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Virginia Rural Health Association 2015
Conference
The Honorable William A. Hazel, Jr., M.D.
Virginia Secretary of Health a...
Program and Services Map
VA Health and Human
Resources Secretariat
SSA DOL AOA NIH
ACL ACF FNS CDC SAMHSA EPA CMS
DARS DBH...
Policy, funding, workflow, people
Silos come in many forms...
The Virginia Health and Human Resources Secretariat is focused on six strategic issues.
Virginia Health and Human Resource...
An interaction in one domain may only be measured by impact in another domain.
Coalition Partners
Fiscal Impact Data
Outco...
Virginia is shifting from a ‘program-focused’ model to a more ‘Customer-Centric Coordinated Care’ model.
‘Customer-Centric...
System Transformation, Excellence and Performance (STEP Virginia) – The Path
to a Healthy Virginia
• Establishes Certified...
Other recent grants
• With help from the Center for Health Care
Innovation, VHQC recently received a $5.7
million grant fr...
METRICS ALONE ARE INSUFFICIENT
• We also require:
• Vision – Where we want to be
• Process – How to get there
• Accountabi...
What is DSRIP?
• Medicaid waiver to access federal dollars to
invest in transformation of the Medicaid
delivery system
• C...
DSRIP program is an opportunity
for transformation
• The future is a Medicaid delivery system that
reimburses based on hig...
DSRIP program is an opportunity for
Virginia to transform
 The future is a Medicaid delivery system that reimburses based...
Certificate of Public Need
• Study group required by 2015 legislation
• Evaluating whether Virginia’s COPN process,
needs,...
Provider Assessment
• Workgroup mandated by 2015 legislation
• Will analyze options for creating a provider
assessment pro...
Intersection of SIM and DSRIP
27 SIM projects from 8
workgroups and three
subgroups
1) Population Health,
Quality, Payment...
Rates of Opioid Overdose Deaths, Sales, and
Treatment Admissions, United States, 1999–2010
0
1
2
3
4
5
6
7
8
1999 2000 200...
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Motor Vehicles 1037 1035 1052 1070 1124 928 841 823 878 877 831
Gun...
Deaths from Heroin and Rx Opiates in Virginia
0 4
19
100
89
107
48
100
135
213 210
0
50
100
150
200
250
NumberofDeaths
Yea...
The systems of care are constantly evolving due to some key challenges in Virginia.
Key Challenges in Health and Human Ser...
An interaction in one domain may only be measured by impact in another domain.
Coalition Partners
Fiscal Impact Data
Outco...
The illustration below provides spending overlaps of individuals served by Medicaid, SNAP, and TANF in Virginia.
Program O...
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Hazel

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Presentation by Health and Human Resources Secretary William A. "Bill" Hazel Jr.

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Hazel

  1. 1. Virginia Rural Health Association 2015 Conference The Honorable William A. Hazel, Jr., M.D. Virginia Secretary of Health and Human Resources
  2. 2. Program and Services Map VA Health and Human Resources Secretariat SSA DOL AOA NIH ACL ACF FNS CDC SAMHSA EPA CMS DARS DBHDS DHP DMAS VDSS OCS VBPD VDBVI VDDHH VDH VFHY • Vocational Rehabilitation • Disability Determination • Community Rehabilitation for Disabled • Aging Services • Adult Protective Services • Developmental Disability Services • Mental Health Services • Substance Abuse Treatment Services • Behavioral Health Emergency Response Services • Provider Licensing • Licensing and Health Profession Regulation • Prescription Monitoring Program (PMP) • Health Practitioners Data Center • Medicaid • Family Access to Medical Insurance Security (FAMIS) • Medicaid Analytics and Reform • Supplemental Nutrition Assistance Program • Temporary Assistance for Needy Families • Child Care • Energy and Cooling Assistance • Eligibility Determination • Foster Care and Adoption Services • Child Support Enforcement • Child and Adult Protective Services • Licensure • Community Policy and Management Teams (CPMT) • Family Assessment and Planning Teams (FAPT) • At-Risk Youth and Families • Policy Setting • Grants for Innovation • Leadership and Advocacy Training Programs • Disability Services Assessment • Vocational Rehabilitation • Randolph- Sheppard Vending Program (RSVP) • Virginia Industries for the Blind • General Library Services and Education Services • Technology Assistance Program (TAP) • Virginia Relay • Outreach and Community Services • Interpreter Services • Family Health Services • Emergency Preparedness and Response • Environmental Health Services • Licensure and Certification • Epidemiology • Virginia Certificate of Public Need (COPN) • Minority Health and Equity • Drinking Water • Youth Programs • Youth Tobacco Use Prevention • Youth Obesity Prevention IRS A Focus on Value What do we do? How well do we do it? How much does it cost?
