Health Care Reform Update

1
Health Care Reform Update

• Jeff Schiff, MD, Medical Director, DHS
• Pat Adams, Assistant Commissioner, MDH
• Scott Leitz, Assistant Commissioner, MDH
• Presentation to Health Care Access Commission
• December 1, 2008

2
Health Reform Bill Key Elements

• Health reform bill passed in May contains a
  number of key elements
• Public health improvement (SHIP)
• Health care coverage/affordability
• Chronic care management/health care home
• Payment reform and price/quality transparency
• Administrative efficiency
• Health care cost measurement

3
Vision and Framework for Implementation

• Create meaningful, transformative health reform
  based on the Institute for Healthcare
  Improvements Triple Aim. The goals of the
  Triple Aim are to simultaneously
• Improve population health
• Improve patient/consumer experience and
• Improve affordability of health care.

4
Health Reform Implementation Principles

• Purpose of reform is to improve health of
  Minnesotans and redesign care to improve value
  (quality/costs).
• We must start with end in mind and always
  remain focused on what we want to accomplish and
  what success looks like.
• To ensure all Minnesotans benefit, we will aim
  for market-wide implementation of health reforms
  not just reforms for government programs.
• We will seekand expectunprecedented
  collaboration among public and private partners
  as we implement comprehensive health reform
  initiative.

5
Overview of presentation

• Quality Incentive Payment System (QIPS)
• Provider Peer Grouping
• Baskets of Care
• Other Activities
• SHIP
• Health Care Homes

6
Article FourUpdate on Implementation of
Quality, Transparency, and Payment Reform

• Scott Leitz
• Assistant Commissioner
• Minnesota Department of Health
• Health Care Access Commission
• December 1, 2008

7
Quality and Incentive Payment System

• Minnesota Statutes, section 62U.02
• MDH contracted with local organizations to
  implement the QIPS
• Minnesota Community Measurement contract lead
  with
• Minnesota Hospital Association
• Minnesota Medical Association
• StratisHealth
• University of Minnesota
• 3 million contract over 4 years

8
Quality and Incentive Payment System

• Key Tasks
• Task One Quality measures identification and
  documentation to be used for public reporting
• Task Two Development of an incentive payment
  system
• Task Three Collection and public reporting of
  standardized quality measures
• Important Dates
• July 1, 2009 MDH specifies quality measures and
  quality incentive payment system
• Jan. 1, 2010 Providers submit standard quality
  measures
• July 1, 2010 Standard quality
• measures reported publicly

9
Quality and Incentive Payment System

• Project Status
• On schedule to meet statutory timelines
• Met all key milestones to date (e.g., RFP,
  contract, etc.)

General Timeline General Timeline
Dec. 5, 2008 Inventory of existing quality measures completed
Dec. 2008 thru Jan. 2009 Contractor holds public meetings with stakeholders to develop recommendations on a set of quality measures for public reporting
Feb. 1, 2009 Inventory of existing quality incentive payment and pay-for-performance systems complete
10
Quality and Incentive Payment System
General Timeline General Timeline
Feb. 2009 thru Mar. 2009 Contractor holds public meetings with stakeholders to develop recommendations on quality measures and specific methodology for quality-based incentive payment system
Apr. 2009 thru June 2009 MDH adopts administrative rules to implement the quality measures and incentive-based payment system
July 2009 Contractor begins education and training of providers about QIPS requirements
Jan. 1, 2010 Contractor begins collecting data
July 1, 2010 MDH publishes first public report on quality measures
July 1, 2010 SEGIP begins using the quality incentive payment system
11
Provider Peer Grouping

• Collection of encounter data
• Collection of pricing data
• Analytical work for peer grouping providers based
  on
• The quality and outcome data from QIPS
• The resources used to achieve the outcomes
• The price of those resources
• Important Dates
• July 1, 2009 Health plans TPAs begin
  submitting data
• Jan. 1, 2010 MDH specifies peer grouping
  methodology
• June 1, 2010 MDH disseminates results of peer
  grouping to providers
• Sept. 1, 2010 MDH publicly publishes
• the results of peer grouping

12
Provider Peer Grouping Encounter Data

• Minnesota Statutes, section 62U.04, subd. 4
• MDH will execute a data collection contract in
  2-3 weeks
• Project Status
• On schedule to meet statutory timelines
• Met all key milestones to date (e.g., RFP,
  contract, etc.)

