2018 Learning Collaborative Series CBOs: Positioning For Value Based - - PowerPoint PPT Presentation

2018 Learning Collaborative Series

CBOs: Positioning For Value Based Payment June 5, 2018 10:00-12:00PM

Welcome/Introductions

• CBOs Role in Value Based Payment: Overview
• Partnerships between Healthcare and CBOs: Building Capacity
• How CBOs can add value in a VBP world: Pilot Overview
• Group Discussion
• Wrap Up
• Next Meeting August 7, 2018 10:00AM-12:00PM

CBOs are uniquely positioned to address root causes of poor health due to:

• Their understanding of community needs.
• Their community focus, coupled with the clinical services of other health care

providers (Hospital, ACO, IPA, etc.) can make a significant positive impact on population health and generate savings for entities involved.

• They are in a strong position to impact social determinants of health.

CBOs: Positioning For Value Based Payment

Introduction: Value Based Payment for Providers

Video Content: https://www.youtube.com/watch?v=_mvfd5GXvvs

SDOH

Education

• Early Childhood Education

and Development

• High School Education
• Enrollment in Higher

Education

• Language and Literacy

Social and Community Context

• Social Cohesion
• Civic Participation
• Perceptions of

Discrimination and Equity

• Incarceration/Institutionali

zation

Health and Health Care

• Access to Health Care-

gaining entry into Health System

• Access to Primary

Care/Trusted Provider

• Health Literacy

Neighborhood and Environment

• Affordable/Quality Housing

Environmental Conditions

• Access to Health Foods
• Crime and Violence

Economic Stability

• Poverty
• Housing Security and

Stability

• Employment
• Food Security
• Transportation

Social Determinants of Health 101

Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

Social Determinants of Health: Structural conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

Video Content: https://www.youtube.com/watch?v=qmsYfouVwtQ&feature=youtu.be

Video Content: https://www.youtube.com/watch?v=pdnAiLdeQGw&feature=youtu.be

Social Determinants of Health, CBOs, and VBP

• Addressing social determinants can have a

significant impact on health outcomes

• Social determinants of health interventions can be

less costly than traditional medical interventions

• Under VBP the aim is to realize cost savings while

achieving high quality outcomes

Social Determinants of Health, CBOs, and VBP

Picture Source: http://www.bridgewater.nhs.uk/haltonsthelens/healthforthehomeless/ Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

Addressing SDOH, Better Health Outcomes, Lowering Healthcare Cost, Better Coordinated Care

Community Based Organizations Managed Care Organizations Healthcare Systems

CBOs: Positioning For Value Based Payment

Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

Source: NYS DOH VBP Bootcamp Social Determinants of Health & Community Based Organizations

Health Foundation for Western and Central New York

Advocating for improved health and health care.

Children (birth to 5 years) impacted by poverty Community Health Capacity Older Adults

Health Foundation Regions

Central New York Counties

• Cayuga
• Cortland
• Herkimer
• Madison
• Oneida
• Onondaga
• Oswego
• Tompkins

Western New York Counties

• Allegany
• Cattaraugus
• Chautauqua
• Erie
• Genesee
• Niagara
• Orleans
• Wyoming

Partnerships Between Healthcare and CBOs: Building Capacity

“Change of any kind requires courage” 勇

Healthcare Reform in NYS

Value Based Payments  Performance based payment strategies that link financial incentives to provider performance on a set of defined measures  Goal is to improve quality and slow growth in healthcare spending  DSRIP requires all Medicaid MCOs to employ VBP systems for 80% – 90% of provider payments

A National Imperative

• A growing number of human services

CBOs are not financially strong or sustainable

• ~ 1/2 run persistent operating deficits
• ~ 1/3 have less than one month of
• perating expenses in reserve
• CBOs often lack access to capital for

investment in tech, staff development and evaluation

Partnerships Make Sense

• Healthcare costs are high
• Healthcare providers not trained in SDoH
• Limited time during medical visit/episodic
• Human service CBOs focus on SDoH
• CBOs often have longstanding

relationships in/with community – therefore, more opportunity to engage

• CBOs and HCOs have shared goals

Social Determinants of Health

Image by: vaeenma

“A growing body of evidence reveals that investment in selected social services and partnerships between health care and social services can lead to substantial health benefits and reduce health care costs for targeted populations.”

