health care reform update jeff schiff, md, medical director, dhs pat adams, assistant commissioner,...
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Health Care Reform Update
Jeff Schiff, MD, Medical Director, DHSPat Adams, Assistant Commissioner, MDHScott Leitz, Assistant Commissioner, MDH
Presentation to Health Care Access CommissionDecember 1, 2008
Health Reform Bill Key Elements
Health reform bill passed in May contains a number of key elements:
– Public health improvement (SHIP)
– Health care coverage/affordability
– Chronic care management/health care home
– Payment reform and price/quality transparency
– Administrative efficiency
– Health care cost measurement
Vision and Framework for Implementation
Create meaningful, transformative health reform based on the Institute for Healthcare Improvement’s Triple Aim. The goals of the Triple Aim are to simultaneously:
Improve population health; Improve patient/consumer experience; and Improve affordability of health care.
Health Reform Implementation Principles
Purpose of reform is to improve health of Minnesotans and redesign care to improve value (quality/costs).
We must “start with end in mind” and always remain focused on what we want to accomplish and what success looks like.
To ensure all Minnesotans benefit, we will aim for market-wide implementation of health reforms —not just reforms for government programs.
We will seek—and expect—unprecedented collaboration among public and private partners as we implement comprehensive health reform initiative.
Overview of presentation
Quality Incentive Payment System (QIPS)Provider Peer GroupingBaskets of CareOther ActivitiesSHIPHealth Care Homes
Article Four:
Update on Implementation of Quality, Transparency, and
Payment Reform
Scott Leitz Assistant CommissionerMinnesota Department of Health
Health Care Access CommissionDecember 1, 2008
Quality and Incentive Payment System
• Minnesota Statutes, section 62U.02
• MDH contracted with local organizations to implement the QIPS – Minnesota Community Measurement – contract lead
with:• Minnesota Hospital Association
• Minnesota Medical Association
• StratisHealth
• University of Minnesota
– $ 3 million contract over 4 years
Quality and Incentive Payment System
• Key Tasks– Task One: Quality measures identification and documentation
to be used for public reporting
– Task Two: Development of an incentive payment system
– Task Three: Collection and public reporting of standardized quality measures
• Important Dates– July 1, 2009 – MDH specifies quality measures and quality
incentive payment system
– Jan. 1, 2010 – Providers submit standard quality measures
– July 1, 2010 – Standard quality
measures reported publicly
Quality and Incentive Payment System
General TimelineDec. 5, 2008 Inventory of existing quality measures completed
Dec. 2008 thru Jan. 2009
Contractor holds public meetings with stakeholders to develop recommendations on a set of quality measures for public reporting
Feb. 1, 2009 Inventory of existing quality incentive payment and pay-for-performance systems complete
• Project Status–On schedule to meet statutory timelines
–Met all key milestones to date (e.g., RFP, contract, etc.)
Quality and Incentive Payment System
General Timeline
Feb. 2009 thru Mar. 2009
Contractor holds public meetings with stakeholders to develop recommendations on quality measures and specific methodology for quality-based incentive payment system
Apr. 2009 thru June 2009
MDH adopts administrative rules to implement the quality measures and incentive-based payment system
July 2009 Contractor begins education and training of providers about QIPS requirements
Jan. 1, 2010 Contractor begins collecting data
July 1, 2010 MDH publishes first public report on quality measures
July 1, 2010 SEGIP begins using the quality incentive payment system
Provider Peer Grouping
• Collection of encounter data• Collection of pricing data• Analytical work for peer grouping providers based on:
– The quality and outcome data from QIPS
– The resources used to achieve the outcomes
– The price of those resources
• Important Dates – July 1, 2009 – Health plans & TPAs begin submitting data
– Jan. 1, 2010 – MDH specifies peer grouping methodology
– June 1, 2010 – MDH disseminates results of peer grouping to providers
– Sept. 1, 2010 – MDH publicly publishes
the results of peer grouping
Provider Peer Grouping Encounter Data
• Minnesota Statutes, section 62U.04, subd. 4
• MDH will execute a data collection contract in 2-3 weeks
• Project Status– On schedule to meet statutory timelines
– Met all key milestones to date (e.g., RFP, contract, etc.)
