Payment and Delivery System Reform Marshall Chin, MD, MPH, Emmy - PowerPoint PPT Presentation

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Solving Disparities Through Payment and Delivery System Reform Marshall Chin, MD, MPH, Emmy Ganos, PhD, Scott Cook, PhD, Peter Milgrom, DDS, Elizabeth Howell, MD, MPP, Len Nichols, PhD, Kathryn Gunter, MPH University of Chicago, Robert Wood Johnson Foundation, University of Washington, Icahn School of Medicine, George Mason University A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Chin Disclosures / Funding  Support for this research was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.  AHRQ T32 HS00084, K12 HS023007, U18 HS023050  Merck Foundation  NIDDK P30 DK092949  Co-Chair, NQF Disparities Standing Committee  CMS (NQF collaboration), CMMI (technical assistance)  Former President, SGIM  AMA, AHA, Joint Commission, Families USA, VA, America’s Essential Hospitals, NACHC, Instit Medicaid Innovation, CDC, AAMC, NCQA, NIMHD A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Learning Objectives  Understand emerging opportunities and issues in reducing disparities by integrating payment and delivery system reform.  Recognize practical implementation issues and potential solutions in implementing payment reform to reduce disparities. A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Agenda  RWJF perspective – Emmy Ganos  Policy background – Marshall Chin, Scott Cook  3 grantees – lessons learned – Peter Milgrom, Elizabeth Howell, Len Nichols  Key stakeholder interviews – Katie Gunter  Discussion - All A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Solving Health Disparities through Payment and Delivery System Reform Notes from Robert Wood Johnson Foundation Emmy Ganos, Ph.D. Program Officer

Building a Building a Culture of Hea Culture of Health lth in America in America

County Health Rankings and Roadmaps Model

Payment + Equity Focus + Care Innovations

Lots of Questions + Finding Answers

Finding Answers: Disparities Research for Change Policy Background Marshall Chin, Scott Cook Finding Answers University of Chicago A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Background  Healthcare disparities persist  Value-based payment – Shift from fee-for-service (volume) to value- based payment (quality) A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform MACRA (Medicare Access and CHIP Reauthorization Act)  2019 – Quality Payment Programs – Merit-Based Incentive Payment System (MIPS) – Advanced Alternative Payment Model (APM )  Quality metrics, Health IT, Cost accountability A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Where’s Equity? A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change RWJF Finding Answers  2005-2014: Focus on care transformation to reduce disparities – Grants – Systematic literature reviews – Technical assistance A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care Chin MH, et al. JGIM 2012; 27(8):992-1000 www.solvingdisparities.org National Academy of Medicine – Systems Practices for Care of Socially At-Risk Populations Centers for Medicare and Medicaid Services – CMS Equity Plan for Improving Quality in Medicare A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Roadmap for Reducing Racial and Ethnic Disparities in Care 1) Recognize disparities and commit 2) Implement QI infrastructure and process 3) Make equity an integral part of quality 4) Design intervention(s) 5) Implement, evaluate, and adjust intervention(s) 6) Sustain intervention(s) Chin MH et al. JGIM 2012; 27:992-1000 A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Business Case A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform 2014-2018  “to develop evidence that payment and delivery system reform designs that at- tempt to manage extrinsic and intrinsic incentives for overall quality and effi- ciency , while also explicitly attempting to reduce health care disparities , can produce positive results for each goal.” 19 DeMeester et al. Health Affairs 2017. A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Payment / Value-Based Purchasing  Pay for performance  Infrastructure - Preventive and primary care – e.g. community health workers  Social determinants of health / population health A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Motivation  Intrinsic – Professionalism – Do the right thing  Extrinsic – Financial – Other rewards A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Policy Context: Payment and Equity  CMS – Equity Plan  Social risk factor adjustment in payment – National Academy of Medicine – HHS Asst. Secretary for Planning and Eval. – National Quality Forum  Need to use multiple policy and payment levers to achieve equity , not just social risk factor adjustment A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform CMS and Private Payors Align the Financial Incentives  Require public reporting of stratified disparities data  Pay for reducing disparities – Include equity accountability measures in payment programs – structure/process/outcome  Strengthen incentives for prevention and primary care – Update MD RVU payment schedule – cognitive – Global payment / shared savings – flow of money – Intersectoral partnerships – Social determinants Chin MH. Creating the business case for achieving equity. JGIM 2016. A National Program of the Robert Wood Johnson Foundation at the University of Chicago

Finding Answers: Disparities Research for Change Solving Disparities Through Payment and Delivery System Reform Align the Financial Incentives 2  Align equity measures across public & private payors  Take care of safety net providers – Adequate payment – Calibrate DSH reductions to insurance expansion – Support for quality improvement – Risk adjustment to create level playing field  Conduct payment and delivery demo projects  Have explicit equity lens - payment and QI A National Program of the Robert Wood Johnson Foundation at the University of Chicago

PREDICT 14-county Quality Improvement Project with a randomized controlled design with primary outcomes of access to dental care and oral health at 2 years r Peter Milgrom, DDS University of Washington dfrc@uw.edu

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Adults Children Oral Health in Oregon’s CCOs – A Metrics Report, March 2017

Oral Health in Oregon’s CCOs – A Metrics Report, March 2017

Delivery System Clinical Electronic findings and notification Community Case Community Patient seen in risk sent to based Management teams assessment Primary Care community prevention assists in engaged if setting entered in Dentist and and treatment triaging to care necessary Electronic Case provided Health Record Management