The document summarizes initiatives by several states to implement patient-centered medical homes (PCMHs) and shared care teams through Medicaid programs. It discusses how states like Alabama, Maine, Vermont, and New York have established networks, teams, or "pods" to provide support to primary care practices in order to help them function as medical homes. These support systems receive per-member-per-month payments from Medicaid and other payers. The document also covers initiatives to implement health homes for high-need patients and use of health information technology.
Proposed changes in health care payment, from fee-for-service to alternative, risk-sharing payment models, can have a substantial impact on health services for children, especially those with complex care needs. In addition, tying payment to value can increase use of ambulatory and preventive services and encourage creative outreach. However, abrupt changes can interrupt continuity and reduce access to care.
Proposed changes in health care payment, from fee-for-service to alternative, risk-sharing payment models, can have a substantial impact on health services for children, especially those with complex care needs. In addition, tying payment to value can increase use of ambulatory and preventive services and encourage creative outreach. However, abrupt changes can interrupt continuity and reduce access to care.
Kevin Burke, American Academy of Family Physicians, presented on the AAFP Federal Affairs Update at the State Legislative Conference on November 6, 2015.
Topics covered in this 10-26-2007 presentation to the TWG include background and brief updates of System
Transformation Initiative projects; a benefits package update, and a housing action plan update.
Improving the Health Outcomes of Both Patients AND PopulationsCHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 23, 2019 | 2 p.m. EST
In this webinar experts will share their journey in planning, preparing and launching a population health initiative. With the goals of impacting population health outcomes while ensuring cost effectiveness, our experts designed interventions to eliminate gaps in care, particularly among special populations.
Kevin Burke, American Academy of Family Physicians, presented on the AAFP Federal Affairs Update at the State Legislative Conference on November 6, 2015.
Topics covered in this 10-26-2007 presentation to the TWG include background and brief updates of System
Transformation Initiative projects; a benefits package update, and a housing action plan update.
Improving the Health Outcomes of Both Patients AND PopulationsCHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 23, 2019 | 2 p.m. EST
In this webinar experts will share their journey in planning, preparing and launching a population health initiative. With the goals of impacting population health outcomes while ensuring cost effectiveness, our experts designed interventions to eliminate gaps in care, particularly among special populations.
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
Keynote Presentation delivered by Marvin O’Quinn, Executive Vice President and Chief Operating Officer, Dignity Health at the marcus evans National Healthcare CXO Summit Spring 2018 held in Orlando FL
Reducing Health Disparities: The Journey of Brightpoint HealthBrightpoint Health
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A detailed approach to an integrated health care system in Scotland presented by Dr. Anne Hendry from National Clinical Lead for Integrated Care.
Source Page:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
A journey from the Chronic Condition Care Program to a new health and social integrated care model.
Deck available in link:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
Dr. Arno Elmer presents the catalyst for social care. In this presentation, Dr. Elmer goes over the current challenges, opportunities, future presence and the digitalization of social care.
Details on the presentation can be found in the link:http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
In this presentation, you will receive an overview of the TicSalut Foundation, the Catalon Healthcare System and the integration of health and social care in Catalonia.
Details of the presentation found in link:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
Christina Wanscher presents an introduction to the Danish Healthcare system, healthcare transformation initiatives, National Healthcare IT and Integrated Care.
