Overview of 2019 Investment Strategy & Process February 14, 2019

Transcription

1 Overview of 2019 Investment Strategy & Process February 14,

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3 Webinar Logistics: Asking Questions Click the arrow to expand or collapse this pane Click the hand to raise your hand Click Questions to expand or collapse the Questions box Messages and links from staff will appear here To share a comment or question with staff, type here and click Send. (Please keep in mind: at our discretion staff may address your comment/question publicly during the webinar, privately during the webinar, or privately at a later time.) 3

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5 Goals for Today Share the process HealthierHere has been going through to develop a 2019 Investment Strategy for Medicaid Transformation Tour HealthierHere s Investment Prioritization Tool Share the results of the Investment Prioritization Process 5

6 Why Transformation 6

7 Why Our Region Needs a Broader Collaborative Approach Clinical care represents only 1/5 of the factors that impact health outcomes. To improve the health of people in our community, we must effectively address the social determinants of health. Socio- Economic Factors 40% 20% Clinical Care 10% Physical Environment 20% Health Behaviors 7

8 Today: Too Many Disparate Systems to Navigate Community Based Organizations Housing Transportation Acute Healthcare Step Down Care Criminal Justice Crisis Response Addiction Treatment Behavioral Health Specialty Care Primary Medical Care 8

9 Our Vision: A Connected System of Whole-Person Care People on Medicaid are healthier because they get the RIGHT CARE at the RIGHT TIME in the RIGHT PLACE. 9 9

10 Building a Connected System: Laying the Foundation Convene and Engage to Develop Cross-Sector Working Partnerships Strengthen Capacity to Support Collaboration and Innovation Clinical Community 10

11 Reminder: Staged Investment Based on Readiness Today s Focus Clinical Community To come when Practice Partners are selected. 11

12 Long-term: What Success Looks Like Meaningful mechanisms for community and consumer voice that help drive decision-making for healthcare Care teams that are representative, culturally competent and respectful of individuals and community. Computer systems that talk to each other to improve Community/Clinical connections Payment models that compensate providers for keeping people healthy (rather than # s of procedures) and Community-Based Organizations for contributing to better outcomes 12

13 Developing an Investment Strategy 13

14 A Shared Stewardship HealthierHere Governing Board Executive Committee Community and Consumer Voice Committee Finance Committee Performance Measurement and Data Committee Transformation Committee 14

15 HealthierHere Funds Flow This is Pay-for-Performance at the Systems Level Funds flow from Federal Government to State Government to a Fiscal Intermediary ACH measures whether milestones have been met ACH uses funds to invest in interventions 15

16 HealthierHere has a Pay-for-Performance Contract with HCA Starting in 2019, an increasing portion of Medicaid Transformation Funding is tied to our region s performance on a set of 19 metrics 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 25% 50% 75% 100% 100% 75% 50% 25% Y Y Y Y Y Pay for Performance (P4P) Pay for Reporting (P4R) 16

17 Scope of Investment Discussion HealthierHere Governing Board has already provided guidance on use categories; Partner Organization Incentives = 63%. This is further allocated between Medicaid (50%), Non-Medicaid (42%) and Tribes (8%) provider types System Investments including Population Health & Workforce = 15% This is further allocated between Medicaid, Non-Medicaid and Tribes The remaining 22% of the budget allocation is NOT a part of the IPT process. These dollars are designated for Reserve, Equity & Wellness Fund and HealthierHere Administrative budget. 17

18 Building an Investment Strategy Individual Organizations System Level Traditional Medicaid Community CBOs & Tribes 18

19 HealthierHere s Journey to Transformation Putting the Pieces Together 19

20 2017: Define Organization, Goals and Scope Launch & Launch Design & Design Assess Capacity and Need Partner Engagement Planning Governing Board Formed / Principles Appointment of Executive Director Conflict of Interest Policy Leave-behind Categories Incentive Fund Allocation Principles & Allocation 5-Year Budget Approval Regional Needs Assessment Community Learning Sessions 8 Design Teams Develop Proposals Selection of Projects for Portfolio Portfolio Submitted to the State Implementation Plan to State Investment Priorities 20

