AnIntroductiontotheCommunityMedicaidCollaborative

AnnMonroe

President,CommunityHealthFoundation

ofWesternandCentralNewYorkamonroe@chfwcny.org

November12,2010

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presented at the P2 Quarterly Meeting

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Health Status of Western New Yorkers

Risk Factor Erie County

Niagara County

Other 6 WNY Counties

State

% unemployed (March 2010) 8.2% 8.6% 8.4% - 11% 8.7%

% of population at or below poverty level (2007) 13.7% 11.9% 9.6% - 15.8% 13.8%

CV Disease Crude Mortality Rate per 100,000 372.3 437.2 312.1 – 423.1 313.4

CV Disease Crude Hospitalization Rate /10,000 202.6 266.6 143.6 – 235.0 194.6

Diabetes Mortality Rate per 100,000 26.4 24.2 14.7 – 35.2 20.0

ED Visits per 100 residents 36.1 40.5 30.0% - 41.5% 34.6

ED Visit for Illness (% of ED visits) 68.4% 66.6% 63.1% - 67.3% 74.7%

•  High rates of cardiovascular disease mortality and hospitalization rates

•  Higher diabetes mortality compared to the State average •  Emergency department utilization greater than State average

Sources:NYS DOH, County Health Assessment Indicators, 2005-2007 SPARCS Annual Reports, Emergency Departments of NYS, Table 8: 2006 Emergency Department Visits by County of Residence and Reason for Visit NYS DOH, County Health Indicator Profiles (2003 - 2007) Bureau of Labor Statistics, March 2010

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TheStatePerspective

•  2006NYSMedicaidspendingwas$2,316percapita–  128%abovethenationalaverageof$1,015–  257%abovethemedianspendingof$899

•  Higherspendinghasnotresultedinbetterquality

•  MedicaidinNYS–  Poorhealthindicatorsandlowqualityscores–  Financiallimitationstohospitalsandhealthplans(increasing

netlosses)–  Insufficientphysicianreimbursement–  CurrentfinancialcrisisofNewYorkState

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MedicaidManagedCareinWNY

•  MedicaidManagedCareenrollmentgrowing•  Allhealthplansincreasingmembership•  Economictimesandhealthcarereformforecastcontinuedgrowth

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Medicaid Managed Care and Health Plan Share in WNY

Source: NYS Department of Health, Monthly Medicaid Managed Care reports, data as of January of each year

Health Plan Share by County

BCBS/ Health Now Fidelis

Indepndnt Health Univera

Allegany 63% 0% 0% 37%

Cattaragus 45% 34% 0% 21%

Chatauqua 24% 73% 0% 3%

Erie 17% 25% 28% 31%

Genesee 91% 9% 0% 0%

Niagara 32% 35% 33% 0%

Orleans 42% 58% 0% 0%

MomentofOpportunity

•  NewYorkStateDepartmentofHealth–  enhancedpaymenttoprimarycarephysicianstosupportdevelopmentofpatientcenteredmedicalhomemodels

–  physiciansreceive$2,$4,or$6pmpmforeachManagedMedicaidPatientiftheymeetNCQAPCMHLevel1,2or3,respectively

•  Opportunitytoimprovequalitymetricsandthefinancialstabilityofthehealthsystemsservingthispopulation

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RegionalReadiness

  Priorities  Young children in poverty

 Deferring frailty among elders   Building community health capacity

  Strengthening safety net (SNAPCAP)

  Neighborhood Action Initiative   Collaborative for Improved Transitions   Early childhood emotional/social health

quality improvement collab.

  750+ providers & 2000+ users   25 million results (labs, radiology,

transcribed reports, 1.7M new monthly   75,000 community-wide consents, 3000

added weekly   Payor EMR adoption program

  Regional quality improvement   Consumer engagement

  Performance measurement/public reporting

  Reduce health disparities

  1 of 17 communities funded by RWJF for Aligning Forces for Quality

  Community Health Planning & Reporting Capability

Western New York organizations recognized for leadership in developing regional collaboration for health improvements.

HEAL 10 PCMH Grant support

Federal Regional Extension Center to support meaningful use of EMR WNY Health Equity Coalition

Improving Quality Improvement across the region

Beacon Community

Partners

•  Initialpartners–  Fidelis– HealthNow–  IndependentHealth– Univera–  CommunityHealthFoundationofWesternandCentralNewYork

•  Localproviders(e.g.physicianoffices,hospitals,FQHCs)

•  HomeforthisprojectisP2CollaborativeofWesternNewYork

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CommunityMedicaidCollaborativeOverallGoal

Population:UrbanBuffaloandNiagaraFalls

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•  Improveoutcomes(measuredviaIHITripleAimframeworkofquality,experience,costandoverallhealthstatus)

