The Opportunity for Whole Person Health Elizabeth Cuervo Tilson, - - PowerPoint PPT Presentation
NC Department of Health and Human Services The Opportunity for Whole Person Health Elizabeth Cuervo Tilson, MD, MPH State Health Director Chief Medical Officer NCDHHS 1 All North Carolinians should have the opportunity for health The
NCDHHS 1
NC Department of Health and Human Services
Elizabeth Cuervo Tilson, MD, MPH State Health Director Chief Medical Officer
NCDHHS 2
2
NCDHHS 3
3
NCDHHS 4
NCDHHS 5
Early brain development Adverse Childhood Experiences/Trauma Emerging cost/risk Medically complex/high cost adult
NCDHHS 6
NCDHHS 7
achievement, dysregulated behavior, emotional distress, suicidal ideation.
cardiovascular disease, depression, anxiety.
NCDHHS 8
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
8
Difference: $1800 NHIS/MEPS data adjusted for: age, age squared, gender, race/ethnicity, education, income, rural residence, and insurance. Berkowitz, Basu, and Seligman. Health Services Research: 2017.
NCDHHS 9
SNAP Participation Associated w/ Lower Heath Care Costs
9
Estimated Savings associated w/ SNAP: $1,400 per person per year
Berkowitz, Seligman, Rigdon, Meigs, and Basu. JAMA Internal Medicine 2017.
Connecting Seniors with SNAP:
home admission by 23%
admission by 14%
$2,120 per senior SNAP enrollee per year
recertification period
NCDHHS 10
Burden in NC
instability)
Health Outcomes & Cost
$238m annually
hospitalizations, and costs with good ROI
NCDHHS 11
York M Medicai aid 4 40% in i inpati atient d t days, 2 26% in E ED visits ts and a a 15% in o
all c cost.
sachuse sett tts’ Pay for S Success ss H Housing Initi tiati ative averag age o
t during t the first st 6 6 months. hs.
Housing F First S Seattle M Median mo mont nthly co costs from $4066 p $4066 per p person t to $1 $1492 492 a and nd $958 a $958 after 6 6 and nd 1 12 2 mo mos.
d Clark Commons Housing I Initiative i in Portland O Ore regon I In f first y year, 5 55% in average c costs pe per mo mont nth ($2, $2,006 t 6 to $899) $899) a and nd s significant i imp mprovement in n he health.
ys t to a a Healthy Bernalil lillo C lo County, N New Mexic ico P
rogram - Comple letion ion of the hous usin ing g pathway is estimat ated t to h have heal althcar are c cost s savings b by betwee een $555,500 a and $ $925,833.
10th
th Decile Project
t in L Los A Angeles s –ROI 2 2:1 i in first y st year, 6 6:1 i in subse sequent y t years. s.
Chez ez S Soi
Hom
e Stud tudy-Can anada a – ROI 1 10: 0:1 1
lic H Healt lth & & Mercy H y Housin ing) g) - annu nnual co cost $19, $19,00 000 t to $29, $29,00 000 p per p person
Randomized T Tri rial of Supp pportive H Housing i in San F Francisco - After 1 1 year, treatm atment g t group m medical al co costs >50% >50%, co cont ntrol g group co costs r rose.
NCDHHS 12
NCDHHS 13
NCDHHS 14
NCDHHS 15
Center on the Developing Child, Harvard University
NCDHHS 16
16
NCDHHS 17
NCDHHS 18
Centers for Disease Control and Prevention. Adverse childhood experiences
e.g. Triple P, Parents as Teachers, Nurse Family Partnership, CC4C, Family Connects, Child First, Incredible Years, Parent Child Psychotherapy, Trauma Focused Therapy, Circle of Security
NCDHHS 19
NCDHHS 20
Opioid Crisis Early Childhood Opportunities for Health Medicaid Transformation
NCDHHS 21
and flow of illicit drugs
prevention
recovery oriented systems of care
strategies based on results
FOCUS AREAS
NCDHHS 22
ACEs and Illicit Drug Use
5 10 15 20 25 30 none 1 2 3 4+
Number of Adverse
Percent illicit drug use
ACEs and Injection Drug Use
NCDHHS 23
Drug misuse 56% Addiction 64% IV drug use 67%
PAR
*The portion of a condition attributable to specific risk factors
Source: Dube S, Felitti V, Dong M, Chapman D, Giles W, Anda R. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2003 Mar;111(3):564-72.
Drug Use Problem
NCDHHS 24
Family Forward Work places Home visiting programs for young families Parenting Programs with transportation and child care support Intimate Partner Violence Prevention and Intervention High Quality early child care and pre-school Access to Healthy Food Income support for lower income families Stable, healthy housing Early Literacy Programs Intensive Family Support and Therapy (e.g. Sobriety Treatment and Recovery Teams) Behavioral Health and Substance Use Prevention and Treatment Job training and availability Trauma Informed Schools and Communities Closing the coverage gap for parents Pregnancy intendedness
NCDHHS 25
NCCARE360 - Statewide Resource and Referral Platform “Hot Spot” map for Social Determinants Medicaid Managed Care – Core program elements Regional Pilots Work force e.g. Community Health Workers
Multi-faceted Approach for Promoting the Opportunity for Health
Standardized screening Aligning enrollment and connecting existing resources
https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities
NCDHHS 26
NCDHHS 27
PROPRIETARY & CONFIDENTIAL
27
NCCARE360 is the first statewide coordinated network that includes a robust data repository of shared resources and connects healthcare and human services providers together to collectively provide the opportunity for health to North Carolinians.
