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Healthcare Transformation

Learning Session

May 23, 2014 8:30-11:30AM

What will it take to

successfully implement Ohio's Public-Private

Healthcare Innovation Plan in Greater Columbus?

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Please save the dates for

scheduled learning sessions

• Webinar: 6/25, 1-2PM Choosing Wisely

• Webinar: 7/23, 1-2PM Open Notes

• In-person: 8/22 & 12/5 8:30-11:30AM

Healthcare Transformation Learning Session

May 23, 2014 8:30-11:30AM What will it take to successfully implement Ohio's Public-Private Healthcare Innovation Plan

in Greater Columbus? The Healthcare Collaborative of Greater Columbus (HCGC) invites you to join colleagues and competitors to apply lessons learned from other regions to help Greater Columbus successfully implement Ohio's Public-Private Healthcare Innovation Plan (aka Ohio's SIM grant). BACKGROUND: A public-private partnership led by the Governor’s Office of Health Transformation has created a sustainable, patient-centered delivery and payment system that will be implemented over the next three to five years. During this time, the state, along with a multi-payer coalition that includes the four private payers who represent 80 percent of the commercial market and Medicaid managed care organizations will launch two models statewide: a patient-centered medical home (PCMH) model and an episode-based payment model. PROGRAM: Welcome & Framing Krista Stock, Healthcare Collaborative of Greater Columbus Jeff Biehl, Healthcare Collaborative of Greater Columbus

Sharing lessons learned from SW Ohio on implementing Comprehensive Primary Care in a multi-payer

environment Introduction Maria Courser, MD, Medical Director, Quality, Mount Carmel Medical Group

Comprehensive Primary Care Speakers Richard Shonk, MD, PhD., Chief Medical Officer, the Health Collaborative Barbara B. Tobias MD, Robert and Myfanwy Smith Professor, Vice Chair Dept of Family and

Community Medicine, University of Cincinnati College of Medicine Medical Director, the Health Collaborative

Panel discussion with speakers (moderated by Jeff Biehl)

Health Plan Provider Purchaser Consumer Mark A. DiCello Regional Vice President, Network Management UnitedHealthcare

Janel D. Grover, MHA Director, Ambulatory Services, The Ohio State University Wexner Medical Center

Sarah M. Durfee, RN, Clinical Programs Officer, Ohio Public Employees Retirement System

Learning session participants will be invited to share questions as healthcare consumers

Sharing lessons learned on implementing episode-based payments in a multi-payer environment

Introduction Bruce Wall, MD, Medical Director, OSU Health Plan

Episode-Based Payment Speaker Adi Kumar, McKinsey & Company

Panel discussion with speaker (moderated by Jeff Biehl)

Health Plan Provider Purchaser Consumer

Barbra Cannon, M.A., MBA, Network Director of Payment Innovation, Anthem Blue Cross and Blue Shield

Greg Sawchyn, MD, MBA, Senior Director - Clinical Guidance Councils, OhioHealth

Lisa Kaiser, CEBS, Director, Central Market & Programs, Health Action Council

Learning session participants will be invited to share questions as healthcare consumers

Sharing reflections on the value of implementing Ohio's Public-Private Healthcare Innovation Plan in

Greater Columbus Introduction

Bill Wulf, MD, CEO, Central Ohio Primary Care

Sharing of diverse perspectives from learning session participants

Panel discussion (moderated by Jeff Biehl)

Health Plan Provider Purchaser Consumer Michelle Mathieu, Vice President, Network Management, Aetna

Sean P. Gleeson, MD, MBA, Medical Director, Partners for Kids and VP Community Health and Wellness, Nationwide Children's Hospital

Mike Stull, MBA, Chief Operating Officer, Employers Health

Learning session participants will be invited to share questions as healthcare consumers

The Healthcare Collaborative of Greater Columbus is a non-profit, public-private partnership. The Collaborative serves as a catalyst, convener, and coordinator of healthcare transformation & learning in Greater Columbus.

www.hcgc.org

Sharing lessons learned from SW Ohio on implementing Comprehensive Primary Care in a multi-payer environment

Richard F. Shonk, M.D., Ph.D.