•  ImprovetheCareCoordinationModeltoachieveOutcomes.•  PersonCenteredMedicalHome•  PCMH/HealthPlan/Providerintegrationandalignment•  NeighborhoodCommunities

•  DevelopBusinessSustainabilityModeltoSupportCareCoordinationModelandOutcomes

•  Ensureavailablecommunityresourcesareutilizedasnewandrecurringresourcesaredefinedandpiloted

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Community Coordination

Critical Components to Improve Quality and Affordability

Com

pone

nts

Care Coordination Physician Office

Community Based EMR Meaningful Use

Fund

ing

Sour

ces

• Practice to evolve from limited to fully integrated electronic capability with connectivity/interoperability to support

•  Patient-population data •  Searchable clinical patient

information •  Use of patient registries •  Clinical condition / risk

management •  Population health

management

• Improving quality, safety, efficiency, and reducing health disparities • Engage patients and families in their health care • Improve care coordination • Improve population and public health • Ensure adequate privacy and security protections for personal health information

• Provide care coordination support within the physician practice aligning and maximizing each team members level of training and expertise (i.e. RN, social worker, health coach, care coordinator) to:

•  Address barriers at point of care

•  Assess social / environmental needs

•  Liaison between physician practice and community resources

•  Support patient self management

• Intertwining socio-environmental issues and medical needs require collaboration with community partners and organization to:

•  Promote and support health prevention, early diagnosis and treatment

•  Coordinate, navigate and access community services

•  Develop and support community awareness, education and engagement

•  Empower and promote individual responsibility

•  To be determined based upon scope and approach

• To be determined based upon scope and approach

• Beacon Community •  HEAL 10 • Primary Care (Payor) EMR in kind allocation within HEAL 10 • Regional Extension Centers (REC) • NYS PCMH funding based upon achieving NCQA accreditation level 1, 2, or 3 ($2/ $4/ $6) • Potential funding may be available from individual health plan or hospital programs, government grants, and/or foundations

Patient Centered Medical Home (Physician/practice to achieve NCQA Accreditation)

Use of Technology

CommunityMedicaidCollaborativeCareCoordinationModel

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NeighborhoodCommunity

PCMHHealthplanw/hospital/other

providerintegration

INTERVENTIONS INTERVENTIONS INTERVENTIONS

PersonCenteredHealthCoordinationModel

•  Innovativethoughtandcommitmenttodevelopthenewmodel•  Alignmenttooutcomemeasuresrepresentativeofquality,experienceandcost•  Maximizingcurrentresources,identifyingefficienciesandcreatingvalue

WNY Regional Medicaid Collaborative Coordination of Care – Conceptual Framework

Hospitals / Health Delivery System

Discharge Planner / Case

Manager

Community

Community Health Worker

Care Coordination Health Plan

Health Coach, Disease / Case Manager

Patient Centered Medical Home

(PCMH)

Care Coordinator

Supported by Health Information Exchange

Individual

WNYCommunityMedicaidCollaborativePerformanceMeasurement

initialdrafttobedeveloped

FinancialCost HealthStatus

Experience Quality

•  Medicalpmpm–reducetrend

•  Adminpmpm–reducetrend

•  Prevalence:–Cardiac–Diabetes–Obesity–Cancer

•  QARR/HEDIS•  Utilization(ER,Admits)

•  VariationinCare

•  CAHPS•  PCAHPS•  IHI

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CommunityMedicaidCollaborativeSummit(Nov2,2010)“PromisingModelsforAccountableHealthyCommunity”

•  Speakersfromothercommunitiesacrossthenation–  CenterforHealthCareStrategiesinNewJersey–  InstituteforHealthCareStudiesatMichiganStateUniversity

–  RhodeIslandChronicCareSustainabilityInitiative–  NeighborhoodHealthPlanofRhodeIsland–  CommunityHealthWorkerNetworkofNewYorkCity–  HudsonHealthPlan(NY)–  VermontBluePrint–  AdirondackPlan(NY)

•  PresentationsavailableontheP2website(www.p2wny.org)

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KeyLearnings•  InvestmentintheEMRandClinical/PracticeTransformation

inclusiveofPCMHcertificationandmeaningfuluse–  requiresorganizationalchangemanagement,–  resources(qualityimprovementandcarecoordinators),–  enhancedfinancialreimbursement

•  Practicemustseeitisintheirbestinteresttotransformwhichneedstobecommunicatedbothintermsofqualityandeconomics

•  Timeframetoimplementcanrangefrom2to5years

•  Physicianproviderswhotransformareseekingcommonreimbursement/revenuestreamswithsamequalityoutcomemeasures

•  Abilitytodesignreimbursementmodelsacrosspayershasrequiredsomelevelofstateauthority

Thankyou!