Presentation on theme: "Michigan Department of Community Health Director James K. Haveman Strategic Use of the Rear-View Mirror on the Integration Highway Lessons Learned: Benefits,"— Presentation transcript:
Michigan Department of Community Health Director James K. Haveman Strategic Use of the Rear-View Mirror on the Integration Highway Lessons Learned: Benefits, Exchanges, Enrollment July 29, 2014 Lynda Zeller, Senior Deputy Director Behavioral Health & Developmental Disabilities Administration
Where We Are Today Benefits & Funding Structures Physical Health and Behavioral Health General Population (Mild-Moderate BH) Specialty Behavioral Health & Developmental Disabilities Managed Care- Medicaid (Majority in managed care plans=except NH- LTC) -Competitively Bid -13 Medicaid Health Plans -Multiple plans within regions -Includes Mild/Moderate BH -Model consistent for 17 years -CMH First Opportunity through regional PIHP -PIHP Sole Sourced -10 Regions -Shared Risk, A (b)(c) concurrent -CMH SMI, SUD, DD, SED Services Healthy Michigan Plan (Medicaid Expansion) ABP-SPA & Repeat items above -Added: Savings Acct, Personal Incentives, Contributions -Repeat items above -Added: Broader addiction & recovery services Non Medicaid Funds-Michigan Marketplace (Exchange-EHB include BH) -SUD federal, state, local (SUD Coordinating Agency merging with PIHP) -CMH state, local, federal SMI, DD, SED
3 Where We Are Today Exchanges, Expansion Michigan Health Insurance Marketplace (Exchange) – 4 Plan Levels, as many as 12 companies Healthy Michigan Plan (Expansion) – Began April 1, 2014 – Unique model (incentives for healthy behaviors, health account contributions, etc.) – Enrollment April to early July – 322,000 – September 30 goal met in July –
4 Where We Are Today Information Exchange & Analytics Health Information Currently – Electronic Health Records All 46 CMH use EHR for clinical record real time All 46 submit claims data to statewide data warehouse – Care Connect 360 Analytics Analyzes claims/encounters both physical and behavioral health – individual and population level – Health Information Networks & Exchange Behavioral Health – Physical Health Meaningful Use Cases
5 Provide access to available data in order to: – Improve care coordination and case management – Report chronic conditions – Measure results statewide Outcomes Effectiveness of care Quality Performance Population health – Improve risk and outcome management – Support forecasting 5 “Care Connect360” Claims Analytics - Physical & CMH
SCREEN SHOT- CARE CONNECT 360- Demographic Information and Chronic Conditions 6
Federal MDCH Data Hub Medicaid MSSS State LABS Doctors & Community Providers HIE QOs (Qualified sub-state HIEs) MI HIN Network of Networks : Data Warehouse Copyright Michigan Health Information Network 7 Health Plan QOs (more coming) Single point of entry/exit for state Pharmacies (more coming) State-wide Shared Services Virtual QOs
8 Checking the Rear View Mirror Why & How Did We Get Here? Looking Back and Learning – Pre Specialty Carve Out Through CMH Medical Model-HMOs – Lacking Specialty Service Large Institutions – State & Community Narrow Community Service Continuum (SMI, DD, SED) – Pre Marketplace (Exchange), Parity CMH only provider for both SMI and Mild- Moderate/general uninsured population Indigent funding (state, local, federal) grant structured, & limited for CMH and SUD Coordinating Agency Services
9 Our Next Stop on the Highway ( ) MI Health Link (Medicare-Medicaid Dual Demo) – Integrated Care “Model 4” –Build on Carve Out – 2939__2939__ ,00.html 2939__2939__ ,00.html Health Information Networks & HI Exchanges – Uniform Consent Format (Paper and Electronic) – Behavioral Health CCD (FIRST!) – Behavioral Health & DD Use Cases (ADT, Autism ) Health Homes (2703) SMI, Co-Location State Innovation Model Implementation
10 Intended Use of the Rear View Mirror – Looking back, is there now more or less: Recovery systems and orientation? Trauma informed systems? Access to physical health care (SMI, SUD)? Inpatient recidivism (physical and behavioral health)? Dollars getting to service? (medical loss) Gaps between PIHP and Medicaid Health Plans? Integration between CMH and PH providers? Gaps between SUD and MH services? Success managing chronic illness (diabetes, etc.)?
11 Our Next Big Destination Michigan’s Blueprint For Health Innovation (State Innovation Model Product) Better Health Better Care Lower Cost Fewer early deaths Less chronic disease and obesity Improved mental health and reduced substance abuse Healthy babies Healthy child development Adequate nutrition and exercise Reduced health disparities Access to a patient-centered medical home Person-centered care Coordinated care Fewer hospitalizations and emergency department visits Reduced administrative complexity Constraining the rise in health insurance premiums Reduced expenditures by payers due to a healthier population and reduced administrative complexity Slowing the rate of spending increase through better utilization and efficiency
12 Planning The Trip 26 Plan ( ) Test ( ) Disseminate ( ) Establish transformation governance Engage stakeholders Select pilots Refine testing strategies Execute plan in pilot sites Engage stakeholders Create state level infrastructure Evaluation Scale up and disseminate model successes Engage stakeholders Evaluation
13 Accountable Systems Of Care Provider network – comprehensive medical, behavioral, social for defined population Share financial risk and rewards – performance based Support primary care transformation & infrastructure development Create systems that coordinate complex care Share resources for greater efficiency Link with Community Health Innovation Regions for better performance outcomes Destination Highlights
14 Community Health Innovation Regions Engage all relevant stakeholders for a collective impact of improved health outcomes, including public health, business, payers, providers, community members, community development, philanthropy Address strategic priorities of the community/prosperity region Link to Accountable Systems of Care to integrate healthcare delivery, social care, and prevention and wellness activities 15 Destination Highlights
15 Intended Use of the Rear View Mirror – Looking back, is (are) there now more or less: Disparity in health status from social determinants? Incentives and payment structures that encourage cross system accountability for population health? Consumer satisfaction? Positive trends in morbidity statistics for special populations (SMI, SUD)? Administrative complexity within and across system components? Of all Rear View Check Items (Slide 10)?
16 Vision & Mission Our Guide On The Integration Highway Our vision Our vision is to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. Our Mission Our Mission is to protect, preserve, and promote the health and safety of the people of Michigan with particular attention to providing for the needs of vulnerable and under-served populations.
17 Lessons Learned Benefits, Exchange, Expansion Service-Funder Grids are a great first step Learn the differences: EHR, HIE, Analytics Model, model, model to anticipate how new services interface, duplicate, impact others After the new benefit begins: – Expect gaps and confusion and address quickly – Use personal stories as your “flashlight” – Balance detail and big picture measures – Celebrate improved access and health status!