Community Health Partnership. Improving the health of our community through collaboration

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1 Community Health Partnership Improving the health of our community through collaboration

2 Working Together 101 co a li tion 1. an alliance or union between groups, factions or parties, especially for a specific reason, 2. the union of a mass of separate bodies

3 Improving Health through Collaboration A twenty year old coalition Built on a foundation of trust aligned with mutual values and goals All major health care providers are members, with executive leadership actively engaged

4 Doing What s Best for Our Community Connecting donated medical services to more than 1,300 uninsured residents annually Providing access to medications for more than 1,200 people each year Coordinating care for 19,000 Medicaid members currently

5 Keeping Health Care Local Health care reform drives communities to take ownership of health care delivery and outcomes

6 A Perfect Storm By 2020, two thirds of the American public will get their health care from a government sponsored program Fee for Service = Fee for Volume

7 Accountable Care Model Pay for value, not volume Higher quality at a lower cost Proactive by design, not reactive by design Marriage of payment reform and delivery reform Improved health, lower cost, better patient experience

8 The RCCO Regional Collaborative Care Cooperatives Colorado divided into seven regions having equal Medicaid populations Different ACO models in different regions

9 A local response to health care reform A community based ACO for Medicaid

10 How is an ACO like a Unicorn? Everyone seems to know what it looks like, but no one has actually seen one!

11 Founding Members Memorial Health System (2 hospitals) Penrose St. Francis Health Services (2 hospitals) Colorado Springs Health Partners (CO s largest multispecialty group) Peak Vista Community Health Centers (federally qualified CHC) AspenPointe Behavioral Health (community mental health) El Paso County Public Health El Paso County Medical Society Rocky Mountain Health Care Services (PACE program) Mountain View Medical Group (specialty & primary care group) Pikes Peak Hospice & Palliative Care

12 Pilot Roll Out Initial Phase July 2011 June Primary Care Medical Providers 6,300 Medicaid clients July 2011 (19,000 clients May 2012) Colorado Springs focus community 2/3 adults, 1/3 children Maintain fee for service structure to providers; additional payments to primary care medical homes and RCCOs Expansion Phase July 2012 June Primary Care Medical Providers 60,000 Medicaid clients maximum potential enrollment El Paso, Teller, Park and Elbert Counties Potential shared savings payments Propose payment reform models

13 A Collaborative Approach Chief Medical Officer provided by Peak Vista Contract Manager funded by Penrose St. Francis Financial Manager, Network Development, Service Center, IT Support provided by AspenPointe RCCO CEO provided by CHP Care Management Plan funded by Kaiser Permanente and developed by task force of partners Governance Committee made up of founding partners Fiscal authority provided by CHP Board of Directors

14 Pilot Goals Reduce Emergency Room Visits Reduce Hospital Re Admissions Reduce Outpatient Services (MRI, CT Scans, X Rays) Health improvement goals TBD

15 Model of Care Medical Home Integrated Care Coordination Patient Centered

16 It s about relationships Enhanced access to care Communication between patient and primary care team Comprehensive, coordinated care

17 Looking at the Whole Person Health care plays a surprisingly small role in life expectancy only 10%. 4 in 5 physicians say unmet social needs are directly leading to worse health. Health Care s Blind Side, Robert Wood Johnson Foundation, 2012

18 Coordinated Care Coordinated Care is the core of the ACO model

19 Identifying Risk Stratification of clients by risk (identified by predictive risk and point of care assessments)

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21 The One Question How is your health? Poor Fair Good Excellent

22 Targeted Interventions Health Coaching/Health Literacy Disease Management Tools Shared Decision Making Discharge Follow Up Emergency Department On Site Program Intensive Medical/Psycho/Social Case Management

23 Building a Network Adoption of common standards and expectations for care coordination within the medical neighborhood

24 Collaborative Care Management Mutual Agreement Define responsibilities between PCP, specialist and patient. Clarify who is responsible for specific elements of care (drug therapy, referral management, diagnostic testing, care teams, patient calls, patient education, monitoring, follow-up). Maintain competency and skills within scope of work and standard d of care. Give and accept respectful feedback when expectations, guidelines es or standard of care are not met Agree on type of specialty care that best fits the patient s s needs. Expectations Primary Care Specialty Care Follows the principles of the Patient Centered Medical Home or Medical Home Index. Manages the medical problem to the extent of the PCP s s scope of practice, abilities and skills. Follows standard practice guidelines or performs therapeutic trial of therapy prior to referral, when appropriate, following evidence ce- based guidelines. Reviews and acts on care plan developed by specialist. Resumes care of patient when patient returns from specialist care. Explains and clarifies results of consultation, as needed, with the patient. Makes agreement with patient on long-term treatment plan and follow-up. Reviews information sent by PCP Addresses referring provider and patient concerns. Confers with PCP or establishes other protocol before orders additional services outside practice guidelines. Obtains proper prior authorization. Confers with PCP before refers to secondary/tertiary specialists for problems within the PCP scope of care and uses a preferred list to refer when problems are outside PCP scope of care. Obtains proper prior authorization when needed. Sends timely reports to PCP to include a care plan, follow-up and results of diagnostic studies or therapeutic interventions. Notifies the PCP office or designated personnel of major interventions, emergency care or hospitalizations. Prescribes pharmaceutical therapy in line with insurance formulary with preference to generics when available and if appropriate to patient needs. Provides useful and necessary education/guidelines/protocols to PCP, as needed

25 Measuring Progress Consistent metrics across medical homes and the broader medical neighborhood Dashboards

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27 Data Sharing Use of common HIPPA compliant electronic communication tool for referrals

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30 Key Challenges Lack of Medicaid enrollment stability, i.e. Churn Integrating mental and dental care Access to specialists Payment reform is critical

31 What s Next? Payment reform Policy reform Expansion to other populations Prevention & wellness moving upstream

32 Transformation Takes Time The price of doing the same old thing is far higher than the price of change. Bill Clinton