General Timeline
Jan. 2009 Contractor holds public meetings with stakeholders to develop recommendations on data elements
Feb. 2009 thru May 2009
MDH adopts administrative rules to collect encounter data
July 1, 2009 Contractor begins working with health plans and TPAs to collect encounter data
Provider Peer Grouping Analytical Work
• Minnesota Statutes, section 62U.04
• RFP currently open for bid
• Key contractor tasks:– Issue a request for information (RFI) on peer grouping systems
– Collect and synthesize available research and data on peer grouping systems
– Participate in public meetings to discuss the results of the RFI and research efforts
• Stakeholders will have an opportunity to respond to the RFI
• Public meetings to discuss peer grouping methodologies will begin Summer 09
Baskets of Care
• Minnesota Statutes, section 62U.05• MD will execute a contract to facilitate a steering committee and
seven work groups in 1-2 weeks• Steering Committee will:
– Identify conditions/episodes of care to include in the seven baskets, using:
• Prevalence, Cost of treatment, Potential for innovations
– Identify issues related to implementing baskets
– General oversight of the work groups
• Work groups will:– Identify the health care services and/or outcomes to include in each
basket
– Identify/define quality measures for the baskets of care
– Incorporate patient-directed, decision-making
support in baskets
Baskets of Care
• Steering Committee Chairs:– Dr. George Isham, HealthPartners
– Dr. Doug Wood, Mayo
• Steering Committee Members:– MMGMA
– MMA (2 – primary and specialist):
– MHA (2 – rural/critical access hospital and urban hospital)
– Council of Health Plans (2)
– Mayo
– Insurance Federation
– Employer (1):
– Organization with market experience with baskets of care
– Consumers (2)
• Work Groups Members – All Interested Parties
Baskets of Care
General Timeline
Jan. 2009 thru April 2009
Steering committee and work groups meet to define baskets
July 2009 MDH writes rules defining baskets of care
July 2009 Contractor begins outreach effort to educate providers on defined baskets of care
July 2009 thru Oct. 2009
Steering committee and work groups develop plans to address: 1) quality measures for baskets; 2) administrative challenges in implementing baskets
• Project Status–On schedule to meet statutory timelines–Met all key milestones to date (e.g., RFP, contract, etc.)
Other Activities
• All activities prioritized by due date of deliverables
• Anticipated starting dates of public meetings/workgroups:– Essential Benefit Sets
• Due Dates:October 15, 2009 - Work group submits initial recommendationsJanuary 15, 2010 – MDH submits a report to the Legislature
• Work Group Meetings: Late Spring 2009
– Uniform Claim Study• Due Dates:
January 1, 2010 – MDH submits report to Legislature
• Work Group Meetings: Late Winter 2009
State Health Improvement Program SHIP
Pat Adams Assistant CommissionerMinnesota Department of Health
Health Care Access CommissionDecember 1, 2008
Description of SHIP
Signed into law as integral public health component of Health Reform Initiative
SHIP intended to reduce obesity and tobacco use in Minnesota through policy, systems, and environmental changes
$47 million appropriated for fiscal years 2010 and 2011
Competitive grants to Community Health Boards and tribal governments rolled out beginning July 1, 2009
SHIP Model for Achieving Success
Community input into planning, implementation and evaluation
Adherence to socio-ecological model
Health promotion in four settings: community, schools, worksites, health care
Local program advocates Informed by evidence-
based interventions
Focus on common risk factors
Extensive and comprehensive evaluation linked to program planning
Policy, systems, and environmental change that supports healthy behavior
Accountability and oversight
SHIP Development Structure-Internal and External
SHIP Executive
Team
Intervention Work Group
Evaluation and Data
Collection Work Group
Technical Assistance
Work Group
Communications Work Group
Request for Proposal
Development Work Group
Risk Factor and Chronic
Disease Integration
Work Group
Work Group Accomplishments
Intervention– Drafting a Menu of Interventions for potential grantees to assist in
implementation of policy, systems, and environmental change Evaluation
– Drafting an evaluation plan to address community and tribe assessment, process and outcome evaluation, and surveillance
– Developing linked evaluation options for Menu of Interventions Technical Assistance
– Providing three major pre-implementation opportunities– Developing statewide, regional, and grantee-focused support
Communications– Developing consistent messaging, branding, and market-wide coordination
Chronic Disease Integration– Developing strategies to better coordinate systems throughout Minnesota to
promote chronic disease reduction RFP
– Drafting Request for Proposals to be released in February 2009
Achievements
Planning is fully underway Involving key stakeholders in planning (local public health and
tribal governments) Working closely with other stakeholders to ensure SHIP adds
value and builds on existing efforts Using evidence- and practice-based interventions to maximize
program impact Utilizing and modifying existing data collection, assessment,
and reporting systems RFP is on track to be released February 2009 and will be due
May 1, 2009
Opportunities
Building on existing prevention efforts to expand and not duplicate work that is already being done
Enhancing capacity of local public health and tribal governments to implement policy, systems, and environmental changes
Integrating with other Health Reform Initiative components to support overall health reform transformation
Developing an statewide system to demonstrate that reductions in risk factors decreases in chronic disease substantial health care savings!
