MinnesotaAccountableHealthModel:JointTaskForceMeeting

THURSDAY,   MAY   1 5 ,   2 0 1 4 ,   1 ‐ 4  PM

THE   WEL L STONE   C ENT ER

1 7 9   ROB I E   S TR E E T   EA ST,   SA IN T   PAU L ,   MINNESOTA

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

   

   

                   

   

State Innovations Model

Minnesota Site Visit

Karen M. Murphy, PhD Director, State Innovations Group Center for Medicare & Medicaid Innovation May 12, 2014

Thank  You

• For  your  commitment  to  health  care  reform,  innovation  and  transformation

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What  is  SIM?

• CMS  is  testing   the  ability  of  state  governments  to  utilize  policy  and  regulatory  levers  to  accelerate  health  transformation  to  improve  health,  improve  health  care  delivery  and  decrease  cost.

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Expectations

• Governor‐led   transformation  initiative • Broad‐based  State  Healthcare  Innovation  Plan  • Multi‐payer  commitment  to  value  based  payment • Provider  engagement  in  health  care  transformation • Plan  to  reach  the  preponderance  of  care • Leverage  federal  resources  and  technical  assistance • Ability  to  produce  quantifiable  results 

– ROI – Quality,  cost  and  health  outcomes

SIM  ACTIVITIES

• CMS  currently  supports  6  Model  Test  states  (implementing  statewide transformation;  working  on  innovative  approaches  to  Medicaid  payment and  service  delivery)  and  recently  completed  work  with  19  Model  Design states  (planning  for  transformation) 

• Over  70  individuals  from  CMS  and  HHS  Operating  Divisions  actively engaged  – CDC  leading  population  health  initiatives – ONC  supporting  HIE/HIT  integration – HRSA  developing  workforce  development  plans – SAMHSA  working  with  states  on  behavioral  health  initiatives – ACL  providing  feedback  on  LTSS

• National  experts   and  organizations  engaged  • CMS  Leadership  Group  formed  with  senior  leaders  from  across  CMS  to 

guide  work  and  break  down  barriers 

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Model Testing States

• Arkansas

• Maine

• Massachusetts

• Minnesota

• Oregon

• Vermont

Model Design/Pretesting States

• California • New Hampshire • Colorado • New York • Connecticut • Ohio • Delaware

• Pennsylvania • Hawaii • Idaho • Rhode Island

• Illinois • Tennessee • Iowa • Texas • Maryland • Utah • Michigan

• Washington

    

   SIM Focus Areas

EXPAND VALUE BASED PAYMENT MODELS

TRANSFORM HEALTHCARE DELIVERY

IMPROVE POPULATION

HEALTH

SIM Focus Areas

SIM  Award  is  a  Cooperative  Agreement  with  CMS

                    

                              

   

• The role of CMMI is to test innovative payment and delivery models.

• SIM – Test is the ability of state government to accelerate transformation.

• Cooperative agreement calls for substantial involvement of CMS.

• Federal State partnership.

Site  Visit  Objectives

     

 

                

• Progress of Minnesota Model –Milestones –Lessons learned

–Challenges • Opportunity to meet with stakeholders • Offer support in accelerating transformation

Take  away  messages

• SIM  engaged  25  states  in  transformation  efforts  in  2013

• States  have  the  ability  to  develop  and  execute  transformation  plans

• Transformation  is  a  heavy  lift • Long  journey  is  just  beginning

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

                                                       

                               

Update: Minnesota Accountable Health Model Initiative

• E‐Health Grant • Total proposals:

17 (4 development, 13 implementation) • Total amount of requests:

$12 million (up to $4 million available) • Regions represented:

SW‐2; NW‐3; Central‐1; SE‐3; NE‐2; Metro‐6 • Organization types represented (lead applicant):

ACOs/IHPs, behavioral health, clinics, health plans/purchasers hospitals, long‐term and post‐acute care, local public health, social services

• Estimated award announcement by end of June

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

EVALUATION OF THE MINNESOTA ACCOUNTABLE HEALTH MODEL- UPDATE Donna Spencer State Health Access Data Assistance Center (SHADAC)

Joint Task Force Meeting

May 15, 2014

Click to edit Master title styleCurrent Status of MN State Evaluation

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• Click to Contract pending – edit Master text stylesapprox. June 1 start date • Second levelPreliminary evaluation questions and plans included

Third levelin MN’s Operational Plan Fourth level

• Fifth levelDraft questions directly aligned with MN’s Driver Diagram • Organized by each of the 5 primary model drivers

