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Accountable Care Communities:
Integrating Medical and Social Services
801.538.5082 | [email protected] | 4001 South 700 East suite 700, Salt Lake City, UT 84107
HOUSEKEEPING
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the “telephone” option under “Audio” in the GoToMeeting window, then mute your phone
• There will be several opportunities for questions please submit them using the chat feature of the GoToMeeting window
AGENDA
• Update on recent MSSP Benchmarking Methodology, & CMS-AHIP Collaborative for Multi-Payer Quality Measures
• Presentation on Accountable Health Communities by Dr. Stephen Shortell
• Shared provider insights from Julie Bluhm of Hennepin Health
• Introduction to CMS’ Accountable Health Communities (AHC) model
• Opportunity for Q&A – Members can submit questions ahead of time by emailing
MSSP Benchmarking Methodology
CMS RELEASES A PROPOSED RULE DETAILING CHANGES TO THE MSSP BENCHMARKING METHODOLOGY
• Describes improvements of methodology used for establishing a benchmark to measure an ACO’s financial performance in the MSSP program
• CMS suggests changes to shift to regional benchmark for ACOs
o Can continue in the program past their first 3-year performance period
o Benchmark rebasing methodology would apply to ACOs renewing for subsequent agreement periods beginning on or after January 1, 2017
• CMS announces a new option for ACOs in Track 1
o For those willing to move to a two-sided model (Tracks 2 or 3) for their second agreement period, but elect to defer for one additional year under Track 1.
o This will allow ACOs some time to prepare for risk without having to renew for another 3-year agreement under Track 1.
MSSP Benchmarking Methodology
CMS RELEASES A PROPOSED RULE DETAILING CHANGES TO THE MSSP BENCHMARKING METHODOLOGY
• Proposed modifications to the rebasing methodology include:
o Removing the adjustment to explicitly account for savings generated under the ACO’s prior agreement period.
o Using a regional spending growth trend, rather than the national spending growth trend,
when establishing and updating a rebased benchmark.
o Adjusting the rebased benchmark by a percentage of the difference between an ACO’s historical spending and the spending in the ACO’s regional service area.
o Updating the rebased benchmark on an annual basis to account for regional FFS spending rather than national FFS projected spending.
• Additional proposals include:
o Adding a new option to encourage ACOs to shift to “downside risk” earlier in their participation. Would allow Track 1 ACOs transitioning to Tracks 2 or 3 to extend their first performance period for an
additional year before beginning to bear risk.
o Streamlining the methodology used to adjust an ACO’s historical benchmark
o Establishing policies for making corrections to financial calculations of shared savings or shared losses
o Providing publicly available data of county-level FFS spending and risk scores to support modeling and analysis of proposed changes.
MSSP Benchmarking Methodology
CMS & AHIP Collaborative
Multi-Payer Quality Measures
CMS & AHIP RELEASE COLLABORATIVE LIST OF QUALITY MEASURES
• Measures were developed over the past 18 months o Created by a multi-stakeholder group led by AHIP, CMS and the National Quality Forum (NQF) called the
Core Quality Measures Collaborative
• The group worked with payers, providers, employers, consumers, and patient groups to identify core sets of quality measures o Attempted to discover quality measures that payers are committed to using, meaningful to patients and
physicians, and reduce variability in measure selection, administrative burden, and cost.
• The work will inform CMS’ implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) measures, o Aims to establish widely agreed upon core measure sets that could be aligned across government and
commercial payers.
• The core measure sets include: o ACOs, PCMHs, Primary Care, Cardiology, Gastroenterology, HIV and Hepatitis C, Medical Oncology,
Obstetrics, Gynecology, and Orthopedics
Collaborative Quality Measures
Introduction to
Accountable Health Communities
INTRODUCTION
DR. STEPHEN SHORTELL PhD, MPH, MBA
Blue Cross of California Distinguished Professor of Health Policy and Management and Director, Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, UC-Berkeley.
WHAT ARE ACCOUNTABLE HEALTH COMMUNITIES?