21 2018: Strategically Focus to Optimize Performance Launch & Design Assess Need & Capacity Current State Assessment HIE / HIT Assessment Value-Based Payment Survey CBO Small Grants Program Partner Engagement Planning Implementation Plan to State Investment Priorities 21

22 2018: Strategically Focus to Optimize Performance Launch & Design Assess Need & Capacity Engage & Select Partners Planning Implementation Plan to State Partner Summits & Meetings Selection of Clinical Practice Partners CBO/Community Partner Information Sessions Selection of CBO/Community Practice Partners 2018 Partner Engagement & Planning Allocation Payment to Partners for Planning & Engagement DYI Budget & Fund Allocation 2018 FIMC Allocation Methodology Investment Priorities 22

23 2018: Strategically Focus to Optimize Performance Launch & Design Assess Need & Capacity Engage & Select Partners Plan & Prioritize Implementation Plan to State Clinical Summaries Subject Matter Workgroups Investment Prioritization Tool Clinical Practice Partner Change Plans Implementation Plan Investment Priorities 23

24 2019: Build Implementation Systems and Launch Launch & Design Assess Need & Capacity Engage & Select Partners Plan & Prioritize Implement 2019 Investment Strategy approved Guidelines, Policies, Procedures & Protocols Incentive Contracts with Practice Partners System Level Investments Continuous Quality Improvement Plan Training and Technical Assistance Monitoring and Tracking Systems 24

25 The Investment Prioritization Process 25

26 A Disciplined Process to Focus Investment Decisions Investment Input List Investment Prioritization Tool Scoring & Review Cost/Budget Analysis 2019 Investment Budgets 26

27 What are All the Initiatives We Could Potentially Fund? Potential Investments Inventory Investment Input List What do Practice Partners say they need? What does the system need? Where are the gaps and overlaps? Develop Comprehensive List Based on Input from: Design Groups Implementation Work Groups Current State Assessment HIE/HIT Assessments Committees Change Plans Follow Up Meetings with Partners Internal Analysis 27

28 How Should Investments be Measured and Evaluated? Develop Criteria for Investment & Weighting Equity Investment Input List Develop Prioritization Tool Given the needs are greater than the funding What factors should be used to evaluate potential investments? Which are most important? Innovative Viable Systemic Leveraging Sustainable Investment Prioritization Based on input from: High Priority Medium Priority Implementation Work Groups Committees Governing Board Manatt HealthierHere Staff 28

29 Which Investments are Highest Priority for 2019? Potential Potential Investment Investments Investments Input List Inventory Inventory Potential Investments Inventory Prioritization Tool Scoring & Review Committee Meeting: Review the process, prioritization tool and investment input list HeathierHere Staff & Consultants: Is there anything on this list that you cannot live with? Uses Prioritization Tool to analyze, score, and rank order investments Committee Meeting: Collaboratively review and provide feedback on the ranked investment list (Committee Review) Does the ranking of the priorities make sense and align with our vision and values? 29

30 How Much Revenue Will Be Available to Invest? Potential Potential Investment Investments Investments Input List Inventory Inventory Potential Investments Inventory Prioritization Tool Scoring & Review Cost/Budget Analysis What is the likelihood we will hit our metrics? How much revenue do we estimate we ll earn? What is the delta between potential investments & projected revenue? HealthierHere Staff Develops Budget Based On: Current Revenue Projected Future Revenue Timing of Revenue Budget allocations Identifies Budget Cut-off 30

31 Is it Working? Continually Reassess and Adjust. Performance 31

32 A Tour of HealthierHere s Investment Prioritization Tool (IPT) 32

33 Investment Prioritization Tool (IPT) Investment Input List Gated Model Developed with input from our Board and Committees Provides objectivity to inform decision making Provides transparency Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Prioritized / Costed Committee Review 33

34 Investment Prioritization Tool- Scoring Process HealthierHere consulted with Manatt to develop the IPT model and scoring process HealthierHere Calibration Team (HealthierHere staff) met and conducted a dry run of the IPT to calibrate scoring HealthierHere Evaluation Team (HealthierHere staff + Manatt as SME) will meet and score investments against values and P4P metrics. HealthierHere Finance Team and Manatt will consolidate the scores 34

