Population Health Update 2.1.2019 Board of Trustee Retreat 1 2 - PowerPoint PPT Presentation

Population Health Update 2.1.2019 Board of Trustee Retreat 1

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Topics  AHS Population Health Activities  Epic and Population Health  Population Health Horizon 3

AHS Population Health Activities 4

Population Health SBU Activities Caring Healing Adopt Risk Help Address Transition to Partner to Stratification Social Risk-Based Enhance Our M Mission ssion and Business Determinants Reimburse- Access and Intelligence of Health ment Capacity Tools Serving Teaching All Population health is a AHS-wide strategy involving the entire continuum of care 5

Key Questions  What has AHS achieved to date in its journey toward population health?  Has it been successful in those efforts?  What opportunities still exists? 6

Context Reimbursement is a significant driver in health care delivery system decisions and transformation 7

Value-Based Payment (VBP)  Health care payors hold health care delivery systems accountable for both quality and cost of care  Primary VBP mechanism is contracting - aim is to enhance population health management that improve health and/or systemic cost containment  Uses alternative payment models or pay-for-performance arrangements to create incentives and disincentives by tying compensation to certain performance measures intended to encourage better health care decision- making  Focused on both:  Effective Healthcare - right patient, treatment, time, professional = right outcome  Efficient Healthcare - clinical & administrative work flows 8

Alternative Payment Model  Alameda Health System (AHS) Medi-Cal Managed Care fee-for-service provider with both health plans since 1997  2020 Medi-Cal Waiver - PRIME Alternative Payment Model (APM) requirement  Penalties associated with not meeting requirements (reduction in PRIME funding)  As of January 2019, 60,500 managed care lives – 80% Alameda Alliance for Health and 20% with Anthem Blue Cross 9

AHS Movement to Financial Risk (Compliance with State APM Requirement) APM Component How AHS Meets Requirement Defined Population Alameda Alliance managed care members assigned to AHS medical home Quality Component Alameda Alliance Quality Improvement P4P Program Financial Risk Primary care capitation Phased Implementation (Primary Care Capitation) Eastmont – Highland – Planning Alliance Alliance Initiated Members – 12K Members 14K (9.2017) (8.1.2018) (3.1.2019) Newark – Hayward – All Wellness Alliance Alliance Centers – Members – 9K Members 13K Anthem (4.1.2018) (12.1.2018) Members (TBD) 10

APM Performance Metrics  For State APM, Alameda Alliance requires AHS to meet additional performance metrics related to primary care access at Wellness Centers:  Initial Health Assessment  Primary Care Visits  In-Network Specialty Utilization  Third Next Available Appointment: Return Visits  Emergency Department Visits per 1,000  Updated baseline and improvement targets provided to AHS for each Wellness Center in January 2019  If AHS meets, add’l 5% payout to AHS; if AHS doesn’t meet, 5% claw back (risk-based arrangement)  AHS has developed a tracking tool; Ambulatory Care staff have access to outreach lists based on patient primary care utilization 11

IHA Outreach Activities  Welcome to our system! …and come in for Initial Health Assessments (new Medi-Cal managed care patients)  Outreach to patients due for appointments via new registries and dashboards  Call center activity in follow-up to mailed letters 12

IHA Outreach Results  Outreach efforts to new managed care members hampered by contact information (telephone and address) that may not be accurate and current  Restrictive federal laws on texting – individuals must opt-in as opposed to opting-out  E-mail addresses are readily available – exploring possibilities post-Epic Letters Call Center Activity Results from Completed Calls Letters Mailed Calls to Calls Calls Unable to 1st & 2nd Appts All (IHA due in Make Incomplete Completed Reach/Pt. Call Scheduled Results Dec 2018 & or Pending Declined/ Attempts Jan 2019) Transferred /Left Msg Care/Inactive 1,028 1,028 234 794 286 468 40 794 100% 23% 77% 36% 59% 5% 100% 13

AHS Accomplishments - APM What’s Worked What’s Continued Watch  Met State requirement for APM  Outreach activities – will assess if other strategies should be approached  Infrastructure improvements  County-wide, collaborative  Fulfilled internal timeline for approach to Medi-Cal managed transitioning Wellness Centers to care outreach capitation – working collaboratively with Alameda  Tracking performance on primary Alliance access metric  No negative financial impact – AHS continues to get Federally Qualified Health Centers rate for capitated Wellness Centers 14

Key Questions  Given that AHS has fulfilled State APM requirement under 2020 Medi-Cal Waiver, should AHS receive VBP/risk-based payments for other services?  What is the ideal ratio between fee-for- service and value-based reimbursement? 15

Specialty Care Capitation  Population health strategy to better coordinate care, address out-of-network utilization and reduce fragmentation  Capitating specialty care is more complex than capitating primary care  Factors under consideration  Range of AHS specialty services versus Medi-Cal covered benefits  Division of Financial Responsibility  Financial analysis and capitation rate development  Provider contracting needed for services AHS does not provide  Infrastructure – claims adjudication, medical management (utilization, quality, etc.)  Management service organization (‘build’ vs ‘buy’ decision) part of feasibility analysis  Timing  Work on feasibility analysis begins in Spring 2019  Any specialty care capitation, if determined feasible, would have post-Sept. 2019 Epic go-live 16

Global Capitation  Capitation for all services (primary, specialty and inpatient) with exception of carve-outs and services managed by health plan (e.g., pharmacy)  Capitation would mean that AHS would be responsible for paying for emergency and inpatient services received by managed care members at non-AHS facilities  Recommended decision not to pursue due to:  Significant out-of-network costs  State Department of Managed Health Care proposal that entities assuming "global risk" obtain licensure as a health care service plan  Infrastructure needs 17

Factors Impacting Health Genetics & Biology, 10% Environment, 10% Social & Economic Factors, 40% Clinical Care, 10% A determinant is an underlying factors that ultimately bring Health Behaviors, about disease. 30% 18

Population Health Challenge 80% - 90% of the issues surrounding health are not within the control of the health care delivery system — socio-economic conditions and the choices patients have based on the environment they live in every day are key factors 19

Meeting Social Needs differs from Addressing Social Determinants  Addressing social determinants of health is important to achieving greater health equity (everyone has a fair and just opportunity to be healthier)  Conditions in which people are born, grow, live, work and age drive social determinants  Health care programs that offer food, transportation, temporary housing, etc. are valuable and are less costly than continually providing health care services to high utilizers  These strategies mitigate the acute social and economic challenges of individual patients  Important to recognize and support community-level policy actions for systemic change Brian Castrucci and John Auerbac, “Meeting Individual Social Needs Falls Short Of Addressing Social Determinants Of Health, " Health Affairs Blog, January 16, 2019. DOI: 10.1377/hblog20190115.234942 20

Addressing Housing Needs Medically Complex Patients  Incidence of homelessness  Rate of self-reported homelessness – an estimated 6% (7,100) of AHS patients (excl. community hospital data)  Of those 1,750 (25%) are homeless patients aged 60 and over (excluding community hospital data)  Rationale for AHS intervention  Homeless people’s health status will never improve while they remain homeless  Homeless people are extraordinarily expensive for health systems - the cost of providing/ facilitating housing is less expensive than the cost of doing nothing  Housing programs help health systems improve health outcomes for their communities  Health equity - Homeless and housing as a health care/public health issue  AHS current activities  Contracts with independent living facilities, licensed board and care facilities, a motel and a respite provider  Retained consultant to help explore options related to creating access to community-based housing opportunities 21