Document

Report
Department of Vermont
Health Access
Vermont Blueprint for Health
Building an Integrated System of Health
Innovations in Medicaid: Payment and Delivery Reform
Health Action 2014
Beth Tanzman, MSW
Assistant Director, Blueprint for Health
www.hcr.vermont.gov
[email protected]
Department of Vermont
Health Access
 Global Commitment to Health 1115 Demonstration
Waiver
 Blueprint for Health Payment and Service
Delivery Reforms
 Medication Assisted Treatment “Hub & Spoke”
Reforms
 Vermont Chronic Care Initiative
 Q&A
Department of Vermont
Health Access
Global Commitment to Health
2005 - Present
 Caps total federal funds
 Establishes the state XIX Authority as Managed Care
Entity
 Allows use of XIX funds for state fiscal relief and nonMedicaid health programs
 Flexibility to reduce benefits, increase cost sharing, limit
enrollment for optional and expansion populations with
some limits
Department of Vermont
Health Access
Managed Care Entity (MCE) Savings
 Reduce the rate of uninsured/ underinsured
 Increase access to quality health care to uninsured,
underinsured and Medicaid beneficiaries
 Provide public health approaches to improve the heath
outcomes and quality of life Medicaid-eligible individuals
 Encourage the formation and maintenance of public-private
partnerships in health care
Department of Vermont
Health Access
Patient Centered Medical Homes: Joint Principles
American Academies of Family & Pediatric Physicians,
College of Physicians, Osteopathic Association
Personal Physician
ongoing relationship for continuous & comprehensive care
Physician Directed
team who collectively take responsibility for ongoing care
Whole Person
provide or arrange for all a patient’s health care needs
Care is Coordinated & Integrated across all elements of health care system
and community. Care is facilitated by registries and health information exchange.
Quality & Safety
care planning process based on partnership with patients,
evidence-based medicine, accountability for CQI, voluntary recognition process
Enhanced Access
Payment
open scheduling, expanded hours, electronic communication
recognizes the added value to patients including for coordination of care
Department of Vermont
Health Access
 All insurers pay enhanced
$ PPPM per provider
$3.00
$2.50
payment based on a practices
score as a patient centered
medical home
$2.00
 NCQA PCMH standards and
scoring methods are used to score
practices as a medical home
$1.50
 Payment changes with each 5
point change in the NCQA
PCMH score (score ranges from
0 – 100 points)
$1.00
Requires 6 of 6 Must Pass Elements
$0.50
 Designed to incent ongoing
$0.00
0
10
20
30
40
50
60
70
80
NCQA 2011 PCMH Score
90
100
iterative improvement, and to
provide a disincentive for moving
backwards
Department of Vermont
Health Access
Hospitals
Advanced
Primary
Care
Specialty Care & Disease
Management Programs
Community Health Team
Nurse Coordinator
Social Workers
Nutrition Specialists
Community Health Workers
Public Health Specialist
Social, Economic, &
Community Services
Mental Health &
Substance Abuse
Programs
Advanced
Primary
Care
Advanced
Extended Community Health Team
Primary
Medicaid Care Coordinators
Care
SASH Teams
Spoke (MAT) Staff
Advanced
Primary
Care
Self Management
Programs
Public Health
Programs & Services
Health IT Framework
Evaluation Framework
Multi-Insurer Payment Reform Framework
7/16/2015
7
Department of Vermont
Health Access
Multi-insurer Payment Reforms
•Medicaid
•Commercial Insurers
•Medicare
Insurers
•Fee for Service
•Unchanged
•Allows competition
•Promotes volume
+
•Patient Centered Medical Home
•Payment to practices
•Consistent across insurers
•Promotes quality
+
•Based on NCQA PPC-PCMH Score
•$1.20 - $2.49 PPPM
•Based on active case load
•Community Health Teams
•Shared costs as core resource
•Consistent across insurers
•Minimizes barriers
•5 FTE / 20,000 people
•$ 350,000 per 5 FTE
•Scaled based on population
Department of Vermont
Health Access
160
140
CHT FTEs
# of CHT FTEs and Practices
Recognized Practices
Patients
120
100
80
60
58
43
40
29
20
5.8
0
505,373
483,147
500,000
458,437
442,175
423,015
118.5 120.0
395,725
114.6
122 400,000
105.9
356,341 104
118
342,067
113
100
107
93
89.9
279,828 84
85.9
300,000
79.6
246,983
79 62.0
5
8.8 11.1 11.1 11.1 11.1
16.6 16.6 15.4
19.3
23.9
21.0
49.5
# of Patients
Patient Centered Medical Homes and
Community Health Team Staffing in Vermont
200,000
36.6
100,000
18
11
11
11
7
7
7
7
7
0
Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 2013 2013
*Since joining the Blueprint, three practices have combined to form a new practice, one practice has joined an existing practice, and one practice has closed.