  3. 3. Policy, funding, workflow, people Silos come in many forms...
  4. 4. The Virginia Health and Human Resources Secretariat is focused on six strategic issues. Virginia Health and Human Resources Virginia Health and Human Resources Secretariat Healthy and Productive Virginians Eliminating Intergenerational Poverty Thriving Children and Families An Aging and Diverse Population Integrating Individuals with Disabilities in the Community Supporting and Valuing Our Veterans and Volunteers Financial Sustainability Performance Management Customer- Centric Data Aware Promoting Pathways to the 21st Century Economy for All Virginians While Maximizing the Value of Commonwealth Resources Cultural Competence Trauma Informed Systems of Care
  5. 5. An interaction in one domain may only be measured by impact in another domain. Coalition Partners Fiscal Impact Data Outcome Measures Data Citizen Census Data Population Health Data Specific At-Risk Population Data Social Program Data Health Care Data DMAS DSS, OCS DBHDS, DHCD, DOC, DJJ VDH DMV, Elections Education, DOC, DJJ, State Police Tax, DPB, Trade & Commerce
  6. 6. Virginia is shifting from a ‘program-focused’ model to a more ‘Customer-Centric Coordinated Care’ model. ‘Customer-Centric Coordinated Care’ Model Agency Traditional Program-Focused Model ‘Customer-Centric Coordinated Care’ Model Agency Agency Agency Agency Service Delivery Partner Service Delivery Partner Agency Agency Agency Services driven by individual, family, or community needs Agencies recognize and consider the full range of services provided by other agencies, partners and organizations Services are considered more broadly factoring in role of social determinants
  7. 7. System Transformation, Excellence and Performance (STEP Virginia) – The Path to a Healthy Virginia • Establishes Certified Community Behavioral Health Clinics (CCBHCs) • There are two phases: • Phase 1: Virginia granted $982,000 for 1-year planning grant for CCBHC • Phase 2: Up to 8 CCBHC Planning Grant states will be selected to participate in the demonstration program. • This grant opportunity from SAMHSA arose from the Excellence in Mental Health Act. CCBHCs
  8. 8. Other recent grants • With help from the Center for Health Care Innovation, VHQC recently received a $5.7 million grant from CMS as a Practice Transformation Network. Only such grant awarded in Virginia. • In May, VCU received a $10 million grant to establish a statewide consortium to help small-to-medium-sized primary care practices in Virginia.
  9. 9. METRICS ALONE ARE INSUFFICIENT • We also require: • Vision – Where we want to be • Process – How to get there • Accountability – Who does what and by when • Will – A commitment to move forward • Much of the above will be addressed as we collectively create Virginia’s Plan for Well- Being
  10. 10. What is DSRIP? • Medicaid waiver to access federal dollars to invest in transformation of the Medicaid delivery system • CMS has approved seven DSRIP programs to date (CA, NM, TX, KS, NJ, MA, NY) • Helping states move from Fee-for-Service to Value-Based Reimbursement
  11. 11. DSRIP program is an opportunity for transformation • 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
  12. 12. DSRIP program is an 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
  13. 13. Certificate of Public Need • Study group required by 2015 legislation • Evaluating whether Virginia’s COPN process, needs, and relationship with charity care • Has met 3 times, has 2 more meetings; next is Oct. 27 • Final report due Dec. 1, 2015 • http://www.vdh.state.va.us/Administration/COPN. htm
  14. 14. Provider Assessment • Workgroup mandated by 2015 legislation • Will analyze options for creating a provider assessment program • Prompted in part because of struggles of rural hospitals, about half of which are operating in the red • Group has met twice – next meeting Oct. 28 • http://www.dmas.virginia.gov/Content_pgs/paw g.aspx