NCCARE360 Partners:
NCDHHS 28
PROPRIETARY & CONFIDENTIAL
28
PROPRIETARY & CONFIDENTIAL
NCDHHS 29
NCDHHS 30
NCDHHS 31
NCDHHS 32
egrated ed C Car are e at at provid ider er, car are m e man anagem emen ent, an , and paym ymen ent le level el
−Standard P Pla lan −Tailored Pl Plans f for
people w with m mor
e com
plex beh behavior
hea ealth n needs eeds
ess h health ealth-rel elated ed s socia ial n l need eeds an and red educe e health ealth in ineq equities es
Care Management that b bui uilds up s upon exi xist sting l local, c commu munity b base sed infrastructure
tatewide e Qu Quali ality Str trat ategy th that at in includes es p populat lation h health ealth m metr trics
lter ernative an e and Valu alue-Bas ased P Paym ymen ents ts
NCDHHS 33
are Man Manag agement
y Stra trategy y - screening for and addressing social issues;
ibili ility to allow for Health Plans to finance health-related services
Medical Loss Ratio (MLR)
NCDHHS 34
34
North Carolina
Prepaid Health Plan Prepaid Health Plan
Lead Pilot Entity
HSO HSO HSO
Human Service Organizations (HSOs)
Sample Regi egional Pilot
Care Managers Care Managers Prepaid Health Plan Care Managers
interventions designed to improve health and reduce costs more intensely addressing food insecurity, housing quality and instability, transportation insecurity, interpersonal violence and toxic stress
AMHs and LHDs)
Pilot Overview N C C A R E 3 6
NCDHHS 35
35
To be elig ligib ible f for pilo ilot s servic ices, M Medic icaid id m manage ged c care e enrolle lees m must have: At t least o
ne Socia ial R l Ris isk Factor:
insecure
experiencing interpersonal violence
At t least o
ne Need eeds-Based C Crit iteria ia:
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.
NCDHHS 36
36
North C Carolin ina’s 1 1115 w waiv iver s specifies s servic ices t that c can b be c covered by the Pilo ilot. Pilo ilots w will ill n not b be requir ired t to o
all ll approved services. Housing ng
sustaining services
safety improvements
house payments (e.g., first month’s rent and security deposit)
hospitalization housing
Trans nspor
tati tion
public transit
support access to pilot services, including:
with limited public transit infrastructure
Interp rpersonal l Vio iole lence
services for IPV related issues
parenting support programs
visiting services
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.
NCDHHS 37
− Advisory Committee (National and NC Representation) − RFI to inform fee schedule
Payment Type Description Likely Services for Payment Type Fee-for-service A rate set prior to service delivery for a discrete service. May include a base rate and adjustments for region, acuity, etc. Services whose cost may be reasonably calculated in advanced (e.g. medically tailored meals; consultation with specialized social worked) Cost-based reimbursement A payment for actual bulled cost of
as maximums per beneficiary per type
Services whose prices are set by a contractor (e.g. 1st month’s rent and security deposit; extermination of mold remediation services) Bundled Payment A rate set prior to service delivery for an estimated bundle of services that may be delivered in a variety of ways depending on beneficiary needs.
longitudinal relationship
address a need when provided in complimentary package
NCDHHS 38
valu lue-ba base sed p d paymen ent
Year 1 1 Year 2 2 Year 3 3 Year 4 4 Year 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
NCDHHS 39
eps Cent nter/ r/Seth th Be Berkowi witz
d cycle a assessm essments s
−Evaluation t throughout p pilots t to lea earn i in r n rea eal t time a and m make adjustm tments ts −Evolv lving ing m metric ics - Operatio iona nal r l readine iness, s servic ice d deliv ivery, reso sour urce n needs m met, se self-reported q qualit lity o
life, h healt lth h outcomes, utiliz lizatio ion, c cost
ive e evalua luatio ion
−Healt lth, h, u utiliz lizatio ion, n, a and c cost s saving ings o
ll and b by sub-group ups −Determine ine c cost-neutrality a ty and c cost-effectiv ivene ness of intervent ntio ions ns by sub sub-group −Imple lement ntatio ion s n scie ienc nce −Learn h n how to scale le intervent ntio ions ns t that w worked into M Medic icaid id st statewide
NCDHHS 40
NCDHHS 41
NCDHHS 42
NCDHHS 43
*For more information on the Healthy Opportunities Pilots, please see the Pilot Fact Sheet **All entities must participate in data collection and reporting activities to support evaluation and oversight efforts. 43
PHPs Ps:
implement the program.
services
service authorization.
eligible individuals, within guardrails defined by State.
managers p predomi minantly a at Tier 3 3 AMHs MHs an and L LHD HDs to:
eligibility based on State-developed eligibility criteria
with HSOs
North Carolina’s 1115 waiver provides important flexibility to implement the groundbreaking Healthy Opportunities Pilot program in two to four areas of the state over a five-year period.*
PHPs’ & Care Managers’ Roles & Responsibilities**
ead Pilo ilot E Entit itie ies (LPEs), that will:
facilitate payment to and oversee the network of community-based organization and social service agencies
communication, relationship-building and sharing best practices
servi vices o s organizations s that contract with the LPE:
interventions addressing food insecurity, housing quality and instability, transportation insecurity. interpersonal violence and toxic stress.
by the LPE
the LPE.
CCARE360 – The NC Resource Platform is expected to be an important piece of the infrastructure
LPEs’ & HSOs’ Roles & Responsibilities**