• Looking forward: Develop evaluation design

styleClick to edit Master titlMAHM Model Diagram e Click to edit Master text styles

Second levelThird level

Fourth levelFifth level

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styleScope of Evaluation Click to edit Master title • Click to edit Master text Focused on 3 years: 2014 – styles2016 • A formative Second levelevaluation

• Third levelTo inform decision-making and continuous improvement in SIM implementation Fourth level

• Fifth levelTo monitor progress toward goals

• Focus on initial and interim markers of implementation, processes, and outcomes

• Both quantitative and qualitative methods

Click to edit Master title styleClick to edit Master text styles

Second levelThird level

Fourth levelFifth level

Timeline for Evaluation Design

Task June July Aug Sept Oct Nov

Kick-off project with DHS/MDH X

Participate in DHS/MDH, workgroup, task force meetings as appropriate

X X X X X X

Finalize evaluation questions

X X X

Conduct data scan X X X X X

Evaluation design drafts Outline X X Final

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Click to edit Master title styleKey Components of Evaluation Design

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• Finalize evaluation questions • Click to Driver edit Master text stylesdiagram; Reporting Targets; Accountability Matrix; Input from DHS/MDH,

Second levelOperations Team, Task Forces

• Build on Hennepin Health, HCDS, and other relevant evaluations Third level• Fourth levelConduct data scan to identify data sources • Identify, define, Fifth leveland operationalize evaluation measures

• Care coordination, population health, total cost of care, community engagement, health disparities

• Develop data collection and reporting timeline for evaluation • Regular reporting and feedback loops

• Identify evaluation responsibilities • Internal SHADAC/UMN evaluation team, State agency staff and key stakeholders,

additional evaluation partners to fill gaps

Click to edit Master title styleData Scan to Inform Evaluation Design

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• Major step in evaluation design development Click to edit Master text styles• Assess existing data sources, data gaps, and data needs Second levelrelative to criteria established for evaluation

Third level• Coordinate with existing data collection activities and data Fourth level

sources, e.g.: Fifth level• MDH Minnesota e-Health Initiative • Provider HIT Survey • Health Economics Program (HEP) data collection and market monitoring • DHS quality and cost monitoring • MN Community Measurement, ICSI • HEDIS/CAHPS

• Existing good data to build on

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Second levelThird level

Fourth levelFifth level

Potential New Data Collection • Data Scan will inform potential new data collection • Providers

• Practice site visits/Case study approach • Focus groups/One-on-one interviews • Periodic surveys

• Beneficiaries/Families/Caregivers • Patient satisfaction surveys • Focus groups

• Payers • Focus groups/One-on-one interviews

• State program staff • Interviews

• Other? 25

Informed by Data Scan. Refined in Evaluation Design.

Click to edit Master title styleEvaluation Design: Key Considerations

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• Delineating and understanding existing/ongoing activities vs. new Click to edit Master text stylesSIM activities • Data issues: Second level

• Third levelLeverage existing data/data collection activities/systems • Access to Fourth levelclaims data

Fifth level• Data management and privacy • Units of analysis

• Patients, providers, ACOs

• Comparison groups • Rural and diverse populations • Participant burden • Coordination with Federal Evaluation

Click to edit Master text stylesApprox. June 2014 – March 2015 • Second levelQuarterly progress reports to the state • Third levelConduct data scan

Fourth level• Fifth levelComplete state evaluation design • Prepare survey and interview instruments • Develop baseline data systems • Conduct data collection as relevant • Prepare Year 1 report on evaluation activities and results

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Year 1 Evaluation Tasks & Deliverables Click to edit Master title style

Click to edit Master title styleClick to edit Master text styles

Second levelThird level

Fourth levelFifth level

www.shadac.org @shadac

For More Information

Lynn Blewett, PhD blewe001@umn.edu Donna Spencer, PhDdspencer@umn.edu

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

TheCharge oftheAccountable Communities forHealth (ACH)Subgroup

Convened  February  – April,  2014  to:

• Provide  guidance  and  advice  in  setting  strategies  to  raise  awareness of  the  ACH  vision  across  Minnesota  that  will  create  community readiness  for  innovation  in  health  and  health  care  system  redesign.  

• Provide  advice  on  soliciting  and  receiving  input  from  diverse stakeholders  and  communities  regarding  the  ACH  approach  and applying  that  input  to  program  planning  as  appropriate.

• Develop  recommendations  for  selection  criteria  and  recommendation  of  ACHs  in  collaboration  with  existing  advisory  groups  and  the  SIM leadership  team  by  the  end  of  March.

