Whole Health Walk Early lessons, HIN and value-based purchasing ASU - - PowerPoint PPT Presentation

ASU Center for Applied Behavioral Health Policy 15th Annual Summer Institute, Prescott

July 16, 2014

Walking the Whole Health Walk

Early lessons, HIN and value-based purchasing

Mercy Care Plan I Mercy Maricopa Proprietary and Confidential

Presenters

Eddy D. Broadway Chief Executive Officer Angelo Edge Chief Operating Officer

• Dr. Don Fowls

Chief Medical Officer Paul Fawson Director of Health Economics & Value-Based Purchasing

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Implementation and integration

Eddy D. Broadway, Chief Executive Officer

Lessons learned, moving forward

Mercy Maricopa Integrated Care

Successful Mercy Maricopa launch

Among the largest public integrated systems in the U.S.

• April 1, 2014, launch brought 17,000 people with serious mental illness into

integrated care system

• System disruption kept to minimum

– Extended contracts through Oct. 1 to all current RBHA providers – Maintained members with PCPs at least through Oct. 1, worked to bring PCPs, specialists into new network

• Conducted daily pre- and post-transition meetings with regulators,
• utgoing RBHA, and daily Command Center staff meetings

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Mercy Care Plan I Mercy Maricopa

Lessons Learned

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Make no assumptions: Trust, but verify repeatedly

DATA

• Data is timely
• Data is complete
• Data is accurate
• Data is meaningful

Mercy Care Plan I Mercy Maricopa

Lessons Learned

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Communicate, communicate, communicate

• Take every opportunity to include members, providers, advocates and
• ther stakeholders: Program/ SOC, IT, etc.
• Over-communicate with providers, state agencies, members, peers,

stakeholders and regulators

• Over-staff in the call center for the first 30 days to handle unanticipated

spike in the inbound call volume

• Leverage stakeholders to help communicate key information
• Use the Implementation Committee and the Post Go-live Command Center
• perating models for all Phase II activities

Mercy Maricopa

Moving forward- strategic business priorities

Redesign to support integrated system of care

• Integrated care

─ Connect providers through health information exchange, increase integrated provider network, continue to coach behavioral and physical health providers on integrated care

• Children’s system

─ Reduce number of children in out-of-home and out-of-state care, focus on transitioning youth to adult system, enhance services for children in foster care, launch juvenile justice pilot on peer parent support, create proactive service delivery system

• Crisis system

─ Connect crisis, inpatient, corrections and community-based providers; review 360 system evaluation to maximize and align funding, reduce need for facility-based services and meet community needs

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Mercy Maricopa

Moving forward

Redesign to support integrated system of care

• Arnold v. ADHS

─ Implement SAMHSA evidence-based practices, increase capacity for services, contract directly with providers, implement pay-for-performance model

• General mental health/substance abuse

─ Implement an integrated and coordinated model of care for members with general mental health and substance abuse needs.

• Payment reform

─ Recommend payment methods to incentivize service delivery, determine true market cost of services, gauge provider readiness for payment reform, pilot pay-for-performance with certain providers

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Health Information Network (HIN)

Angelo Edge, Chief Operating Officer

Where the rubber meets the road

Mercy Maricopa Integrated Care

Mercy Maricopa Promises Summary

• Connect Provider Network Organization (PNO) clinical

location EHRs, crisis network & Mercy Maricopa together for data sharing Create a behavioral health focused Health Information Exchange (HIE) for Maricopa County

• Provide customized Health Home applications that

share & receive claims and clinical data

• Create a robust member-centered referral and

coordination network Build a platform for all users to exchange member information in a timely, meaningful manner

• Allows communication between provider & member
• Health coaching & educational tools for members

Implement a mobile platform to communicate with & directly support members and providers

• Predictive modeling tools that allow care teams to

easily identify the high risk, high needs, high cost member Deliver actionable care gaps & quality metrics reporting

Mercy Maricopa Integrated Care

Mercy Maricopa Health Information Network (HIN)

Design goals:

• Improve health care quality, coordination and efficiency through

the exchange of health information at the point of care, utilizing a secure electronic network accessible by a collaboration of behavioral and primary care providers and service members

• Provide seamless data sharing support for multiple levels and

versions of integrated care delivery models

• Support the drive towards improved care, improved outcomes and

lower care delivery costs.

