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Integrated Care 2.0: Policy Partners to Drive Change. GIH Annual Meeting March 6, 2014. Learning Objectives. Learn strategies to establish partnerships with policy makers to support complex health initiatives; - PowerPoint PPT Presentation
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GIH ANNUAL MEETINGMARCH 6, 2014
Integrated Care 2.0:Policy Partners to Drive Change
Learning Objectives
Learn strategies to establish partnerships with policy makers to support complex health initiatives;
Identify potential national accrediting, regulatory, funding and other policy organizations that can enhance sustainability of foundations’ initiatives;
Explore case studies of policy changing partnerships.
LARRY GRAB, DIRECTORBehavioral Health Northeast
& Medicare Advantage Services
WellPoint, Inc.
Public and Private Collaborations
Collaborative Partnerships
The private managed care company partnering with: Not-for-profit organizations (Hospitals,
CMHCs, FQHCs, etc.) State-based policy-maker workgroups Quasi-state organizations – eligible for
grants and public funding Organizational coalitions
Why Collaborate and Partner?
Ability to pilot and/or study programs that are of mutual interest
Lend support and weight for grant funding awards
Increase communication of initiativesEnhance community relations and involvement through local partnerships
The Maine Experience
Anthem’s representation on the Maine Health Access Foundation (MEHAF) Integrated Care Policy workgroup
Mutual interest on integrating medical and behavioral health care Anthem initiated the use of Health and Behavior
Assessment & Intervention CPT codes as a starting point
The Maine Experience (cont)
The Anthem work was the foundation to further evaluate this with other payers; influence change; and share the outcome results to demonstrate value
Maine Experience OutcomesPartnering outcomes included:
Ability to reach a large provider network with significant patient population
A multi-constituent workgroup to spread the word of the initiative and provide feedback
Maintain momentum and focus thru Program staff
Expansion and inclusion of other payers, public and private
Results that help influence ongoing support, future policy or redirection of the initiative
Upcoming Collaborations
Piloting a program with Northeast Business Group on Health (NEBGH) in the NYC metro area
The “One Voice” program links primary care providers with a non-MD BH provider and a consulting psychiatrist
Upcoming Collaborations
Partially grant-funded for the consulting psychiatrist and insurer funded for the face: face work with the patients
Insurers and NEBGH will work together to evaluate health outcomes of those individuals that participated in the program
Sarah Hudson Scholle, Vice PresidentGrantmakers in Health
March 6, 2014
Integrated Care 2.0: Policy Partners to Drive Change
The National Dual Eligibles Summit
Building the PCMH
The Joint Principles of the PCMHDeveloped by the ACP, AAFP, AAP and AOA
• Personal physician• Physician directed medical practice• Whole person orientation• Care is coordinated and/or integrated across all health
care system and patient’s community• Quality/safety are hallmarks of medical home• Care planning• Evidence-based medicine• Clinical decision support• Continuous quality improvement• Patient participation and feedback• Appropriate HIT
• Enhanced access• Payment reform
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About NCQA
Our missionTo improve the quality of health careOur methodMeasurementWe can’t improve what we don’t measureTransparencyWe show how we measure so measurement will be acceptedAccountabilityOnce we measure, we can expect and track progress
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15
• Care access and continuity• Identify and manage a population• Treatment planning and care
management• Provide self-care support and
community resources• Track and coordinate• Measure to improve performance
What is a medical home? PCMH 2011 standards
PCMH is the fastest-growing delivery system reform
16
12/31/08 12/31/09 12/31/10 12/31/11 12/31/12 11/30/130
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2141,976
7,676
16,191
24,544
33,026
28383 1506
33025198
6550
Clinicians Sites
17
NUMBER OF PCMH CLINICIAN RECOGNITIONS BY STATE
ME
VT
RINJ
MD
MA
DE
NY
WA
OR
AZ
NV
WI
NM
NE
MN
KS
FL
CO
IA
NC
MI
PAOH
VAMO
HI
OK
GA
SCTN
MT
KY
WV
AR
LA
AL
INIL
SD
ND
TX
IDWY
UT
AK
CA
CT
NH
61-200 Recognitions
*As of 2/28/14
MS
21-60 Recognitions
0 Recognitions
1-20 Recognitions
201+ Recognitions
35,677 PCMH CLINICIAN RECOGNITIONS PR
Less than 5 percent of practices submit CAHPS PCMH data
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Role of Philanthropy
• Raise awareness • Identify best practices, innovative
models
• Advocate for policy change
• Train and sustain
Key Discussion Questions
As a local/regional grantmaker, what local groups might fit a policy partner profile?
As a national foundation, how does one connect with influential local policy partners?
How much of this work can be done locally?
What type of issues are best addressed with larger national policy partners?
Keep in TouchIrfan HasanThe New York
Community Trust212-686-0010 ext. [email protected]
Becky Hayes BooberMaine Health Access
Foundation207-620-8266 ext. [email protected]
Larry GrabWellPoint, [email protected]
Sarah [email protected]
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