The Role of Healthcare Improvement Collaboratives in an ever Changing Health Landscape

Transcription

1 The Role of Healthcare Improvement Collaboratives in an ever Changing Health Landscape March 23, 2017 HFMA Spring Meeting Carrie Baker, President & CEO

2 Objectives Describe a regional healthcare improvement collaborative broadly and understand Healthcare Collaborative of Greater Columbus specifically; Understand how healthcare improvement collaboratives are responding to support partners practice and learning as healthcare continuously evolves; Recognize emerging projects in the regional Columbus health landscape.

3 Our Collaborative Process Apply collaborative learning ~spread knowledge~ Measure actionable results ~collective impact~ Build collaborations among public and private partners ~trust~ catalyzing healthcare value improvement Catalyze best practices ~awareness~ Convene diverse stakeholders ~exploration~ Coordinate activities that improve value ~commitment~

4 Our Public-Private Board of Directors Mike Stull (Board Chair) Employers Health, Business Representative Dianne Radigan (Board Vice Chair) Cardinal Health, Franklin County Representative Bill Wulf, M.D. (Board Secretary) Central Ohio Primary Care, Columbus Medical Association Representative Doug Anderson (Board Treasurer) Bailey Cavalieri, City of Columbus Representative Carrie Baker (President beginning 1/1/2017) nonvoting, ex-officio Dianne Biggs Labor Representative Tara Britton The Center for Community Solutions, United Way of Central Ohio Representative Sarah Durfee, RN Ohio Public Employees Retirement System, Purchaser Representative L. Arick Forrest, MD, MBA The Ohio State University Wexner Medical Center, Hospital Representative Jeff Geppert Battelle, Health Care Representative Thomas Hadley Wells Fargo Insurance Services, Chamber of Commerce Representative Kevin Hinkle Anthem Blue Cross & Blue Shield, Health Plan Representative Isi Ikharebha Physicians CareConnection, Consumer Representative Karen King, M.D. Northwest Ob/Gyn, Columbus Medical Association Foundation Representative Teresa Long, M.D. Columbus Public Health, Health Department Representative Tani Mann The Dispatch Printing Company, Employer Representative Julie Erwin Rinaldi Syntero, Behavioral Health Representative Valerie Ruddock Nationwide Children s Hospital, Hospital Representative Greg Sawchyn, M.D. OhioHealth, Hospital Representative Bruce Wall, M.D. Aetna, Columbus Medical Association Representative Todd Weihl, D.O. OhioHealth, Columbus Osteopathic Association Representative ww.hcgc.org

5 Our Public-Private Funding Partners

6 VISION Optimal health for all people in Greater Columbus MISSION To improve the value* of health care for all people in Greater Columbus by catalyzing collaboration among public and private partners. *Value = quality + consumer experience cost

7 ... catalyzing healthcare value* improvement The Healthcare Collaborative of Greater Columbus is a non-profit, publicprivate partnership. Our mission is to improve the value of health care for all people in Greater Columbus by catalyzing collaboration among public and private partners. The value of our current healthcare situation is not acceptable in terms of quality, cost, and the consumer experience. We strive for win-win solutions recognizing that change is required by all. We believe the best solutions come from a collaborative approach we seek no authority in our role as a catalyst/convener/coordinator We work with our public-private partners to address a useful need and avoid duplicating the collaborative work of others in the region. *value = (quality + consumer experience) cost

8 Patient-Centered Medical Homes ( ) advancing high-value primary care to improve access, care coordination, and patient engagement Value-based Behavior (2017+) aligning value-based decision making among providers, purchasers, social services and their consumers Medical Neighborhood (2014+) advancing accountable care coordination across clinical and social service organizations Quality Transparency (2014+) advancing the measurement and sharing of data to improve quality strong adoption of Patient-Centered Medical Homes as a foundation of value-based healthcare in policy, delivery & payment systems Collaborative Learning (2009+) hosting safe space with regional partners to explore results-based practices and apply learning To improve the value* of health care for all people in Greater Columbus by catalyzing collaboration among public and private partners. *value = (quality + consumer experience) cost

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10 NRHI Members

11 A Three Pronged Approach: How do we embed the definition of value (quality + customer experience/cost) in current work? What new value-based work should we catalyze in 2017? How does HCGC walk the walk and showcase its own value proposition to the region and to partners more effectively?

12 Collaborative Learning: hosting safe space with regional partners to explore results-based practices and apply learning Increase the knowledge of our stakeholders in each respective area of learning. Help stakeholders make sense of healthcare s shift to value-based care delivery and payment. Inform the work of the collaborative. Build and strengthen relationships among regional healthcare stakeholders. Collaborative Learning Groups Regional Learning Sessions Care Coordination Learning Group Quality Improvement Learning Group Behavioral Health Learning Group Purchaser Learning Group

13 Quality Transparency Project: Based on nationally endorsed measures, compile and share all-payer quality data from electronic medical records to: Help health care professionals see where they can improve, enable consumers to make more informed choices about their health and healthcare, and allow purchasers to know the value of the healthcare that they are buying. Align work with existing national, state, and regional quality improvement efforts. Share and apply learning to catalyze the adoption and spread of best practices. Providers Sharing Quality Data Berger Health Partners Central Ohio Primary Care Physicians CompDrug Concord Counseling Services Heart of Ohio Family Health Centers Lower Lights Christian Health Center Mount Carmel Medical Group OhioHealth Physician Group The Ohio State University Wexner Medical Center Primary Care PrimaryOne Health Southeast, Inc. Syntero

