Connecticut State Innovation Model Health Enhancem ent Com m unity Initiative Population Health Council Planning Kick-Off March 29, 2018 10:00 am – 12:00 pm 1
Meeting ng A Agenda 1. Introductions 2. Public Comments 3. Minutes 4. Updates 5. Introduction to Health Enhancement Community Initiative 6. Closing Comments
DPH PH/OHS U Updates
Introd oduction on to H HMA
HMA T Tea eam + HMA SUBJECT MATTER EXPERTS + HMA CORE TEAM Liddy Kathleen Ciccone, Dorothy David Garcia-Bunuel Bergman, MPA DrPH, RN, MBA Teeter Principal Principal Principal Principal Washington, DC Albany New York Seattle Hope Plavin Cathy Homkey Deborah Zahn, MPH Senior Consultant Principal Principal Albany Albany Albany Carol Cathy Lori Bruce-Fritz Kaufmann Coyner Principal Principal Principal Portland Denver Portland + OTHER SUBJECT MATTER EXPERTS: Cara Henley Ellen Breslin Tom Dehner, JD Airam Actuarial Senior Consultant Principal Managing Principal Albany Boston Boston Social Finance 5
HMA E Exper erience ce Facilitating diverse Quantifying and Synthesizing and stakeholder groups developing key communicating the and committees to recommendations impact of population establish shared vision written documents to health initiatives and solicit input and effectively through actuarial and meaningful communicate to economic modeling engagement stakeholders and leadership teams • Community Healthcare Association of • New York State DSRIP Connecticut • Oregon Health Leadership Council • Connecticut Prevention Services Initiative • Oregon Health Authority – CBO Linkage Model • Pennsylvania Medicaid ACO • Washington Accountable Communities of • Michigan SIM Health • Colorado SIM • New York State SIM 6
Today’s Me Meet eting
Purpose of of ou our D Discu cussio ion • Discuss Health Enhancement Community (HEC) Initiative planning, including: Goals Outcomes Roles Process and timelines • Review questions to be answered over the course of our planning work • Share input on the process and what is critical for success
Health E Enhancement Co Community I Initiative Focuses on creating the conditions that promote and sustain cross-sector community-led strategies focused on prevention. A Health Enhancement Community (HEC) is: • Accountable for health, health equity, and related costs for all Provisional Definition residents in a geographic area Uses data, community engagement, and cross sector activities to • identify and address root causes • Operates in an economic environment that is sustainable and rewards communities for health improvement by capturing the economic value of Improved health Aligns with health improvement work underway in communities, previous and current SIM work, and adds sustainability and scale focus. Many components of the HEC definition are intentionally undefined to accommodate a thoughtful, community-driven planning process.
3 Buc uckets of P Prevention Total Population of Community-Wide Traditional Clinical Innovative Clinical Prevention Prevention Prevention 1 2 3 Increase the use Provide services Implement of evidence- outside the interventions based services clinical setting that reach whole populations Health Care Public Health
Envisioned Core Elements for HECs
Connecticut ut’s He Health S System T Transformation P Path Our Vision for the Future: “To Be” Health Enhancement 3.0 Communities Connecticut’s Current • Accountable for all Accountable Care 2.0 Health System: “As Is” community members • Rewards prevention • Accountable for patient outcomes & lower cost population Fee for Service 1.0 of healthcare & poor • Rewards better healthcare health outcomes, preventive care • Limited accountability • Cooperation to reduce processes, & lower cost of • Pays for quantity without risk and improve health healthcare regard to quality • Shared governance, • Competition on healthcare • Lack of transparency including ACOs, outcomes, experience & • Unnecessary or avoidable employers, non-profits, cost schools, health care • Coordination of care across departments and • Limited data infrastructure the medical neighborhood municipalities • Health inequities • Community integration to • Community initiatives to • Unsustainable growth in address social & address social costs environmental factors that demographic factors affect outcomes that affect health
Key HE y HEC P Plann nning S Strategy: y: P Paym yment R Reform Primary Care Modernization CT Multi-Payer Demonstration Health Enhancement Communities 13
