Population Health Council Meeting Health Enhancement Community - - PowerPoint PPT Presentation

Population Health Council Meeting Health Enhancement Community

March 12, 2020

Agenda

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Item Lead Time Mins

Welcome, Introductions, and Meeting Purpose OHS HMA 10:00 – 10:10 10 HEC: Progress Since the Release of the HEC Framework HMA 10:10 – 11:35 85 HEC Status Overview HMA 10:10 – 10:20 10 HEC Pre-Planning Communities HMA 10:20 – 10:35 15 HEC Funding Strategies HMA 10:35 – 10:55 20 HEC Financial Model HMA 10:55 – 11:10 15 HEC Measurement Development HMA 11:10 – 11:20 10 Feedback and Discussion OHS HMA 11:20 – 11:50 30 Next Steps and Adjourn All 11:50 – 12:00 10

Health Enhancement Communities Update

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Post-HEC Framework Approval (May 2019 – March 2020)

• HEC status overview
• HEC pre-planning communities
• HEC funding strategies
• Financial modeling
• HEC measurement development

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HEC Status Overview

• 9 communities doing initial planning
• Office of Health Strategy has provided funds to support initial community-

level planning and Technical Assistance

• Fundraising strategy with support from the Office of Health Strategy
• Two new financial impact models that complement the Medicare

Impact Model to tell us if the HEC Initiative makes economic sense for Connecticut and potentially inform considerations around reinvestment opportunities.

• A Medicaid Impact Model
• A Commercial Impact Model, which includes the State employees

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HEC Status Overview

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• Further work on potential HEC measurement
• Examination of alignment opportunities with other initiatives, including

the Hospital Anchor Institution strategy that is now starting

• OHS is currently leading in collaboration with the Office of the Governor and

various stakeholders including the Connecticut Hospital Association.

HEC Pre-Planning Communities

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HEC Pre-Planning Communities

• HEC Pre-Planning RFP issued August 15, 2019; responses were

due October 1, 2019

• Up to $25,000 to participate in a 90-day HEC pre-planning process to

develop key elements of an HEC for their community (Scope 1)

• Up to an additional $10,000 for rapid-cycle measurement (Scope 2)
• 9 awardees (participant communities) were selected
• The RFP included an option for second planning period dependent

upon funding.

• OHS has provided funding for that second planning period.
• Work to be done by Participant Communities in this RFP are

intended to inform a future process to establish and designate HEC.

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Awardees

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Awardees Phase 1 Scope* Nov 1 – Jan 31 Bridgeport Hospital/YNHHS Scope 1 & 2 Charlotte Hungerford Hospital Scope 1 City of Hartford, DHHS Scope 1 & 2 Ledge Light Health District Scope 1 Middletown Board of Education Scope 1 Mid Fairfield Child Guidance, Inc. Scope 1 Southern Connecticut State University Scope 1 & 2 StayWell Health Center, Inc. Scope 1 Uncas Health District Scope 1

* Scope 1 – Main grant; Scope 2 – Rapid Cycle Measures

Awardee Map

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HEC Pre-Planning Phase 1: Activities

• Awardees:
• Engaged community residents in the planning process
• Convened participant organization members
• Identified primary and secondary drivers impacting need related to

the HEC health priority aims

• Identified partners within their geography
• Identified potential cities or towns outside of their initial

geographic boundary with which it would be beneficial to align

• Each awardee was assigned a coach from Health

Management Associates to work with them throughout the pre-planning process and provide technical assistance.

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HEC Pre-Planning Phase 1: Rapid Cycle Measures

• Goal: develop an approach in communities to collect

measurement information to provide rapid-cycle feedback on the effectiveness of HEC interventions.

• 3 awardees received additional $10,000 to participate.
• Awardees:
• Defined a set of measures that include information generated

directly by community members.

• Created a plan for implementing data collection to measure

population outcomes at the local community level.

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HEC Pre-Planning Phase 2

• All 9 communities continued onto Phase 2 planning
• Performance Period: February 1, 2020 – June 30, 2020 (5 months)
• Seamless continuation of work
• Funding supported by OHS
• Phase 2 objectives include:
• Creation of MOA among partners outlining governance structure
• Develop a preliminary or core set of interventions to pursue as an HEC
• Initiate discussion related to the measurement and analysis of collected

data aligned with HEC measurement guidance

• Continue to meaningfully engage community residents in process
• Tools developed and provided to support work

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Funding Strategies

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HEC Funding

• Although SIM funding ends January 31, 2020, the work will

continue to advance with funding from OHS.

