Denise Chuckovich Deputy Director, IDHW October 31,2014

1. Denise Chuckovich Deputy Director, IDHW October 31,2014

2. Agenda for today • Overview of State Healthcare Innovation Plan (SHIP) • Background/Evolution • Status Update • SHIP Development • SHIP Goals • SHIP Model Elements and Model Design • Workforce Implications for SHIP/Role of Workforce Education Council

3. Idaho State Health Innovation PlanHow did we get here? • Idaho has been engaged in efforts to redesign our healthcare system for a number of years: • 2008 – Governor Otter convened Healthcare Summit. • 2008 – Governor Otter tasked Select Committee on Health Care. • 2008 – Idaho Health Data Exchange established. • 2010 – Idaho Medical Home Collaborative established. • 2013 –Idaho awarded CMMI planning grant to develop State Healthcare Innovation Plan (SHIP) • 2014 – Governor Otter establishes Idaho Healthcare Coalition • 2014 – Idaho submits CMMI testing application to CMMI

4. SHIP Status Update • SHIP Grant proposal submitted to CMMI July, 2014 • CMMI requested detailed response to numerous questions Sept 2014 • Idaho invited to Baltimore to present proposal October 2014 • Awards announced 10/31/2014? • Model Test begins January 1,2015?

5. How was the SHIP Developed? • 2013 SHIP planning process – numerous Idaho healthcare stakeholders participated over 6 month planning period. • 60 focus group and town hall meetings held in 2013. Over 300 individuals involved in the planning process. • SHIP Steering Committee received recommendations from four workgroups: • Network Design • Quality Measures • HIT/Data • Payment Reform

6. How was the SHIP Developed? • SHIP Steering Committee considered recommendations and finalized plan design. • SHIP submitted to CMMI December 2013 as product of planning process. • Governor Otter signed executive order creating Idaho Healthcare Coalition to guide SHIP implementation. • SHIP was basis of design for model testing proposal/grant application submitted to CMMI in July 2014.

7. Primary SHIP Goal Redesign Idaho’s healthcare delivery system to evolve from a fee-for-service, volume-based system to a value-based system of care based on improved health outcomes.

8. SHIP Proposal Goals Goal 1: Build 180 PCMH primary care practices with 900 primary care providers serving 1.3M Idahoans Goal 2: Adoption and use of EHRs and IHDE connections among the 180 Model Test PCMHs, and across the Medical Neighborhood. Goal 3: Establish 7 Regional Collaboratives to support the integration of each PCMH with the broader Medical Neighborhood. Goal 4: Improve rural patient access to PCMH by developing 75 virtual PCMHs.

9. SHIP Proposal Goals Goal 5: Build a statewide data analytics system. Goal 6: Align payment mechanisms across payers to transform payment methodology from volume to value. Goal 7: Reduce healthcare costs

11. Idaho SHIP Model Elements • Strong primary care system in rural and urban communities throughout the state. • Patient Centered Medical Homes (PCMH) – foundational. • Medical Neighborhood links PCMH to other needed health and social services. • Regional Cooperatives (RC) support local primary care providers and medical neighborhood.

12. Idaho SHIP Model Elements • Idaho Healthcare Coalition (IHC) guides SHIP model implementation at the state level • Health information is linked electronically by EHR and HIT. • Data analytics used to improve individual patient care and address population health trends. • Payment methodologies are aligned across major payers. • Patient engagement/accountability key to success.

13. Model DesignPatient Centered Medical Homes • 60 primary care practices per year for 3 years to undertake practice transformation • SIM request include funding for: • payment incentives for practices going through transformation • training, technical assistance and coaching for practice transformation • Participating PCMHs’ EHR connection to Idaho Health Data Exchange • Technical assistance in clinic data collection and analytics

14. Model DesignVirtual Patient Centered Medical Homes • Designed to improve access to primary care in rural communities • Focus on extending the PCMH model through: • telehealth equipment and training • use of Community Health Workers and CHEMS to extend PCMH team services to rural communities

15. Model Design Regional Collaboratives • Regional Collaborative (RC) are part of the Idaho Healthcare Coalition addressing regional healthcare issues . • RC performs advisory and administrative role creating support for PCMH and integration of ‘medical neighborhood’. • Supports primary care practices in adoption of PCMH model with training, technical assistance, coaching. • Assists in integrating PCMH with other local health and community services. • Provides regional and practice-level data gathering and analytic support using protocols created at IHC.

16. Model Design Idaho healthcare coalition • Idaho Healthcare Coalition (IHC) charged with guiding the implementation of the SHIP. • Coalition members includes providers, payers, policy makers and consumers. • IHC supports and oversees coordinated system including: • Coordinates activities of the regional collaborative. • Convenes policy level discussions regarding system improvements. • Assures consistency and accountability for statewide metrics. • Collects and distributes quality and population health metrics.

17. Model DesignQuality Improvement • Core quality measures identified for all PCMHs. • All participating PCMHs will report on quality measures for all patients in their practice. • In Year 1 three selected quality measures will be tracked statewide to establish a baseline. • Tobacco use. • Comprehensive diabetes care. • Weight assessment for kids.

18. Model DesignData Sharing, Interconnectivity, Analytics and Reporting • EHR capacity in healthcare providers’ offices is critical. • IHDE an important element to link patient information across providers/medical neighborhood. • Expanded capabilities such as data marts, clinical analysis, and incorporation of claims data will be developed towards appropriate configuration to support PCMH data and reporting requirements, including use of interfacing technologies to leverage existing HIT systems.

19. Model DesignMulti-payer Payment Model • Payment model recognizes the value of the PCMH model. • Payment escalates with increasing patient complexity and practice capabilities. • Phased redesign strategy over five years: • Phase 1--establish per member/per month (PMPM) payments layered on current fee for service payment. • Phase 2—develop bonus payment based on use of evidence based practices and reporting adherence. • Phase 3—develop shared savings and/or value based payments for practices meeting cost/quality targets. • Phase 4-5—begin to expand complex payment models to include more complex patients.

20. Critical Workforce Issues • Adequate primary care providers to provide patient centered care to Idaho population • Training and support for primary care providers and staff in PCMH model • Recruitment of community health workers and community health EMS workers to support virtual PCMH • Role of IHPEC in SHIP Implementation

21. Next Steps in Process • SHIP Steering Committee has transitioned to Idaho Healthcare Coalition and is meeting monthly to further refine the SHIP model. • IHC seeking advice and guidance from various groups regarding aspects of healthcare system redesign. • State and SHIP stakeholders committed to continuing healthcare system transformation regardless of receipt of further CMMI funding.

22. Questions