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Federal Initiatives to Support State/Community-Based Approaches to Coordinated Care ASA-N3C-NYAM Symposium April 27, 2011 Julianne R. Howell, Ph.D. Senior.

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Presentation on theme: "Federal Initiatives to Support State/Community-Based Approaches to Coordinated Care ASA-N3C-NYAM Symposium April 27, 2011 Julianne R. Howell, Ph.D. Senior."— Presentation transcript:

1 Federal Initiatives to Support State/Community-Based Approaches to Coordinated Care ASA-N3C-NYAM Symposium April 27, 2011 Julianne R. Howell, Ph.D. Senior Advisor State HIE Programs

2 Overview  Alignment through implementation of the Affordable Care Act – Strategic Framework on Multiple Chronic Conditions – National Quality Strategy – Federal HIT Strategic Plan – Partnership for Patients  Themes recurring across multiple initiatives: – Importance of care coordination – Focus on care transitions – Role of community-based services – Focus on the patient and family caregivers  Triple Aim: Better care, better health, lower cost 2

3 Multiple Chronic Conditions: A Strategic Framework December 2010 Source  HHS Interagency Workgroup with input from public and stakeholders Overarching Goals :  #1 Foster health care and public health system changes to improve the health of individuals with multiple chronic conditions.  #2 Maximize the use of proven self-care management and other services by individuals with multiple chronic conditions.  #3 Provide better tools and information to health care, public health, and social services workers who deliver care to individuals with multiple chronic conditions.  #4 Facilitate research to fill knowledge gaps about, and interventions and systems to benefit, individuals with multiple chronic conditions. 3 Multiple Chronic Conditions: A Strategic Framework

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5 National Quality Strategy March 2011 Aims  Better Care: Improve quality, by making health care more patient- centered, reliable, accessible, and safe  Healthy People and Communities: Improve health of population  Affordable Care: Reduce cost of quality health care Six Priorities and Goals to help focus public and private efforts:  Safer Care: eliminate preventable health care-acquired conditions  Effective Care Coordination  Person- and Family-Centered Care  Prevention and Treatment of Leading Causes of Mortality: prevent and reduce harm caused by cardiovascular disease  Support Better Health in Communities  Make Care More Affordable 5 National Quality Strategy

6 Partnership for Patients April 2011 Public-Private Partnership to make care safer, potentially save up to $50 billion Two Goals of the Partnership:  Keep hospital patients from getting injured or sicker: decrease preventable hospital-acquired conditions 40% by 2013 cf – Up to $500M from CMS Innovation Center  Help patients heal without complication: decrease preventable complications during transition from one care setting to another so that hospital readmissions will be reduced 20% by 2013 cf – Up to $500M available through Community-Based Care Transitions Program authorized by Section 3026 of ACA 6

7 Illustrative Federal Programs to Support State/Community Initiatives  Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration  HITECH – Beacon Communities – State HIE Challenge Grants  Partnership for Patients – Community-Based Care Transitions Program ACA Section 3026  State Demonstrations to Integrate Care for Dual Eligible Individuals 7

8 MAPCP Demonstration Overview  3-year demonstration open to states  Medicare will join Medicaid and private insurers in state health reform initiatives aimed at improving delivery of primary care  A multi-payer effort –Aligns economic incentives –Reduces administrative burdens –Provides resources that can be shared across practices 8

9 MAPCP Goals  Goals include… –Improve safety, timeliness, effectiveness, and efficiency –Reduce unjustified variation in utilization and expenditure –Increase patient participation in decision making –Increase access to evidence-based care in underserved areas –Contribute to ‘bending the curve’ in health expenditures 9

10 Application Requirements  Applicant had to be a State agency  Program operational prior to Medicare participation  Multi-payer participation –Medicaid FFS & managed care –Medicare Advantage –“Significant” private payer participation  Specifications to be an Advanced Primary Care Practice (APCP)  Evidence of physician support & participation  Community-based support  Coordination with state wellness/disease prevention efforts 10