35 Investment Input List List developed from multiple sources: Design Groups Implementation Work Groups Current State Assessment HIE/HIT Assessments Committees Change Plans Follow Up Meetings with Partners Internal Information Gathering/Analysis Investment Input List Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Investments Prioritized / Prioritized / Costed Costed Committee Review 35

36 HealthierHere Values Equitable (High) Definition: Addresses the areas of greatest need, health disparities, and underinvestment as determined by authentic community engagement. Innovative (High) Definition: Extent to which investments support innovation (e.g. is a novel approach) Viable (High) Definition: Greater likelihood that the proposed activity will deliver intended results (during waiver). Systemic (Medium) Definition: Supports the development of solutions that align w/system-wide needs. Leveraging (Medium) Definition: Leverages available resources in order to build momentum for scaling. Sustainable (Medium) Definition: Extent to which investments are sustainable. Investment Input List Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Prioritized / Costed Committee Review 36

37 IPT Pay for Performance (P4P) Each investment that scored 50 th percentile on values are then scored based on 19 P4P Metrics Investments are scored based on their ability to impact metric during MTP timeline Metrics weighted based on their potential for DSRIP revenue Investment Input List Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Prioritized / Costed Committee Review 37

38 Investment Prioritization Investment options are ranked based on value and P4P scores Investment options can then be costed out, based on priority Investment Input List Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Prioritized / Costed Committee Review 38

39 IPT Committee Review Investment options are evaluated against values and P4P Investment options are evaluated on cost Derive a list of investment options that will be analyzed against: Available revenue: Based on DY1 and DY2 DSRIP earnings ($TBD) Budget allocations between provider types and uses Cash Flow Analysis Investment Input List Investments Scored Against HealthierHere Values Investments Scored for P4P Impact Investments Prioritized / Costed Committee Review 39

40 Investment Prioritization Results 40

41 Potential Investment Option Themes Organization Specific Resources Other - infrastructure/ system gaps System Level Investments HealthierHere Investment Input List Innovation Fund 41

42 The IPT Gated Model All 23 Investment Options are evaluated against HealthierHere Values Investments above the 50 th percentile on Values advance to P4P evaluation Values and P4P are weighted, aggregated, then prioritized 42

43 First Gate: Performance on HealthierHere Values H I G H M E D I U M Equitable Innovative Viable Systemic Leveraging Sustainable Addresses the areas of greatest need, health disparities, and underinvestment as determined by authentic community engagement. Extent to which investments support innovation (e.g. is a novel approach) Greater likelihood that the proposed activity will deliver intended results (during waiver). Supports the development of solutions that align w/system-wide needs. Leverages available resources in order to build momentum for scaling. Extent to which investments are sustainable 43

44 100% Value Performance: The Top 12 90% 80% 50 th Percentile 70% 60% High Value Medium Value 50% 40% 30% 20% Low Value 10% 0% Regional Community Information Exchange Pre-Mange System-level Implementation Data Integration and Optimiztion & Analytics Support for Population Health Management Standardized Social Determinants of Health (SDOH) Screening Non-licensed Direct Care Staffing EHR Optimization Mechanism for Shared Care Planning Support Partner- Support Clinical Support Quality Integrate Data Driven Innovations Best Practices Improvement Use into Clinical Workflows 44

45 Value Performance: The Bottom % 90% 80% 50 th Percentile 70% 60% 50% 40% High Value Medium Value Low Value 30% 20% 10% 0% Recruitment of Qualified, Diverse Staff Flex Fund Enhance Retention of Diverse & Qualified Workforce Telehealth / econsult Certification / Licensing Support Licensed Direct Care Staffing Address Gaps for VBP Readiness New/ Replacement EHR Software Other Infastructure / System Gaps Comp for Participation in Training and Technical Assistance Comp for Completing Data Reporting 45

