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Shifting Landscape and Implications
for Future Plans
Feb 2, 2017
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But where is the puck going to be????
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Shifting Political and Health
Care Landscape - uncertain
Likely some changes to the Affordable Care Act Full repeal will be hard, defunding certain elements more easy
Medicaid expansion for NC?
Some elements of value-based payments likely to continue ? Future of Centers for Medicare and Medicaid Innovations?
May be changes in how Medicaid is administered at the federal and state level Proposal of block grants (i.e. a capitated set amount) given to the states to cover Medicaid costs
? Status of Medicaid 1115 Innovation Waiver at CMS?
Expectation of more privatization of Medicaid and Medicare. i.e. stronger presence of
Managed Care Organization (MCOs) and perhaps on a shorter time line
Evolving Pre-paid Health Plans (PHPs)/MCOs Provider MCOs– Hospital-system/Presbyterian (P19), NCMS/NC Community Health Center/Centene
Corporate MCOs
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Pre-paid Health Plan (PHP)
Corporate, Provider
Payor/ insurance product
Adequate network of high value providers/ enhanced medical homes
Care management/
Population management infrastructure
Community/ Medical
Neighborhoods/ Social
Determinants of health
PHP
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(Uncertain) Scenario-based
planning
Pivot the
other 20%
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What’s the 80%?
What strengths can be expanded and
brought to the table?
Access to care
Community partnerships, relationships, and collaborations – Social Capital
Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management
Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)
QI and practice support to help transformation to value-based care (Practice Transformation Network)
Statewide footprint
Proven track record of cost savings and quality improvement
These are the foundational strengths on which we will build The 20% pivot will be with whom we contract
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What’s the 80%?
What strengths can be expanded and
brought to the table?
Access to care
Community partnerships, relationships, and collaborations – Social Capital
Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management
Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)
QI and practice support to help transformation to value-based care (Practice Transformation Network)
Statewide footprint
Proven track record of cost savings and quality improvement
These are the foundational strengths on which we will build The 20% pivot will be with whom we contract
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Patient OutcomesEnhanced Patient Centered Medical Homes/Behavioral Health Integration
INTEGRATED CARE
Screening
Evidence Based
Practice
Population Management
Practice Support
Collaborative Care
Integrated Care
Management
9
Enhanced Patient
Centered Medical Home
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Connections made to the local Medical and
Health Neighborhood;
Social determinants of health addressed
Embedded and Community-based
Multidisciplinary Team; Holistic, inclusive of
Behavioral Health and Pharmacy; emphasis
on Motivational Interviewing
Analytic-enabled care management tailored
to Medicaid and Health Choice –
guides interventions and prioritization
Patient OutcomesNCQA Complex Care Management
Patient OutcomesPatient SatisfactionQuestion Weighted Mean
Score
The Care Manager helped show you how to manage
your health.95.4
You are satisfied with the Care Manager’s ability to
understand your needs.95.6
You are satisfied with your level of involvement in
developing your care plan to better improve your health.95.0
The Care Manager assisted in coordinating your care. 94.6
When you needed help, the Care Manager was readily
available and responsive to your concerns.93.9
Overall, you are satisfied with the services provided by
the Care Manager.95.2
Total Average 94.7
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What’s the 80%?
What strengths can be expanded and
brought to the table?
Access to care
Community partnerships, relationships, and collaborations – Social Capital
Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management
Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)
QI and practice support to help transformation to value-based care (Practice Transformation Network)
Statewide footprint
Proven track record of cost savings and quality improvement
These are the foundational strengths on which we will build The 20% pivot will be with whom we contract
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Statewide Provider Network Community Care Physician Network
Statewide - 1,417 primary care clinicians in 408 Practices
Locally - 265 primary care clinicians in 77 practice sites
Board of Manager Representation – Dr. Larry Mann, Jeffers, Artman, and Mann
Beginning recruitment of Specialists – OBs and Behavioral Health
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Statewide Community Pharmacy Enhanced Services Network (CPESN)
Established 2014
CCNC created Network of over 246
community pharmacies in NC willing to
provide enhanced services and
coordinate care with the broader care
team
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Support medication adherence
Conduct medication reconciliation after hospital discharge
Prevent medication wastage by verifying patient need prior to each fill
Provide clear and clinically relevant communication with the provider and care team
Offer comprehensive medication review, care plan development, reinforcement, and longitudinal follow up
Reinforce patient care plan and offer disease and medication management education
Enhanced care coordination and additional monitoring between provider office visits for patients with chronic medical conditions
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What’s the 80%?
What strengths can be expanded and
brought to the table?
Access to care
Community partnerships, relationships, and collaborations – Social Capital
Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management
Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)
QI and practice support to help transformation to value-based care (Practice Transformation Network)
Statewide footprint
Proven track record of cost savings and quality improvement
These are the foundational strengths on which we will build The 20% pivot will be with whom we contract
Practice Transformation Network
Engine to help practices move to Value Based Care
This train is leaving the station with or without us!
