State Innovation Models (SIM) Initiative Clare Wrobel, MHSA SIM - - PowerPoint PPT Presentation

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State Innovation Models (SIM) Initiative Clare Wrobel, MHSA SIM - - PowerPoint PPT Presentation

State Innovation Models (SIM) Initiative Clare Wrobel, MHSA SIM Team Lead State Innovations Group CMS Innovation Center September 4, 2014 CMS Innovations Portfolio Accountable Care Organizations (ACOs) Capacity to Spread Innovation


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SLIDE 1

State Innovation Models (SIM) Initiative

Clare Wrobel, MHSA SIM Team Lead State Innovations Group

CMS Innovation Center September 4, 2014

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SLIDE 2

CMS Innovations Portfolio

Accountable Care Organizations (ACOs)

  • Medicare Shared Savings Program (Center for

Medicare)

  • Pioneer ACO Model
  • Advance Payment ACO Model
  • Comprehensive End-Stage Renal Disease (ERSD)

Care Initiative Primary Care Transformation

  • Comprehensive Primary Care Initiative (CPC)
  • Multi-Payer Advanced Primary Care Practice

(MAPCP) Demonstration

  • Federally Qualified Health Center (FQHC) Advanced

Primary Care Practice Demonstration

  • Independence at Home Demonstration
  • Graduate Nurse Education Demonstration

Bundled Payment for Care Improvement

  • Model 1: Retrospective Acute Care
  • Model 2: Retrospective Acute Care Episode &

Post Acute

  • Model 3: Retrospective Post Acute Care
  • Model 4: Prospective Acute Care

Capacity to Spread Innovation

  • Partnership for Patients
  • Community-Based Care Transitions Program
  • Million Hearts

Health Care Innovation Awards (Rounds 1 & 2) State Innovation Models (Rounds 1 & 2)

  • Model Design
  • Model Test
  • Maryland All Payer Model

Initiatives Focused on the Medicaid Population

  • Medicaid Emergency Psychiatric Demonstration
  • Medicaid Incentives for Prevention of Chronic

Diseases

  • Strong Start Initiative

Medicare-Medicaid Enrollees

  • Financial Alignment Initiative
  • Initiative to Reduce Avoidable Hospitalizations of

Nursing Facility Residents

2

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SLIDE 3
  • CMS is testing the ability of state

governments to utilize policy and regulatory levers to accelerate health transformation resulting in improved health, improved care and lower cost of care through a sustainable model of multi- payer payment and delivery reform

State Innovation Model

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SLIDE 4

SIM Focus Areas

EXPAND VALUE BASED PAYMENT MODELS TRANSFORM HEALTHCARE DELIVERY IMPROVE POPULATION HEALTH

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SLIDE 5

The mission of the State Innovation Models Initiative (SIM) is to support states in designing and testing innovative care and payment models that will result in improved health, improved quality of care and lower costs

SIM Mission

  • Governor-led transformation

initiative

  • Based on a comprehensive State

Health Care Innovation Plan

  • Multi-payer commitment to value-

based payment

  • Provider engagement in health care

transformation

  • Population health improvement
  • Designed to reach the

preponderance of care

  • Leverage federal resources, national

experts and technical assistance contractors

  • Ability to produce quantifiable results

in improvements in quality, health and cost

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SLIDE 6
  • In Round 1 (began April 2012), CMS

supported:

– 6 Model Test states

  • Up to $45M over 3.5 years
  • Implementing innovative approaches to

statewide multi-payer payment and service delivery transformation

– 19 Model Design and Pre-Test States

  • Up to $3 million over 6-12 months
  • Developed State Healthcare Innovation Plans

SIM Round 1 – Where we are now

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SLIDE 7

Round 1 Model Design/Pre-Test States

  • California
  • Colorado
  • Connecticut
  • Delaware
  • Hawaii
  • Idaho
  • Illinois
  • Iowa
  • Maryland
  • Michigan
  • New Hampshire
  • New York
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Tennessee
  • Texas
  • Utah
  • Washington
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SLIDE 8