• Strategies to move forward:
• Securing a mix of near-term/upfront funding for implementation

and administration

• Pursuing braided and blended funding opportunities
• Pursuing federal opportunities when available
• Scaling and/or timing HEC initiative roll out based on availability of

near-term and long-term resources

• Because this is a “home-grown” initiative, have flexibility to make

decisions about the scale and timing

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Funding Phases

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Planning Funds Implementation Funds Long-Term/Sustainable Financing

Intent is to have funds be used to leverage other funds and bridge to the next type of funds rather than relying solely on any single source or type of resource.

Example of Potential Funding Phases

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SIM and OHS funds and philanthropic grants to design and develop HECs Braided and blended funds to align existing programs, wellness trust grants and investments to

• perate HEC and

for TA Prevention Savings Program to reinvest savings into initiative and HECs, tax credits, health-related tax revenue, braided and blended funds

CT Funders Consortium and Wellness Trust Potential Approach

CT FUNDERS CONSORTIUM

Public-private partnership comprising funders from across CT contributing funds.

• Encourages new and HEC-specific funds

from funders with vested interest in CT and communities

• Leverages existing funds through aligning

(braiding or blending) funders’ existing funding priorities and commitments

• Attracts and leverages national funders

and investors

• Could enable rapid response to federal
• pportunities
• Wellness Trust could provide a

mechanism for aligning funders and pooling funds and absorbing future infusions (e.g., portions of an opioid settlement, health-related tax).

National Funders Investors* Funds for All HECs, Multiple HECs, or One HEC Funds for to Administer HEC Initiative Funds for Statewide Interventions CT Funders

Philanthropy, corporate giving, community benefit, etc. * Option if long-term funds are secured.

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Wellness Trust 101 Podcast

• https://nff.org/commentary/wellness-trusts-101

New Developments: Medicare Demonstration

• The HEC Initiative framework envisioned negotiating a multi-

payer demonstration with the federal government. This strategy is no longer being pursued.

• However, there may be opportunities to pursue other

reinvestment strategies in the future.

• The Medicare, Medicaid, and Commercial financial modeling could

inform such strategies.

• The federal government may also issue their own opportunities.

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Financial Modeling

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Medicaid Impact Model

• Objective: The HEC Medicaid Impact Model quantifies the potential short-

term and long-term savings impact of the HECs on Medicaid spending, both per capita and total

• Using Medicaid claims and eligibility data from the Connecticut Department
• f Social Services (2012-2018), the model projects per capita costs and risk

scores for the Medicaid population without HEC interventions

• Estimated potential savings through 2030 with HEC interventions are based
• n evidence-based population health interventions associated with reducing
• besity and adverse childhood experiences (ACEs)
• Note: similar analysis was conducted for commercial health insurance,

including state employees and dependents

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Data Strengths and Limitations

Strengths

• The Medicaid Impact Model is based on detailed longitudinal claims and

eligibility data that is then summarized into major groupings for analysis

• File includes most Medicaid Fee for Service (FFS) claims data, except for

certain individuals who are dually eligible for Medicare and Medicaid and some state only expenses (not federally matched) Limitations

• Diagnosis codes, used to identify people who are obese or potentially have

an ACE, are likely underreported

• Unable to perform national and state comparisons and benchmarking
• File does not include non-health sector spending

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Historical Enrollment Trends by Age Group

Key Takeaways

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Source: CHN Developed Dataset for CT Medicaid Population

Total Program 400,000 450,000 500,000 550,000 600,000 650,000 700,000 750,000 800,000 850,000 900,000 2012 2013 2014 2015 2016 2017 2018

Average # of Medicaid Members Over Time (2012 – 2018) Total

<1 1-8 9-20 21-44 45-64 65+

• 50,000

100,000 150,000 200,000 250,000 300,000 2012 2013 2014 2015 2016 2017 2018

Average # of Medicaid Members Over Time (2012 – 2018) By Age Band

• The average annual growth rate of

4.6% for all age groups from 2012 – 2018 is driven by adults age 21 to 64

• Age 21 to 61 average annual growth

rate of 7.3% driven primarily by HUSKY D (Adult ACA Expansion Group)

• The <1 age band had a slight

decrease (-0.5% average annual growth)

