Community Health Team Pilot Program within CSI-RI

1. Community Health Team Pilot Program within CSI-RI September 13, 2013 Debra Hurwitz, MBA, BSN, RN CSI Co-Director

2. Agenda • Background of CHTs and summary of other states’ models • Existing Resources in RI • Committee Membership • Committee Charter/Plan • Deliverables and Time Frame • Next Steps

3. CSI-RI Strategic Plan • Plan: As part of the 2013 Strategic Plan, CSI will develop and pilot the implementation of 2 CHT. • Purpose: To help support small practice in becoming PCMHs. • Budget: $75,000 per site to launch pilot by April 1, • Contingent on approval of the plan by Budget Committee • Additional budget ask for next year

4. What is a Community Health Team? Definition: • Community Health Teams (CHT) work with primary care practices in a given region or network to improve care for patients with chronic conditions. • The CHT often provides direct care: • Care management • Behavioral health care, • Assists with transitions of care • Links patients to community resources. • Based in a pre-existing health care entity (such as a hospital, primary care organization or an FQHC) or a newly-formed non-profit and provide services to a number of associated primary care practices.

5. Vermont CHT Model Overview • Each Hospital Service Area (HSA) has a project manager who oversees two HSA-wide workgroups: the Health Information Technology Workgroup and the Integrated Health Services Workgroup (IHS). • IHS oversees CHT implementation: reorganization of existing services, creating new services, CHT composition and administrative entity • CHT employed by administrative entity (CMS eligible-hospital or health center)

6. Vermont CHT Services

7. Vermont CHT Measures

8. Vermont CHT Funding • Direct predefined payment from participating payers: commercial, Medicare and Medicaid • Funding required by 2007 legislation • There is an agreed upon shared cost structure paid to administrative entity • Rates: $350,000 per year for salaries and benefits for each community health team • CHT use is not based on insurance status and does not require co-pays or prior authorization

9. Oregon CHT Overview • Coordinated Care Organizations (CCOs) are regional provider networks made up of a variety of health care providers who work together to deliver coordinated acute and preventive care to the State’s Medicaid beneficiaries. • Preexisting health care entities apply to serve as a regional CCO. • Each CCO (currently 15 in operation) develops a transformation plan specific to the needs of the community it serves. • These plans demonstrate how the organization will work to improve health outcomes, increase member satisfaction and reduce overall costs.

10. Oregon CHT Services • Each CCO must have: • Pcp/nurses • Mental health providers • Community members • Consumer advisory council (representative sits on the CCO board

11. Oregon CHT Measures • 17 CCO incentive measures

12. Oregon CHT Funding • CCOs operate on an accountable global budget from the state • Participants in CCOs have one single health plan which integrates physical, dental and mental health care • SIM grant of $45 million

13. Environmental Scan: Funding • Most states fund CHTs under the authorization of • 1915 (b) Medicaid Managed Care Waivers • 1115 research and demonstration waivers • PPACA 2703 health homes state plan amendments

14. Environmental Scan: Funding • Vermont-CHT receives direct pre-defined payment from participating payers • Alabama, Maine, Montana, North Carolina, South Carolina, Oklahoma-CHT receives direct PMPM from participating payers • New York- Primary care practices receive direct PMPM from payers and “pass-on” portion to their associated CHT • Minnesota- CHT funded through state grant

15. References • The Association of State and Territorial Health Officials. Community health teams issue report (Job Code 16015). Retrieved from website: http://www.astho.org/Programs/Access/Primary-Care/_Materials/Community-Health-Teams-Issue-Report/ • Buxbaum, Jason. (2012, April). Community-based support teams: The national landscape. Building medical home neighborhoods through community-based teams: lessons from three states with emerging programs. Retrieved from http://www.nashp.org/webinar/building-medical-home-neighborhoods-through-community-based-teams • Craig Jones, M.D. (Chair), (9/21/12). Webcast: Vermont blueprint for health: working together for better care. • Department of Vermont Health Access, (2010). Vermont blueprint for health implementation manual. Retrieved from website: http://hcr.vermont.gov/blueprint • Department of Vermont Health Access, (2012). Vermont blueprint for health 2011 annual report. Retrieved from website: http://hcr.vermont.gov/blueprint • U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2012). Policy innovation profile: Statewide program supports medical homes through multidisciplinary teams, easy access to information, and incentives, leading to lower costs and better care. Retrieved from website: http://www.innovations.ahrq.gov/content.aspx?id=3640 • Lisa Watkins, MD, Associate Director, Vermont Blueprint for Health, L. W. Maine Quality Counts PCMH Pilot, (2011). Community health teams and the medical home. Retrieved from website: http://www.mainequalitycounts.org/hosp-tools-and-resources/doc_view/212-community-health-teams-a-new-tool-for-improving-care-and-outcomes.html