Details on the presentation found in link:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
South Florida Behavioral Health Network implemented a solution that has helped to reduce the probability of re-arrests of mental health patients by 50%
Hear from:
Mike Hortatsos, Channels IBM Smarter Care & Social Programs
Panel 1: Solution Delivery with System Integrators
Andrew Wishart, Partner, Deloitte
Ashish Mukherji, President, eSystems
Thomas Stockdale, Business Development Manager, Wipro
Panel 2: New Solution Capabilities with Technology Partners
Mahesh Chavan, President & CEO, Connvertex
Patty Donaldson, Executive Vice President, Diona
Daniel Lakier, Director, RedMane
Dr. Robert J. Dudzinski, Executive Vice President, West Corporation
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
Presented by:
Oisin Clark, Director, Director, IBM Smarter Care & Social Programs Development and Product Management
Amy Santenello, Director, Director, IBM Smarter Care & Social Programs Product Management
Ronan Rooney, Director, Programs of Care, IBM Research
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
Hear from:
Martin Duggan, Director, IBM Curam Research Institute
Hans-Horst Konkolewsky, Secretary General, International Social Security Association (ISSA)
Tracy Wareing, Executive Director, American Public Human Services Association (APHSA)
John Halloran, CEO, European Social Network (ESN)
Steven Lieber, President and CEO, Health Information and Management Systems Society (HIMSS)
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
Presented by: Ronan Rooney, IBM Research, Director of Care Programs
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
Presented by: Nicole Gardner, IBM Global Industry Leader, Government Healthcare and Social Services
Learn more: http://www.ibm.com/software/products/en/category/health-social-programs
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The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
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This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
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Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Lessons Learned: The Government Healthcare Transformation Journey
1. 1
Lessons Learned: The Government
Healthcare Transformation Journey
Craig Rhinehart’s Blog
Insights from NASHP Conference in Atlanta
Trick or Treating for State Healthcare
Innovation Treats
http://craigrhinehart.com
2. The Government Healthcare
Transformation Journey
2
Barbara Wirth, MD MS
Program Manager
National Academy for
State Health Policy
3. The Government Healthcare
Transformation Journey
3
Lyn Hohmann, MD PhD MBA
Medical Director
Island Peer Review
Organization
Department of Health
4. Medical Homes and Shared Resource Teams:
State Initiatives Impacting
Healthcare Delivery
Barbara Wirth, MD, MS
IBM Health and Social Programs Summit
Arlington, VA October 20, 2014
5. 5
NASHP
27-year-old non-profit, non-partisan organization
Offices in Portland, Maine and Washington, D.C.
Academy members
Peer-selected group of state health policy leaders
No dues—commitment to identify needs and
guide work
Working together across states, branches and
agencies to advance, accelerate and implement
workable policy solutions that address major
health issues
5
6. Where do we
want to go?
Background Image by Dave Cutler,
Vanderbilt Medical Center
(http://www.mc.vanderbilt.edu/lens/article/?
id=216&pg=999)
6
7. Patient Centered Medical Homes
Key model features:
•Multi-stakeholder
partnerships
•Qualification standards
aligned with new
payments
•Practice teams
•Health Information
Technology
•Data & feedback
•Practice Education
Graphic Source: Ed Wagner. Presentation entitled “The Patient-centered Medical Home: Care
Coordination.” Available at: www.improvingchroniccare.org/downloads/care_coordination.ppt
7
10. 10
Medicaid PCMH Payment Activity
WA
OR
TX
CO
NC
WI
★ ★
LA
PA
NY
IA
VA
NE
OK
AL
MD
MT
ID
KS
MN
NH
ME
AZ
VT
MO
CA
WY
NM
IL
MI
WV
SC
GA
FL
UT
NV
ND
SD
AR
IN
OH
KY
TN
MS
DE
RI
NJ CT
MA
HI
AK
Making medical home payments (30)
Payments based on provider qualification standards (28)
Payments based on provider qualification standards, making payments in a multi-payer initiative (18)
Participating in MAPCP Demonstration (8: ME, MI, ★ MN, NY, NC, PA, RI, VT)
Participating in CPC Initiative (7: AR, CO, NJ, NY, OH, OK, OR)
★
★
★
★
★
★
As of June 2014
SOURCE: National Academy for State Health Policy. “Medical Home and Patient-Centered Care.”
Available at: www.nashp.org/med-home-map.