General Timeline General Timeline
Jan. 2009 Contractor holds public meetings with stakeholders to develop recommendations on data elements
Feb. 2009 thru May 2009 MDH adopts administrative rules to collect encounter data
July 1, 2009 Contractor begins working with health plans and TPAs to collect encounter data
13
Provider Peer Grouping Analytical Work

• Minnesota Statutes, section 62U.04
• RFP currently open for bid
• Key contractor tasks
• Issue a request for information (RFI) on peer
  grouping systems
• Collect and synthesize available research and
  data on peer grouping systems
• Participate in public meetings to discuss the
  results of the RFI and research efforts
• Stakeholders will have an opportunity to respond
  to the RFI
• Public meetings to discuss peer grouping
  methodologies will begin Summer 09

14
Baskets of Care

• Minnesota Statutes, section 62U.05
• MD will execute a contract to facilitate a
  steering committee and seven work groups in 1-2
  weeks
• Steering Committee will
• Identify conditions/episodes of care to include
  in the seven baskets, using
• Prevalence, Cost of treatment, Potential for
  innovations
• Identify issues related to implementing baskets
• General oversight of the work groups
• Work groups will
• Identify the health care services and/or outcomes
  to include in each basket
• Identify/define quality measures for the baskets
  of care
• Incorporate patient-directed, decision-making
• support in baskets

15
Baskets of Care

• Steering Committee Chairs
• Dr. George Isham, HealthPartners
• Dr. Doug Wood, Mayo
• Steering Committee Members
• MMGMA
• MMA (2 primary and specialist)
• MHA (2 rural/critical access hospital and urban
  hospital)
• Council of Health Plans (2)
• Mayo
• Insurance Federation
• Employer (1)
• Organization with market experience with baskets
  of care
• Consumers (2)
• Work Groups Members All Interested Parties

16
Baskets of Care

• Project Status
• On schedule to meet statutory timelines
• Met all key milestones to date (e.g., RFP,
  contract, etc.)

General Timeline General Timeline
Jan. 2009 thru April 2009 Steering committee and work groups meet to define baskets
July 2009 MDH writes rules defining baskets of care
July 2009 Contractor begins outreach effort to educate providers on defined baskets of care
July 2009 thru Oct. 2009 Steering committee and work groups develop plans to address 1) quality measures for baskets 2) administrative challenges in implementing baskets
17
Other Activities

• All activities prioritized by due date of
  deliverables
• Anticipated starting dates of public
  meetings/workgroups
• Essential Benefit Sets
• Due DatesOctober 15, 2009 - Work group submits
  initial recommendationsJanuary 15, 2010 MDH
  submits a report to the Legislature
• Work Group Meetings Late Spring 2009
• Uniform Claim Study
• Due DatesJanuary 1, 2010 MDH submits report
  to Legislature
• Work Group Meetings Late Winter 2009

18
State Health Improvement Program SHIP

• Pat Adams
• Assistant Commissioner
• Minnesota Department of Health
• Health Care Access Commission
• December 1, 2008

19
Description of SHIP

• Signed into law as integral public health
  component of Health Reform Initiative
• SHIP intended to reduce obesity and tobacco use
  in Minnesota through policy, systems, and
  environmental changes
• 47 million appropriated for fiscal years 2010
  and 2011
• Competitive grants to Community Health Boards and
  tribal governments rolled out beginning July 1,
  2009

20
SHIP Model for Achieving Success

• Community input into planning, implementation and
  evaluation
• Adherence to socio-ecological model
• Health promotion in four settings community,
  schools, worksites, health care
• Local program advocates
• Informed by evidence-based interventions

• Focus on common risk factors
• Extensive and comprehensive evaluation linked to
  program planning
• Policy, systems, and environmental change that
  supports healthy behavior
• Accountability and oversight

21
SHIP Development Structure- Internal and External
22
Work Group Accomplishments

• Intervention
• Drafting a Menu of Interventions for potential
  grantees to assist in implementation of policy,
  systems, and environmental change
• Evaluation
• Drafting an evaluation plan to address community
  and tribe assessment, process and outcome
  evaluation, and surveillance
• Developing linked evaluation options for Menu of
  Interventions
• Technical Assistance
• Providing three major pre-implementation
  opportunities
• Developing statewide, regional, and
  grantee-focused support
• Communications
• Developing consistent messaging, branding, and
  market-wide coordination
• Chronic Disease Integration
• Developing strategies to better coordinate
  systems throughout Minnesota to promote chronic
  disease reduction
• RFP
• Drafting Request for Proposals to be released in
  February 2009

23
Achievements

• Planning is fully underway
• Involving key stakeholders in planning (local
  public health and tribal governments)
• Working closely with other stakeholders to ensure
  SHIP adds value and builds on existing efforts
• Using evidence- and practice-based interventions
  to maximize program impact
• Utilizing and modifying existing data collection,
  assessment, and reporting systems
• RFP is on track to be released February 2009 and
  will be due May 1, 2009

24
Opportunities

• Building on existing prevention efforts to expand
  and not duplicate work that is already being done
• Enhancing capacity of local public health and
  tribal governments to implement policy, systems,
  and environmental changes
• Integrating with other Health Reform Initiative
  components to support overall health reform
  transformation
• Developing an statewide system to demonstrate
  that reductions in risk factors ? decreases in
  chronic disease ? substantial health care
  savings!