Department of Vermont
Health Access
Self-management Workshops
 Healthier Living Workshops (Stanford University Self-management)
– Chronic Disease
– Pain
– Diabetes
 Tobacco Cessation
 Wellness Recovery & Action Planning (WRAP)
 Diabetes Prevention (National YMCA)
7/16/2015
10
Department of Vermont
Health Access
Patient Centered Medical Homes and
Community Health Team Staffing in Vermont
Key Components
PCMHs (scored by UVM)
PCPs (unique providers)
Patients (per PCMHs)
CHT FTEs (core staff)
SASH provider FTEs (extenders)
Spoke Staff FTEs (extenders)
7/16/2015
December 2013
122
613
505,373
120
46.5
30
11
Department of Vermont
Health Access
A “Perfect” Storm
Increasing Rates of Opioid Dependence
Inadequate Network Capacity
High Health Care Expenditures
Poor Patient (Client) Outcomes
Program & Funding Silos
Department of Vermont
Health Access
“ Hub & Spoke” Health Home for Opioid Addiction
Care As Usual
5 Regional Centers
Addictions Treatment
Methadone
OTP
125 Physicians
Prescribing
Buprenorphine
OBOT
Health Home
~ 6 FTE RN, MA / 400 Pts
- OTP & OBOT
- Methadone & Buprenorphine
-
2 FTE RN, MA / 100 Pts
OBOT
Buprenorphine
Comprehensive Care Management - Care Coordination - Health Promotion - Transitions of Care Individual and Family Support - Referral to Community & Social Supports
Advanced Primary Care Practices and Community Health Teams
HUB
SPOKES
Department of Vermont
Health Access
Health Homes
Section 2703 Affordable Care Act
6 Core Services
 Comprehensive Care Management
 Care Coordination
 Health Promotion
 Comprehensive Transitions of Care
 Individual and Family Support Services
 Referral to Community and Social Support Services
Department of Vermont
Health Access
Vermont Chronic Care Initiative
KEY STATISTICS
Total Number of Medicaid Enrolled (as of
October 2013)
VCCI Eligible Candidates
Total Number in the top 5%
Total Engaged via face-to-face and/or
telephonic case management (SFY 2012)
Average Episode of Care Duration
Target Caseload
7/16/2015
187,019
103,058
10,102
3,015
77 days
Field – 25
Embedded – 50
Phone –50
15
Department of Vermont
Health Access
Financing
Payment Reform
Fee for Service (Volume)
Medicaid
Medicare
BlueCross
MVP
Cigna
Self Insured
$ PPPM - NCQA Score
Delivery System Reform
Patient-Centered
Medical Homes
Pay for Performance
Shared Capacity
Community Health
Teams
Specialized Services
$ PPM Capacity
Medicaid
$ Quality (in design)
• Vermont Chronic Care
Initiative
$ Shared Interest
(proposed)
• Medication Assisted
Treatment (Hub &
Spoke)
7/16/2015
16

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