Rhode Island State Innovation Model (SIM)

Test Grant

An Overv iew of Rhode Is land’s Healthcare Transformation Landscape

April 2018

SIM Background• $20 million grant from the Centers for Medicare and

Medicaid Services (CMS)

• Transforms the way we deliver and pay for healthcare

• Enhances the way individuals are engaged in their health

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The Ultimate Goal

Adapting the Triple AimHealthier People

Better Care Smarter Spending

Adapted from Institute for Healthcare Improvement, 2012

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SIM Theory of Change

Empower Patients

Support Providers

Address Determinants

of Health

Improved Population

Health &

Progress Toward Triple

Aim

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SIM Strategies

Linking Payment to Outcomes

Developing Infrastructure for Quality Care

Planning and Aligning for a Healthy Population

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SIM funds are supporting 3 categories of activitiesSIM Investments

Practice & Workforce

Transformation

Patient Empowerment

Data Capacity & Expertise Expansion

Engage patients in positive health

behaviors and self-advocacy

Improve primary care and behavioral health

infrastructure

Expand the ability of providers and policy makers to use and

share data

Improved Population

Health

$7.1 M $2.2 M $5.3 M

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Linking Payment to Outcomes

Aligned Approach to Payment Reform

SIM, Medicaid, OHIC, and the Governor’s Office are working together to reform the way healthcare is paid for in Rhode Island

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Volume-Based Value-Based

Providers paid based on quantity of services

delivered

Link provider payments to quality and cost-

efficiency

SIM Aligned Measure Sets

OHIC Affordability

Standards

Reinventing Medicaid

Fee-For-Service

Developing Data Infrastructure for Quality Care

“Collect data once and analyze many times”

Healthcare Quality

Measurement Reporting &

Feedback System

Care Management Dashboards

Integrated Health and

Human Services Data Ecosystem

HealthFacts RI

SIM investments in Health Information Technology (HIT)

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Integrating Physical & Behavioral Health

SIM Investments in Integrated Care

Integrated Behavioral

Health Pilot

Child Psychiatry Access Program

Screening, Brief Intervention and

Referral to Treatment

(SBIRT)

Provider Coaching

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Healthcare Workforce Transformation

Needs Assessment Strategic PlanningStakeholder Engagement

• Gather input from diverse range of stakeholders

• Build consensus for promising strategies

• Develop lasting partnerships across sectors

• Identify health workforce transformation strategies

• Identify barriers to implementation

• Identify resources for implementation

• Profile current healthcare workforce

• Project future healthcare workforce NEEDS and OPPORTUNITIES

• Inventory educational and training capacity

Build Healthcare Career Pathways to Develop Skills

for Jobs that Pay• Entry-Level Workforce• Diversity and Cultural

Competence• Youth Initiatives• Provider Shortages

Teach Core Concepts of Health System and Practice

Transformation• Integrated

Team-Based Care• Health System

Transformation Concepts

Expand Home and Community-Based Care

• Community-Based Health Professional Education

• Healthcare Support Occupations and Emerging Roles

What is Population Health?

The Health of Populations Considering the Whole Person

Population Mean

Mortality

Population Mean Life

Expectancy

Population Mean Health

Related Quality of Life

Physical & Behavioral

Health Outcomes

Ou

tcom

es

Disp

arities A

cross A

ll

Physical Health

Behavioral Health

Mental Health

Substance Use

Including Oral Health

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What determines Population Health?Determinants of Health

Social Supports

Safe Housing & Neighborhoods

Education & Employment

Health Literacy

Access to Care

Affordability

Genetics[30%]

Individual Behavior

[40%]

Social & Environmental

[20%]

Healthcare[10%]

Substance Use

Seeking Medical Care

Diet and Exercise

Adapted from Schroeder, SA. (2007).

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A report describing the physical and behavioral health of Rhode Islanders using these 8 health focus areas:

Planning and Aligning for a Healthy Population

SIM Health Focus Areas

Obesity Tobacco Use

Chronic Disease

(i.e., Diabetes,

Heart Disease, &

Stroke)

Maternal & Child Health

Depression

Children with Social

& Emotional Disturbance

Serious Mental

Illness (e.g. Schizo-

phrenia)

Opioid Use Disorders

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Health Focus Area

SIMIntegrated

Population Health Focus Area

HARICommunity

Health Needs Assessment

LifespanCommunity

Health Needs Assessment

HEZRegional Health

Needs Assessments

Chronic Disease ✓ ✓ ✓ ✓

Obesity ✓ ✓ ✓

Tobacco Use ✓ ✓

Maternal and Child Health

✓ ✓ ✓

Depression ✓ ✓ ✓ ✓

Children with Serious Emotional Disturbance

✓ ✓ ✓ ✓

Serious Mental Illness ✓ ✓ ✓ ✓

Substance Use ✓ ✓ ✓ ✓

SIM Alignment with Health Needs Assessments

SIM Integration & Alignment ProjectFacilitating and supporting Integrated Population Health

Collaborations in 1-2 Health Focus areas.

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SIM

RIDOH

OHIC

HSRI

EOHHS/ Medicaid

EOHHS/ Health IT

DHS/DEA

BHDDH

DCYF

DHS

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Example: Quality Measure Alignment

CMS Programs

Commercial Payers

Medicaid Managed

Care

OHIC PCMH Program

Provider

Other Programs

Before SIM Measure Alignment Work Group

Provider

SIM Aligned Measures

After SIM Measure Alignment Work Group

Slide Title is Georgia 36 point

SIM Alignment with Other Initiatives

BHDDH

Mental Health & Substance Use Block Grants

Collaborative Agreement to Benefit Homeless Individuals

Project for Assistance in Transition from Homelessness Program

Healthy Transitions

Strategic Prevention Framework Partnerships for Success

Governor’s Office

Reinventing Medicaid

Working Group for Healthcare Innovation

EOHHS

Integrated Care Initiative

Medicaid 1115 Waiver

Medicaid Accountable Entities

Home Stabilization Services

Money Follows the Person

Medicaid Health Homes

Medicaid EHR Incentive Program

Adult Medicaid Quality Grant

RIDOH

Health Equity Zones

Community Health Workers Certification

Community Health Network

RIDOH Academic Center

OHIC

Care Transformation Advisory Committee

Alternative Payment Methodology Committee

Public Health Accreditation

Hospital Conversion Act

Opioid Overdose Task Force

SIM Core Staff Team

Used grant funds to embed staff across state agencies

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SIM PROJECT DIRECTOR*

Marti Rosenberg

SIM LIAISON (RIDOH)*

James Rajotte

SIM LIAISON (BHDDH)*

Ann Detrick

SIM LIAISON (EOHHS)*

Melissa Lauer

SIM LIAISON (OHIC)*

Libby Bunzli

SIM LIAISON

(HealthSource)*

Betsy Kerr

SIM LIAISON (DCYF)

Heather Warner

SIM LIAISON (SBIRT)

Janie O’Donnell

SIM LIAISONS (HSTP)

Rick Brooks

Lauretta Converse

SIM CONSULTANT*

Jill Glickman

EOHHS SECRETARY

Eric Beane

OHIC COMMISSIONER

Marie Ganim

SIM LIAISON (Medicaid)

Debbie Morales

Interagency Composition

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OFFICE OF THE GOVERNOR

SIM Website

http://www.eohhs.ri.gov/Initiatives/StateInnovationModel.aspx

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