25
SHIP Next Steps

• Continue planning with our partners
• Award funds to roll out July 1, 2009
• Provide technical assistance to grantees to
  ensure successful implementation
• Secure future funding to achieve goals of
  reducing obesity and tobacco use and exposure in
  Minnesota
• Reduce the burden of chronic disease to generate
  future health care-related cost savings

26
Health Care Homes

• Dr. Jeff Schiff, Medical Director, DHS
• Pat Adams, Assistant Commissioner, MDH
• Health Care Access Commission
• December 1, 2008

27
Health Care Homes (HCH)

• A model of delivering care that is
• comprehensive
• coordinated
• culturally-competent
• continuous
• accessible
• family-centered
• compassionate

28
HCH Program Development Tasks

• Criteria for participation
• Verification process
• Common payment methodology
• Incorporation of collaborative learning
• Measurement of results

29
Assumptions for Development and Implementation of
HCHs

• Learning from and building on local and national
  experiences with HCH models
• Collaborative process with broad stakeholder
  input
• Flexibility within the parameters of the
  legislation creating opportunity to test
  different models
• Meaningful measures that focus on desired
  outcomes more than process
• Refinement of model over time

30
HCH Development process

• Collaboratively organized in state government
  between the Departments of Human Services and
  Health with emphasis on public-private
  collaboration
• A combination of grant contracts and state
  organized processes
• Integration with all of the other parts of the
  Health Care Reform legislation

31
HCH Activities

• Active current work
• Foundational
• Outcome recommendations
• Capacity Assessment
• Consumer and Family Council
• Criteria development workgroup

32
HCH Activities

• Program components in development
• Verification
• Collaborative learning model development and
  testing
• Payment system development
• Development of specific evaluation measures

33
HCH Activities to Date

• Outcomes Start with the end in mind.
• RFP issued October 2008 to develop
  recommendations for broad outcomes or goals to be
  used to guide the evaluation of health care
  homes.
• Contract awarded in November 2008 to Institute
  for Clinical Systems Improvement (ICSI). Work
  product due 12/31/08.
• Draft outcomes were sent out for public input on
  11/21/08.

34
HCH Activities to Date (cont.)

• Capacity Assessment.
• RFP issued October 2008 seeking an entity to
  conduct an assessment of 1) the readiness of the
  primary health care delivery system to implement
  health care homes 2) consumer understanding and
  readiness for the implementation of health care
  homes and 3) to make recommendations that will
  guide capacity building efforts in establishing a
  statewide health care home system.

35
HCH Activities to Date (cont.)

• Consumer/Family Council
• Opportunity for consumer and public engagement
  and input
• First meeting November 21st
• Representatives to serve on other work groups,
  including criteria/standards work group

36
HCH Activities to Date (cont.)

• Creation of criteria/standards.
• Process will include facilitated group processes
  for broad input from a variety of stakeholder
  groups.
• HCH Community Meeting Dec. 12, 2008 (will be
  archived for later viewing).
• Work groups will convene beginning Dec. 18 to
  develop standards.
• Collaboration with leading national
  criteria/standards organizations
• Development process will include opportunity for
  public input.
• Recommendations to Commissioners of Health and
  Human Services in late Jan. 2009

37
HCH Opportunities and Challenges

• Transformational change in care delivery
• Changes in infrastructure and culture
• Creation of a patient and family centered health
  care system
• Measurement must evaluate all three goals of the
  IHI Triple Aim
• Measures will be developed concurrent with the
  program and refined over time
• Measures must evaluate progress to decreasing
  disparities
• Payment must blend payments for services,
  coordination of care, and improved outcomes
• Payment mechanisms will evolve over time

38
Contact Information

• Jeff Schiff, MD, DHS
• Jeff.Schiff_at_state.mn.us
• Pat Adams, MDH
• Patricia.Adams_at_state.mn.us
• Scott Leitz, MDH
• Scott.Leitz_at_state.mn.us