Virginia Health Innovation Plan 2015:

State Innovation Model (SIM) Design

December 3, 2015Beth A. Bortz | President & CEO

The State Innovation Model (SIM) Initiative

• Provides financial and technical support to states for the development and testing of state-led, multi-payer health care payment and service delivery models that will: improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and CHIP beneficiaries—and for all

residents of participating states.

• Improving access to care is not an expressed, targeted priority of this initiative, as most SIM states were expected to have already expanded Medicaid.

• This makes it especially challenging for Virginia.

• In December of 2014, CMS announced 32 winners of the Round 2 awards. Virginia was awarded a $2.6 M Design Grant. CMS estimates the 38 SIM grants (Rounds 1 and 2) now collectively cover 61% of the U.S. population.

2

3

The State Innovation Model (SIM) Initiative

SIM Overview

How To Engage As We Near the Completion of

the SIM Plan

Engage in the work of your regional Accountable Care Community (ACC).

Learn more about Virginia’s emerging Delivery System Reform Incentive Payment (DSRIP) Waiver.

Join An Emerging ACC

Public and private stakeholders work collaboratively to advance the Triple Aim for their region’s population

• The creation of Accountable Care Communities (ACCs) in Virginia is the core strategy of Virginia’s State Innovation Model Design Award.

• Successful ACC development requires multiple public and private stakeholders to commit to working collaboratively to advance the Triple Aim (better care, better health, and lower cost) in their regions and to share the responsibility for the health of the community.

• The success of regional ACC development depends on the creation of non-traditional partnerships. The healthcare community cannot do this work alone.

• ACC’s will include representatives from state and local government, health care providers, health plans, area nonprofits, employers, and consumers.

SIM: ACCs

• Select 5 regions to serve as pilot Accountable Care Communities (ACC) and hold ACC development meetings with community leadership to finalize coordinating structures.

• Review each region’s performance on core population health and quality improvement measures to target priorities.

• Review emerging pilots from Virginia’s SIM portfolio (Primary Care Transformation, Care Transitions, Integrated Care, Telemedicine and Remote Patient Monitoring) and consider community adoption.

• Develop priorities for Regional Transformation Plans for each of the ACC regions.

ACC Development Strategy

Next Steps

• Beginning next year, VCHI hopes to lead each regional ACC in the development of a Regional Transformation Plan for enhanced population health.

• VCHI then hopes to provide assistance for the implementation of the innovations which stem from those plans.

• Future SIM funding from CMS is unlikely so identifying alternative funding sources will be necessary.

Regional Transformation Plans

DSRIP Waiver

Delivery System Reform Incentive Payment

DSRIP waivers provide financial incentives to achieve Medicaid delivery system reforms through:

Infrastructure Development System Redesign Clinical Outcome Improvements Population-Focused Improvements

Department of Medical Assistance Services

http://www.dmas.virginia.gov/ 10

Delivery System Reform Incentive Payment Program

Common Features Include:

State has clear vision for a transformed Medicaid delivery system

State identifies activities intended to transform the delivery system

Providers join together to undertake transformation activities

State funds providers based on achievement of specified milestones/metrics

NY, NJ, CA, TX, MA, and KS have implemented DSRIP programs

Department of Medical Assistance Services

http://www.dmas.virginia.gov/ 11

Greatest Opportunity for Virginia’s Medicaid System

DSRIP program is a great opportunity for Virginia to transform

The future is a Medicaid delivery system that reimburses based on high-value care

Ensure that even the most medically complex enrollees with significantly behavioral, physical, and developmental disabilities can live safely and thrive in the community

To accomplish either of these, significant investment in data infrastructure at the provider and state level is imperative

Opportune time to leverage upcoming Managed Long-term Services and Supports (MLTSS) procurement

Department of Medical Assistance Services

http://www.dmas.virginia.gov/ 12

Transforming Virginia’s Medicaid Delivery System

In 5 years, Virginia envisions a Medicaid delivery system where high-value care is the norm and even the most medically complex enrollees with significant behavioral, physical, sensory, and developmental disabilities can live safely and thrive in the community

Four Transformation Steps:

1.Integrate Service Delivery

2. Invest in Data Integration

3. Expand Community Capacity

4. Advance How DMAS Pays for Services

Stay Connected

Additional Resources:

• Join the Virginia Health Innovation Network: www.InnovateVirginia.org

• View Commissioner Levine’s Plan for Well-being webinar on our website: http://bit.ly/VirginiaPopHealthUpdate

• Share your projects that align with the SIM Key Improvement Areas: brenden@vahealthinnovation.org