Thank you for joining today s webinar: An Overview of The New Jersey Medicaid Accountable Care Organization Business Planning Toolkit

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1 Thank you for joining today s webinar: An Overview of The New Jersey Medicaid Accountable Care Organization Business Planning Toolkit We will begin shortly. 1

2 An Overview of The New Jersey Medicaid Mdi idaccountable Care Organization Business Planning Toolkit Rob Houston, MBA, MPP - CHCS Tricia McGinnis, MPH, MPP - CHCS Bruce Dees - Applied Health Strategies Derek DeLia, PhD - Rutgers Center for State Health Policy July 12,

3 How to Ask Questions During the Webinar To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 3

4 Agenda ACO Toolkit Overview The New Jersey Medicaid ACO Demonstration Project ACO Demonstration Project Nuts and Bolts The Tools Q & A 4

5 The New Jersey Medicaid Accountable Care Organization Business Planning Toolkit A primer designed to accelerate ACO planning efforts Funded by the Nicholson Foundation Authored by CHCS, Applied Health Strategies, and Rutgers Center for State Health Policy Tools: Readiness Assessment Business Plan Template Sample Work Plan Download at chcs.org 5

6 How to use the ACO Toolkit Sections: The Concept Level The Essential Level The Advanced Level Can be read vertically or horizontally ontally All levels correspond to the Readiness Review Tool in the Appendix 6

The New Jersey Medicaid ACO Demonstration Project NJ P.L.

to serve Medicaid beneficiaries in New Jersey through a three-year demonstration Requirements:

Medicaid beneficiaries Support of all general hospitals within the designated area Support of 75%

behavioral health providers Establish a governing board and shared governance Define a

7 The New Jersey Medicaid ACO Demonstration Project NJ P.L. 2011, Chapter 114 enacted August 18, 2011 Allows the formation of Accountable Care Organizations to serve Medicaid beneficiaries in New Jersey through a three-year demonstration Requirements: Form a New Jersey nonprofit corporation Define a designated area that includes: At least 5,000 Medicaid beneficiaries Support of all general hospitals within the designated area Support of 75% of Primary Care Providers in the designated area Participation of at least four qualified behavioral health providers Establish a governing board and shared governance Define a gain-sharing arrangement Define a quality plan Define a community engagement process Draft regulations released on May 6, day comment period ended July 8,

8 ACO Toolkit Nuts & Bolts Establishing a Leadership and Governance Structure Partnering with Stakeholders Performing Data Analysis and Building an IT Infrastructure Improving Care Delivery Ensuring Quality Improvement 8

9 Establishing a Leadership and Governance Structure Legal Structure Nonprofit Status Bylaws The Board of Directors Board Composition Voting Options 9

10 The Governance Team 10

11 Partnering with Stakeholders An ACO must partner with health care, community, and other stakeholders in order to succeed Health Care Stakeholders Community Organizations Other Stakeholders Hospitals PCPs Behavioral Health Providers FQHCs and Clinics Specialists Community Service Organizations Faith-Based Organizations Housing and Homeless Services MCOs Food Pantries and Soup Kitchens Transport Services Pti Patient tadvocates State and Local Public Health Resources Social Services Government Officials Community Residents 11

12 The Stakeholder Partnership Process Identify Health care, community, and other stakeholders with interests in the designated area Engage Stakeholders through discussions with ACO representatives, integrating their interests in ACO structure and mission and envisioning a role for them in the ACO leadership Collaborate With stakeholders after the ACO launch to build an effective ACO structure that the community can embrace through formal and informal means 12

Just get started State and Federal Regulations HIPAA New

13 Performing Data Analysis and Building an IT Infrastructure Advice from the Camden Coalition of Health Care Providers: Just get started State and Federal Regulations HIPAA New Jersey regulations Types of Data Patient-level data Population-level data 13

14 Types and Sources of Data Types of Data Claims Inpatient admissions / discharge Ambulatory Immunization Pharmacy Patient Experience Electronic Health Records Sources of Data MCOs Hospitals Providers NJ Medicaid Public Health Departments Individuals 14

