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Integrated Care 2.0: Policy Partners to Drive Change

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;

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Integrated Care 2.0: Policy Partners to Drive Change

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  1. Integrated Care 2.0:Policy Partners to Drive Change GIH Annual Meeting March 6, 2014

  2. 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.

  3. Public and Private Collaborations Larry Grab, Director Behavioral Health Northeast & Medicare Advantage Services WellPoint, Inc.

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. Integrated Care 2.0: Policy Partners to Drive Change Sarah Hudson Scholle, Vice President Grantmakers in Health March 6, 2014

  12. Building the PCMH

  13. The Joint Principles of the PCMHDeveloped 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

  14. 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

  15. 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

  16. PCMHis the fastest-growing delivery system reform 16

  17. NUMBER OF PCMH CLINICIAN RECOGNITIONS BY STATE *As of 2/28/14 WA ME ND MT MN VT OR NH MA WI SD ID NY MI WY RI IA PA CT NJ NV NE OH IN DE IL UT WV MD CO CA MO VA KS KY NC TN 0 Recognitions NM AZ OK AR SC 1-20 Recognitions MS AL GA LA 21-60 Recognitions TX 61-200 Recognitions FL AK 201+ Recognitions HI 35,677 PCMH CLINICIAN RECOGNITIONS PR

  18. Less than 5 percent of practices submit CAHPS PCMH data

  19. Role of Philanthropy • Raise awareness • Identify best practices, innovative models • Advocate for policy change • Train and sustain

  20. 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?

  21. Keep in Touch Irfan Hasan The New York Community Trust 212-686-0010 ext. 573 iha@nyct-cfi.org Becky Hayes Boober Maine Health Access Foundation 207-620-8266 ext. 114 bhboober@mehaf.org Larry Grab WellPoint, Inc. 203-654-3305 Larry.Grab@anthem.com Sarah Scholle NCQA 202-955-3588 Scholle@ncqa.org

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