Accountable Communities forHealth(ACH)SubgroupMembers

Alex  Alexander  MPA,  MBA • Beacon  Group,  SE  MN,  Project  Management 

Office,  Mayo  Clinic Catherine  Brunkow,  RN • HCMC,  Community  Care  Team,  Hennepin  County

Human  Services  &  Public  Health  Dept Catherine  Vanderboon,  RN,  PhD • Community  Care  Team,  Mayo  Clinic,   Gina  Nolte • Partnership  for  Health  and  CTG,  Clay  County 

Public  Health Heidi  Favet,  CHW • Essentia  Health  Ely  Community  Care  Team Jan  Malcolm • Courage  Kenny  Center,  Allina  Health Jennifer  DeCubellis  and  Ross  Owen • Hennepin  Health

Jim  Przybilla • PrimeWest Joanne  Foreman,   RN,  BAN • Institute  For  Clinical  Systems  Improvement,    Accountable  Health  Community Kristin  Godfrey,  MPH • HCMC,  Community  Care  Team,  MPHA Roxanne  King,  CHW  • NorthPoint  Health  and  Wellness Sarah  Keenan  RN,  BSN  • Bluestone Susan  Severson  • Stratis  Health Kathy  Gregersen  • Mental  Health  Resources  Center Kevin  A.  Peterson  MD,  MPH,  FRCS,  FAAFP  • Dept  of  Family  Medicine  &  Community  Health,  U 

of  MN,  Minnesota  Academy  of  Family  Physicians

                                                     

                

                              

   

ScopeandFocusofACHPartnerships

• The state is sending a signal to the marketplace that this model is intended to help build the next step in delivery system transformation and to build more integration. Includes community partnerships/engagement; enhanced

health/health care integration and coordination.

• The state is testing models of coordinated systems of care and community integration which address social determinates of health.

                                                  

                                               

KeyElement #1:ACO InclusioninACHModel

• Minnesota’s proposal to CMMI makes clear that ACHs must “include at least one ACO that provides primary care services to a threshold percentage of the community’s population”.

• In response to community questions, the state has made clear that the ACO doesn’t need to be the lead applicant, but needs to be “significantly involved”

                            

                            

                 

                        

                                                                                                     

KeyElement #2:CommunityCareTeams(CCTs)PlannedEvolutionintoACHs

• The CCTs are early implementers of the ACH framework. • There are three CCTs currently operating in Minnesota:

Mayo: Wrap‐around team approach, focusing on the development of the core teamstructure for senior population.

HCMC (Brooklyn Park/Brooklyn Center): Focus on diabetes and community/parishlinkages.

Essentia Ely: Began with pediatric mental health, extended to broader populationthrough community partnerships.

• The state will contract with up to 12 ACH and three CCTs. • The state is committed to supporting both urban and rural ACHs. • The CCTs will have a separate contract, which will require they

meet all ACH criteria as well as engage in activities above andbeyond what the other ACHs will be expected to do.

Key Element#3:ACHReadiness • This  is  a  model  test  grant,  applicants  must  be  ready  to  test

their  models.  • The  state  is  interested  in  innovative  models  that  may  not  be 

far  along  in  the  process,  but  will  not  provide  ‘start  up’  grants.

• The  state  is  considering  the  use  of  the  Accountability  Matrix  as  a  benchmark  to  determine  applicant  readiness.

Revised ACHImplementation Timeline July  Task  Force  Meetings • Continued  Discussion  and  Feedback  on  Model  Development Early  September  • RFP  Release  date  (open  for  7  weeks) Late  October/early  November • State  scoring  of  RFP

Mid‐November/late  December • Contract  negotiations  and  finalization  January  1,  2015

• Implementation  of  two  year  contract

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

DataAnalyticsforIntegrated HealthPartnerships: ThePayer Perspective – Assignment

• Thank  you  for  the  information  and  input  submitted  in response  to  the  homework  assignment. 

• In  March,  the  State  requested  information  from  payers  on  the Multi‐Payer  Alignment  Task  Force  on  the  types  of  data  currently shared  with  providers  participating  in  Total  Cost  of  Care  (TCOC) or  shared  savings  arrangements. The  following  slides  are  a  summary  of  the  responses  the March  homework. Payers  also  submitted  actual  reports  as  requested,  which will  be  presented  and  discussed  at  the  July  task  force meeting.   