  15. 15. Intersection of SIM and DSRIP 27 SIM projects from 8 workgroups and three subgroups 1) Population Health, Quality, Payment, HIT 2) Care Transitions 3) Workforce 4) Medicaid Innovation 5) VBID/Choosing, Wisely 6) Telehealth 7) Integrated Care (Behavioral Health, Oral Health, Complex Care) Possible SIM project funding via DSRIP
  16. 16. Rates of Opioid Overdose Deaths, Sales, and Treatment Admissions, United States, 1999–2010 0 1 2 3 4 5 6 7 8 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Rate Year Opioid Sales KG/10,000 Opioid Deaths/100,000 Opioid Treatment Admissions/10,000 CDC. MMWR 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e1101a1.htm?s_cid=mm60e1101a1_w. Updated with 2009 mortality and 2010 treatment admission data. Rates of Opioid Overdose Deaths, Sales, and Treatment Admissions, United States, 1999–2010
  17. 17. 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Motor Vehicles 1037 1035 1052 1070 1124 928 841 823 878 877 831 Guns 799 824 884 812 838 818 843 868 863 830 848 Drug/Poisons 595 498 545 669 721 735 713 690 819 799 912 0 200 400 600 800 1000 1200 NumberofFatalities OCME's Top 3 Methods of Death by Number and Year of Death, 2003-2013
  18. 18. Deaths from Heroin and Rx Opiates in Virginia 0 4 19 100 89 107 48 100 135 213 210 0 50 100 150 200 250 NumberofDeaths Year Number of Fatal Heroin Overdoses by Year, 2004-2014* 1 Fatal heroin overdoses may have one or more drug or poisons contributing to death. 2 The number of fatal heroin overdoses in 2014 is estimated based upon data for January 1, 2014 to June 30, 2014. 389 422 398 415 487 414 468 508 0 100 200 300 400 500 600 2007 2008 2009 2010 2011 2012 2013 2014 NumberofDeaths Year Number of Fatal Prescription Opioid Overdoses by Year, 2007-2014* 1 Heroin and prescription drug deaths are tallied separately. Where heroin and prescription opioids caused or contributed to death, decedents will be counted twice. 2 Prescription opioid deaths are drug/poison deaths where one or more prescription opioids caused or contributed to death. 3 The number of fatal heroin overdoses in 2014 is estimated based upon data for January 1, 2014 to June 30, 2014.
  19. 19. The systems of care are constantly evolving due to some key challenges in Virginia. Key Challenges in Health and Human Services Delivery Population demographic changes including aging and ethnicity Key Challenges Keeping pace with technological and political shifts Developing and retaining a skilled health and human services workforce Balancing the requirement for specialization with need for integration Addressing the role of social determinants of health Coordinating with complex federal, state and private structures and requirements Managing funding instability and inflexibility
  20. 20. An interaction in one domain may only be measured by impact in another domain. Coalition Partners Fiscal Impact Data Outcome Measures Data Citizen Census Data Population Health Data Specific At-Risk Population Data Social Program Data Health Care Data DMAS DSS, OCS DBHDS, DHCD, DOC, DJJ VDH DMV, Elections Education, DOC, DJJ, State Police Tax, DPB, Trade & Commerce
  21. 21. The illustration below provides spending overlaps of individuals served by Medicaid, SNAP, and TANF in Virginia. Program Overlaps – Spending NOTE: Costs for each program have been derived by using population overlap data from SFY 2014 and program spending from SFY 2013 SOURCES: SFY 2014 VDSS Clients Served Annually , SFY 2013 VDSS Annual Statistical Reports • Majority of the state and federal HHR spending focuses on individuals receiving Medicaid only followed by individuals receiving both Medicaid and SNAP benefits • Spending on individuals receiving TANF is accompanied by Medicaid and SNAP spending as well Program Annual Program Spending (in Millions) Annual Per- Capita Spending Medicai d $7,600 $6,138 SNAP $1,625 $1,251 TANF $105 $655 Medicaid Only $5,100 M Medicaid & SNAP $2,100 M Medicaid, SNAP & TANF $997 M SNAP Only $572 M TANF Only $0.88 M Medicaid & TANF $36 M SNAP & TANF $30 M

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