Transforming Clinical Practice Initiative/
Practice Transformation Network (PTN)
TCPI Aims
1) Support more than 140,000 clinicians
2) Build the evidence base so effective solutions can be scaled
3) Improve health outcomes for millions of patients
4) Reduce unnecessary hospitalizations for 5 million patients
5) Sustain efficient care delivery by reducing unnecessary tests and procedures
6) Generate $1 to $4 billion in savings to the federal government and commercial payers
7) Transition 75% of practices to participate in Alternative Payment Models
CCNC PTN practices
292 practices, 1,396 clinicians
We exceeded Year 1 Enrollment Targets!
Starting Year 2 Recruitment and Activities
Primary Care, OBs, Behavioral Health
Behavioral Health Integration
Pharmacy Integration
Themes from Initial Practice Assessments (First 207 practices)
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Patient and Family Engagement
Team Based Relationships
Population Management
Community Partner
Coordinated Care
Organized Evidenced-Base Care
Enhanced Access
Engaged and Committed Leadership
Quality Improvement Strategy Supporting Culture of Quality
Transparent Measurement and Monitoring
Optimize Health Information Technology
Strategic Use of Revenue
Workforce Vitality and Joy in Work
Capability to Analyze and Document Value
Operational Efficiency
Pers
on a
nd F
am
ily-C
ente
red C
are
De
sig
n
Co
ntin
uou
s, D
ata
Driven Q
ualit
yIm
pro
ve
me
nt
Su
sta
ina
ble
Busin
ess
Op
era
tio
ns
% of PTN Practices with Completed Milestone
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What’s the 80%?
What strengths can be expanded and
brought to the table?
Access to care
Community partnerships, relationships, and collaborations – Social Capital
Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management
Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)
QI and practice support to help transformation to value-based care (Practice Transformation Network)
Statewide footprint
Proven track record of cost savings and quality improvement
These are the foundational strengths on which we will build The 20% pivot will be with whom we contract
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Key Performance Indicators
(KPI’s) YE September 2016
Total Costs PMPM
CCWJC
CCNC
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CCWJC
ED Visits
CCNC
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CCNC
CCWJC
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Potentially Preventable
Readmissions
CCNC
CCWJC
Quality Clinical Metrics
Diabetes
57.9%
28.0%
64.8%59.6%
28.3%
64.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
HbA1c Control < 8.0 HbA1c Poor Control > 9.0(lower is better)
Blood Pressure ControlBP < 140/90
FY 2015 FY 2016 HEDISMean
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Quality Clinical Metrics
Asthma
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Asthma Medication Ratio
FY 2014 FY 2015 FY 2016
HEDIS Mean
Quality Clinical Metrics
Developmental and Behavioral Screenings
92.3%
75.9%
21.6%
28.2%
91.7%
79.1%
26.2%
35.0%
91.0%
71.3%
25.8%
34.5%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
ABCD/Dev MCHAT/Autism School Age Adolescent
FY2014 FY2015 FY2016
Quality Clinical Metrics
Pediatric Oral Health Measures
Result Notes
CCNC consistently performs higher than benchmark on the Annual Dental Visit measures
Measures rose consistently year-to-year except for the 19-20 year old ADVs
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
ADV 2-3Yr ADV 4-6Yr ADV 7-10Yr ADV 11-14YrADV 15-18YrADV 19-20Yr ADV Total 4+Varnishings
Oral Health
FY2014 FY2015 FY2016 HEDIS Mean
Quality Clinical Metrics
Maternal Health Measures
Result Notes
- Timeliness of Prenatal care and Risk screening during pregnancy results mirror each other 2014-2016 trends
- Tobacco Cessation counseling increased over time
- Progesterone injections measures declined in 2015 but bounced back in 2016
- Unintended Pregnancy has experience a steady decline
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Timeliness ofPrenatal Care
Risk Screeningduring Pregnancy
Tobacco CessationCounseling Received
during Pregnancy
ProgesteroneInjections forPreterm BirthPrevention
UnintendedPregnancy Rate
Pregnancy Measures
FY2014 FY2015 FY2016 BENCHMARK
Quality Clinical Metrics
Delivery Outcomes
29.1%
7.1%
10.0%
1.7%
29.2%
8.1%
10.7%
1.8%
28.9%
7.5%
10.4%
1.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Cesarean Delivery Rate Elective Deliveries before39 Weeks of Gestation
Low Birth Weight Very Low Birth Weight
FY2014 FY2015 FY2016
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Enormous amount of uncertainty,
but really doesn’t change core
work
Access to care
Community partnerships, relationships, and collaborations – Social Capital
Focus on Patient Outcomes (Enhanced Medical Homes, Connected Health Neighborhoods, Complex
Care Management)
Provider networks (CCPN, CPESN)
QI and practice transformation to value-based care support (Practice Transformation Network)
Statewide footprint
Proven track record of cost savings and quality improvement
These are the 80% core foundational strengths on which we will build
The 20% pivot will be with whom we contract (e.g. MCOs, PLE, the state)
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