Accountable C e Care Or e Organizations and S nd Sha hared ed Savi vings Program Assignment Patients assigned to ACO based on terms What is an of contract Accountable Care Organization? Distribution Billing ACO responsible for Providers bill dividing bonus A group of doctors, normally receive FFS payments among hospitals, and other payment ACO stakeholders health care providers, who come together voluntarily to give coordinated, Shared Savings Benchmark Payment Total cost of care for high-quality care to Bonuses or penalties assigned population their patients. based on variance of compared to risk- expenditures from adjusted target target expenditures
Op Oppor ortunity ty t to Enhance R ce Reward f for P Preven enti tion on Traditional Savings Based Existing Shared New Shared Community/ on Claims Savings Model Savings Model Prevention Expenditures Savings Based on a Risk- Based on a To Be Adjusted Clinical Determined Measures Benchmark Prevention Benchmark Existing Shared Savings Model • Views improvement on short-time horizon Health Enhancement Communities • Rewards premised on health care utilization and Prevention Service Initiative management of current disease • Limits ability to diversify care teams and provide non- Primary Care Modernization visit methods for patient care support/engagement • Does not adequately reward prevention of disease progression
Op Oppor ortunity ty t to Enhance R ce Reward f for P Preven enti tion on Traditional Savings Based Existing Shared New Shared Community/ on Claims Savings Model Savings Model Prevention Expenditures Savings Based on a Risk- Based on a To Be Adjusted Clinical Determined Measures Benchmark Prevention Benchmark New Shared Savings Model • Views improvement on longer time horizon Health Enhancement Communities • Rewards upstream prevention through social, Prevention Service Initiative environmental, and genomic interventions • Creates need for new measures for quantifying long- Primary Care Modernization term impacts of health/wellness improvement activities • Opportunity to harness non-traditional and private investments
How t the P e Piec eces es Come T Toge gether Develop better community linkages Prevention Addresses CT SIM Service Initiative objectives for CBO linkage model. (PSI) Multi-sector investments that reward Health community Enhancement partners that Communities Community contribute to (HEC) prevention Members Multi-payer outcomes for primary care community Primary Care payment reform members Modernization including increased (PCM) payer investment, bundled payments. Improve access to high-quality primary care
Economic ic B Ben enefits its of of th the H e HECs The Economic Benefit Model Key aspect of HEC Initiative is will quantify the myriad being able to measure specific economic benefits of what the economic benefits and where they HECs do. accrue to assess success and to develop investment strategies HMA will develop an analytical model and a actuarial tool with Airam Consulting to inform the sustainability approach of the HEC model including: • Impact of the HECs on Medicare and other payers, which will be used to pursue a federal partnership • Impact of the HECs on the economy, which will inform other implementation and sustainability strategies
Socia ocial F l Finance Social finance refers to Key aspect of HEC Initiative is investment mechanisms that developing social finance generates financial returns to approaches implement and/or sustain • Not just another project that goes away when the money does social impact. • Multi-payer demonstration • Prevention escrow account • Blending and braiding federal, state • Low-income housing tax credits and local funds • New Markets Tax Credit • Capture and reinvest • Pay for Success/Social Impact Bonds • Community benefit financial • Wellness Trust institutions • Captive insurance • Hospital Community Benefit
Socia ocial F l Finance Mix E Exa xample Multi-Payer Demonstration Local Investments or Wellness Trust Repurposed Sustainability Funds Model Pursued by State and Communities Hospital New Markets Benefit Funds Tax Credits * For illustrative purposes only.
Outcome of the HE HEC I Initiative P Planning P Process A plan that details: • Key, logical, realistic, and actionable components of the HEC initiative • Strategies for implementing and sustaining HECs throughout the state • Evidence of the economic benefit of HECs
Timeline
Reference ce C Communities
Recommend
More recommend
