Opportunities for Health: Addressing Social Determinants of Health - - PowerPoint PPT Presentation
NC Department of Health and Human Services Opportunities for Health: Addressing Social Determinants of Health in Primary Care Elizabeth Cuervo Tilson, MD, MPH State Health Director/Chief Medical Officer All N orth Carolinians should have the
NC Department of Health and Human Services
Addressing Social Determinants of Health in Primary Care
Elizabeth Cuervo Tilson, MD, MPH State Health Director/Chief Medical Officer
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Transition to Medicaid Managed Care Multi-Payer Alignment
Value
violence
housing
Nor North Car h Carolina ranks 3 lina ranks 37th
th in o
in overall stat erall state health outcomes e health outcomes
Percent of Children Who Do Not Have Consistent Access to Food
21% (1 in 5 N C children)
Infant Mortality Disparity
AVG: 7.1 43rd in the country In N C, black babies die at a rate 2.5 times higher than white babies
Food Security Housing Stability Transportation Interpersonal Violence Employment
Toxic Stress/ Early Brain Development
Healthcare Costs Associated w/ Food Insecurity
4208 6071 1000 2000 3000 4000 5000 6000 7000 Food Secure Food Insecure
2015 US Dollars
Annualized Estimated Expenditures
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Difference: $1800 N HIS/MEPS data adjusted for: age, age squared, gender, race/ethnicity, education, income, rural residence, and insurance. Berkowitz, Basu, and Seligman. Health Services Research: 2017.
SNAP Participation Associated w/ Lower Heath Care Costs
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Estimated Savings associated w/ SNAP: $1,400 per person per year
Berkowitz, Seligman, Rigdon, Meigs, and Basu. J AMA Internal Medicine 2017.
Connecting Seniors with SNAP:
home admission by 23%
admission by 14%
$2,120 per senior SNAP enrollee per year
recertification period
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Healthy Opportunities Framework for all populations Robust elements within Medicaid Managed Care Healthy Opportunity Pilots
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Infrastructure and Elements across all populations
census tract level
Hot Spot Map
Screening
technology platform NCCARE360
Supportive Housing Workforce Development
Florence Back@Home
Medicaid, WIC, SNAP Aligning Enrollment
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(e.g PRAPARE, Accountable Health Community)
resource needs
− Public Review − Fall 2018 Pilot testing in 18 clinical sites and telephonically (n=804) − Ready Providers/Systems adopting − Encouraging everyone to use for all populations − Launch of Managed Care
Screening
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10 20 30 40 50 60 70 80 90 100 Felt Screening Length was good Felt Comfortable with Screening Questions Understood Questions
High Acceptability
English speaking patients Spanish speaking patients Clinic Staff
N=804
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5 10 15 20 25 30 35 40 45 50 Food Insecurity Housing Insecurity Utilities Transportation Interpersonal Violence
Need Prevalence and Desire for Resource Connection
Screened Positive 14% 20% 20% 9%
Desire for Resource Connection
42%
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PROPRIETARY & CONFIDENTIAL
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NCCARE360 is the first statewide coordinated network that includes a robust repository of shared resources and a shared technology platform to connect healthcare and human services providers together to collectively provide the opportunity for health to North Carolinians.
NCCARE360 Partners:
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PROPRIETARY & CONFIDENTIAL
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PROPRIETARY & CONFIDENTIAL
Functionality Partner Timeline Resource Directory Call Center Support
Directory of statewide resources verified by a professional data team adhering to AIRS standards 24/7/365 call center with a team of NCCARE360 Navigators, and the addition
Ongoing work Resource Repository
APIs integrate resource directories across the state to share resource data.
Phased Approach Referral & Outcomes Platform Community Engagement Managers
Referral platform with closed loop functions. Community Engagement Managers for workflow, change management, continued in person support.
