parle Mahnomen Becker Otter Tail Yellow Medicine Lyon Murray Nobles Clearwater Douglas Pope Swift Kandiyohi Meeker Chippewa Redwood Renville Cottonwood Beltrami Hubbard Wadena Todd Stearns Brown Cass Watonwan Crow Wing Morrison McLeod Sibley Nicollet Benton Sherburne Wright Blue Earth Itasca Mille Lacs Hennepin Carver Scott Aitkin Le Sueur Kanabec Isanti Anoka Rice Waseca Steele Ramsey Dakota Carlton Chisago Washington Goodhue Wabasha Dodge Olmsted Winona Martin Freeborn Jackson Faribault Mower Fillmore Houston Pine Saint Louis Lake Cook

13 Two Organizations, One Mission Enhancing the life and health of people in our communities and across our region.! Joint Powers Organization! 501c-3 Non-Profit Organization! Governed by County Commissioners! Governed by Stakeholders, Partners! Advise SPCC! Partner to Advance Mission! Governance for HIE (SPCLink)! Contracted Entity for IHP! State Certified HIO 13

14 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

15 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)

16 The Four Pillars of SPCC Health equity - access to care and services Southern Prairie Community Care Integrated Community Care INTEGRATED COMMUNITY CARE HEALTH INFORMATION SERVICES POPULATION HEALTH IMPROVEMENT HEALTH EQUITY AND ACCESS Improved population health in our 12-county region Person and Population Quality of Life Information Strategies for Accountable Health

17 PILLAR I: Integrated Community Care 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 17

18 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

19 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

20 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

21 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

22 DDIS: High ED Use ED Count >/= 4 during 12 month observation period. Started June 1, 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.

23 DDIS: High Rx Use Medication count >/= 10 active medications Purpose is to improve medication adherence, safety, and effectiveness 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

24 Year 1: $5.8 Million Saved Attributed Population 22,900 Medicaid Patients Total Cost Avoidance $5.8 million in CY 2014 Average Cost Avoidance $ per person Southern Prairie Dollars To Reinvest $1.39 million paid in CY2015 Quality Bonus and Impact of Final Settlement Calculation 1 Savings Portion Retained by DHS $808,000 additional paid in CY2016 $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 Change resulted in additional savings distributed to SPCC, beyond the quality bonus

25 Year 2: $10.3 Million Saved Attributed Population 25,300 Medicaid Patients Total Cost Avoidance $10.3 million in FY 2015 Average Cost Avoidance $ 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 $ million (pending quality bonus)

26 Questions? Liz Cinqueonce, Senior Vice President, SPCC