State Innovation Models (SIM) Update

State Innovation Models (SIM) Update

November 14, 2013

PRELIMINARY PREDECISIONAL WORKING DOCUMENT: SUBJECT TO CHANGE

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Agenda for today

Summary of Feedback

Plan Updates, Next Steps and Timeline

Potential Organizational Structure


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Summary of Feedback

▪ Feedback received (Delaware)–Significant amount of feedback on second draft–Stakeholders eager to continue momentum–Specific focus on level playing field throughout – fairness and transparency–Importance of selecting/tracking the right metrics–Expanded definition of “health care team” –Interest in receiving plan before submission to CMMI

▪ Feedback received (CMMI and NGA Technical Assistance)–Plan is well developed–Level of stakeholder participation sets Delaware apart–Deliberately flexible approach is articulated and supported well


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Summary of respondents (Qs 1-3)

15%

Patient/consumer

15%Other

19%

Community organization

26%

4%11%

Payer

State 11%

Health system

Nurses, behavioral specialists and other providers

Physician

11%

15%

Sussex

Kent

74%

New Castle

Yes

No56%

44%

Stakeholder group County

Involved with SIM to date?

SOURCE: Delaware’s State Health Care Innovation Plan – Survey Responses

Note: N = 27


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The case for change (Qs 4 & 5)

Q: There is a compelling case for change to improve the health of Delawareans, improve health care quality and patient experience, and reduce health care costs." To what extent do you agree or disagree with this statement?

Strongly disagree 0

Disagree 0

Neutral 0

Agree 19

Strongly agree 81

Aggregate responses, percent


Note: N = 27


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Importance of collaboration (Q6)

Q: “We should work together as much as possible across health care professionals, providers, payers and individuals for a solution in the best interests of Delawareans." To what extent do you agree or disagree with this statement?


11

Strongly agree 85

Strongly disagree 4

Disagree 0

Neutral 0

Agree


Note: N = 27


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Aggregate responses ,percent

Plan focus areas (Qs 7-8)

67

67

70

52

74

48

67

78

56

63

26

30

22

26

15

11

22

19

26

7

4

4

4

4

4

4

4

4

4

4

26Policy changes

Holistic approach to workforce

15

Continuing to build

System-wide shift 30 7

Shared services and resources

7

Simple, commonscorecard

15 4

More effective diagnosis 4

Care coordination

Technology-enabled patient engagement

4

"Healthy Neighborhoods" model

4 4

Q: To what extent do you support or oppose the focus areas of the plan?

Strongly oppose

Oppose

Neutral

Strongly support

support


Note: N = 27


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Proposed governance structure (Q9)

Q: "The proposed governance structure, the Delaware Health Innovation Center, will be effective in bringing people together to sustain Delaware's health care transformation." To what extent do you agree or disagree with this statement?



30

Agree

30

33

Strongly agree

0

Disagree 7

Strongly disagree

Neutral

Note: N = 27


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Remaining work to finalize plan

More detail related to:•Organizational structure•Potential impact •Workforce


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Organizational Structure: Delaware Health Innovation Center

Purpose

Principles

Roles and responsibilities

Accountability

Staffing

▪ Continue to drive transformation of Delaware’s health system and to implement the Health Care Innovation Plan

▪ Offer a continuing forum to bring stakeholders together ▪ Provides structure necessary for long-term success and ensuring ongoing

inclusive and participatory nature of transformation

▪ Deliver services only where needed ▪ Connect with the Health Care Commission and DHIN▪ Continue the multi-stakeholder approach▪ Board large enough to be representative and small enough to move quickly▪ Outside government with public and private participation (non-profit?)

▪ Reports to– Health Care Commission and DHIN– General Assembly– Governor

▪ Track and monitor overall progress against state health scorecard and cost impact▪ Develop shared services and resources, including protocols and guidelines, and

promote a common provider scorecard▪ Manage the patient activation and engagement strategy ▪ Operationalize Delaware’s vision as Learning State and develop integrated workforce▪ Implement Healthy Neighborhoods strategy

▪ Board with 9-13 members with demonstrated executive leadership, with sub-committees including patient representatives, providers, payers, the State, and employers (unpaid)

▪ Full-time staff of Executive Director and two full-time administrators, in addition to consulting support

DRAFT


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Innovation Center roles and responsibilities

Clinical committee

Patient advisory committee

Workforce education and training committee

Healthy neighborhoods committee

DRAFT

Innovation Center Board

▪ Tracks progress on state scorecard of metrics▪ Establishes and monitors transparency and progress for overall

implementation ▪ Approves membership and reviews work of committees

▪ Establishes shared services, including care coordination and transformation support shared services, and learning collaboratives

▪ Identifies, distributes, and regularly updates guidelines to focus on more effective diagnosis and treatment

▪ Represents patient perspective on all services and/or activities provided by Innovation Center

▪ Responsible for patient activation and engagement program

▪ Coordinates efforts to improve population health and leads Healthy Neighborhoods program– Facilitates establishment of the neighborhoods– Sets statewide goals – Ensures integration of population health efforts with delivery– Creates transparency on progress

▪ Coordinates workforce and educational training and retraining statewide to fill gaps and build capacity to support the new delivery system, population health, and technology requirements.