CA http://www.chhs.ca.gov/PRI/CalSIM%20State%20Healt h%20Care%20Innovation%20Plan_Final.pdf MI http://www.michigan.gov/documents/mdch/Michigan_Bl ueprint_APPENDICES_REMOVED_454499_7.pdf CO http://coloradosim.org/ship-final/ NH http://www.dhhs.state.nh.us/ocom/documents/nh-sim- plan.pdf CT http://www.healthreform.ct.gov/ohri/lib/ohri/sim/plan_doc uments/ct_ship_2013_12262013_v82.pdf NY https://www.health.ny.gov/technology/innovation_plan_i nitiative/docs/ny_state_health_innovation_plan.pdf DE http://dhss.delaware.gov/dhss/dhcc/cmmi/files/chooseh ealthplan.pdf OH http://www.healthtransformation.ohio.gov/LinkClick.asp x?fileticket=WsSlPFly5GI%3D&tabid=138 HI http://hawaiihealthcareproject.org/images/pdf/policy- papers/Hawaii%20Healthcare%20Innovation%20Plan_ February%202014.pdf PA http://www.portal.state.pa.us/portal/server.pt/communit y/department_of_health_information/10674/center_for_ medicare_and_medicaid_innovation_(cmmi)/1535774 ID http://healthandwelfare.idaho.gov/Portals/0/Medical/SHI P/IdahoSHIP.pdf RI http://www.healthcare.ri.gov/healthyri/resources/SHIPw ithAppendix.pdf IL http://www2.illinois.gov/gov/healthcarereform/Documents /Alliance/Alliance%20011614.pdf TN http://www.tn.gov/HCFA/forms/SHIP.pdf IA http://www.dhs.state.ia.us/uploads/IA%20SHIP%20Final. pdf TX http://www.hhsc.state.tx.us/hhsc_projects/Innovation/pr

  • posal.pdf

MD http://hsia.dhmh.maryland.gov/Documents/SIM%20Plan %20Final%20(compressed).pdf UT http://health.utahsummit.com WA http://www.hca.wa.gov/shcip/Documents/SHCIP_Innov ationPlan.pdf

State Health Care Innovation Plans

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SLIDE 9
  • Arkansas
  • Maine
  • Massachusetts
  • Minnesota
  • Oregon
  • Vermont

Round 1 Model Test States

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SLIDE 10

What is the State testing? What is CMMI funding?

  • Engaging primary care providers in

patient-centered medical homes

  • Bundle payments for acute

conditions

  • Support providers with data,

technical assistance and learning system

  • Provider/payer infrastructure and
  • perational support for new care

models

  • Payment model design (episodes

and Patient-Centered Medical Home (PCMH))

  • Funding for provider engagement
  • Program management,

governance, and technical support

Arkansas

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State HIT Plans and Existing Infrastructures:

  • Medicaid Management Information System (MMIS): Core claims

processing and payment system for Medicaid.

  • Enterprise Data Warehouse (EDW)

– Storing data in a centralized location bring Department of Human Services (DHS) closer to the goal of full data integration.

Arkansas Payment Improvement Initative (APII) Investments in existing and new HIT & Analytics infrastructures:

  • SHARE (State HIE)

– Connecting large practices and hospitals serves as a key accelerant to HIT adoption and transformation in Arkansas.

  • Episode Analytics Engine
  • All Payer Claims Database Plus (APCD+)
  • Broadband Technology Opportunities Program (BTOP):
  • Provider Portal based data collection
  • PCMH Analytics Engine

Arkansas Health Information Technology (HIT)

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What is the State testing? What is CMMI funding?

  • Expanding PCMH, ACO’s and

Health Homes

  • Operate a public-private partnership

to accelerate delivery system reform

  • Align PCMH model with behavioral

health and long term delivery

  • Providing data/analytics
  • Initiative support/governance

Structure (including personnel)

  • Incentives for HIT adoption for

behavioral health providers

  • Quality measurement and

advanced data sharing, and enhanced analytics

  • Learning collaborative for providers

Maine

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Existing Infrastructure:

  • Maine Health Data Organization (MHDO) maintains health care utilization

data on all patients in an inpatient, outpatient, and ER setting

  • The Maine Health Management Coalition (MHMC) will enable the

development of data analytics capability for population health management.

  • HealthInfoNet (HIN)

Ongoing SIM Investments:

  • Clinical “dashboard”
  • Statewide HIE

Future Investments:

  • Maine is promoting efforts to encourage HIT among Behavioral Health (BH)

providers.