Mercy Maricopa Integrated Care

Models of Care for Delivering Integrated Health Services

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Co-location Virtual Health Home Person- Centered Medical Home (PCMH) Person Centered Health Care Home (PCHCH)

Coordinated Care Integrated Care

Mercy Maricopa Integrated Care

Mercy Maricopa Integrated Care Models

• Co-location
• Member is comfortable receiving both their physical and behavioral

health services at an SMI clinic

• Physical health providers have office space and hours within the SMI

clinic

• Health Information Exchange links all providers, shares information in

near real time and provides alerts when the member accesses crisis services

• Community Case Managers and Mercy Maricopa Care Manager /

Coordinators work together to facilitate communication

• Virtual Health Home
• Member has an existing relationship with both a PCP and BH Provider

that he or she would like to maintain (not in the same physical location)

• Member accesses physical health services through current PCP
• Member accesses behavioral health services through an SMI clinic

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Mercy Maricopa Integrated Care

Mercy Maricopa Integrated Care Models(cont.)

• Person-Centered Medical Home (PCMH)
• Members prefer to receive services close to their home with community

providers

• PCMH clinics are often located in Federally Qualified Health Centers

(FQHCs). Intended to serve members in the communities in which they reside

• PCMH clinics achieve NCQA accreditation status
• Mercy Maricopa Care Manager / Coordinators with BH expertise will

support the PCMH

• Health Information Exchange shares information in near real time with

providers involved in the member’s care and provides alerts when the member accesses crisis, ER and inpatient services

• Training to key contacts and services providers in the community in
• rder to engage members

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Mercy Maricopa Integrated Care

Mercy Maricopa Integrated Care Models(cont.)

• Person-Centered Health Care Home (PCHCH)
• Members prefer to receive services close to their home with community

providers

• Based on standards established by Utilization Review Accreditation

Commission (URAC)

• Members receive fully integrated care at provider site
• Health Information Exchange shares information in near real time with all

providers involved in the member’s care and provides alerts when the member accesses crisis services

• On-site Mercy Maricopa Care Manager / Coordinators will:
• Connect members to community-based resources and supports
• Identify members with high needs using data provided by Mercy Maricopa and

follow up with the member’s case manager

• Training to key contacts and services providers in the community in
• rder to engage members

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Mercy Maricopa

HIN is key to integrated care

Challenges, opportunities for HIN include:

• Better, smarter care in real time

─ Life-saving technology

• Member concerns

─ Stigma ─ Security of medical information

• Legal issues

─ Attorneys pouring over federal privacy laws and state DOI rules, consent language to ensure compliance

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Mercy Maricopa

HIN is key to integrated care

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Mercy Maricopa

Health Information Network (HIN) Model

Mercy Maricopa Integrated Care

Analytics & Reporting

Physical & Behavioral Health Integration:

• Integrated Clinical Record

─ Labs, Claims, Pharmacy, Demographics, Clinical and Medical Diagnosis, Advanced Directives, Psychiatric Evaluations, HRA Results, Crisis Plans, Individual Service Plans, etc.

• Actionable Items

─ Enriched Health Home Reporting ─ Improved identification of care gaps

Mercy Maricopa

Current Status

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Mercy Maricopa

Future HIN Vision

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Full integration with:

• Health Information Network of Arizona

(HINAz)

• Behavioral Health Network of Arizona

(BHINAz)

The Network (HINAz) BHINAz Mercy Maricopa Integrated Care

• Dr. Don Fowls, Chief Medical Officer

Paul Fawson, MHSA, MBA, Director of Health Economics & Value-Based Purchasing

Improving Patient Outcomes through Value-Based Purchasing

Mercy Maricopa

Industry Scan

Mercy Maricopa

Why Value-Based Purchasing?

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Mercy Maricopa

Nationally

CMS Innovation Models

• Overseen by the CMS Innovation Center
• “The Health Care Innovation Awards are funding up to $1 billion in awards to
• rganizations that are implementing the most compelling new ideas to

deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and Children's Health Insurance Program (CHIP), particularly those with the highest health care needs.”