11. 11
Care Coordination Payments
in Multi-Payer Medical Home Initiatives
State Initiative
Per member per
month range
Adjusted for
Patient
Complexity or
Demographic
Adjusted for
Medical
Home Level
Lump Sum
Payment
Financial
Incentive
Based on
Quality
TOTAL (n=9) $1.20 - $79.05 7 3 2 6
Maine* $6.95 - $7.00 ▲
Maryland $3.51 - $11.54 ▲ ▲ ▲
Massachusetts $2.10 - $7.50 ▲ ▲ ▲
Michigan* $4.50 - $6.50 ▲ ▲
Minnesota $10.14 - $79.05 ▲
North Carolina $2.50 - $5.00 ▲ ▲
Pennsylvania $2.10 - $8.50 ▲ ▲ ▲
Rhode Island $5.00 - $6.00 ▲
Vermont $1.20 - $2.39 ▲
* Michigan: Payments to Provider Organizations; pass-through to practices that employ care coordinators.
Maine: Commercial insurer PMPM rates unavailable.
12. Medical Homes vs. Health Homes
Medical Homes
• Designed for everybody
• Primary care provider-led
• Primary care focus
• No enhanced federal
Medicaid match
2703 Health Homes
• Designed for eligible
individuals with a serious
mental illness and/or specific
chronic physical conditions
• Primary care provider is key,
but not necessarily the lead
• Focus on linking primary care
with behavioral health and
long-term care
• Eight-quarter 90 percent
federal Medicaid match
• Significant increase in
financial support to providers
13. Expanding Medical Home Capacity through
Multi-disciplinary Teams
Key model features:
•Practice teams—often
shared among practices
•Payments to teams and
qualified providers
•Teams are based in a
variety of settings
•Community developed,
teams vary from region to
region
13
14. 14
Whose on the team?
•New or Expanded Roles for:
• Nurses
• Behavioral Health Specialists
• Community Health Workers
• Social Workers
• Peer Specialists
• Pharmacists
• Health Coaches
15. 15
Shared Support Teams
RI
IA
MT
ME
NY
AL
OK
MN
NC
MI
VT
Making Payments to Shared Support Teams
Pursuing similar models through State Innovation Model Grants
MD
ID
IL
PA
16. 16
Shared Community Care Team Michigan
Snapshot
Scope Payer(s) Payment Strategy Core Team Composition
Alabama Maine
Alabama:
Patient Care
Networks of
Alabama
4 networks,
170,000 eligible
patients.
Medicaid (Health
Home SPA)
Networks receive $9.50
PMPM for each Health
Home patient
Must include clinical director or
medical director, clinical
pharmacist, chronic care clinical
champion (nurse), care managers
(nurse or social worker)
Maine:
Community
Care Teams
10 care teams,
130,000 eligible
patients.
Medicaid (Health
Home SPA),
Medicare, private
plans, some self-insured
employers
including state
employees.
Teams receive $129.50
PMPM for Medicaid Health
Homes; $2.95 Medicaid non
Health Home; $2.95 PMPM
for Medicare; $0.30 PMPM
for privately insured.
Must include part-time clinical
leader; team composition based
on each entity’s care
management strategy
Vermont:
Community
Health Teams
14 teams;
514,000 eligible
patients.
Medicaid, Medicare,
private plans, some
self-insured.
Teams receive $350,000 for
5 FTE team; costs divided
proportionately among
payers
Staffing structures are flexible;
most include nurse care
managers, behavioral health
specialists/social workers, health
coaches, panel managers, and
tobacco cessation counselors
New York:
Adirondack
Region Medical
Home Pilot Pods
3 pods,
106,000 eligible
patients.
Medicaid, Medicare,
private plans, some
self-insured employers
including state
employees.
Pods receive $7 PMPM
payment to providers who
contract with pods for
support services. Average
payment to pod
approximately $3.50 PMPM.
No specific staffing requirements;
structures vary across pods.