Chief Medical Officer: The Greater Cincinnati Health

Collaborative, The Greater Cincinnati Health Council,

and HealthBridge

Dr. Richard Shonk has been the Chief Medical Officer (CMO) of The Health Collaborative, the Greater Cincinnati Health Council, and HealthBridge since May of 2013. The three nonprofit health improvement, technology, and hospital service organizations aligned in 2012 under a common CEO. Dr. Shonk leads the quality and performance measurement activities at all three organizations, as well as expanding the programs that contribute to the triple-aim; better health, better care, and lower cost. SW Ohio is one of the few markets in the US that have been involved simultaneously in the Comprehensive Primary Care initiative, Beacon and Regional Extension center activity and has recently achieved Qualified Entity status. Dr. Shonk previously served as Market Medical Director for UnitedHealthcare (UHC) where he greatly improved relations between UHC and the health care provider community, and became a thought leader around measurement, payment reform and the advancement of the Patient Centered Medical Home approach to primary care. He also represented UHC on the Health Collaborative Board, and the Cabinet of HealthBridge. Dr. Shonk practiced as a primary care physician for many years before shifting his career to hospital administration. He served as Medical Director of the Quality Institute at the Cleveland Clinic and is a former Vice President of Quality at Ohio Health System in Central Ohio. Dr. Shonk has served in a leadership role with numerous state-wide organizations in Ohio, including the Ohio Hospital Association and the Ohio Patient Safety Institute. Dr. Shonk serves as co-chair of the Ohio Department of Health’s Ohio Patient Centered Primary Care Council whose mission is to accelerate the expansion of the Patient Centered Medical Home. Dr. Shonk received his Medical Degree from Case Western Reserve School of Medicine and holds a PhD in pharmacology, also from Case Western Reserve.

Barbara B. Tobias, M.D.

Robert and Myfanwy Smith Professor, Vice Chair Dept of Family and Community

Medicine, University of Cincinnati College of

Medicine Medical Director, the Health Collaborative

Barbara B Tobias, MD is a family physician and Medical Director of the Health Collaborative, providing leadership and support to physicians and practices in public reporting, quality improvement and practice transformation initiatives including Aligning Forces for Quality, the Greater Cincinnati Beacon Collaborative and the Comprehensive Primary Care Initiative. She is a clinical advisor to the Greater Cincinnati Health Council and the Accountable Care Transformation Committee. Dr. Tobias is currently co-PI on Urban Serving University/AAMC Health Care Work Force Diversity Initiative for the University of Cincinnati Academic Health Center. Dr. Tobias is the Robert and Myfanwy Smith Professor of Family Medicine and Vice Chair in the Department of Family and Community Medicine at the University of Cincinnati College of Medicine. Dr. Tobias was a 2009-2010 RWJ Health Policy Fellow in the Immediate Office of the Secretary at the US Department of Health and Human Services. Previously she was the Director of Medical Education in the Department of Family and Community Medicine with awards in teaching, mentoring and clinical excellence, including the Dean’s Teaching Award for Excellence and the Leonard R. Tow Humanism in Medicine Award. She is a graduate of the University of Cincinnati College of Medicine and received her BA from Cornell University. Dr. Tobias has practiced family medicine for over 25 years. Her practice included over a decade at Lincoln Heights Health Center, Ohio’s oldest federally qualified health center and a suburban university affiliated practice and now currently volunteers at the Good Samaritan Free Clinic.

Sharing lessons learned on implementing episode-based payments in a multi-payer environment

Adi Kumar

Associate Principal McKinsey & Company

Adi Kumar is an Associate Principal in McKinsey & Company’s Healthcare Practice. Adi primarily serves healthcare payors, both across the private and public sectors, across a range of topics spanning strategy, operation, pricing, and technology enablement. He has a particularly deep focus in the area of payment innovation, helping transition payers and providers to value based payment systems, and co-leads McKinsey's Episode Based Payment service line. He has worked on multi-payor episode based payment transformations across three states, and has served both payers and providers on the topic of transitioning to episode based payment models. Prior to joining McKinsey, Adi served in the White House where he worked for both the President and the Vice President, and oversaw the implementation of the American Recovery and Reinvestment Act, commonly referred to as ARRA or the 2009 stimulus package. Adi is based out of McKinsey's Washington DC office.

Patient-centered medical homes Episode-based payments

Goal 80-90 percent of Ohio’s population in some value-based payment model (combination of episodes- and population-based payment) within five years

Year 1 ▪ In 2014 focus on Comprehensive Primary Care Initiative (CPCi)

▪ Payers agree to participate in design for elements where standardization and/or alignment is critical

▪ Multi-payer group begins enrollment strategy for one additional market

Year 3

Year 5

▪ State leads design of five episodes: asthma (acute exacerbation), perinatal, COPD exacerbation, PCI, and joint replacement

▪ Payers agree to participate in design process, launch reporting on at least 3 of 5 episodes in 2014 and tie to payment within year

▪ Model rolled out to all major markets ▪ 50% of patients are enrolled

▪ 20 episodes defined and launched across payers

▪ Scale achieved state-wide ▪ 80% of patients are enrolled

▪ 50+ episodes defined and launched across payers

State’s Role ▪ Shift rapidly to PCMH and episode model in Medicaid fee-for-service ▪ Require Medicaid MCO partners to participate and implement ▪ Incorporate into contracts of MCOs for state employee benefit program

5-Year Goal for Payment Innovation

1. Perinatal 2. Asthma acute exacerbation 3. COPD exacerbation 4. Joint replacement 5. Percutaneous coronary intervention (PCI)

(formerly Access HealthColumbus)

2014-2016 Collaborative Activity Overview

(updated: May 2014)

The Healthcare Collaborative of Greater Columbus is coordinating the following collaborative activities with our public-private partners. These activities are aligned with national, state and regional best practices with the goal of transforming healthcare delivery and value for all people in Greater Columbus through collaboration with consumers, providers and purchasers.

