Emerging Professionals: Today’s Opportunity State Innovation Model Emerging Professionals Learning Community Kick-Off Event September 24, 2015 Jennifer P. Lundblad, PhD, MBA Stratis Health

Today’s Opportunity Extraordinary set of aspirations, legislation, and resources has led to a unique window of opportunity for emerging professionals such as Community Health Workers and Community Paramedics to play and sustain key roles in health and health care in Minnesota.

Topics Why is now the right time for emerging professions in health and health care? What is the SIM program and how is it advancing new roles in health care? How can emerging professions help Minnesota address health equity issues? What is the call to action? 2

Why is now the right time for emerging professions in health and health care? 3

National Changes With the passage of the Patient Protection and Affordable Care Act, new payment models that reward provider systems for better outcomes favor integrated approaches that incorporate innovative workforce strategies in order to meet the three-part aim. 4

National Changes: HHS Payment Goals HHS announcement sets direction and pace of the march to value with payment goals –Category 1—fee-for-service with no link of payment to quality –Category 2—fee-for-service with a link of payment to quality –Category 3—alternative payment models built on fee-for- service architecture –Category 4—population-based payment 85% of Medicare fee-for-service payments in value-based purchasing categories 2-4 by 2016 and 90% by % of Medicare payments in alternative payment models by the end of 2016 and 50% in categories 3 and 4 by the end of 2018.

National Changes: HHS Payment Goals (cont.) Achieved through investment in alternative payment models such as Accountable Care Organizations (ACOs), advanced primary care medical home models, new models of bundling payments for episodes of care, and integrated care demonstrations for beneficiaries that are Medicare-Medicaid enrollees. –These programs give ample opportunity for leveraging new roles and responsibilities, and for re-conceptualizing team care and support.

State Changes Minnesota laws and regulatory changes have opened the doors to payment and reimbursement which supports emerging professionals. Minnesota SIM (State Innovation Model) supports an environment of testing and experimentation to better understand what works. 7

IOM Report Just Released Envisioning the Future of Health Professional Education: Workshop Summary was released 9/14/2015 –Chapter 3: A Changing Healthcare Workforce, offers alternative approaches to traditional health care workforce, and debates pros and cons 8

The Result: Rapidly Changing Health Care Environment Significant momentum behind the payment transformation from volume to value Care delivery is being redesigned around population health, care coordination, and team care New governance approaches are essential

What is the SIM program and how is it advancing new roles in health care? 10

State Innovation Model (SIM) Minnesota was selected in a 2013 competitive federal grant process to be one of the first six model-testing states under the State Innovation Model (SIM) program, through the Innovation Center at CMS. SIM provides financial and technical to states to: –Develop and test state-led, multi-payer health care payment and service delivery models –With a goal to improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries— and for all residents of participating states. 11

Minnesota SIM Goals By 2017, Minnesota’s public health and health care system will be one where: –Majority of patients receive care that is patient centered and coordinated across settings –Majority of providers are participating in Accountable Care Organizations or similar models that hold them accountable for costs and quality of care –Financial incentives for providers are aligned across payers and promote the Triple Aim –Communities, providers, and payers have begun to implement new collaborative approaches to setting and achieving clinical and population health improvements 12

SIM Implementation in MN SIM builds upon innovation already underway in care delivery and payment redesign: –design and implementation of health care homes –adoption of accountable care approaches to improving population health –using emerging health care workers such as community health workers and community paramedics –leveraging e-health to support high quality and low cost care 13

MN SIM Implementation (cont.) Four settings prioritized for special efforts to build their capacity to support patients and families in a well-coordinated and integrated approach: –behavioral health –long-term/post-acute care –public health –social services 14

After six months of planning, Minnesota’s SIM program is now in implementation -- programs have been launched and funds have been granted in the community: –Accountable Communities for Health –e-health –emerging professions –learning collaboratives –data analytics –practice facilitation 15 MN SIM Implementation (cont.)

SIM Task Forces Minnesota SIM program is guided by two task forces, with stakeholders and leaders from across the state: –The Multi-Payer Task Force focuses on building alignment across public and private health care payers. –The Community Advisory Task Force works to advance community and patient engagement, integration across the continuum of care, and population health improvement. 16

SIM MN Driver Diagram 17

How can emerging professions help Minnesota address health equity issues? 18

New IOM Report Offers Guidance Purpose: “…to explore the implications that shifts in health, policy, and the health care industry could have on HPE and workforce learning; to identify learning platforms that could facilitate effective knowledge transfer with improved quality and efficiency; and to discuss opportunities for building a global health workforce that understands the role of culture and health literacy in perceptions and approaches to health and disease. 19

Transitioning from Volume to Value The Volume-to-Value transition is shifting payment away from rewarding for greater volume of care (visits, procedures, tests) to rewarding for achieving outcomes through high quality, efficiency, and positive patient experiences. The transition is the impetus for new care delivery approaches…re-thinking how care is organized, and going beyond the traditional walls of a hospital, clinic, or health system, recognizing the importance of social determinants and community support. 20

Adopting a Population Health Approach Translating community health needs assessments into action –CDC resource: Community Health Assessment for Population Health Improvement – HI_508.pdfhttp://wwwn.cdc.gov/CommunityHealth/PDF/Final_CHAforP HI_508.pdf Addressing cultural competence and health literacy –National Institutes for Health resources – 21

Building an Effective Care Coordination Program The Promise of Care Coordination: Transforming Health Care Delivery developed by Families USA from consumer and patient perspective Community-Based Care Coordination: A Comprehensive Development Toolkit developed by Stratis Health provides tools for use at different stages in the development of a CCC program Care Coordination in Rural Communities, a RUPRI paper which identifies key ingredients to effective care coordination in rural places 22

Health Equity and Emerging Professionals Community Health Workers: –Function as liaisons between health and social services and communities to facilitate access to coverage and care, improve the quality and cultural competence of service delivery, and build individual and community capacity for better health. Community Paramedics: –Trained as direct service providers who offer basic levels of care appropriate to prevention, emergencies, evaluation, triage, disease management, and basic oral and mental health. They serve as advocates, facilitators, liaisons, community brokers, and resource coordinators. 23

What is the call to action? 24

Call to Action 1.Understand how emerging professions fit in the rapidly changing care delivery and payment context 2.Create a compelling vision and value proposition –Data driven! 3.Take advantage of learning and networking opportunities to advance your work and your profession 25

In Summary To quote a Chinese proverb: Teachers open the door, but you must enter by yourself. For emerging health professions, the converging forces described today have opened the door, but you must create the reason the to be invited in. 26

Jennifer P. Lundblad, PhD, MBA President/Chief Executive Officer

Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities.