Health Care Cabinet: Delivery System Innovation Work Group February 6, 2012

1. Health Care Cabinet: Delivery System Innovation Work GroupFebruary 6, 2012 Mark Borton, Staff to the Work Group MBorton@snet.net 860-938-2991

2. Agenda • Mark Borton’s new role as Staff to Work Group • Review Operating Principles • Preliminary list of Healthcare Reform Projects in CT • Review form for presenting suggested Recommendations to HCC • Members get 5 minutes to present their policy and priority suggestions and rationale • Review and rank suggestions • Next Steps and meeting schedule

3. Healthcare Reform Projects—State Comptroller’s Office: • Patient-Centered Medical Home (PCMH) • Focus on Provider Practice transformation and Payment Reform • July 2010 with ProHealth, July 2011 with Hartford Medical Group • NCQA-PCMH Level 3 certified Practices • 35,000 State employees, retirees, and dependents • Prospective population-based payment plus performance bonus • Early results are good: Quality improvement. Cost: Too soon to tell. • Health Enhancement Program • Focus on Patient behavior change in lifestyles and service choices • Began 1/1/2012. 51,500 Patient enrolled (97% of eligible) • Required screenings; optional programs (smoking, weight loss) • Financial incentives for participation, reduced co—pays and Rx cost. • Targeted savings: $20 million/year

4. Healthcare Reform Projects—Connecticut Medicaid: • New Administrative Services Organization (ASO) • Focus on more efficient administration and improved care management • Community Health Network (CHN) contractor—live as of 1/1/2012 • Includes Medicaid medical programs for 600,000+ Patients • Support for emerging Medical Homes, ACO/ICO, Health Neighborhoods • Patient-Centered Medical Home (PCMH) • Focus on Provider Practice transformation and Payment Reform • NCQA-PCMH Level 3 certification; “Glide Path” support to achieve • Up-front payments, monthly fees, performance bonuses • Small scale in 2012—but available state-wide as Providers are certified. • Medicare-Medicaid Dual-Eligible (MME) • Focus on care coordination, whole-person orientation, Value • In planning—application to CMS in April for multi-year demonstration • Initially focus on frail elderly, then all 75,000; Average cost 2x national • ACO-like Integrated Care Organizations Incorporates Mental Health, etc. • Risk-adjusted global payments in addition to Fee-for-Service

5. Healthcare Reform Projects—Other: • Medicare: Comprehensive Primary Care Initiative (CPCI) • Goal: Multi-Payer “critical mass” adoption of PCMH-like programs • Grants of $25 to $50 million each to 5-7 communities nationally • Funds paid directly to PCPs as $20 pmpm average (risk-adjusted) • Requires 75 Practices with NCQA-PCMH Level 3, and use of HER (CT has) • Office of Health Care Reform lead collaborative application process with help from Connecticut Business Group on Health and others • Private Payers: Aetna, Anthem, Cigna, ConnectiCare, United • Public Payers: Comptroller’s Office, Connecticut Medicaid • Expect to hear in March if CT won grant. • Other Healthcare Reform Projects • See spreadsheet---Please send additions, updates, and corrections to: Mark Borton, Mborton@snet.net

6. Characteristics of High-Performing Healthcare Systems • Focus on Primary Care and Prevention* • Two-thirds Primary Care – One-third Specialty/Hospital Care • vs. the reverse in the US • Foundational elements of Primary Care* • Access to Care (both timeliness and insurance coverage) • Coordination of Care • Continuity of Care with PCP • Comprehensive Care (most performed by PCP) * Research by Barbara Starfield/Johns Hopkins University

7. Cost and Quality Issue Areas: • Disparities • Social determinants • Chronic Diseases • Diabetes, Heart Disease, Obesity, Asthma • Frail and Elderly • Medicare-Medicaid Eligible (MME, or “Dual-Eligible”) • Avoidable Utilization • Emergency Room (ER) use, and Re-Admissions • Medication Management • Adverse reactions, adherence, generics • Legal • Fraud & Abuse, Malpractice Reform • Nursing Homes • Quality and cost issues, Alternatives • End-of-Live Care

8. Delivery System Focus Areas:AHRQ, CMMI, RWJF, CWF, IHI • Hospitals • Hospital-acquired infection, adverse events • Re-Admissions; discharge and coordination • Emergency Room utilization, internal process, out-patient coordination • Primary Care • Patient-Centered Medical Homes, Medical Neighborhoods • Culturally-sensitive Care • Mental Health integration • Information Technology • Electronic Health Records (EHR, EMR)—i.e. “nodes” • Health Information Exchanges (a.k.a. RHIOs)—i.e. “connections” • Measurement • Process and Outcomes, Nodes and Connections (i.e. “systemness”) • Learning • Collecting and disseminating Best Practices

9. Delivery System Focus Areas:AHRQ, CMMI, RWJF, CWF, IHI • Payment Reform • Pay-for-Performance • Shared Savings • Medical Homes • Accountable Care Organizations • Bundled or partially-capitated payments • Insurance Reform • Exchanges • Cooperatives • Medical Loss Ratio (MLR) • Cost-Effectiveness Research • Patient-Centered Outcomes Research Institute (PCORI)

10. Other Issues and Ideas: • State “Convener” authority (overcome anti-trust issues) • Community-based Care Coordination Services (e.g NCCC) • Focus on applying for and winning national grants • Workforce development: New curriculum, new roles • “No wrong door” to Care: Retail, workplace, school clinics, Rx • Secondary—Tertiary facility balance (“arms race”) • Malpractice Reform

11. Delivery System Innovation Work Group • Next Steps • Next Meeting