▪ Leads efforts to position Delaware as a “Learning State”


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Open questions on organizational structure

▪ How will the Innovation Center be established (near-term/long-term)?

▪ Who will appoint the Board and committee members?

▪ How will the public/private structure work?


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Plan Update: Delaware’s Aims and Drivers

Delaware will…▪Be one of the 5 healthiest states in the nation by 2019 (chronic disease prevalence, healthy and preventive behavior indicators)

▪Be in the top 10 percent in health care quality and patient experience by 2019 (outcome measures TBD)

▪Reduce health care costs by 6.0 percent by 2019

Primary Drivers Secondary Drivers Example metricsAims

DRAFT

▪ Engage patients in their health ▪ Data tools and resources▪ Awareness campaign▪ Adoption of HIT by providers to achieve

meaningful use 2

▪ Percent use of new tools

▪ Percent MU2

▪ Every Delawarean in a Healthy Neighborhood to improve integration among community organizations and create local plans to enhance wellness, prevention, and primary care

▪ Total cost of care payment model to incentivize and fund change

▪ Common scorecard to track progress and ensure consistency of focus

▪ Data/analytic infrastructure inform strategy

▪ Proportion of population in Healthy Neighborhoods

▪ Prev services/ screening rates

▪ Provide care coordination for all high-risk adults/elderly and children that is person centered and team-based

▪ Shared resources for care coordination, practice transformation, and learning collaboratives

▪ Aligned incentives▪ Delawarean at center of framework▪ Workforce strategy that focuses on team-

based training and retraining, expands access to providers (e.g., by simplifying credentialing)

▪ Patient satisfaction▪ ED visits or admits

per 1000

▪ Promote more effective diagnosis and treatment

▪ Shared resources for clinical guidelines and protocols

▪ Common provider scorecard with aligned quality metrics, linked to population health scorecard

▪ Scorecard measures TBD

▪ More than 80% of population in total cost of care models that pay for outcomes with consistency across payers on non-price terms, with flexibility to maximize participation

▪ Data and analytics infrastructure (e.g., provider portal) and performance reports

▪ Medicaid MCO RFP▪ IT workforce to support

▪ Percent in new payment models

▪ Total system costs

▪ Design for scale and assure transparency to ensure momentum

▪ Participatory organizational structure▪ Public-private leadership

▪ Overall participation


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Sample Scenario: Potential for Gross Savings2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024Baseline

Spend per capita ($) 6468 6600 6825 7117 7451 7872 8344 8827 9358 9921 10518

Total spend ($M) 5504 5766 6169 6538 6955 7481 8030 8575 9183 9824 10511

Insured population (000s) 851 874 904 919 933 950 962 971 981 990 999

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024Provider participation

TCC – 40% 55% 70% 80% 85% 90% 95% 95% 95% 95%

P4V – 30% 20% 10% 5% 0% 0% 0% 0% 0% 0%

Neither – 30% 25% 20% 15% 15% 10% 5% 5% 5% 5%

Total – 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 Year 9 Year 10Impact by Year of Participation

– 0.5% 2.5% 4.5% 7.0% 9.0% 9.0% 9.0% 9.0% 9.0% 9.0%TCC

– 0.6% 1.2% 1.8% 2.4% 3.0% 3.0% 3.0% 3.0% 3.0% 3.0%P4V

– 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Neither

2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024Gross impact

Savings ($M) – 19 76 157 284 440 586 692 771 825 883

Impact as % of Spend for participants

0% 1% 3% 4% 6% 7% 8% 9% 9% 9%–


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Key Dates

• Original project dates:• Project period end date: September 30 • Plan due October 31

• Extended project dates:• Project period end date: November 30• Plan due December 31

• Next round of CMMI funding• FOA anticipated by January 31, 2014• CMMI seeking input re: specifics of FOA


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Proposed Next Steps and Tentative Timeline

•November 27 - Complete revisions based on feedback•December 6 - Distribute final version of plan to stakeholders•December 15 - Submit plan to CMMI


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Project Support

• McKinsey contract end date September 30• RFP issued for ongoing support• Bid review/vendor selection underway• Interim funding possibilities

State Innovation Models (SIM) Update

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