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 Improvement’s 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 seek—and expect—unprecedented 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 Four: Update 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 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 Project Status –On schedule to meet statutory timelines –Met all key milestones to date (e.g., RFP, contract, etc.)

10. Quality and Incentive Payment System 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 2009Contractor begins education and training of providers about QIPS requirements Jan. 1, 2010Contractor begins collecting data July 1, 2010MDH publishes first public report on quality measures July 1, 2010SEGIP 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 Jan. 2009Contractor 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, 2009Contractor 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 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 Project Status –On schedule to meet statutory timelines –Met all key milestones to date (e.g., RFP, contract, etc.)

17. Other Activities All activities prioritized by due date of deliverables Anticipated starting dates of public meetings/workgroups: –Essential Benefit Sets Due Dates: October 15, 2009 - Work group submits initial recommendations January 15, 2010 – MDH submits a report to the Legislature Work Group Meetings: Late Spring 2009 –Uniform Claim Study Due Dates: January 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 SHIP Executive Team Intervention Work Group Evaluation and Data Collection Work Group Technical Assistance Work Group Communications Work Group Request for Proposal Development Work Group Risk Factor and Chronic Disease Integration Work Group

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 21 st  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@state.mn.us Pat Adams, MDH Patricia.Adams@state.mn.us Scott Leitz, MDH Scott.Leitz@state.mn.us