DataAnalyticsforIntegrated HealthPartnerships: ThePayerPerspective – Attribution andRiskScores

• Majority  of  respondents  use  data  to  attribute  members.  Different  approaches  to  such  attribution  include:

Member  choice Utilization  history Claims  data  (e.g.,  provider  seen  most  often) Provider/member  location

• Majority  of  respondents  provide  risk  scores  or  other  health  risk   information  aggregated  at  the  patient  and  population  levels.

Itasca  Medical  Care’s  information’s  aggregate  at  the  provider  level  only. St.  Mary’s  Health  Clinic  and  Hennepin  County  do  not  provide  or  receive  risk 

scores  or  other  health  risk  information.

DataAnalyticsforIntegrated HealthPartnerships:ThePayerPerspective – DataSharing/Exchange

• All  respondents  are  sharing/exchanging  data. Majority  of  respondents  are  sharing/exchanging  clinical,  quality,  utilization,  attribution,  gaps  in  care,  and  cost  of  data  in  addition  to  other  types  of  data. St.  Mary’s  Health  Clinic  is  providing  financial,  pharmacy  and  eligibility  data.

• Payers  with  one‐way  data  sharing:  Prime  West,  Medica,  and  UCare.

• Payers  with  two‐way  data  sharing:  HealthPartners,  Hennepin  County  and  Minnesota  Health  Action.

• Payer  with  both  a  one‐way  and  two‐way  data  sharing: BCBS

DataAnalyticsforIntegrated HealthPartnerships:ThePayerPerspective ‐ DataUsage

• Data  used  to  better  coordinate  care  and  assist  quality initiatives.

• Care  coordinators  and  quality  staff  have  access  to,  and utilize,  the  data.   Additional: PrimeWest  financial  personnel  have  access  to  data. Hennepin  County  data  warehouse  staff  and  leadership  have  access  to  data.

• Respondents  report  using  a  mix  of  tools  to  exchange  data.  UCare,  BCBS,  HealthPartners,  and  Hennepin  County  utilize  a  provider  portal. A  portal  is  in  development  at  Itasca  Medical  Care. PrimeWest,  BCBS,  and  Hennepin  County  utilize  direct  data  feeds. Medica,  BCBS,  Hennepin  County,  Itasca  Medical  Care,  St.  Mary’s  Health Clinic,  and  MHAG  utilize  spreadsheets. BCBS,  Hennepin  County,  and  Itasca  Medical  Care  also  utilize  paper  reports.  

DataAnalyticsforIntegrated HealthPartnerships:ThePayer Perspective – Timeliness ofData

• Near  time  data,  specific  to  member  care,  provided  by  PrimeWest,  Medica,  BCBS,  and  Itasca  Medical  Care  exchange.  

• Weekly  reports  provided  by  BCBS  and  Hennepin  County. • Monthly  reports  provided  by  PrimeWest,  UCare, 

HealthPartners,  and  Hennepin  County. • Quarterly  reports  provided  by  PrimeWest,  UCare,  BCBS, 

HealthPartners,  and  Itasca  Medical  Care.

DataAnalyticsforIntegrated HealthPartnerships: ThePayer Perspective – DataFeedbacktoMarketPayers

• Medicaid  only: • Hennepin  County  and  Itasca  Medical  Care

• Medicaid  and  Dual  Eligible  (Medicare  /  Medicaid): • PrimeWest 

• Medicaid  and  Medicare: • UCare  and  Essentia

• Commercial  fully  insured,  commercial  self‐insured  and  Medicaid:

• Medica  and  BCBS

• Commercial  fully  insured  and  self‐insured,  Medicaid  and  Medicare:

• HealthPartners 

DataAnalyticsforIntegrated HealthPartnerships: ThePayer Perspective‐ Internal andExternal Reporting

• Four  respondents  use  dashboards,  reports,  and  scorecards  to  share  summary,  patient  information,  and  aggregate  partner  performance  with  internal  care  coordinators  and  staff. 

• Five  respondents  share  global  outcomes  and  programmatic  results,  externally  through  reports,  dashboards,  and  task  forces/committees.

• UCare uses  a  licensed  software  application  to  share  detailed  patient‐level  risk  scores,  diagnoses,  and  utilization  information  with  internal  and  external  care  coordinators. 

DataAnalyticsforIntegrated HealthPartnerships: The PayerPerspective – Reportsfrom ClaimsorAdministrative Data

• Medica,  BCBS,  HealthPartners,  Hennepin  County,  and  Itasca  Medical  Care  provide  a  standard  set  of  reports  for  every  provider  group. 