~ The Commission on Value-Based Care

Benefits of Partnering

• For CBOs:

– Training and Professional Development – Expanded Services for Clients – Increased Access to Funding

• For HCOs:

– Training and Professional Development – Quality Services for At-Risk Populations – Improved Access to Care for Patients

Challenges of Partnering

• Knowing who to talk to
• Speaking a different language
• Defining, agreeing on, and measuring
• utcomes
• Funding/regulatory Issues
• Service value/ROI and cost
• CBO capacity
• HCO complexity
• Data sharing/privacy concerns

Creating Successful Partnerships – Setting the Stage

• Be Strategic

– Mission and Goals – Areas of Expertise

• Build Trust
• Sharing Risk
• Communicate
• Recognize Value

Creating Successful Partnerships – Digging Deeper

• Identify a project/partnership leader
• Formalize the partnership
• Assess capacity
• Address imbalances
• Technology and data collection
• Funder and regulatory requirements
• Establish funding and payment structures
• Develop a referral process

Building Capacity – Setting the Table

• The legs of the table:

– Management – Governance – Financial Resources – Administrative Systems

• The top of the table:

– Programs

• The decorative centerpiece:

– Organizational Mission

Capacity Building 101

• Ready or Not/Get Set – Health Foundation and other funders

– Help health and human service organizations improve their ability to respond to needs in the community and improve population health

• utcomes by providing grant funding and organizational development

consultation in the areas of program, governance, financial, and administrative processes

• StoryGrowing – Health Foundation, CNY Community Foundation &

Gifford Foundation

– Helps non-profits strengthen their storytelling culture and skills through intensive workshops, group training, and one on one coaching

• ADVANS (Advancing and Developing the Assets of Nonprofits in

Syracuse) – Gifford Foundation

– Strengthen nonprofit’s operating capacity to sustain mission-critical programs

Capacity Building 201

• Social Determinants of Health
• Value-based and other payment structures
• Mentoring/Coaching
• Building networks
• Learning collaboratives
• Developing successful partnerships across

sectors

Health Foundation for Western and Central New York

• Program & organizational sustainability

– Advocacy

• Access to high quality care
• Healthy communities

References

• A National Imperative: Joining Forces to Strengthen

Human Services in America, Alliance for Strong Families and Communities, 2018

• Partnerships Between New York City Health

Institutions and Community Based Organizations, Greater NY Hospital Association and NY Academy

• f Medicine, 2018
• Integrating Health and Human Services: A Blueprint

for Partnership and Action, Human Services Council of New York, 2018

Marnie Annese, MPH, CPH Program Officer 431 East Fayette St, Suite 250 Syracuse, NY 13202 315-671-0057 ext. 200 mannese@hfwcny.org

How CBOs can add value in a VBP world: Pilot Overview and Data Dive

June 4, 2018

Agenda

• Salient Interactive Miner Overview
• Medicaid Population Demographics
• 13202 Zip Code Performance Overview
• CBO/Behavioral Health Performance Overview
• Questions

Overview

• Source
• Medicaid claims data warehouse
• Content
• De-identified patient level data
• Most data elements from claims

history for CNYCC’s attributed population

Opportunities

• Ad Hoc Analysis
• CNYCC can query the data

directly to gain insights that are not available in the dashboards

• Diagnosis Codes
• Procedures including

counts

• Visits including counts
• Partner Attribution
• Ability to create collections

using CPT codes which can identify attribution to Partners throughout the PPS

• Multi Dimensional
• Ability to evaluate multiple

factors simultaneously (e.g. disease burden and geographic distribution)