Relative Cost of ACEs or Obesity

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Source: CHN Developed Dataset for CT Medicaid Population Dollar amounts adjusted for non-system claims including: Rx Rebates, GME, TPL

$261 Non-ACEs Child $372 ACEs Child $262 Non-Obese Child $454 Obese Child $1,008 Non-Obese Adult $1,276 Obese Adult $- $200 $400 $600 $800 $1,000 $1,200 $1,400

PMPM Cost Condition & Age Band

Relative Cost of ACEs or Obesity 7 Year Average PMPM (2012 - 2018)

Medical LTSS Rx

• The relative cost of care for a Medicaid

member with an ACE or Obesity is pronounced when compared to members without these conditions

• A child with an ACE is 1.4 times more

expensive than a child without an ACE

• An obese child is 1.7 times more

expensive than a child without obesity

• An obese adult is 1.3 times more

expensive than an adult without obesity ➢ When excluding LTSS—services that are predominantly utilized by Medicaid members 65+—the cost

• f an obese adult is nearly double

the cost of an adult without

• besity

Key Takeaways

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Opportunity to Bend the Cost Curve by Reducing Future Prevalence Rates

Savings are dependent on statewide prevention strategies and success of HECs interventions

Obese Adults Prevalence, with Intervention 37.7% 37.4% Obese Adults Prevalence, Absent Intervention 44.4% Obese Children, with Intervention 23.5% 20.7% Obese Children, Absent Intervention 27.7% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% 2018 2020 2022 2024 2026 2028 2030

Reduction in Prevalence Rates in Model Adult Obesity, Childhood Obesity

Adult Obesity Childhood Obesity

ACEs Prevalence, with Intervention 36.6% 40.7% ACEs Prevalence, Absent Intervention 40.7% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 2018 2020 2022 2024 2026 2028 2030

Reduction in Prevalence Rates in Model Children with ACEs

Children with ACEs

Reduction in Prevalence Rates in Model (Low Savings Scenario) Adult Obesity, Childhood Obesity Reduction in Prevalence Rates in Model (Low Savings Scenario) Children with ACES

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Medicaid Per Capita Cost projections are estimated using trends from the CMS Office of the Actuary and exclude LTSS Dollar amounts are adjusted for Rx Rebates, GME and TPL in the model; assumes HEC interventions fully implemented by January 2023

$684 $664 $300 $350 $400 $450 $500 $550 $600 $650 $700 $750 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Medicaid PMPM Cost Projection (Low Savings Scenario) with and without Interventions

Baseline PMPM Costs (Actual) Baseline PMPM Costs (Projected) Scenario 1 PMPM

HEC Impact Model Projections Summary: Medicaid PMPM Savings

➢ Preliminary analysis suggests that the HEC Initiative has the potential to reduce Medicaid spending by 1.8% to 2.8%, over the time period through 2030.

Years 2012 – 2018 Source: CHN Developed Dataset for CT Medicaid Population

Low Savings PMPM

$3.0 $4.0 $5.0 $6.0 $7.0 $8.0 $9.0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030

Medicaid Expenditures (in Billions) Year

Total Medical Expenditures by Year by Cost Saving Scenario (in Billion Dollars)

Baseline Total Costs (Actual) Baseline Total Costs (Projected) Low Savings Medium Savings High Savings

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➢ Total cumulative savings over the time period through 2030 range between $1.1B and $1.9B* from improvements in the overall health of the Medicaid population

HEC Impact Model Projections: Medicaid Expenditures Savings Scenarios

Years 2016 – 2018 Source: CHN Developed Dataset for CT Medicaid Population Expenditures exclude LTSS Dollar amounts are adjusted for Rx Rebates, GME and TPL in the model; assumes HEC interventions fully implemented by January 2023

HEC Measurement Development

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HEC Measurement Development

• Reviewed the full compendium of measures and identified alignment with

SHIP and other state/national initiatives and data sources

• Developed a preliminary list of Stage 1, Stage 2, and Stage 3 measures and

recommended a process to revise measures over time based on factors such as experience and funder input

• Aligned these stages with level of administrative burden based on whether

additional data sharing agreements and collaboration are required to collect and analyze measures

• Determined that it was premature to start process of developing data sharing

agreements for later stages

• Presented recommended Stage 1 measures for long-term outcomes in

conjunction with rapid cycle measures for short to intermediate term

• utcomes

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H E A LT H M A N AG E M E N T A S S O C I AT E S

Questions & Discussion

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