• Seven  respondents  customize  reports  by  provider  group. PrimeWest,  Medica,  BCBS,  Hennepin  County,  Itasca  Medical  Care,  and  St.  Mary’s  Health 

Clinic  provide  static  reports  by  email  and/or  mail.  UCare,  HealthPartners,  and  Hennepin  County  provide  an  online  portal  with  standard 

reports  views.  PrimeWest,  BCBS,  HealthPartners,  and  Hennepin  County  provide  an  online  portal  with 

customizable  views.  UCare,  BCBS,  HealthPartners,  and  Hennepin  County  have  an  online  portal  with  access  to 

raw  data.  BCBS  also  provides  a  direct  data  feed  to  EMR. 

DataAnalyticsforIntegrated HealthPartnerships:ThePayer Perspective – Requested Information

• Three  respondents  are  often  asked  for  data  that  they  cannot  provide  due  to  State  privacy  laws,  HIPAA,  or  provider  contract  provisions.

• UCare  and  HealthPartners  noted  requests  for  code  level  detail  and  granular  data  that  should  be  seen  in  the  proper  context.

DataAnalyticsforIntegrated HealthPartnerships: Provider View:Data Needed tomanage patient& population health

• The  majority  of  responders  listed  detailed  real‐time  member  data  including: Cost  of  care,  utilization,  and  care  plans.    This  allows  providers  to  understand  patient  experience,  within  and outside  system  of  care,  to  manage  cost  and  improve  quality.

• Multiple  responders  want  information  on  health outcomes/quality  for  clinics  and  providers  to  inform  areas  where clinics  and  providers  are  not  achieving  benchmarks.

• A  few  responders  noted  interest  in  regular  engagement  with other  providers  participating  in  the  ACO  (e.g.  learning  networks, data  sharing)

Agenda

• Welcome  and  Overview  of  Agenda

• Introduction  and  Overview  from  the  Center  for  Medicare  and  Medicaid  Innovation

• Update:   Minnesota  Accountable  Health  Model  Initiative

• Proposed  Evaluation  Tool  Framework

• Accountable  Communities  for  Health

• Data  Analytics  for  Integrated  Health  Partnerships:  • The  Payer  Perspective

• The  Provider  Perspective

• Public  Comment

    

 

                

 

     

DataAnalyticsforIntegrated HealthPartnerships: TheProvider Perspective

Paul Berrisford Chief Operating Officer Entira Family Clinics

Robert Wieland, MD Executive Vice President, Clinics and Home Care Services

Allina Health

Erin Hilligan Campus Administrator

Ebenezer Ridges Campus

DataAnalyticsforIntegrated HealthPartnerships: TheProvider Perspective

1. What typesofinformationdoyoureceive? • Inwhatformat?

2. Howistheinformationbeingusedto drive transformationalchange? • By whomintheorganization?

3. What elseisneededtoadvance thetransformational work you’retryingtodo? • What doyouneedfrompayers tomake thiseasier?

           

       

       

           

                            

DataAnalyticsforIntegrated HealthPartnerships: ThePayer andProvider Perspective

1. Any questions to clarify key substantive points?

2. Where is the strongest consistency?

3. Where is stronger consistency needed?

4. Where is consistency less (or not) important?

5. Did anything stand out as particularly interesting or notable for the State to consider replicating?

                      

                       

                  

Agenda

• Welcome and Overview of Agenda

• Introduction and Overview from the Center for Medicare and Medicaid Innovation

• Update: Minnesota Accountable Health Model Initiative

• Proposed Evaluation Tool Framework

• Accountable Communities for Health

• Data Analytics for Integrated Health Partnerships: • The Payer Perspective

• The Provider Perspective

• Public Comment

Contact Information Multi‐PayerAlignment TaskForce

• Garrett  Black  (garrett_E_black@bluecrossmn.com),  Chair • Marie  Zimmerman  (Marie.Zimmerman@state.mn.us),  DHS

• Diane  Rydrych   (Diane.Rydrych@state.mn.us),  MDH

Facilitation  Team • Dianne  Hasselman  (dhasselman@chcs.org) • Diane  Stollenwerk  (diane@stollenwerks.com) • Shannon  Kojasoy  (shannonkojasoy@gmail.com)

Contact Information Community AdvisoryTaskForce

• Jennifer  Lundblad  (jlundblad@stratishealth.org),  Chair • Marie  Zimmerman  (Marie.Zimmerman@state.mn.us),  DHS

• Diane  Rydrych   (Diane.Rydrych@state.mn.us),  MDH

Facilitation  Team • Shannon  McMahon  (smcmahon@chcs.org) • Diane  Stollenwerk  (diane@stollenwerks.com) • Shannon  Kojasoy  (shannonkojasoy@gmail.com)