11 Program Attributes  8 States: ME, VT, RI, NY, PA, NC, MI, MN –Some projects state-wide; others limited in geographic scope or # of practices –APCP requirements vary by state –Monthly payment to the practice for beneficiaries “assigned” using a state-specific algorithm – Some projects involve community health teams – Some projects include additional payment to state for administrative/evaluation services  Some states will launch July 2011; some October

12 Eligible Practices  Geographic range/size of project determined by state –Regional vs. state-wide –Planned expansion  Definition of APCP –Determined by state –NCQA-PCMH commonly used (often supplemented by additional requirements)  FQHCs participating in some states 12

13 Eligible Beneficiaries  Reside in the state –Some states have county restrictions –Excludes beneficiaries who cross state lines (operational limitations/impacts)  Have Medicare A & B  Covered under traditional FFS Medicare –Not enrolled in MA or other Medicare health plan –No restrictions on other categories such as disabled, ESRD, hospice, etc.  Medicare must be primary payer 13

14 Payment Rates and Policy  Monthly payments to APCP generally < $10 per beneficiary per month (pbpm) –Exception: Minnesota, which uses clinically risk-adjusted tiers (range: $0 - $60.81 pbpm; average: $14.43 pbpm estimated based on historic ACGs)  Variables determining APCP payment rate: –Age of beneficiary –NCQA-PCMH certification status of practice –Use of independent community teams vs. expecting practice to provide/contract for community-based care coordination services 14

15 HITECH Act (Health Information Technology for Economic and Clinical Health)  Section of the American Recovery & Reinvestment Act (ARRA) signed into law in February 2009  Key components of the legislation –Codifies the Office of the National Coordinator for HIT –Creates Federal Advisory Committees on HIT Policy & Standards –Creates Medicare & Medicaid “Meaningful Use” (MU) incentives for physicians and hospitals to adopt EHRs –Creates new HIT and HIE (Health Information Exchange) Programs State HIE Planning and Implementation grants Regional Extension Center (RECs) grants Workforce Training grants New technology research & development grants –Increases privacy protections 15

16 HITECH Programs Address Barriers to Adoption, Meaningful Use, Exchange Barriers Intervention Funds Allocated Cost of EHR Adoption MU Incentives Meaningful Use difficult to achieve for small providers REC and HITRC Lack of trained workforce Workforce $27.3 B* $643M $50M $643M $50M $118M Need for “real world” examples of HIT contribution to Health Care Transformation Beacon Communities SHARP Beacon Communities SHARP $250M $60M Lack of trust, policy framework Privacy and Security Addressed across all Programs Barriers to health information exchange HIE Program Standards & Interoperability HIE Program Standards & Interoperability $64.3M $548M *$27.3 B is high scenario 16

17 HITECH Programs and Goals: Where Are We Today? 17 58,810 Enrolled Providers Regional Extension Centers 84 Community College Partners Curriculum Available Summer 2011 Workforce Training Adoption of EHRs Medicare & Medicaid incentives 21,000 Total providers State HIE Grants 46 Approved States 10 Challenge Grants Beacon Communities Meaningful Use of EHRs Exchange of health information Improved individual and population health outcomes Increased transparency and efficiency Improved ability to study and improve care delivery 17 Communities Research to enhance HIT 4 Awardees Standards & Interoperability framework Security & Privacy framework

18 Key Objectives  Align HITECH programs and initiatives to accomplish – Adoption of EHRs – Meaningful Use of EHRs – Exchange of information  Leverage HITECH programs to have a measurable impact on health care, health, cost –Improve transitions –Reduce readmissions –Reduce medication errors –Achieve better chronic care outcomes  Support health care transformation in each state 18