17. 17
Patient Care Networks of Alabama
• Four new 501(c)(3) organizations
• Support Patient 1st Medicaid providers
• Focus on high risk, high acuity patients
• Providers who partner with networks receive
$1.60 - $2.10 PMPM + $1 PMPM from Patient 1st
• Total PMPM rate for Patient 1st patients in
network areas decreased by 7.7% vs. 0.6% for
the rest of the state, after 1st 6 months
• 3 network areas had a 15% decrease in their ER Use vs. non-network
areas that had a 2 % during same time
(http://medicaid.alabama.gov/news_detail.aspx?ID=6608)
18. 18
Maine Community Care Teams
• Multi-payer support: PMPM varies by payer
• Community care teams based in wide variety
of organizations
• Support providers meeting “NCQA Plus”
including:
• Behavioral health integration
• Population risk-stratification and management
• Team-based care
• Connection to community resources
• Focus on High Costs utilizers aka “Super Utilizers”
• No outcome data available
19. Vermont Blueprint for Health:
Community Health Teams
• Statewide, multi-payer support
• Provider reimbursement tied to NCQA PCMH
recognition and CHTs help practices meet NCQA
PCMH recognition
• CHTs focus on public health helping patients engage in
preventive services and adopt healthier lifestyles
• Specialized care coordinators added to teams to care
for elderly patients and substance abusers added
• 2013 Vermont Annual Report found that people cared
for in PCMH + CHT setting had favorable outcomes vs.
comparison groups including reductions in annual
expenditures, more than offsetting payer investments in
PCMHs and CHTs
19
20. 20
Adirondacks Regional Pods
• Three “pods” in upstate NY supported by a central
entity (Adirondack Health Institute)
• Regional, Multi-payer support
• Workforce shortages was primary reason for
development of PCMH initiative
• Support affiliated practices and smaller independent
practices in region
• PMPM reimbursement passed through by providers
• From 2006 to 2007 the region lost 24 PCPs. Since the
pilot began, primary care has stabilized and grown;
total costs of care has been trending downward for
commercial payers and Medicaid
(http://www.adkmedicalhome.org/wp-content/uploads/2013/10/Dennis-Weaver-
Medical-Home-Summit-Presentation.pdf)
21. 21
Key Takeaways
• Team-based care is a key feature of a medical
home
• Meeting medical home criteria, including team-based
care, is hard work for practices—particularly
small & rural practices
• Shared community-based support teams offer
providers of all types the opportunity to participate
in value-based health care delivery models
• Community-based teams can extend their reach by
leveraging social, public health and other services
• Community based teams provide infrastructure for
ACOs
21
22. 22
For More Information
Please visit:
• www.nashp.org
• www. nashp.org
/med-home-map
• www.nashp.org
/state-accountable-care-• www.statereforum.org
Contact:
bwirth@nashp.org
23. Transforming The Medicaid
Health care system
In New York State
Lyn Karig Hohmann, MD, PhD, MBA (IPRO)
Division of program Management and Development
Office of health Insurance Programs
NYS Department Of Health
23
24. Where We Were:
o In 2010 Medicaid reform was not
on the agenda.
o Program was stuck in neutral,
reform derailed by a harsh
political climate and a deep
recession.
o In 2011, Governor Cuomo
changed the game by creating the
Medicaid Redesign Team (MRT).
o The MRT developed a multi-year
action plan – we are still
implementing that plan today.
24
25. Major MRT Reforms Implemented
Cost Control: Reduced Medicaid’s annual spending growth rate
from 13% to less than 1%.
Global Spending Cap: Introduced fiscal discipline to an out of
control government program; focus on transparency with
monthly report on spending.
Care Management for All: Expanded existing and created new
models of improved primary/coordinated care that will both
improve outcomes and lower costs, moving Medicaid members
from fee-for-service to managed care.
PCMH and Health Homes: Investments in high-quality primary
care and care coordination through major MRT reforms such as
Patient Centered Medical Homes and the creation of Health
Homes.
25
26. Where We Have Been:
At its core, MRT was about trying to ensure that the Medicaid
program was financially sustainable.
After years of out of control cost growth the state budget was no
longer able to afford Medicaid driven budget problems.
MRT and its approach to cost containment was to launch many
initiatives simultaneously with the goal being to both generate
immediate cost savings while also launching multiple systemic
reforms designed to generate future cost savings.
To date, the MRT fiscal impact has been staggering – billions of dollars
have been saved.