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Mercy Maricopa

Nationally

CMS Innovation Models

Seven Different Categories

• Accountable Care (6 ongoing, 1 no longer active, 1 forming)
• Bundled Payments for Care Improvement (6 ongoing, 1 no longer active, 1

forming)

• Primary Care Transformation (6 ongoing, 1 no longer active, 1 forming)
• Initiatives focused on the Medicaid and CHIP population (3 ongoing, 1

forming)

• Initiatives focused on the Medicare-Medicaid enrollees (1 ongoing, 1

forming)

• Initiatives to Speed the Adoption of Best Practices (5 ongoing)
• Initiatives to Accelerate the Development and Testing of New Payment and

Service Delivery Models (8 forming, 1 ongoing)

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Mercy Maricopa

AHCCCS 2014-2018 Strategic Plan

Four major goals for AHCCCS related to value-based purchasing:

1. Bend the cost curve while improving the member’s health outcomes

─ Implement shared savings requirements for ALTCS and Acute contractors ─ Modernize hospital payments to better align incentives, increase efficiency and improve quality of care

2. Pursue continuous quality improvement 3. Reduce fragmentation in healthcare delivery to develop an integrated system of healthcare

─ Align and integrate model for SMI, CRS and dual-eligible members ─ Build care coordination opportunities in the system ─ Leverage HIT investments to create more data flow in the system ─ Build analytics into actionable solutions

4. Maintain core organization capacity, infrastructure, and workforce

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Mercy Maricopa

AHCCCS SFY 2014 Payment Modernization

Payment modernization mission

To leverage the AHCCCS managed care model toward value based health care systems where patients’ experience and population health are improved, per- capita health care cost is limited to the rate of general inflation through aligned incentives with managed care organizations and provider partners, and there is a commitment to continuous quality improvement and learning

Payment modernization broad goals

1. AHCCCS must promote and facilitate a culture of learning and growth around payment modernization both internally and externally 2. AHCCCS must leverage its position among Arizona healthcare payers to promote more cost and outcome transparency in the healthcare delivery system 3. AHCCCS must deploy a variety of strategies that leverage health plans and other stakeholders resulting in more value based purchasing moving up the payment modernization continuum

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Mercy Maricopa

AHCCCS Payment Reform Spectrum

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Mercy Maricopa

Mercy Maricopa Approach

Mercy Maricopa

Mercy Maricopa Objectives

• Focus on the member and pay for services members need

− Take a holistic, person-centered focus − Ensure provision of the right service at the right time in the right place − Optimize member outcomes − Provide recovery and resiliency-oriented service delivery

• Facilitate the member provider relationship

− Support strengths in the current delivery system − Enhance the delivery of best practices

• Align incentives among providers and payers
• Measure performance and reward success
• Support development of integrated care and the technology,

data, and tools to do it

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Mercy Maricopa

Mercy Maricopa Objectives

One of our key Business Priorities: Align payment processes and incentives to purchase high- quality, cost-effective services that improve member

• utcomes and increase accessibility

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Mercy Maricopa

Desired Outcomes

• Improved member satisfaction, access to care, and health and

functional outcomes,

• Reduction or elimination of duplicative or unnecessary health care

services and associated costs

− Reduced unnecessary or inappropriate emergency room use − Reduced unnecessary or inappropriate hospitalizations and re- hospitalizations

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Mercy Maricopa

Payment to Support the Objectives

To achieve Mercy Maricopa’s desired objectives and

• utcomes, the payment model needs to encourage and

support the following:

• “Money follows the member” – implement mechanisms that do this
• A collaborative, transparent process that actively engages providers and

system stakeholders

• Focus on outcomes and continuous quality improvement supported by

integrated clinical data analytics

• Adop criteria for evaluating performance
• Determine the true cost of delivering services
• Improved system efficiencies
• Integration of physical and behavioral health services
• A phased approach that accounts for the safety net delivery system, eg,

pilots

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Mercy Maricopa

A Range of Possible Approaches

• Each has its pros and cons
• Block payments and fee for service
• Pay for performance – incentives for meeting program objectives
• Performance guarantees
• Case rates
• Bundled payments accounting for diagnoses and episodes of care
• Accountable Care Programs

− Shared risk/reward for

• Reducing unnecessary ED visits, facility-based care
• Managing complex, high-cost members more effectively
• Improved member outcomes

− Capitation − Global capitation

• Collaborations like Florida Health Partnership and Colorado Community

Health Network

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Mercy Maricopa

Analytics

The cornerstone of aligning improved member outcomes and payment is actionable analytics, which includes:

• Identification of high risk members, inclusive of both behavioral and

physical health experience (whole member)

• Identification of discrete gaps in care/episodic opportunities for member

intervention

• Tracking of critical markers of performance at both the member and

provider level

• Providing a complete view of member experience, both behavioral and

physical health

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Mercy Maricopa

Thank you