1. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g Transforming Care Delivery in the Hudson Valley Susan Stuard, Executive Director March 1, 2012 1

2. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g MISSION To advance health care quality and coordination of care among health care organizations in the Hudson Valley 1. Convene Garner community support and offer a neutral collaboration point 2. HIT Adoption Sponsor implementation of EHRs and health information exchange 3. Quality and Care Coordination Support initiatives that address quality and coordination of care 4. Evaluation Assess whether interventions demonstrate improvement in quality or cost 5. Funding Secure funding for collaborative projects in Hudson Valley Community OBJECTIVES

3. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g Hudson Valley Westchester, Putnam, Dutchess, Rockland, Orange, Ulster and Sullivan Counties Strong collaboration in this community – particularly the Hudson Valley Initiative with Taconic IPA, 15 private practices and FQHCs, MedAllies, mental health providers A disaggegrated community No large integrated delivery network 6-8 commercial payers with real presence Many strong ambulatory care providers – FQHCs and multi-specialty private practice Geography

4. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g 1. HIT Infrastructure: EHRs and Connectivity 2. Primary Care Capacity: Patient Centered Medical Home 3. Care Management for High Risk Patients: Show Quality and Cost Improvement 4. Value/ Outcome Measurement: Quality, Utilization and Patient Satisfaction Measures to Evaluate Success 5. Value-Based Reimbursement: Transition to Outcome Based Reimbursement Aligned with ACOs and Health Homes: Must complement and support this activity within community Trajectory to system restructuring: Goals of care coordination and outcome measurement © 4

5. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g EHRs were THINC’s first project – Support with a HEAL 1 grant from NYS DOH – Initiated work in July 2007 and still working – 850 implementations completed; 220 in contract – Rely on local vendor, MedAllies, for implementation Health information exchange followed EHRs – Legacy HIE running in two counties since 2001 – Started work on SHIN-NY-compliant HIE in late 2008 – Public health reporting 8 hospitals; lab ordering and delivery with 8 labs – Waiting to bring patient record look-up live on state network with NYeC 5 1. HIT Infrastructure

6. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g Hudson Valley Medical Home Project – With Taconic IPA, six health plans and IBM – 15 practices (3 FQHCs and 12 private); 367 PCPs at Level 3 PCMH – Multi-payer data set for evaluation and quality profile – Incentive payments of $1.5million for each of last two years Lessons – Leadership, benchmarking and transformation support are critical – Real medical home requires continuing QI; cannot treat as a paper exercise – Significant effort to maintain engagement with health plans; difficulty of exception processing for health plans – Took 3x as long as expected to assemble multi-payer data set – Evaluation results are slow: delays in data and complexity of analysis – Appears that the money is in managing the complex, very sick patient 6 2. Primary Care Capacity

7. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g Care Management for High Risk, High Cost Patients – THINC, in partnership with Taconic IPA and Geisinger, is piloting a model of embedded care management within Level 3 PCMHs – Goals: cost and quality improvement for patients and test in non-IDN setting – Six nurse care managers trained and deployed at 12 practice sites – Three commercial health plans are supporting the pilot Lessons – Model wins huge accolades with practice and patients – Monthly site and weekly team meetings pressures care team to transform – Designing evaluation to test for regression to the mean – Garnering health plan support requires disproportionate effort; predictive modeling data has been of marginal use – Medicare population is real population in need 7 3. Care Management for High Risk Patients

8. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g Quality profile for groups and physicians – 10 HEDIS quality measures, 7 utilization measures, patient experience – Claims data set on 1 million patients from six health plans – 2010 quality measure profile in test with groups and health plans – Reliability of utilization data being analyzed by RAND – CG-CAPS being done on rolling basis within PCMH practices Lessons – Incredibly time consuming: 3 years to get up and running – Real concern that utilization data will not be reliable at individual physician level; if reliable, may measure bias of patient risk – Patient experience is a significant, but hugely worthwhile commitment – Unfolding process – will this be valid just for quality improvement or can/should it be used as a basis for payment 8 4. Value/Outcome Measurement

9. H EALTH 2 R ESOURCES Taconic Health Information Network and Community w w w. t h I n c. o r g Critical success factors for transition to outcome based reimbursement in open community – Success and reliability of quality profile at practice and, hopefully, physician level – Rigorous third party evaluation of care manager model shows improvement in cost and quality outcomes Lessons – Strong drive of Feds to ACOs and State to Health Homes; not best fit our multi-group, multi-plan, consensus-based community model – Real question of whether we can identify an outcome based reimbursement model that fits what we do well and is also synergist with individual groups’ ACO and Health Home initiatives 9 5. Value-Based Reimbursement