Impact Analysis Population Health 2/13/2018. Analysis of Policies, Procedures, and Regulations. Implications on TennCare Program and Contractors

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1 Impact Analysis Findings on Population Health in Medicaid February 13, 2018 Julie Grady, MA Marketing/Technical Communications Specialist 2 Impact Analysis Background TennCare Annual Deliverable Analysis of Policies, Procedures, and Regulations Implications on TennCare Program and Contractors TennCare Determines Topics TennCare Health Plan Meeting 1

3 2017 Impact Analysis Topic: Population Health in Medicaid Medicaid Trends Recent Regulatory Changes in Medicaid, Managed Care Population Health, Population Health Management (PHM) PHM Topics

2 Impact Analysis Topic: Population Health in Medicaid Medicaid Trends Recent Regulatory Changes in Medicaid, Managed Care Population Health, Population Health Management (PHM) PHM Topics Implementations and Innovations 4 Impact Analysis Key Words Focused Actionable Words Representative of Findings Projected Considerations to Innovate Population Health Partnerships Enhanced Evaluation Promotions to Providers and Consumers TennCare Health Plan Meeting 2

3 5 Key Words Call-to-Action 6 Key Words Spread TennCare Health Plan Meeting 3

7 Contribution of Managed Care Medicaid consumers enrolled in risk based MCOs in 2016 Source: Adapted from Paradise, Julia. 2017.

org/medicaid/issue-brief/data-note-medicaid-managed-care-growth-and-implications-of-the-medicaid-expansion/.

4 7 Contribution of Managed Care Medicaid consumers enrolled in risk based MCOs in 2016 Source: Adapted from Paradise, Julia "Data Note: Medicaid Managed Care Growth and Implications of the Medicaid Expansion." KFF. April MMC Rule Medicaid and CHIP Managed Care Final Rule (May 2016) Aligns EQR Requirements for CHIP MCOs, PIHPs, PAHPs, and PCCMs with Medicaid EQR by July 2018 Aligns Key Provisions with Private and MA Plans Improved Care Delivery and Consumer Experience Strengthened Integrity and Accountability (e.g., VBP) Modernized Managed Care with Effective Data Sharing (e.g., HIT) Increased Integration of Behavioral Health with Universal Health Risk Assessments Spread Long Term Services and Supports (LTSS) TennCare Health Plan Meeting 4

9 MMC Rule LTSS Integration by FY2018 Most States Enacted Long Term Care (LTC) in Communities FY2017 2018 Source: HMA. 2017. "HMA Weekly Roundup: Trends in State Health Policy." HMA. October 25.

5 9 MMC Rule LTSS Integration by FY2018 Most States Enacted Long Term Care (LTC) in Communities FY Source: HMA "HMA Weekly Roundup: Trends in State Health Policy." HMA. October Definitions: HCBS= Home- and Community-Based Services; SPA= Children s State Plan Amendment; MLTSS=Medicaid LTSS; PACE= Program of All-Inclusive Care for the Elderly 10 Mental Health Parity Medicaid and CHIP Managed Care Mental Health Parity Rule (May 2016) Facilitates MCO integration of mental health and substance use disorder (SUD) services Increased access to and ensured parity of LTSS Applies parity protections to managed care Medicaid Innovation Accelerator Program (IAP) Offers States targeted technical support in four areas that include mental health integration, LTSS community integration, and SUDs Helps States with data analytics, performance improvement, quality measurement, and VBP TennCare Health Plan Meeting 5

6 11 Other Recent Regulations National Clinical Care Commission Act (Nov 2017) Early Hearing Detection and Intervention Act of 2017 (Oct) Bipartisan Budget Act of 2018 (Feb 9); Division E, The Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act extends the following health initiatives: CHIP through 2027 Pediatric quality measures Education, outreach, and enrollment programs Family to family health information centers Telehealth and Interoperability Community health centers National Health Service Corps 12 Population Health and PHM Population health recognizes multiple factors in health outcomes and examines their distribution PHM is a healthcare system approach: Reduces costs while improving care Helps ensure better outcomes and quality of life Focused on system level variables and interrelated patterns Informs policies and interventions Addresses health concerns of populations Enacts proactive strategies throughout life course Prevents or manages chronic disease and degenerative conditions TennCare Health Plan Meeting 6

7 13 Key Components of PHM Monitoring and Evaluation Meaningful Incentives for Patient/Provider Participation Addressing the Continuum of Care Combine Initiatives and Tools Tailor Programs to Individual Needs Deliver Care Via Multiple Modalities Integrated Behavioral Health and LTC Enhanced Patient Engagement Provider Training and Technology Proactive, Robust Data Collection and Analysis 14 PHM Technology Decision Support Tools Electronic or Personal Health Records (EHRs/PHRs) Database Registries to Designate Participants ONC Online Educational Tool Health IT Playbook Federal Health IT Strategic Plan for TennCare Health Plan Meeting 7