SHIP Next Steps
Continue planning with our partnersAward funds to roll out July 1, 2009Provide technical assistance to grantees to ensure
successful implementationSecure future funding to achieve goals of reducing
obesity and tobacco use and exposure in MinnesotaReduce the burden of chronic disease to generate
future health care-related cost savings
Health Care Homes
Dr. Jeff Schiff, Medical Director, DHSPat Adams, Assistant Commissioner, MDH
Health Care Access CommissionDecember 1, 2008
Health Care Homes (HCH)
A model of delivering care that is: – comprehensive– coordinated– culturally-competent– continuous– accessible– family-centered– compassionate
HCH Program Development Tasks
Criteria for participationVerification processCommon payment methodology Incorporation of collaborative learningMeasurement of results
Assumptions for Development and Implementation of HCHs
Learning from and building on local and national experiences with HCH models
Collaborative process with broad stakeholder input
Flexibility within the parameters of the legislation creating opportunity to test different models
Meaningful measures that focus on desired outcomes more than process
Refinement of model over time
HCH Development process
Collaboratively organized in state government between the Departments of Human Services and Health with emphasis on public-private collaboration
A combination of grant contracts and state organized processes
Integration with all of the other parts of the Health Care Reform legislation
HCH Activities
Active current work:– Foundational
• Outcome recommendations
• Capacity Assessment
• Consumer and Family Council
– Criteria development workgroup
HCH Activities
Program components in development– Verification – Collaborative learning model development and
testing– Payment system development– Development of specific evaluation measures
HCH Activities to Date
Outcomes: Start with the end in mind. RFP issued October 2008 to develop
recommendations for broad outcomes or goals to be used to guide the evaluation of health care homes.
Contract awarded in November 2008 to Institute for Clinical Systems Improvement (ICSI). Work product due 12/31/08.– Draft outcomes were sent out for public input on
11/21/08.
HCH Activities to Date (cont.)
Capacity Assessment. RFP issued October 2008 seeking an entity to
conduct an assessment of: 1) the readiness of the primary health care delivery system to implement health care homes; 2) consumer understanding and readiness for the implementation of health care homes; and 3) to make recommendations that will guide capacity building efforts in establishing a statewide health care home system.
HCH Activities to Date (cont.)
Consumer/Family CouncilOpportunity for consumer and public
engagement and inputFirst meeting – November 21st
Representatives to serve on other work groups, including criteria/standards work group
HCH Activities to Date (cont.)
Creation of criteria/standards. Process will include facilitated group processes for
broad input from a variety of stakeholder groups.– HCH Community Meeting – Dec. 12, 2008 (will be archived
for later viewing). – Work groups will convene beginning Dec. 18 to develop
standards. – Collaboration with leading national criteria/standards
organizations– Development process will include opportunity for public
input.– Recommendations to Commissioners of Health and Human
Services in late Jan. 2009
HCH Opportunities and Challenges
– Transformational change in care delivery• Changes in infrastructure and culture• Creation of a patient and family centered health care system
– Measurement must evaluate all three goals of the IHI Triple Aim
• Measures will be developed concurrent with the program and refined over time
• Measures must evaluate progress to decreasing disparities – Payment must blend payments for services,
coordination of care, and improved outcomes• Payment mechanisms will evolve over time
Contact Information
Jeff Schiff, MD, [email protected]
Pat Adams, [email protected]
Scott Leitz, [email protected]