Rolled out by community January 2019 – December 2020
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PROPRIETARY & CONFIDENTIAL
Organizations verified 1695 Programs Verified 5441 Counties with at least 80% of resources verified 50
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A coordinated network connects providers (such as health care providers, insurers, or community organizations) through a shared technology platform to:
Creating a Collaborative Network through Shared Technology Platform
PROPRIETARY & CONFIDENTIAL
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PROPRIETARY & CONFIDENTIAL
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NCCARE360 Status Update (as of 7/26/19)
Counties launched
Counties started on implementation
Organizations engaged in socialization process (77 counties)
Active Users
Referrals Sent
Clients Impacted
26% 12% 8% 17% 7% 7% 23%
Engaged Organizations by Service
Healthcare Housing Employment Food Interpersonal Safety Transportation Other
Robust Elements within Medicaid Managed Care
Care Management Quality Strategy
Value-Based Payment
Healthy Opportunity Pilots In Lieu of Services Contributions to Health- Related Resources Integration with Department Partners Address 4 Priority Domains:
Housing Food Transportation Interpersonal Violence
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Care Management
violence needs
actively experiencing interpersonal violence
Care Management
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Financial tools and Strategies
financial incentives and accountability around total cost of care and overall health outcomes
increase by twenty (20) percentage points or represent at least fifty percent (50%) of total medical expenditures.
numerator of their Medical Loss Ratio (MLR) as part of Quality Improvement Activities
related resources may be awarded a preference in auto-assignment
Value-Based Payments Contributions to Health-Related Resources
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North Carolina
Prepaid Health Plan Prepaid Health Plan
Lead Pilot Entity
HSO HSO HSO
Human Service Organizations (HSOs)
Sample Regional Pilot
Care Managers Care Managers Prepaid Health Plan Care Managers
the impact of providing selected evidence-based interventions to high risk Medicaid enrollees.
provide up to $650 million in Medicaid funding for capacity building and pilot services in two to four areas of the state that are related to housing, food, transportation and interpersonal safety and directly impact the health outcomes and healthcare costs of enrollees.
and evaluation of a systematic approach to integrating and financing evidence- based, non-medical services into the delivery of healthcare.
Pilot Overview
Healthy Opportunities Pilots
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To be eligible f be eligible for pilo r pilot t services, M ices, Medicaid m dicaid managed c naged care e enrolle rollees m es must h st have: ve: At l At least o ast one So Soci cial Risk Risk F Factor: :
insecure
experiencing interpersonal violence
At l At least o ast one Needs-Bas Needs-Based Crit d Criteri eria:
Physical/behavioral health condition criteria vary by population:
conditions)
gestation)
intensive care unit graduate)
three or more categories of adverse childhood experiences)
* See appendix for full list of eligibility criteria.
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North Carolina’s 1115 North Carolina’s 1115 waiver specifies servic waiver specifies services that es that can be covered by the Pilo can be covered by the Pilot. Pilots will not be Pilots will not be required to required to offer all approved servi
es. Hous Housing
sustaining services
safety improvements
house payments (e.g., first month’s rent and security deposit)
hospitalization housing
Transpor
tation
public transit
support access to pilot services, including:
with limited public transit infrastructure
Int Interper ersonal nal Viol Violenc ence
services for IPV related issues
parenting support programs
visiting services
Fo Food
based food services (e.g., SNAP/WIC application support, food bank referrals)
coaching/counseling
delivery
* See appendix for full list of approved pilot services.
payments
Year 1 1 Yea ear 2 2 Yea ear 3 3 Yea ear 4 4 Yea ear 5 5 Incentive payments for successful implementation Incentive payments for delivering pilot services Withhold payments to ensure enrollees unmet resource needs are met Withhold payments linked to health
Shared savings payments* *Costs savings based on subset of pilot enrollees whose services are likely to result in decreased medical expenses in the short-term. Assures pilot entities are not penalized for approving effective, evidence-based upstream interventions that result in a financial return on investment over the longer- term
−Evaluation throughout pilots to learn in real time and make adjustments −Evolving metrics - Operational readiness, service delivery, resource needs met, self-reported quality of life, health outcomes, utilization, cost
−Health, utilization, and cost savings overall and by sub-groups −Determine cost-neutrality and cost-effectiveness of interventions by sub- group −Implementation science −Learn how to scale interventions that worked into Medicaid statewide
Manatt/Commonwealth Fund - Advisory Group on Fee Schedule
−Further guidance on Lead Pilot Entity (LPE)/Non-binding Statement of Interest −Pilot Service Definitions, Methodology for constructing fee schedule
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For More Information
Transformation:
https://www.ncdhhs.gov/assistance/medicaid-transformation
https://www.ncdhhs.gov/about/department-
initiatives/healthy-opportunities
Betsey.Tilson@ dhhs.nc.gov