46 Second Gate: Performance on P4P Investments that advance through the Values Gate are scored for P4P: 19 P4P Metrics Score based on likely ability to impact metric during MTP timeline Metrics weighted based on their potential for DSRIP revenue Hospital / ED All-cause ED visit rate Acute hospital utilization Follow up ED visit for chemical dependency Follow-up ED visit for mental illness Follow-up hospitalization for mental illness All-cause hospital readmission rate Behavioral Health Mental health treatment penetration Antidepressant medication management SUD treatment penetration SUD treatment penetration - opioid use disorder Chronic Disease Diabetes care: Eye exam Diabetes care: Hemoglobin A1c testing Diabetes care: Kidney screening Asthma medication management Statin therapy for heart disease Opioid Patients on high-dose chronic opioid therapy Patients with concurrent opioids & sedatives prescriptions Other Child and adolescent access to primary care Percent homeless 46

47 Pay 4 Performance 100% 90% 80% 70% 60% 50% 40% High P4P Medium P4P Low P4P 30% 20% 10% 0% Integrating Data Use into Clinical Workflows Non-licensed Direct Care Staffing Mechanism for Shared Care Planning Support for Population Health Management Pre-Mange Implementation and Optimiztion Standardized Social Determinants of Health (SDOH) Screening System-level Data Integration & Analytics Support Partner- Support Quality Driven Improvement Innovations EHR Optimization Support Clinical Best Practices Regional Community Information Exchange 47

48 The Finalists: Ranked by Overall Performance Hold for CBO Investment Opportunities 48

49 Staging and Phasing of Investments 49

50 Roles of HealthierHere in Transformation Convening Investing Policy Sustainability Convene partners and stakeholders around specific topic areas Invest in strategies that lead to a transformed system Participate in local and statewide policy making related to transformation goals Identify mechanisms to sustain MTP investments and strategies Examples: Learning Collaboratives Shared Care Plans SDOH Screening Data governance Examples: Training and TA Non-licensed direct service staff capacity Clinical Information Exchange Optimizing PreManage Examples: Participate in defining MCO contract requirements Work with HCA to obtain 90/10 funding to support providers connectivity to HIE Participate in removing regulatory barriers to integration Examples: Work with MCOs and HCA to identify VBP structures that support care models Identify alternative or additional funding sources to implement and sustain MTP investments 50

51 How do we get from here to there? We Can t Do Everything At Once! We know what our current state is We know where we want to get to How do we lay the cobblestones at the right time, in the right order to get there? 51

52 Stages and Phases of Implementation Infrastructure and Capacity Building Marathons Targeted Innovations that improve specific metrics Sprints Quick tests of innovation/proof of concepts How do we order our implementation and investment strategies so that they build off of one another Mindful of revenue drivers Mindful of what needs to happen first Move as quickly as we can Involve as many partners as we can 52

53 Budget Information 53

54 HealthierHere Total Available Budget: $97M Updated Project Budget $97M includes: Project Funds ($83M) Project Incentives: $75M Social Equity and Wellness Fund: $5M Reserves: $3M Administration ($15M) 54

55 Project Funds by Provider Type: $75M Note: Allocations between Systems and Projects may be revisited based on investment decisions. Changes would require board approval. 55

56 Medicaid Project Incentive Budget: $39M By Year Earned Spent $6.2M on Provider Engagement & Planning 56

57 Medicaid Project Incentive Budget: $39M By Year Received Spent $6.2M on Provider Engagement & Planning 57

58 Medicaid Project Funds: $33.4M Estimated Medicaid revenues over MTP: $39.6M Total Spent through CY2018: $6.2M Total Remaining: $33.4M 58

59 Annual Investment Budgets: $33.4 investment from

60 DRAFT 2019 Investment Strategy 60

61 Long-term: What Success Looks Like Meaningful mechanisms for community and consumer voice that help drive decision-making for healthcare Care teams that are representative, culturally competent and respectful of individuals and community. Computer systems that talk to each other to improve Community/Clinical connections Payment models that compensate providers for keeping people healthy (rather than # s of procedures) and Community-Based Organizations for contributing to better outcomes 61

62 The Finalists: Ranked by Overall Performance Hold for CBO Investment Opportunities 62

63 2019 Investment Categories Strengthen Foundational System Infrastructure and Capacities Tools that Enable Whole Person Care thru clinical/ community linkages Catalyze & Test Cross-Sector Innovations to Improve Outcomes MARATHONS SPRINTS 63