8 15 PHM Telehealth Telehealth using technology as a platform for delivery of health information, monitoring, prevention, or care Telemedicine remotely practicing medicine using some electronic interface Why Needed? 10,000 to 30,000 in physician shortages by 2025 Since 2010, 82 rural hospitals (most in the South) have closed nationwide and as many as 700 could close in the next 10 years 70% of all healthcare visits could be virtual 7 of 10 patients would choose virtual care 80% of telemedicine patients viewed it favorably 16 PHM Telehealth in Practice About half of hospitals practice telemedicine Telestroke, an AHA Class I intervention, common in EDs and trauma Other telehealth: teletrauma, teleburns, teledermatology, and teleicu South Carolina Telehealth Alliance system network Massachusetts General uses video visits by risk Mayo Clinic web based apps for care management and self reporting measures TennCare Health Plan Meeting 8

17 PHM Telehealth in Practice May 2017 Texas became last state to approve telemedicine without prior face to face More healthcare organizations adopt telemedicine 54% in 2014, 71% in 2017 Healthcare

saving $6,500 per patient per year, or $1 billion in 2012 using telehealth California expanded Medicaid to cover teleophthalmology 18 PHM Care Management Care management process and components

9 17 PHM Telehealth in Practice May 2017 Texas became last state to approve telemedicine without prior face to face More healthcare organizations adopt telemedicine 54% in 2014, 71% in 2017 Healthcare Organization Plans 21% said telehealth was a top priority 26% planned to increase patient access through telemedicine 89% said improving outcomes with telemedicine was a top priority VA estimated saving $6,500 per patient per year, or $1 billion in 2012 using telehealth California expanded Medicaid to cover teleophthalmology 18 PHM Care Management Care management process and components Source: Clary, Kathleen. 2017b. "Care Management Part 2 - A Critical Component of Effective Population Health." Health Catalyst. September TennCare Health Plan Meeting 9

10 19 PHM Care Management Study PHM Approach to Diabetes Care Management of Children 44% relative decrease in LOS for patients with DKA 30.9% relative reduction in recurrent DKA admissions 34.4% relative improvement in diabetic patients receiving flu vaccine +90% of patients received annual preventative screening recommended by the American Diabetes Association 20 Partner Researchers Partnering with investigative researchers Address problems translating science into policy Engage researchers and stakeholders in participatory studies to improve population health Ensure appropriate measures of outcomes Prove interventions improve health outcomes and reduce costs TennCare Health Plan Meeting 10

11 21 Partner Researchers NESCSO New England States Consortium Systems Organization Nonprofit collaboration Board of five New England States HHS Commissioners with the University of Massachusetts Medical School and other New England universities Share information and jointly implement Medicaid projects in all participating states: Connecticut, Massachusetts, New Hampshire, Rhode Island, and Vermont 22 Partner ACH Delivery System Accountable Communities for Health (ACH) Combines public health with behavioral health, social services, and community based supports Partners the clinical community within a common geographic area as a coalition Focuses on impacting the health of a community and whole populations TennCare Health Plan Meeting 11

12 23 Partner National Resources CDC Division of Population Health (DPH) provides expertise in PHM through 21 programs including BRFSS the telephone survey Behavioral Risk Factor Surveillance System BAM! Body and Mind website designed for 9 to 12 yearolds on a variety of health topics Self Management Education program for resources on chronic health conditions 6 18 Initiative informs decisions that improve health outcomes and reduce costs by partnering Medicaid and public health leaders 24 Partner National Resources CORIDOR the Collection of Online Resources & Inventory Database: Organized and Readily accessible alerts Practice based resources (e.g., model policies/programs, toolkits Searchable Intervention resources The Community Guide: Interventions Engaging Community Health Workers How Schools Work and How to Work with Schools TennCare Health Plan Meeting 12

13 25 Partner Oral Health Resources The State Oral Health Leadership Institute (SOHLI) Partners Medicaid dental program directors and state oral health program directors First cohort January to December 2017, four states and DC Focuses included Addressing social determinants, e.g., healthy foods, cultural norms, and transportation availability Considering public private partnerships for funding Ensuring whole person care incorporates oral health Reducing opioid abuse subsequent to dental related pain 26 Partner Vision Health Resources Call for collaboration of eye professionals, payers, clinical care systems, public health, and community organizations Eliminate preventable vision loss Ensure quality of life despite chronic vision impairment Address eye care that can impacts mortality, eye disease occurs for the following: 86% of heart condition diagnoses 48% of musculoskeletal disorders 43% of diabetes diagnoses 39% of anemia or mental health conditions 26% of lung disease diagnoses TennCare Health Plan Meeting 13

14 27 Evaluate Considerations PHM depends on trending and analyzing quality data More seamless integration of HIT has enhanced interoperability and data sharing Automating population health benefits providers Monitoring approaches to inform and enhance policy and programs 28 Evaluate Get Local 500 Cities provides small area estimates by city/census tract Chronic disease risk factors Health outcomes Preventive service utilization Auto Updated local data widget Data and maps for all measures by city Comparisons with national rates Multiple categories include annual checkup, dental visit, screenings, and core preventive services TennCare Health Plan Meeting 14

