We Need P4P

Report
Integrated Care 2.0:
Policy Partners to Drive Change
GIH ANNUAL MEETING
MARCH 6, 2014
Learning Objectives
 Learn strategies to establish partnerships with
policy makers to support complex health
initiatives;
 Identify potential national accrediting,
regulatory, funding and other policy
organizations that can enhance sustainability of
foundations’ initiatives;
 Explore case studies of policy changing
partnerships.
Public and Private Collaborations
LARRY GRAB, DIRECTOR
Behavioral Health Northeast &
Medicare Advantage Services
WellPoint, Inc.
Collaborative Partnerships
 The private managed care company
partnering with:
 Not-for-profit
organizations (Hospitals, CMHCs,
FQHCs, etc.)
 State-based policy-maker workgroups
 Quasi-state organizations – eligible for grants
and public funding
 Organizational coalitions
Why Collaborate and Partner?
 Ability to pilot and/or study programs
that are of mutual interest
 Lend support and weight for grant
funding awards
 Increase communication of initiatives
 Enhance community relations and
involvement through local partnerships
The Maine Experience
 Anthem’s representation on the Maine
Health Access Foundation (MEHAF)
Integrated Care Policy workgroup
 Mutual interest on integrating medical and
behavioral health care

Anthem initiated the use of Health and Behavior
Assessment & Intervention CPT codes as a starting point
The Maine Experience (cont)
 The Anthem work was the foundation to
further evaluate this with other payers;
influence change; and share the outcome
results to demonstrate value
Maine Experience Outcomes
 Partnering outcomes included:
 Ability
to reach a large provider network with
significant patient population
 A multi-constituent workgroup to spread the word
of the initiative and provide feedback
 Maintain momentum and focus thru Program staff
 Expansion and inclusion of other payers, public
and private
 Results that help influence ongoing support, future
policy or redirection of the initiative
Upcoming Collaborations
 Piloting a program with Northeast Business
Group on Health (NEBGH) in the NYC
metro area
 The “One Voice” program links primary care
providers with a non-MD BH provider and a
consulting psychiatrist
Upcoming Collaborations
 Partially grant-funded for the consulting
psychiatrist and insurer funded for the face:
face work with the patients
 Insurers and NEBGH will work together to
evaluate health outcomes of those
individuals that participated in the program
Integrated Care 2.0: Policy
Partners to Drive Change
Sarah Hudson Scholle, Vice President
Grantmakers in Health
March 6, 2014
Building the PCMH
The National Dual Eligibles Summit 12
The Joint Principles of the PCMH
Developed by the ACP, AAFP, AAP and AOA
• Personal physician
• Physician directed medical practice
• Whole person orientation
• Care is coordinated and/or integrated across all health
care system and patient’s community
• Quality/safety are hallmarks of medical home
•
•
•
•
•
•
Care planning
Evidence-based medicine
Clinical decision support
Continuous quality improvement
Patient participation and feedback
Appropriate HIT
• Enhanced access
• Payment reform
13
About NCQA
Our mission
To improve the quality of health care
Our method
Measurement
We can’t improve what we don’t measure
Transparency
We show how we measure so measurement will be accepted
Accountability
Once we measure, we can expect and track progress
14
What is a medical home?
PCMH 2011 standards
• Care access and continuity
• Identify and manage a population
• Treatment planning and care management
• Provide self-care support and community
resources
• Track and coordinate
• Measure to improve performance
15
PCMH is the fastest-growing
delivery system reform
35,000
33,026
30,000
24,544
25,000
20,000
16,191
15,000
10,000
7,676
6,550
5,198
5,000
214
0
3,302
1,976
383
1,506
28
12/31/08
12/31/09
12/31/10
Clinicians
12/31/11
Sites
12/31/12
11/30/13
16
NUMBER OF PCMH CLINICIAN
RECOGNITIONS BY STATE
*As of 2/28/14
WA
ND
MT
VT
NH
MN
OR
WI
SD
ID
MI
IA
PA
NE
UT
CA
IL
CO
KS
OH
IN
MA
NY
WY
NV
ME
RI
CT
NJ
DE
MD
WV
MO
VA
KY
NC
TN
AZ
NM
OK
0 Recognitions
AR
SC
MS
AL
1-20 Recognitions
GA
LA
21-60 Recognitions
TX
FL
AK
61-200 Recognitions
201+ Recognitions
HI
35,677 PCMH
CLINICIAN RECOGNITIONS
PR
17
Less than 5 percent of practices
submit CAHPS PCMH data
18
Role of Philanthropy
•
Raise awareness
•
Identify best practices, innovative
models
•
Advocate for policy change
•
Train and sustain
Key Discussion Questions
 As a local/regional grantmaker, what local groups might fit
a policy partner profile?
 As a national foundation, how does one connect with
influential local policy partners?
 How much of this work can be done locally?
 What type of issues are best addressed with larger national
policy partners?
Keep in Touch
Irfan Hasan
The New York Community
Trust
212-686-0010 ext. 573
Larry Grab
WellPoint, Inc.
203-654-3305
[email protected]
[email protected]
Becky Hayes Boober
Maine Health Access
Foundation
207-620-8266 ext. 114
[email protected]
Sarah Scholle
NCQA
202-955-3588
[email protected]

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