HEATHER PETERMANNMN DEPARTMENT OF HUMAN SERVICES

DECEMBER 2015

Integrated Health Partnerships

Minnesota’s Medicaid ACOs

Continuum of Integrated Care Models and Features

Measurement

Success Indicators

Data capturing & sharing

Improved clinical processes

Improved outcomes (costs down, patient experience up)

Payment $15-service$5– quality

Metrics/ Evaluation

Some MU core set; some adult/child core sets

measures

Practice measurement changes and process measures that will lead to outcomes improvement

Clinical processes and new benchmarks informed by data collection; benchmarks

adjusted for continuous improvement

Improved care outcomes, not volume; patient

experience

Process measures indicate improved care in future, yield data collection for policy

development and baseline

Care Models

Possible bonus pool

$5-service

Made to individual PCP; fixed $ amount Made to individual providers or entity; upfront $, savings & FFS

Made to entity; $ based on savings

Full ICMs

Population-FocusedIndividual Service-Focused

Population health, functional status, total cost of care

Little/No Accountability for Quality and Cost Outcomes Significant Accountability for

Quality and Cost Outcomes

PCCFFS Only

PCCM Plus P4P

PCMH PCMH + Health Home

Network of PCMH

ACOs Comprehensive ACOs

Other ICMs

$10-service $10– Quality/savings

$15– Quality/savings

ExamplesOklahoma

PCMHMissouri PCMH HH

North Carolina CCNCs

Colorado RICOs

Minnesota ACOs

Oregon CCOs

Source: Centers for Medicare & Medicaid Services (CMS)

What is an Accountable Care Organization (ACO)?

• A group of health care providers with collective responsibility for patient care that helps coordinate services – deliver high quality care while holding down costs

• Creates an incentive through payment structures for providers to efficiently and effectively manage the full spectrum of care a patient receives throughout the care system

• There are a variety of ACO models, many with flexibility in their structure, payments and risk assumptions

Impetus for Accountable Care Organizations

Impetus for ACOs Desired Outcomes

• Develop payment approaches to create incentives for value not volume

• Shift risk and rewards closer to point of care to foster local accountability

• Realize return on federal and state investments

• Improve access to care, outcomes and information for the enrollee

• Value = Better Quality + Lower Cost/“The Triple Aim”

• Integrated prevention, wellness, and community services

• Coordinate care across care cycle

• Data to monitor utilization, compare and share locally and across states

• New reimbursement structures, including incentives that encourage integrated care models

Slide provided by Center for Health Care Strategies (CHCS)

IHPs authorized in 2010 by Minnesota LegislatureAllow for broad flexibility and innovation under a common

framework of accountability – away from incentive “to do more”

IHPs voluntarily contract under two options Integrated or Virtual

Framework of accountability includes: Established provider requirements (delivery primary care, coordinate with

specialty providers and hospitals, demonstrate ways they partner with community organizations and social service agencies)

Payment based on accountability for, total cost of care (TCOC) Robust and consistent quality measurement

Integrated Health Partnerships (IHP)Background and Goals

Existing provider payment persistsGain-/loss-sharing payments made annually based on

risk-adjusted TCOC performance, contingent on quality performance.

Medicaid recipients (MA, MN Care, SNBC) across both FFS and all managed care organizations

Core set of services included in TCOC; IHP may elect to include additional services

Performance compares each IHP’s base year TCOC (year prior to start of demo) to subsequent years.

How are IHPs Accountable? Total Cost of Care (TCOC)

How do we calculate TCOC shared savings?

Total Cost of Care (TCOC) target (risk adjusted, trended) is measured against actual experience to determine the level of claim cost savings (excess cost) for risk share distribution

GAIN: Savings achieved

beyond the minimum

threshold are shared between the payer and delivery

system at pre-negotiated levels

LOSS: Delivery system pays back a pre-

negotiated portion of spending above

the minimum threshold

Quality Measurement

Performance on quality measures impacts the amount of shared savings an IHP can receive; phased in over 3-year demo Year 1 – 25% of shared savings based on reporting only Year 2 – 25% of shared savings based on performance Year 3 – 50% of shared savings based on performance

Core set of measures based on existing state reporting requirements – Minnesota’s Statewide Quality Reporting and Measurement System

Core includes 7 clinical measures and 2 patient experience measures, totaling 32 individual measure components – across both clinic and hospital settings IHPs have flexibility to propose alternative measures and methods

Each individual measure is scored based on either achievement or year-to-year improvement

IHP Participation

204,119

IHP Geographic area Size (# Attributed)

Bluestone Physician Services (V) Minneapolis/St. Paul ~1,000

CentraCare (I) Central MN, N of Mpls/SP 19,712

Children’s Hospital (I) Minneapolis/St. Paul 18,724

Courage Kenney (Allina Health) (V) Minneapolis/St. Paul 1,699

Essentia Health (I) Duluth/NE MN 37,482

FQHC Urban Health Network (10 FQs) (V) Minneapolis/St. Paul 27,715

Hennepin Healthcare System/HCMC (I) Minneapolis/St. Paul 30,000

Lake Region Healthcare (I) West Central MN 3,833

Lakewood Health System (I) Central MN 3,953

Mankato Clinic (V) Mankato 8,564

Mayo Clinic (I) Rochester/SE MN 5,239

North Memorial (I) Minneapolis/St. Paul 4,696

Northwest Health Alliance (Allina/HealthPartners) (I) Minneapolis/St. Paul 16,053

Southern Prairie Community Care (V) Marshall/SW MN 24,385

Wilderness Health (V) NE MN 10,664

Winona Health (I) Winona/SE MN 4,410

Results to Date

In 2013 the first six participating providers saved $14.8 million compared to their trended targets. All beat their targets and met quality requirements; 5 received

shared savings payments $6 million in total payments, ranging from $570,000 to $2.4

million.

2014 interim TCOC savings estimated at $61.5 million. All 9 providers to receive shared savings settlements – up to $22.7

million in total. For 2014, a quarter of each IHP’s shared savings is dependent on

quality measurement to be calculated with final settlement.

Role of Emerging Professions

Use of Community Paramedics and Community Health Workers are examples of the innovative approaches that flexible payment models are intended to encourage

Several IHPs have credited use of emerging professions in their care coordination efforts, improving patient engagement and reaching goals at reducing readmissions

What’s Next?

Incorporate provider feedback to develop advanced model track Explore Medicare/Medicaid Integrated ACO model for under 65

dualsEmphasis on integration of acute care and other care settings,

behavioral health, and home and community based services/social services

Support ACO strategies toward more community responsibility for health/accountable communities for health

Work with new health financing taskforce on state purchasing reform and planning related to waiver options under the ACA to align requirements across affordability programs.