29 Evaluate 500 Cities Model based estimates for visits to a doctor for routine checkup within the past year among adults aged 18 years and older Data Source: National Center for Chronic

instigates improvement projects for declines California Medicaid identifies population specific performance measures, incorporates PDSA Sets targeted range for performance Requires quarterly

15 29 Evaluate 500 Cities Model based estimates for visits to a doctor for routine checkup within the past year among adults aged 18 years and older Data Source: National Center for Chronic Disease Prevention and Health Promotion (NCCD 2017a) * Crude prevalence as opposed to age-adjusted prevalence 30 Evaluate State Examples Kentucky Medicaid trends performance measures and instigates improvement projects for declines California Medicaid identifies population specific performance measures, incorporates PDSA Sets targeted range for performance Requires quarterly submission of improvement plans and plan dostudy act (PDSA) worksheets New Jersey study examined Medicaid consumers also in the state s Homeless Management Information System TennCare Health Plan Meeting 15

16 31 Evaluate State Examples States vary performance improvement projects (PIPs) Multiple health plans in one study Multiple study indicators to capture standard data and other outcome measures Illinois mandated statewide PIP on community based care coordination to improve care coordination and linkage to ambulatory care and community services Kentucky health plans conduct statewide (all MCOs) collaborative PIPs Interventions involved providers, members, and health plans Developed a profile report for ongoing risk monitoring, follow up, and care coordination 32 Evaluate State Examples Behavioral Health Monitoring Louisiana deemed failing October 2017, 45% of professionals did not meet licensing Increased oversight of MCOs behavioral health provider data Initiated desk audits, onsite reviews, and targeted secret shopper calls to verify provider qualifications, licensure, and whether the provider is taking new patients Offered MCOs onsite technical assistance to improve reporting Gave state notices of noncompliance and monetary penalties New Jersey expanded monitoring and tracking of LTSS and HCBS TennCare Health Plan Meeting 16

Evaluate State Examples Comparison of performance measures evaluating adults healthcare quality for

17 33 Evaluate State Examples Comparison of performance measures evaluating children s healthcare quality for managed care plans in EQR technical reports from , , and Evaluate State Examples Comparison of performance measures evaluating adults healthcare quality for managed care plans in EQR technical reports from , , and TennCare Health Plan Meeting 17

35 Promote Multimodal Outreach States enhance provider consumer engagement/education Providers offer clinical follow up and health literacy help MCOs can offer more intensive communications Applied

18 35 Promote Multimodal Outreach States enhance provider consumer engagement/education Providers offer clinical follow up and health literacy help MCOs can offer more intensive communications Applied technology Alternatives to direct patient connections Training healthcare community in multimodal contact MCOs can assist providers with outreach technology and identifying the best solutions In 2017, 90% of providers used phone calls for outreach Only 54% used s, 50% direct mail, and 43% text messages 36 Promote Telehealth Reasons Hesitant Consumers Try Virtual Health Source: Accenture "Voting for virtual health: Why 21st Century consumers want more than 20th Century healthcare." Accenture. w /us-en/_acnmedia/pdf-43/accenture-health-voting-for- Virtual-Health.pdf. TennCare Health Plan Meeting 18

19 37 Promote To Providers California managed care plans promoted complex case management and care coordination teams to PCPs Determined failing measures Identified providers with highest density of members failing to comply Contacted top seven providers Reported patients with medication gaps Recommended follow up with each Improved rates 38 Promote To Community California County Organized Health System (COHS) Combined high volume provider education and engagement with patient engagement and resources Gave high volume providers lists of member patients identified and asked medical groups and clinics to report regular EHR data Collected clinical information at homes for high risk Offered education via clinic pharmacists or nurse educators for newly diagnosed members Tested member engagement in a PDSA cycle TennCare Health Plan Meeting 19

20 39 Promote To Community Kentucky MCO Conducted onsite visits at public health departments Collaborated with school based dental programs Telephoned members with reminders Utah and Virginia provider systems enacted voiceautomated outreach Intermountain Healthcare in Salt Lake City Reduced staff response time Declined ED bounce backs 29.5% and readmissions declined 10% Sentara Healthcare in Norfolk Reduced readmission rates to 6.3% from 21.5% Gained efficiencies in the volume and length of calls 40 Closing Grounded in self management and supported by community partners and enhanced evaluations, population health can ensure quality States and MCOs will need to assist direct care providers Community collaborations can help providers spread cost and time demands, increase coordination and analyses, and improve health outcomes Successful PHM engages MCOs, care teams, communities, patients, and their families This presentation and related material was prepared by Qsource under a contract with the Tennessee Division of TennCare. Contents do not necessarily reflect FHKC policy. 18.EQRTN TennCare Health Plan Meeting 20

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