www.chcs.org

ASTHO 2016 Senior Deputies Annual MeetingJuly 14, 2016

Tricia McGinnis, Vice President of ProgramsCenter for Health Care Strategies

The 6|18 Initiative: Accelerating Evidence Into Action

About the Center for Health Care Strategies

CHCS is a non-profit policy center dedicated to improving the health of low-income Americans

Our Priorities and StrategiesIntegrating

services for people with complex needs

Enhancingaccess to coverage

and services

Advancing delivery system and

payment reform

Best practicedissemination

Collaborativelearning

Technicalassistance

Leadership and capacity building

2

Public HealthHealth Care

Innovative Clinical Prevention

Traditional Clinical Prevention

Increase the use of clinical preventive

services

Provide services that extend care outside the clinical setting

Community-Wide Prevention

Implement interventions that

reach whole populations

1 2 3

SOURCE: Auerbach J. The 3 Buckets of Prevention. J Public Health Management Practice 2016. http://journals.lww.com/jphmp/Citation/publishahead/The_3_Buckets_of_Prevention_.99695.aspx

CDC’s Prevention and Population Health Framework

Promote adoption of evidence-based interventions in collaboration with health care purchasers, payers, and providers

The 6|18 Initiative

High-burdenhealth conditions 6 18 Evidence-based

interventions that improve health and save money

CDC.gov/sixeighteen

Hester, J. A., J. Auerbach, L. Seeff, J. Wheaton, K. Brusuelas, and C. Singleton 2015. CDC’s 6|18 Initiative: Accelerating evidence into action. National Academy of Medicine, Washington, DC. http://nam.edu/wp-content/uploads/2016/02/CDCs-618-Initiative-Accelerating-Evidence-into-Action.pdf

|

Six High-Burden Health Conditions

State Medicaid Engagement

3Focus Areas: Tobacco, Asthma,

and Unintended Pregnancy Prevention Action Plans

17MTotal Medicaid Enrollees

(as of November 2015)

9State Medicaid and Public

Health Programs Represented

Up to

CO

SC

MI

LA

MARI

MNNY

GA

With funding from the Robert Wood Johnson Foundation, and in coordination with the CDC, CHCS and ASTHO are providing technical assistance to the 9 state teams.

Reduce Tobacco Use Expand access to evidence-based cessation treatments, including individual, group, and telephone counseling and

FDA-approved cessation medications—in accordance with 2008 Public Health Service Clinical Practice Guidelines.

Remove barriers to covered cessation treatments, such as cost sharing and prior authorization.

Promote increased utilization of covered treatment benefits by tobacco users.

Control Asthma Promote evidence-based asthma medical management in accordance with 2007 National Asthma Education and

Prevention Program guidelines.

Promote strategies that improve access and adherence to asthma medications and devices.

Expand access to intensive self-management education for individuals whose asthma is not well-controlled with guidelines-based medical management alone.

Expand access to home visits by licensed professionals or qualified lay health workers to improve self-management education and reduce home asthma triggers for individuals whose asthma is not well-controlled with guidelines-based medical management and intensive self-management education.

Prevent Unintended Pregnancy Reimburse providers for the full range of contraceptive services (e.g., screening for pregnancy intention; tiered

contraception counseling; insertion, removal, replacement, or reinsertion of long-acting reversible contraceptives (LARC) or other contraceptive devices; and follow-up) for women of child-bearing age.

Reimburse providers or health systems for the actual cost of LARC or other contraceptive devices in order to provide the full range of contraceptive methods.

Reimburse for immediate postpartum insertion of LARC by unbundling LARC payment from postpartum services.

Remove administrative and logistical barriers to LARC (e.g., remove pre-approval requirement or step therapy restriction and manage high acquisition and stocking costs).

6|18 in Medicaid

Focus Areas for Participating Medicaid / Health Department Teams

States State Identified PrioritiesTobacco Asthma LARC

Colorado Georgia Louisiana Massachusetts Michigan Minnesota New York Rhode Island South Carolina

• Authority over benefits and coverage

• Expertise in health care payment and delivery

• Establish health quality goals• Collaborate with federal/state

policymakers, and health plans

• Access to and analysis of state/federal data

• Disease-specific expertise • On-the-ground knowledge of

access and utilization barriers• Population health focus• Expertise in intervention

design and implementation• Experience with knowledge

dissemination and provider training

Medicaid Public Health

9

The Medicaid-Public Health Partnership

• A set of concrete, specific interventions from which to choose

• A clear evidence base demonstrating that interventions improve health and help control health care costs

• Access to state and federal public health officials for expertise on health conditions and current public health initiatives to leverage

10

Why 6|18 Appeals to Medicaid

• Built strong Medicaid-Public Health teams through frequent, structured conversations

• Collaboratively developed project action plans• Advanced coverage/access and utilization goals:

11

State Progress to Date

Coverage and Access Utilization • Created provider and health plan

surveys to understand landscape of coverage and barriers

• Engaged with health plans to standardize benefits

• Conducted financial analysis of benefit change

• Hosted provider training symposium• Created provider ordering and billing

guide• Developed media campaign strategy• Designed beneficiary outreach

materials (posters, social media ads, etc.)

• Visit CDC.gov/sixeighteen for more information, including evidence summaries for each health condition

• Set up a meeting with your state Medicaid agency to discuss priorities and opportunities for collaboration

• Look for future engagement opportunities from CDC and CHCS

12

How to get Engaged in 6|18

Download practical resources to improve the quality and cost-effectiveness of Medicaid services

Subscribe to CHCS e-mail, blog and social media updates to learn about new programs and resources

Learn about cutting-edge efforts to improve care for Medicaid’s highest-need, highest-cost beneficiaries

Visit CHCS.org to…

13