An Accountable Community for Health (ACH) is a multi-payer, multi-sector alliance of the major health care systems, providers, and health plans, along with public health, key community and social services organizations, schools, and other partners serving a particular geographic area. An ACH is responsible for improving the health of the entire community, with particular attention to achieving greater health equity among its residents.
Accountable Community for Health
Source: CHHS and CDPH, 2014
SOME ESSENTIAL FUNCTIONS Accountable Community for Health
• Convene a broad set of key stakeholders across sectors that influence
health – housing, transportation, education, public health, etc.
• Develop a shared vision and goals
• Conduct community health needs assessments
• Assess community assets
• Develop a “backbone” integrator organization to manage a population health
budget and allocate resources
• Create information systems for performance measurement, management,
continuous improvement and accountability
SOME APPROACHES TO FINANCING ACHS
Accountable Community for Health
• Community Benefit Funds
• Regional Global Payment
• ACO Shared Savings
• Health and Wellness Trusts
• Social Investing (e.g., Fresno Asthma Project)
Adapted from E.S. Fisher and J. Corrigan, “Accountable Health Communities: Getting There from Here,” JAMA, Nov. 26, 2014,
312(20): 2093-94.
ACHS MUST SELECT HEALTH IMPROVEMENT INTERVENTIONS
Accountable Community for Health
Five levels:
• Clinical
• Community
• Clinical-community linkages
• Systems – policy
• Environmental
INTERVENTIONS CATEGORIES SUMMARY TABLE
Clinical Interventions Community Interventions
Clinical Community Linkages
System-Policy/ Environment
SINGLE (One intervention and/or targeting one condition)
PORTFOLIO
(Addresses multiple conditions and/or uses multiple approaches, e.g., structural, process, cultural, technology, etc.)
Primary Care QI (7) Provider training (4) Shared decision making & motivational interview (2)
Medical home, chronic care model (4) Disease Management (1)
Lifestyle/behavioral Intervention (29) Exercise (10) Nutrition (3) Web-based/Internet (3) Social Network (2)
Pharmacist on the care team (20) Nurse care manager (6) Telephone-based support (3) Community health worker (CHW), lay health worker (25) Education Intervention (for patients & caregivers) (23) Health screenings (1) School-based (5)
Community collaborative (11) Built environment (4) Government policies (1)
Increasing in complexity
Incr
eas
ing
in c
om
ple
xity
PROMISING CONDITION SPECIFIC INTERVENTIONS – ASTHMA (CONT’D)
Intervention Description Time frame
Health Outcomes
ROI Ease of Implementation
Indicators of success
Data needs
Community
4. Boston Children’s Community Asthma Initiative
Proactive community based asthma services, multi-disciplinary, coordinated disease management programs to prevent costly complications and hospitalizations
1-3 years
Reduced ED visits, improved quality of life
Significant Intermediate Reduced cost, improved quality of life
Not Reported
Citation: U. Bhaumik, K. Norris, G. Charron, S. P. Walker, S. J. Sommer, E. Chan, D. U. Dickerson, S. Nethersole and E. R. Woods. “A cost analysis for a community-based case management intervention program for pediatric asthma.” J Asthma 50.3 (2013): 310-317.
PROMISING CONDITION SPECIFIC INTERVENTIONS – CARDIOVASCULAR DISEASE (CONT’D)
Intervention Description Time frame
Health Outcomes
ROI Ease of Implementation
Indicators of success
Data needs
Community
2. Physical activity and weight loss
Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health
1-3 years Mobility, weight loss
Not reported
Easy Improved mobility as measured by time needed to complete a 400m walk
Observational
Citation: Rejeski, W. Jack, et al. "Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health." Archives of internal medicine 171.10 (2011): 880-886
SUMMARY Accountable Community for Health
• Studies with the strongest evidence base were primarily single focus/easier to implement, short term (1 to 3 years) and targeted the clinical or clinical-community linkages
• Strong strength of evidence was reported for diabetes interventions (4/5) and least frequent among asthma interventions (about half)
• Most common interventions were lifestyle/behavioral/ pharmacist on the care team, those involving community health workers, and patient/caregiver education
• Multi-component strategies included primary care QI efforts, exercise, community collaboratives, nurse care managers and school-based initiatives
An Accountable Care Community:
Hennepin Health
INTRODUCTION
JULIE BLUHM Clinical Operations Manager Hennepin Health
WHAT IS HENNEPIN HEALTH?