Transformation Focus

Collaborative Activity (best practice)

Activity Purpose

A. Value*-based Healthcare Delivery

A1. Patient-Centered Medical Home Recognition (PCMH standards)

PROVIDERS: Increase the number of nationally recognized PCMHs in private practices, hospital-affiliated practices, and federally qualified health centers serving patients with Commercial insurance, Medicaid, Medicare, and the uninsured

A2. Align Public-Private Payment Innovation (Ohio’s Innovation Plan)

PROVIDERS & PURCHASERS: Increase awareness of Ohio’s Public-Private Healthcare Innovation Plan and catalyze organizational commitments to align payment innovation • Comprehensive Primary Care (CPC) • Episode-based Payments

A3. Coordination of care across the medical neighborhood (PCMH/CPC standards)

PROVIDERS: Improve shared infrastructure that supports more efficient care coordination across community based organizations and health care providers

A4. Integrated Physical-Behavioral Healthcare Pilot

PROVIDERS: Measure the value and sustainability of integrating physical and behavioral healthcare

B. Value*-based Healthcare Reporting

B1. Primary Care Quality Reporting Prototype (National Quality Forum)

PROVIDERS & PURCHASERS: Based on nationally endorsed measures, compile local comparative quality data to: • Identify opportunities for quality improvement • A good place to start demonstrating meaningful use of health

information technology

C. Value*-based Healthcare Literacy

C1. Provider-defined evidence-based healthcare (Choosing Wisely)

CONSUMERS, PROVIDERS, PURCHASERS: Catalyze consumer, providers, and purchasers thinking and talking about medical tests and procedures that may be unnecessary, and in some instances can cause harm – a shared responsibility to improve the value of healthcare

C2. Patients, parents, caregivers use visit notes to improve health (Open Notes)

PROVIDERS: Build better relationships with patients and take better care of them by sharing visit notes as a standard of care CONSUMERS: Use visit notes to take better control of their health and health care

C3. Patient Engagement Education-Training (Power of Questions)

CONSUMERS: Catalyze patients, parents, and caregivers learning how to use the right questions to receive high-quality healthcare at a lower cost

* Value = (quality/cost) + patient experience Please visit our website to learn more: www.hcgc.org

Transformation Focus

Collaborative Activity (best practice)

Activity Purpose

D. Apply Collaborative Learning

D1. Healthcare Transformation Learning Sessions D2. Speaking Engagements D3. Community Advisory Committee D4. FQHC Senior Leadership Group D5. Navigator & Certified Application Counselor Learning Group D6. Purchaser Learning Group (Collective Impact)

CONSUMERS, PROVIDERS, PURCHASERS: Host forums where colleagues and competitors can learn about national, state, and regional best practices; and explore actionable steps for transforming healthcare delivery and value in Greater Columbus

E. Coordinate collaborative grants with our public-private partners to support healthcare transformation in the Greater Columbus region

E1. SIM Grant/Ohio’s Public-Private Healthcare Innovation Plan E2. Research, Measurement, Assessment, Design, and Analysis (RMADA) E3. Quality Improvement Organization (QIO) Programs (public-private partnerships)

PROVIDERS & PURCHASERS: Catalyze participation in collaborative grants focused on the following federal/state funding opportunities: • SIM Grant/Ohio’s Public-Private Healthcare Innovation Plan –

public-private partnership led by the Governor’s Office of Health Transformation to create a sustainable, patient-centered delivery and payment system over the next three to five years. During this time, the state, along with its Medicaid managed care organizations (Molina, United Healthcare, CareSource, Paramount and Buckeye) and a multi-payer coalition that includes the four private payers who represent 80 percent of the commercial market (Aetna, Anthem Blue Cross and Blue Shield, Medical Mutual of Ohio and United Healthcare) will launch two models statewide: a patient-centered medical home (PCMH) model and an episode-based payment model.

• Research, Measurement, Assessment, Design, and Analysis (RMADA) – to design, implement and evaluate a broad range of research and/or payment and service delivery models to test their potential for reducing expenditures for Medicare, Medicaid, CHIP, and uninsured beneficiaries while maintaining or improving quality of care. (CMS announcement May 2014)

• Quality Improvement Organization (QIO) Programs – to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. (CMS announcement July 2014)

Please visit our website to learn more: www.hcgc.org