19 Beacon Communities Program  17 communities selected to demonstrate feasibility and health care delivery benefits of widespread HIT adoption and exchange of health information.  Core Aims: –Build and strengthen community/regional health IT foundation to achieve long-term improvements in care quality, health outcomes, and cost efficiencies; –Demonstrate that health IT-enabled interventions and community collaborations can achieve concrete cost/quality performance improvements; –Test innovations to improve health and health care  14 of 17 include a care transitions component 19

20 Beacon Communities 20

21 Beacon Communities’ Transitions Aims  To reduce hospital utilization, especially that arising from errors in transitions  To use HIT to improve care for individuals with high cost / high risk chronic conditions (e.g., DM, CVD, etc.)  To connect local hospital associations with primary and chronic care settings  To engineer electronic continuity and care plans, and to incorporate them into EHRs and HIEs  To build on initial successes by ongoing learning with other Beacon Communities and by seeking Community-Based Care Transitions funding 21

22 Beacon Communities Transitions Interventions  Three tiers of IT focus –Many Communities are using HIT systems to notify PCPs of hospital and/or ER use –Some are using HIT to provide hospital discharge information (e.g., medications, lab values) to next providers (e.g., nursing homes, FQHCs, PCPs) –A few are using HIT to facilitate making appointments for quick follow-up (e.g., PCPs to specialists)  IT tools are coupled with case management (e.g., self- management coaching, medication reconciliation, care coordination) 22

23 State HIE Challenge Grants  Program Goal: provide additional funding to recipients of State HIE Cooperative Agreements to spearhead development of technology and approaches focused on 5 “Challenge Themes”: – Achieving health goals through health information exchange – Improving long-term and post-acute care transitions – Encouraging consumer-mediated information exchange – Enabling enhanced query for patient care – Fostering distributed population-level analytics 23

24 Challenge Theme 2: Improving Long-Term and Post-Acute Care Transitions  Requirements – Identify types of long-term and post-acute care providers to be included – Describe technology and policy to achieve timely electronic exchange of clinical summaries, medication lists, advance directives and other information most relevant to transitions – Develop and monitor relevant quality measures – Identify barriers to timely electronic exchange and how they will be addressed  Grantees : Colorado, Maryland, Massachusetts, Oklahoma 24

25 Partnership for Patients: Community- Based Care Transitions Program  5 years beginning April 12, 2011; rolling application process  Program Goals: –Improve the quality of care transitions –Reduce readmissions for high-risk Medicare beneficiaries –Document measureable savings to the Medicare program by reducing unnecessary readmissions  Creates source of funding for effectively managing transitions from acute to community-based settings  Eligible entities paid on per-discharge basis for Medicare benes at high risk of readmission, including those with multiple chronic conditions, depression, or cognitive impairment. 25

26 Community-Based Care Transitions Program: Selection Criteria  Preference given to Administration on Aging grantees that –Provide care transition interventions in conjunction with multiple hospitals and practitioners –Provide services to medically-underserved populations, small communities, and rural areas  Applicants must –Identify root causes of readmissions and define target population and strategies for identifying high-risk patients –Specify transition interventions, including improving provider communications and patient activation –Indicate how community and social supports and resources will be incorporated to enhance beneficiary post-hospitalization management outcomes 26

27 State Demonstrations to Integrate Care for Dual Eligible Individuals  Partnership between Federal Office of Integrated Care and the Innovation Center – Testing delivery system and payment reform that improves the quality, coordination, and cost-effectiveness of care for dual eligible individuals.  On April 14, 2011, 15 states awarded contracts for up to $1million to design new models for serving dual eligibles: –West: California, Colorado, Oregon, Washington –Midwest: Oklahoma, Michigan, Minnesota, Wisconsin –South: North Carolina, South Carolina, Tennessee –East : Connecticut, New York, Massachusetts, Vermont  Models will be person-centered and fully coordinate primary, acute, behavioral and long-term supports and services. 27

28 Further Information  Websites: – General – Innovation Center – Office of the National Coordinator for HIT  For Questions:


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