Challenges

• Data Age
• 6+ months lag due to claims

adjudication process

• Data Accuracy
• Same underlying data that

feeds the MAPP dashboards

• Analysis approach impacts
• utcomes
• Processing Time
• Single query can take 4+

hours to complete

• Partner Access
• Access limited by State to

PPS

Salient Interactive Miner

Medicaid Population Demographics – July 2016 to June 2017

• 242,373 Attributed Patients in 63 Counties/Boroughs
• 226,941 (93.6%) Patients located in CNYCC’s six (6) county region

15572 3591 10776 60226 106508 30268 15432

County of Fiscal Responsibility (Number of Lives) Cayuga Lewis Madison Oneida Onondaga Oswego Other

00-05 12% 06-11 11% 12-17 9% 18-44 41% 45-64 20% 65+ 7%

Current Age

White 69% Black 18% Asian 5% Unknown 5% Other 3%

Race

Medicaid Population Demographics – July 2016 to June 2017

611 Medicaid Members enrolled at the Organization 1 for Care Management Services

96% 3% 1%

Care Management Agency Enrollment

Not Health Home Enrolled CNYCC Partner Organizations Non-CNYCC Partner Organizations 40% 60%

Medicaid Insurance Type

Fee-for-Service Managed Care 96% 4% 0%

Health Home Enrollment

Not Health Home Enrolled CNYCC Partner Organizations Non-CNYCC Partner Organizations

Zip Code 13202 – Performance Overview

• CNYCC has 48 Pay for Performance Measures
• Utilization
• Access
• Behavioral Health
• Cardiovascular
• CAHPS Survey (Clinician & Group and Hospital)
• For introductory purposes, CNYCC will focus on:
• Potentially Avoidable Readmissions (PPR)
• Potentially Preventable Emergency Room Visits (includes Urgent Care) (PPV)
• Potentially Preventable Emergency Room Visits (for persons with a BH Diagnosis) (PPVBH)
• Does not have to be a Behavioral Health visit

Zip Code 13202 – Performance Overview

1308.97 613.82 599.06 200 400 600 800 1000 1200 1400

13202 Result CNYCC

Potentially Avoidable Readmissions

CNYCC Target 56.6 34.21 33.93 10 20 30 40 50 60

13202 Result CNYCC

Potentially Preventable ED Visits

CNYCC Target 159.67 81.66 89.39 20 40 60 80 100 120 140 160 180

13202 Result CNYCC

Potentially Preventable ED Visits (BH)

CNYCC Target

4,034 Patients Residing in the 13202 Zip Code (1.67%)

Medicaid Member Roster

• 94 Unique Lines of Data Submitted
• 91 De-duplicated Unique Members
• 5 Patients with no CIN
• 86 Unique Members
• 7 Members have had an intervention with Organization 1
• 79 Successfully Uploaded into Salient Interactive Miner
• Possible that CINs were incorrect
• 57 out of the 79 Members have been attributed to CNYCC at one point in time
• Roster is from April 2015 to current (May 2017)

Medicaid Member Utilization

• 56 Unique Members have had 127 out of CNYCC’s 154,647 ED Visits from July 2016

to June 2017

• Members can have multiple visits as well as no visits
• 127 ED Visits Occurred At:

ED Visit Count Provider Name Visit Count Upstate University Hospital 66

• St. Joseph’s Health

33 Crouse Health 20 Eastern Niagara Hospital 5

• St. Elizabeth Medical Center

2 Faxton St. Luke’s Healthcare 1

Medicaid Member Utilization

• 56 Unique Members have had 50 out of CNYCC’s 40,321 Inpatient Admissions from

July 2016 to June 2017

• Members can have multiple visits as well as no visits
• 50 Inpatient Admissions Visits Occurred At:

Inpatient Admissions Provider Name Visit Count Upstate University Hospital 18 Crouse Health 10 Not Available 6

• St. Joseph’s Health

6

• St. Elizabeth Medical Center

4 Conifer Park 3 Syracuse Brick House 2 McPike Addiction Treatment Center 1

Medicaid Member Utilization

• 56 Unique Members have had 162 out of CNYCC’s 594,216 Primary Care Physician

Visits from July 2016 to June 2017

• Members can have multiple visits as well as no visits
• 162 Primary Care Physician Visits Occurred At:

Primary Care Physician Visits Provider Name Visit Count

Syracuse Community Health Center 47 Syracuse Behavioral Healthcare 25 Upstate University Hospital 15 Syracuse Recovery Services 13 NOCHSI 11 Crouse 9 Community Health Center of Buffalo 8

• St. Joseph’s Health

8 Family Care Medical Group 5 UB Family Medicine 4 Eastern Niagara Hospital 3 Liberty Resources 3 Community Care Physicians 2 Faxton St. Luke’s Healthcare 2 Not Available 2 Other 5

Medicaid Member Performance

• CNYCC has broken down data provided by the organizations into 3 categories for

comparison purposes:

• All Members that were submitted from both organizations (Total)
• Patients with Organization 1 Interventions (O1)
• Patients with only interventions from Organization 2 (O2)
• The following slides will show the performance for the 3 categories listed above for

PPRs, PPVs & PPVBHs

MC PCP Identified Relevant Measures Selected CINs uploaded to SIM CINs provided by Partner

Potentially Avoidable Readmissions

6000 33333.33 4255.32 613.82 599.06 5000 10000 15000 20000 25000 30000 35000 Total O1 O2 CNYCC CNYCC Target Rate per 100,000

Potentially Preventable Emergency Room Visits

134 200 129.79 34.21 33.93 50 100 150 200 250 Total O1 O2 CNYCC CNYCC Target Rate per 100

Potentially Preventable Emergency Room Visits - BH

223.08 250 220.83 81.66 89.39 50 100 150 200 250 300 Total O1 O2 CNYCC CNYCC Target Rate per 100

Managed Care Assigned PCPs

Potentially Avoidable ED Visits – BH MC PCP Name Result Numerator Denominator NO MC PCP 187.50 15 8 Provider 4 650.00 13 2 Provider 5 700.00 7 1 Provider 6 350.00 7 2 Provider 7 700.00 7 1 Provider 8 200.00 6 3 Provider 9 100.00 1 1 Provider 10 100.00 1 1 Provider 11 100.00 1 1 Potentially Avoidable ED Visits MC PCP Name Result Numerator Denominator Provider 1 100,000.00 1 1 Provider 2 100,000.00 1 1 Provider 3 100,000.00 1 1

Managed Care Assigned PCPs

Potentially Avoidable ED Visits MC PCP Name Result Numerator Denominator LAPPIN SARAH 700.00 7 1 COLQUHOUN JANELLE 700.00 7 1 GREEN-EL DIANE 350.00 7 2 SMITH ROY 242.86 17 7 AUGUSTIN YOLA 200.00 6 3 NELSEN ELIZABETH 200.00 2 1 NO MC PCP 114.29 16 14 LAMANNA SUZANNE 100.00 1 1 LEE SYLVIA 100.00 1 1 TAYLOR VIVIENNE 100.00 1 1 AZIZ SURAIYA 50.00 1 2 RUTAGARAMA YVONNE 50.00 1 2

Questions

Value Based Payment Readiness

How would you rate your readiness for VBP? (A) This is the first I have heard about the CBOs role in VBP (B) I have prior knowledge, but I am still unsure of the process to begin VBP (C) I have good knowledge of VBP, my organization has began the VBP process (D) I have full knowledge of VBP, my organization has already entered into a VBP contract

• A: Now that you have some knowledge of VBP, what are you going to take back to your
• rganization? What are your next steps?
• B: How do you see your organization fitting into VBP? What do you need to begin the VBP

process?

• C and D: What have you learned along the way?

Group Discussion

Learning Collaborative 2018

• Series 1: Access To Care Access
• Series 2: CBOs: Positioning For VBP (June, August)
• Tuesday August 7th, 2018 10:00AM-12:00PM
• Series 3: Cardiovascular: Monitoring & Treatment (September, October)
• Series 4: Behavioral Health (November, December)