Fiscal Impact of MRT
26
30. MRT: Development of
Health Homes
Care management for high cost, high risk Medicaid
Members
30
31. NYS Medicaid Health HOmes
• New Medicaid program from the ACA
• Care management model that supports coordination of care across medical,
behavioral health and social needs.
• Health Home services include:
comprehensive care management,
health promotion;
transitional care including appropriate follow-up from inpatient to other
settings,
patient and family support,
referral to community and social support services,
use of health information technology to link services.
• New York State's Health Home eligibility definition is as follows:
Two (2) chronic conditions; or
One (1) single qualifying condition (HIV/AIDS or SMI)
• State has specific metrics to measure the impact of Health Homes
31
32. NOTE: Health information technology is a key component
of Health homes!
• New York State has invested heavily in HIT infrastructure through
development of RHIOs with HIEs, partnership with NYeHealth
Collaborative with the SHIN-NY, and support of electronic medical
records within the Patient Centered Medical Home projects.
• Health Homes were required to implement electronic clinical care
management records exchangeable with down stream care
management agencies and to connect with the local RHIO’s HIE for
exchange of medical/clinical information.
BUT:
Connectivity to the NYS DOH through the Health Home portal on
the NYS Health Commerce System was generally by file transfer,
not real time, and not user friendly. The limitations forced policy,
rather than responding to policy.
New York Department of Health needed a connectivity solution to
meet the growing needs of the Health Home Program….
32
33. Building the concept ….
The DOH with its partner agencies - OHITT, OMH, OASAS, AI
and several Health Homes and MCOs - participated in a
series of end-user innovation workshops to develop key
IT concepts and capabilities for the Health Home
program, from which came the Health Homes Analytics
Platform (the Portal).
These Health Home workshops focused on defining use
cases and supporting workflows. The use cases were the
basis for the Health Home system and portal concepts
and capabilities.
33
34. NY Health HHoommeess UUssee CCaasseess
Identification … Assignment … Outreach
…
Consent …
Referral …
Care Planning … Care
Coordination
…
Performance
Mgmt ...
Conceptual
Solution
Architecture
34
35. Building the concept….
The Department decided to build a flexible and scalable architecture
with robust data, analytics, and care management capabilities.
The goal was to deliver a solution which supports interoperability across
systems, users and business functions – allowing for the collection, use
and sharing of information critical to the processing, monitoring, and
coordinated care of the program.
Based on assessment of best in class, the decision was made to built
using Cúram Software on the Medicaid Data Warehouse and linked
with Salient for analytic capability.
Within the portal will be an optional Care Management Lite component,
similar to RHIOs that provide a portal to access EMRs.
90:10 Federal funding has been approved through the APD process.
Initial goal was to use this capability for Health Homes now and other
state care management programs over time.
35
36. Health Homes AAnnaallyyttiiccss PPoorrttaall ((HHHHAAPP))
Conceptual Solution Architecture Capabilities
Health Homes Portal Facility
sync
Medicaid Data Warehouse
Information
Sources
HH-PF
HH-MR HH-CI
Health Homes
Master Records
Health Homes
Care Intelligence
Information
Consumers
Operational
Systems
(e.g., Care
Mgmt
Lite)
• Service Bus HH-IS
• Data Staging / Integration
• Data Quality
• Data Harmonization
• Portal
• Security
• Privacy
• Audit & Logging
• Person Master
• Provider Master
• Relationship Mgmt
• Data Stewardship
• Care Metrics
• Analytics / Reporting
• Predictive Models
• Text Mining
• Claims &
Encounters
• Provider
Sources
(e.g.,
CMART,
Card Swipe)
• Criminal
Justice
• Social
Services
• RHIOs
• DOH
• MCO
• Lead HH
• Downstream
Care Mgmt
Provider
• Clinicians
• Community
• Patient /
Family
• Care • RHIOs
Planning
• Care
Coordin-ation
36
Salient
Analytics
38. Then came the NYS Delivery system Reform
Incentive Payment Program (DSRIP)
• DSRIP is the culmination of the MRT action plan.
