WA STATE HEALTH CARE INNOVATION MODEL INITIATIVE Center for Medicare and Medicaid Innovation (CMMI) GRANT APPLICATION For Bree Collaborative Monday, October 1, 2012 Jason T. McGill Executive Policy Advisory Governor s Executive Policy Office Agenda State Innovation Models (SIM) Background Grant Model Test Overview of Washington s Proposal Bree s role OB Alliance s role managing chronic conditions Timeline and Next Steps Questions 2 1
Background The Centers for Medicare & Medicaid Services (CMS) Innovation Center issued a new grant opportunity. $275 million competitive fundingfor for states to design OR test multi payer payment and delivery models that deliver high quality health care and improve health system performance. Model Design Grant total of $50 million available for up to 25 states, 6 months duration Model Testing Grant total of $225 million available, up to 5 states, Three to four years duration Governor must submit only one 3 Model Testing Objectives Systemic Change Long term impact to achieve Triple Aim Improves the Experience of Care Improves the Health of Populations Reduces per capita costs of health care The Proposal (Triple Aim) Foster the role of consumers and communities in shaping the health care system; Use multi payer quality and cost data with regular feedback tools to reduce variation; Incentivize the shift from high cost, low value services to high value, lower cost care; Fully link payment to quality including integration i of professional, facility practices; Utilize best practices learned from delivery and transfer learning's to the medical homes model; Make transparent reporting of metrics and outcomes broadly available. 4 2
Our Proposal With this grant, Washington will: 1. Reform payment by shifting from fee for service to new payment methods that provide incentives for professionals and facilities to work together to achieve Triple Aim; 2. Build on our state s quality collaboratives, the Bree Collaborative (Bree) and the Puget Sound Health Alliance (Alliance), to develop quality and utilization metrics and evaluation criteria; and 3. Start this effort with the work that the collaboratives already initiated: 1. obstetrics/deliveries (Bree); and 2. managing chronic conditions (Alliance). 5 Vision To continue using the collaboratives and the strong evidence based medicine foundation we have in WA to: 1. Further the development and adoption of evidencebased practices; 2. Develop robust and transparent metrics to turn dt data into information for payers and consumers; 3. Fully implement quality payment reform; and 4. Apply these reforms to other low value, higher cost treatments and episodes of care. 6 3
Structure 7 Diagram of Washington Model 8 4
Bree role Initial Payment Reform for OB: Use the Collaborative s recent obstetrics report. Develop payment methods to promote best practices (reduced unnecessary C sections and labor inductions). Next steps: Establish bundled payment to combine doctor and facility fees and incentivize providers and hospitals to provide the most appropriate care to mother and baby. Use (establish) quality metrics Select next episode of care to reform http://hrsa.dshs.wa.gov/evidencebasedmedicine/oboutcomes.shtml 9 Proposed OB model: The following table presents an approximate dollar amount per care episode for each live birth by provider category. Delivery Type Prof Facility Rad & Imag Lab OP Drug Total Cesarean $3,500 $5,800 $800 $400 $500 $11,000 Vaginal $2,700 $3,700 $600 $300 $400 $7,700 Model: The payer and providers would set a global budget and use quality and utilization metrics to differentiate payment (cost) increases. The above five provider categories would collectively constitute a virtual delivery system that is clinically and financially accountable for the OB episode of care. The rate of increase will be set at the same percentage for all provider categories within the episode of care, based on performance during each episode. Results: Incentivizing quality breaks down silos, rewards all members of an accountable delivery system equally, and encourages cooperation among the professionals and facilities to achieve common quality and outcome goals. By linking quality and costs, the local delivery systems have motivation to problem solve and participate in quality improvement initiatives. 10 5
Alliance role Managing Chronic Conditions: Coordinate implementation of chronic care health homes across multiple payers. The goal is to focus attention on the 5% of patients who account for 50% of health spending or those at risk ikfor chronic conditions. 11 Managing Chronic Conditions model Key elements include: The Alliance convening a collaborative to build on existing medical home efforts, catalogue existing quality measures and develop new ones; Participating payers and providers agreeing to adopt the quality measures and structure payment incentives within plans business models; Participating payers and providers agree to publish provider feedback reports to track performance; and The plans and providers will agree to secure data reporting for academic evaluation and research through the University of Washington (UW) and others to ultimately inform us on what works and what may not for future improvement. 12 6
Chronic Care Model developed by Edward Wagner, M.D. 13 State Innovation Models Initiative Timeline: Final Grant Application was submitted to CMS/CMMI on September 22, 2012. Asked for $34 million to accomplish (grant ranges from $20 60 million) Decision expected in December. If awarded, work begins immediately, with at most 6 month start up. May be awarded a $2 million design grant, if CMMI believes more work is necessary. 14 7
More Information & Grant Application The CMMI Innovation grant application website: http://www.hca.wa.gov/innovation.html 15 Questions? 16 8