Maine HIT Examples

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SLIDE 14

What is the State testing? What is CMMI funding?

  • Expand Primary Care Payment

Reform Initiative (MassHealth)

  • Data Infrastructure for LTSS
  • Establish a statewide patient

experiences of care measurement strategy

  • Design assistance and project

management

  • Infrastructure support
  • Technical assistance to providers

Massachusetts

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SLIDE 15

Ongoing investments in existing and new HIT & Analytics infrastructure:

  • Quality Data Repository/Clinical Data Repository (QDR/CDR)

– Goal is to receive Quality Reporting Document Architecture (QRDA) data from provider EHRs via HIE, use quality data for payment reform, research and reporting, and make MMIS more “quality aware.”

  • HIE Technical Assistance to Behavioral Health and Long Term

Services and Support providers

  • Electronic Referrals:

– Goal is to enable providers to provide electronic referrals to community resources.

  • All Payer Claims Database (APCD) Provider Portal

– Mass will utilize their APCD to enable providers to access claims-based reports for their entire patient panels with standard formats and timeframes.

Massachusetts HIT Examples

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What is the State testing? What is CMMI funding?

  • Broaden Medicaid ACOs to include

behavioral health, long-term support services, and social services

  • Planning Accountable Communities

for Health

  • Transformation Center for rural

primary care practices

  • Support for data analytics and

exchange

  • Direct support to providers for

transformation

  • Design Accountable Communities

for Health

  • Technical assistance to standardize

ACO metrics, payment methodologies

Minnesota

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SLIDE 17

Ongoing HIT Investments

  • Direct Gateway
  • Community Collaboratives e-health Grant Program
  • E-health Roadmaps
  • Privacy and Security

Ongoing Data Analytics Investments

  • Integrated Health Partnership Program (IHP): expansion of

Data analytics reporting and support for partners participating.

  • Analytic Infrastructure Enhancements
  • Technical Assistance on development and use of

customized reports

Minnesota HIT Examples

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SLIDE 18

What is the State testing? What is CMMI funding?

  • Expand coordinated care organization

model to cover state employees

  • Enhancements to the state

Transformation Center that will disseminate best practices among Coordinated Care Organizations (CCOs) and other health plans

  • PCMH initiative
  • Design assistance and project

management

  • Infrastructure support
  • Technical assistance to providers
  • Advance analytics
  • Support staff for Transformation

Center

Oregon

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SLIDE 19

Ongoing HIT & Analytics Investments

  • First Quarterly multi-payer dashboard

– Goal is to provide a transparent view of Oregon’s health system from multiple payers, including commercial and public payers

  • Emergency Department Information Exchange

(EDIE) Future Investments

  • Accountable Care Data System (ACDS)
  • Telehealth Pilots

Oregon HIT Examples

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SLIDE 20

What is the State testing? What is CMMI funding?

  • Engaging primary care providers in

patient-centered medical homes

  • Bundle payments for acute

conditions

  • Support providers with data,

technical assistance and learning system

  • Funding for evaluation and

advanced analytics

  • Technical assistance to providers
  • Assistance with payment model

design

  • Infrastructure and operational

support

Vermont

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Ongoing HIT & Analytics Investments

  • All Payer Claims Database (VHCURES)

– Goal is to expand the scope of VHCURES to support the integration of both claims and clinical data.

  • Incorporate long term care, mental health,

home care and specialist providers into the HIE infrastructure

  • Clinical Registry: Design and enhancements to

clinical registry and reporting systems.

Vermont HIT Examples

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  • CMS is launching Round Two of the State Innovation

Models initiative to provide up to $730 million for continued support to existing Model Design states and partner with additional states to accelerate health transformation

– Up to $30 million to fund up to 15 Model Design cooperative agreements – Up to $700 million to fund up to 12 Model Test cooperative agreements – Applications were due July 21, 2014 – Expect to announce selected states for Model Design and Model Test cooperative agreement awards Fall 2014

Round 2

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Questions & Discussion

Clare Wrobel E-mail: Clare.Wrobel@cms.hhs.gov

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Questions? Contact Clare.Wrobel@cms.hhs.gov or StateInnovations@cms.hhs.gov