• DSRIP creates the opportunity to fundamentally restructure delivery to
achieve the system we need while also ensuring its long term sustainability.
• The health care delivery system we have is a direct result of how we purchase
and regulated health care services. DSRIP changes that.
• The NYS Waiver Amendment to the State Partnership plan has been approved
for $ 8 billion to implement changes in the NYS Medicaid delivery system.
• $ 6.42 billion will be used for the DSRIP program
• Other dollars will go to stabilize the safety net system, support
infrastructure development for Health Homes and be investments in long
term care workforce and enhanced behavioral health services.
38
39. NYS DSRIP Program: Key Goals
o Transformation of the health care safety net at both the
system and state level.
o Reducing avoidable hospital use and improve other health
and public health measures at both the system and state
level.
o Ensure delivery system transformation continues beyond the
waiver period through leveraging managed care payment
reform.
o Near term financial support for vital safety net providers at
immediate risk of closure.
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41. NYS DSRIP Plan: Key Components
o Key focus on reducing avoidable hospitalizations by 25% over
five years.
o Statewide initiative open to large public hospital systems and a
wide array of safety-net providers.
o Payments are based on performance on process and outcome
milestones.
o Providers must develop projects based upon a selection of
CMS
approved projects from each of three domains.
o Key theme is collaboration! Communities of eligible providers
are required to work together to develop DSRIP Project Plans.
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42. DSRIP is Performance based…..
• Performing provider systems need access to information about their
population in order to understand how the system needs to change to meet
these needs.
• Performing provider systems need access to data to monitor how they are
meeting their process and outcome metrics.
• The state needs a robust platform to exchange real time data with the
Performing Provider Systems to ensure they are acting on most current data.
• The state needs a robust platform that will allow them to maximize the
benefits of the robust analytics of the Salient system that we use in
conjunction with the Medicaid Data Warehouse (MDW) and to share these
analytics with the Performing Provider Systems.
• The portal must have the capability for PPSs to enter either directly or through
the SHIN-NY and RHIOs’ HIE platforms.
• The portal must be secure, capable of role restrictions/permissioning, be
flexible and expandable.
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43. Medicaid Analytics Performance Portal
(MAPP)
• Based on the service capability of the already in process Health
Home Information Portal, the Department of Health in
conjunction with various technology staff and consultants
determined that this portal would be able to provide the service
needs for both Health Homes and DSRIP.
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44. What is MAPP
o MAPP: Medicaid Analytics Performance Portal
o MAPP supports both Health Homes and DSRIP performance
management technology needs
o MAPP Technology:
o Serve as retail front-end to the Medicaid Data Warehouse for
PPS / Health Home community
o Robust dashboard capabilities provided by Salient
o Online tools available in portal technology to support DSRIP
o Health Homes Business and Care Management Functionality
o Data management and analytics to drive performance
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46. The DSRIP Vision: Five Years in the Future
How The Pieces Fit Together: MCO, PPS & HH
Role:
-Insurance Risk Management
-Payment Reform
-Hold PPS/Other Providers Accountable
-Data Analysis
-Member Communication
-Out of PPS Network Payments
-Manage Pharmacy Benefit
-Enrollment Assistance
-Utilization Management for Non-PPS Providers
-DISCO and Possibly FIDA/MLTCP Maintains Care
Coordination
Role:
-Care Management for Health Home Eligibles
-Participation in Alternative Payment Systems
Role:
-Be Held Accountable for Patient Outcomes and
Overall
Health Care Cost
-Accept/Distribute Payments
-Share Data
-Provider Performance Data to Plans/State
-Explore Ways to Improve Public Health
-Capable to Accept Bundled and Risk-Based
Payments
*Mainstream, MLTC, FIDA, HARP & DISCO
Supported by
the data and
analytics
capabilities of
MAPP.
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47. We want to hear from you!
DSRIP e-mail:
dsrip@health.ny.gov
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@NewYorkMRT
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