14 HCGC Quality Measure NQF CMS CQM Ohio CPC CPC+ Other Controlling High Blood Pressure 0018 CMS165v5 PQRS, ACO, MUII, Million Heart Tobacco Use and Cessation 0028 CMS138v5 PQRS, ACO, MUII, Million Heart Colorectal Cancer Screening 0034 CMS130v5 PQRS, MUII Diabetes Care: Hemoglobin Control Diabetes Care: Nephropathy Care 0059 CMS122v5 PQRS, ACO, MUII 0062 CMS134v5 PQRS, MUII Depression Utilization of PHQ CMS160v5 PQRS, MUII Depression Remission at 12 months Depression Response at 12 months 0710 CMS159v5 PQRS, MUII

15 HCGC Quality Measures Controlling High Blood Pressure: Percent of patients ages with hypertension and whose blood pressure is adequately controlled (<140/90) Tobacco Use: Percent of adult patients who were screened for tobacco use and who received cessation counseling intervention. Colorectal Cancer Screening: Percent of patients ages who had appropriate screening for colorectal cancer. Diabetes Care: Percent of patients ages with diabetes whose most recent HbA1c level was reported as in control. Diabetes Care: Percent of patients ages with diabetes who received a nephropathy screening test or had evidence of nephropathy. Depression Utilization of PHQ-9: Percent of adult patients with major depression or dysthymia who had a PHQ-9 administered during a 4-month period Depression Remission at 12 months: Percent of adult patients with major depression or dysthymia and initial PHQ-9 >9 who demonstrate remission at 12 months. Depression Response at 12 months: Percent of adult patients with major depression or dysthymia and initial PHQ-9 >9 who demonstrate response to treatment at 12 months.

16 Quality Transparency Reporting Quality Improvement reporting: ask partners about measuring behavior change based on QILG discussions (asking for a check box along with data collection to quantify if learning among the group change practice or behavior and measuring it) Adding pediatric measures?

17 Quality Transparency Reporting Quality Improvement Learning Group will include: BH Learning Group Chronic Conditions Group

18 Medical Neighborhood/Care Coordination Asking the referral network about expanding partners, services and increasing payer participation Help us articulate how the referral network is achieving better health and patient outcomes as well as decreasing costs

19 Organizations Participating in Referral Project Alliance Healthcare Partners Central Ohio Area Agency on Aging Central Ohio Diabetes Association Central Ohio Primary Care Charitable Pharmacy of Central Ohio Clintonville-Beechwold Community Resource Center Columbus Free Clinic Equitas Health (formerly ARC Ohio) Helping Hands Health and Wellness Center Kroger Pharmacy La Clinica Latina LifeCare Alliance Lower Lights Christian Health Center Metropolitan Family Care Physicians CareConnection PrimaryOne Health Ripple Life Care Planning Southeast, Inc. Syntero The Breathing Association YMCA of Central Ohio

20 Medical Neighborhood/Care Coordination Care Coordination Summit, November 7, 2017 The Grand, Grandview, Ohio Accountable Health Communities

21 Medical Neighborhood Referral Project: Advancing accountable care coordination across clinical and social service organizations Healthcare Provider Organizations Exchanging Referrals Central Ohio Primary Care Helping Hands Health and Wellness Center Lower Lights Christian Health Center Metropolitan Family Care Mount Carmel Health Partners PrimaryOne Health Southeast, Inc. Syntero

22 Purchaser Learning Group Re-engaging current partners to learn what payer/employer/purchaser needs are to attain value Building key relationships yet-untapped with employers and payers Business First Healthiest Employers connections and presentations New Quarterly Meeting Schedule

23 Emerging Opportunities

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26 2017 Value Based Behavior

27 ACA/Obamacare vs. AHCA/House Republicans Individual Mandate Employer Mandate Premium Subsidies Out of Pocket Subsidies Repeal continuous coverage incentive 30% penalty Repeal Change Subsidy age based vs income Tax credits: Full to $75,000/ $150,000 family Repeal in 2020 Source: NYTimes

28 ACA/Obamacare vs. AHCA/House Republicans Medicaid Expansion Health Savings Accounts Age Restrict Premiums Dependent Covered to 26 Pre-existing Conditions Essential Plan Elements Prohibit Annual/Lifetime Awards Change Maintain until 2020 Cap funding Reduce $ for new post 2020 Change Increase amounts: $6550/$13,100 Change Increase ratio 3/1 to 5/1 Keep Keep Keep Keep Source: NYTimes

29 2017 Calendar Regional Learning Sessions All 8:30-11:30 AM with optional networking lunches May 12, August 25, December 8 Care Coordination Learning Group All 8:30-10:30 AM-coffee/water May 3, August 2, November 1, Quality Improvement Learning Group All 8:30-10:30 AM-coffee/water April 25, July 25, October 26 Purchaser Learning Group All 10-11:30 with boxed lunch March 30, June 8, September 14, December 8 Care Coordination Summit All day 9-4, breakouts, breakfast, lunch, reception, exhibit tables November 7, 2017