64 Establish a Strong Foundation Strengthen Foundational System Infrastructure and Capacities Tools that Enable Whole Person Care thru clinical/ community linkages Catalyze & Test Cross-Sector Innovations to Improve Outcomes Assure that providers have the necessary tools to manage Population Health and help them learn how to use them. Provide training and TA for advancing technology and data Incent Partners with PreManage implementation and optimization; Incent Partners with EHR optimization & integrating data into workflows; Provide training and TA for population health management tools and technology Incent Partners for conducting risk stratification; Incent partners for developing and using registries for population health management; Provide QI training, technical assistance, and practice coaching Help prepare organizations to participate in system level data and analytics 64

65 Create Blueprints and build linkages Strengthen Foundational System Infrastructure and Capacities Tools that Enable Whole Person Care thru clinical/ community linkages Catalyze & Test Cross-Sector Innovations to Improve Outcomes Convene clinical and community partners to co-develop blueprints for system-wide care models: Shared Care Planning: Convene partners to define data elements, develop workflows, implement pilot and determine what platform is needed Standardized Social Determinants of Health Screening: Convene partners to provide SDOH screening tool recommendations and sample workflows Community Information Exchange System: Convene partners, experts and investors on how best to develop and fund Support system-level data integration and analytics: Co-develop system level data set/system and evaluate analytics tools 65

66 Catalyze and Test Innovations Strengthen Foundational System Infrastructure and Capacities Tools that Enable Whole Person Care thru clinical/ community linkages Catalyze & Test Cross-Sector Innovations to Improve Outcomes Catalyze & Test Innovative Models of Care to Improve Outcomes Provide seed funding for focused pilots of innovations that leverage provider change plans: Focused Innovations: Develop and test interventions to improve outcomes for specific metrics or populations. Example: ED Utilization: Test models to reduce inappropriate ED use Build capacity for Non-Licensed Direct Care Staffing: Test innovated care models that include Community Support Specialists through community/clinical partnerships * 2019 Deliverable 66

67 2019 Investment Strategies Matrix Investment Strengthen Foundational System 1 Integrate Data Use into Clinical Workflows X Tools to promote clinical/community linkages 2 Non-licensed Direct Care Staffing X 3 Mechanism for Shared Care Planning X 4 Support for Population Health Management X 5 Pre-Manage Implementation and Optimization X 6 Standardized Social Determinants of Health (SDOH) Screening X 7 System-level Data Integration & Analytics X 8 Support Partner-Driven Innovations X 9 Support Quality Improvement X 10 EHR Optimization X 11 Support Clinical Best Practices X 12 Regional Community Information Exchange (CIE) X Innovation Fund 67

68 Next Steps 68

69 Next Steps Finalize cost estimates for the prioritized investment strategies Determine cost/revenue gap or surplus Investment Strategy Meeting #4 TBD Review cost information and cost/revenue gap or surplus If gap present options for funding adjustments If surplus present options for additional investment strategies Finalize recommended investment strategy Board approves investment strategy at March 7 th meeting 69

70 Timeline for Developing 2019 Investments Budget DECEMBER JANUARY FEBRUARY MARCH APRIL MAY 12/4 Committees Overview of process, prioritization tool and Investment Input List 1/10 Gov. Board Update on process Preview 5-Yr Budget 2/7 Gov. Board Reviews 2019 Investments Budget 3/7 Gov. Board Approves 2019 Investments Budget Wave of 2019 Funding is Released 12/6 Gov. Board Update on process Investments Scored by Prioritization Tool & Rank Ordered Establish Cut-off & Develop 2019 Investments Budget 2/13 Committees finalize investment strategy recommendation Develop Contracts with Practice Partners 12/17 Committees Review rank order Investment Input List Provide feedback and finalize 1/16 Committees If needed, finalize rank order recommendation 70

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75 Transportation: A Game Changer for Care Coordination February 20, 2018 Noon - 1pm Join HealthierHere and local expert Julie Povick, of Seattle Children s Hospital, for a Partner Learning Webinar discussion about transportation and health. Ms. Povick is the Manager of External Relations at Seattle Children s, and has a unique range of skills and firsthand knowledge about addressing the challenges of transportation in health care. She will share insights from her experience ensuring that Medicaid individuals have transportation to access the care they need and will reflect on how transportation can impact coordination of care. Click Here to Register Today 75