$
• Defined Provider Network, Shared Electronic Health Record
• Risk-Sharing Funding Model, Alignment of Finances
• Integration of Medical and Social Services to Address Social Determinants
• Consensus-Based Governance Model
Prospective
enrollment
via managed
care choice
or default
Capitated Reimbursement
from State Medicaid Agency
Hennepin County
Hennepin County
INNOVATION HIGHLIGHT: HOUSING NAVIGATION
• Dedicated staff work to place medically complex Hennepin Health members in supportive housing available to them
• Resulted in considerable reductions in ED (-36%) and hospital (-16%) use post-housing
Hennepin County
CHALLENGES
• Collaborative initiatives are always hard. – Leadership buy-in is essential.
– Clear roles and expectations.
– Operational authority where possible.
• Safety net culture = uncomfortable serving some and not all.
• Target social interventions for maximum health effect given limited resources...we can't realistically solve all social issues with just health care resources.
• Difficult to determine the specific effect of each piece of the care model (e.g. Did the housing unit or the care coordinator keep the patient out of the hospital?)
• Many of these kinds of investments take many years or decades to see a return, this is a mismatch with the short term savings incentives in health care
THANK YOU!
Videos, newsletter, and more information: hennepinhealth.org
Hennepin County
The CMS Model:
Accountable Health Communities (AHC)
WHY IS THE CMS AHC ANNOUNCEMENT SO TRANSCENDENT?
• First time testing social needs nationally as part of the delivery system
• First time testing unmet social needs within a payment model nationally
• First time to address what constitutes as health care by a major U.S. payer for health care services
CMS Will Test Accountable Health Communities
CMS PLANS TO TEST ACCOUNTABLE HEALTH COMMUNITIES (AHC) MODEL
• Makes available $157 million in funding for a five-year model
• Aims to identify and address beneficiaries’ health-related social needs in the following core areas:
o Housing instability and quality,
o Food insecurity,
o Utility needs,
o Interpersonal violence, and
o Transportation needs beyond medical transportation
• Examines whether systematically identifying and addressing health-related social needs of beneficiaries through referral and community navigation services can impact:
o Health care costs
o Reduce inpatient and outpatient health care utilization
o Improve health care quality and delivery
• Becomes first program to test ways to address the health-related social needs for Medicare and Medicaid beneficiaries
Overview of Accountable Health Communities (AHC) Model
EACH TRACK REQUIRES THE AWARD RECIPIENT TO SERVE AS A HUB RESPONSIBLE FOR COORDINATING EFFORTS How AHC Actually Works for Award Recipients
• Identifies and partners with Clinical Delivery Sites (CDS) (e.g., clinics, hospitals)
• Conducts systematic health-related social needs screenings, and making referrals
• Coordinates and connects community-dwelling beneficiaries
o Those who screen positive for certain unmet health-related social needs and are randomized to the intervention group to community service providers
• Aligns model partners to optimize community capacity
• Becomes the “Bridge Organization” and is expected to partner with:
o At least one state Medicaid agency
o Clinical Delivery Sites including at least one of the following types:
Hospital
Provider or practice that furnishes primary care services
Provider of behavioral health services
o Community service providers capable of addressing core or supplemental health-related social needs identified through the screening tool
AHC WILL CONSIST OF THREE-TRACK MODELS BASED ON PROMISING SERVICE DELIVERY APPROACHES
Accountable Health Communities (AHC) Model
Track Type Number of Organizations
Funding Description
Track 1
Awareness
12
$1M per Awardee
Increase beneficiary awareness of available community services through information dissemination and referral
Track 2
Assistance
12
$2.57 per Awardee
Provide community service navigation services to assist high-risk beneficiaries with accessing services
Track 3
Alignment
20
$4.51 per Awardee
Encourage partner alignment to ensure that community services are available and responsive to the needs of beneficiaries
Q & A
Q & A
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Questions About the ACLC? If you have questions about the ACLC please email