15 Data Analysis Techniques Hotspotting Data mining i 15

16 IT Infrastructure and Personnel Three key questions for IT infrastructure How do you access your data? What kind of data are you receiving? What kind of resources do you have to devote to data analysis? Personnel Director of Research and Evaluation Data Analyst Evaluation Manager 16

care team Building a care model and workflow Stratification of patients

17 Improving Care Delivery Identifying populations and patients Referrals Health risk assessments Data mining Promoting effective care coordination Building a care team Building a care model and workflow Stratification of patients Patient engagement Developing a care plan Stabilizing i and graduating patients 17

utilization Patient experience 6 voluntary quality measures One prevention and

18 Ensuring Quality Improvement 21 core quality measures in the areas of: Prevention and effectiveness of care Acute care Behavioral health Chronic conditions Resource and utilization Patient experience 6 voluntary quality measures One prevention and effectiveness of care measure Five chronic conditions measures Additional quality measures 18

19 ACO Quality Requirements by Year Year ACO Measurement Requirement 1 Reporting only, performance is not measured. 2 3 Relative performance improvement must be shown for at least two quality measures. Relative performance improvement must be shown for at least five quality measures, and absolute improvement must be shown for at least two quality measures. 19

20 Nuts & Bolts Q&A To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 20

21 The Tools 21

22 Savings Measurement 22

Issues in Savings Measurement Gainsharing presupposes

assess the counterfactual Gold standard: Rigorous comparison

statewide trend Can be done with claims data Precedent in

23 Issues in Savings Measurement Gainsharing presupposes existence of savings Pre/post trend is not sufficient Need to assess the counterfactual Gold standard: Rigorous comparison group Difficult/time-consuming Alternative: Comparison to statewide trend Can be done with claims data Precedent in Medicare & other shared savings arrangements Recommendations in CSHP report 23

Framework for Statewide Trend Comparison Key quantities Baseline & performance year per capita spending Statewide trend in Medicaid spending growth Benchmark spending = Baseline

24 Framework for Statewide Trend Comparison Key quantities Baseline & performance year per capita spending Statewide trend in Medicaid spending growth Benchmark spending = Baseline spending + statewide trend factor Performance year spending < benchmark spending ==> savings are established Important issues Risk adjustment Random variation Inflation adjustments 24

25 Savings Measurement Q&A To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 25

26 The Business Plan 26

Purchasing of health care services Movement away from volume (payments for clinic

27 The Business Planning Process Forces managers to think through financial and operational matters unfamiliar to most providers Promotes the concept of Value-Based Purchasing of health care services Movement away from volume (payments for clinic visits) And toward dhigher h payments for measurably higher quality care and healthier people p 27

) Allows the responsible management of limited resources, which is a key to

28 The Business Planning Process Reduces nebulous concepts into metrics that can be reasonably forecasted (e.g. lives, revenue, etc.) Allows the responsible management of limited resources, which is a key to sustainability Brings the question of who is the customer? front and center Drives the shift to population management thinking 28

How do we forecast and measure e our return on investment ( ROI ) in the Care

29 Population Management Thinking How can we manage the health of 30,000 people? What is the Total Cost of Care ( TOC )? What are member months and PMPMs? How do we forecast and measure e our return on investment ( ROI ) in the Care Coordination Team? How much care coordination can we afford? What is extensibility? 29

Who and what providers of care are already in the community, and how do we engage

30 Population Management Business Thinking What model of care coordination will we adopt? What is the right mix of professionals in the care coordination team(s)? Who and what providers of care are already in the community, and how do we engage them? What care coordination resources do those providers already have? Are there PCMHs? 30

31 The People Connection P S S P P FQHC ACG ACG PCP PCP? S S P S S ACO Clinicians S 31

32 Business Planning Q&A To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 32

33 The Work Plan 33

34 Sample Work Plan 34

35 Work Plan Q&A To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 35

36 Community Readiness Assessment 36

37 Community Readiness Assessment 3 levels Conceptual Level Essential Level Advanced Level It is recommended that ACOs achieve the Essential Level for all questions before participating in the demonstration 37

38 Community Readiness Assessment Q&A To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 38

39 General Q&A To submit a question please click the question mark icon located in the toolbar at the top of your screen. Your questions will be viewable only to panelists. Answers to questions that cannot be addressed due to time constraints will be shared after the webinar. 39

40 Wrap Up Download The New Jersey Medicaid Accountable Care Organization Business Planning Toolkit: h / ti 960/publications_show.htm?doc_ id= #.uchbmzemf1m 40

Leveraging Crimson to Support Network Utilization Strategy

Crimson Population Risk Management Leveraging Crimson to Support Network Utilization Strategy January 25, 2016 2 Managing Your Screen To minimize the control panel To minimize the presentation area Minimizes