landgraf csg erc
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Delaware Health and Social Services
Council of State Governments Eastern Regional ConferencesAnnual Meeting and Regional Policy Forum: Aug. 18, 2015
Rita Landgraf, Secretary, Delaware Department of Health and Social Services
The Impact of Health CareInnovation in Delaware
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Delaware Health and Social Services
Providerslack time andresources toproactivelycoordinate care
Health care is confusing for
Patients, and premiums are rising
Employersare facingincreasing costs, an unhealthyworkforce, and complexdecisions
faces health carecosts that consumeapproximately 25%of the state budget
The State ofDelaware
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Delaware Health and Social Services
4.3% ofadults
consideredsuicide in 2011
Health care costs consume
25%of state budget
Diabetesincidence rate of
11.1%
31.1%of Delawareansare obese
1 in 5Delawareans aresmokers
Health care costsgrowing at
6% per yearhistorically
Per capita costs
25%higher than U.S.average
More than
$8Bannual spend onhealthcare in Del
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Delaware Health and Social Services
Our Vision for 2018! All Delawareans will have a primary care provider, and it will be easy forthem to access care when they need it.
! When patients from a primary care practice need to go to the ER, theoffice will be notified on arrival or check-in (if not by the patient before).
!
Care coordination will be integrated with primary care rather than aremote system disconnected from care delivery.
! When a mother needs help caring for her child with asthma, she willknow where to turn.
! Doctors offices will be paid for care coordination in between officevisits, and rewarded for quality and efficiency of care.
! Providers will work more closely together so that patients will feel as
though the individuals caring for them, including behavioral healthproviders, are part of a team.
! Employers will be able to continue providing health insurance to their
employees.
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Delaware Health and Social Services
Governor
Department ofHealth & SocialServices
Payers and other
purchasers
Delaware HealthInformationNetwork (DHIN)
Payment ModelMonitoringCommittee
Workforce andEducationCommittee
ClinicalCommittee
DelawareCenter for HealthInnovation (DCHI)
Patient/Consumer
AdvisoryCommittee
TechnicalAdvisory Group
HealthyNeighborhoodsCommittee
Health CareCommission(HCC)
Consumers and
patientsProviders
State of Delaware
Public-private
Private sector
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WorkforceandEducation
! Innovative two-year learning and development program with commoncurriculum on team-based, integrated care
! Development of the health professional residency consortium
Clinical
! Transformation of primary care through Patient-Centered MedicalHomes (PCMHs) and Accountable Care Organizations (ACOs)
!
Support for primary care practice transformation & care coordination
HealthyNeighbor-hoods
!
Integration of community-based health initiatives with deliverysystem focused on priority health needs
! Scorecard, tools, data, and resources to support neighborhoods
Payment
! Multi-payer value-based payment models offered statewide: Pay-4-Value
(P4V) and Total Cost aligned with CMS models! QHP standards, Medicaid MCO RFP, & state employees driving adoption
HIT! First in the country multi-payer performance scorecard! Nationally leading HIE to enable integrated clinical and claims data
over time
Patient /ConsumerAdvisory
! Patient at center of everything Delaware does! Patient engagement tools to support individuals to engage in their
own health
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Aspirations for Triple Aim
!Become 1 of the 5 healthiest
states in the U.S.!Achieve top performance forquality/patient experience
!Bring health care spendinggrowth more closely in line
with growth of economy!PLUS ONE: Achieve highprovider experience
Specific Goals Reflected in Plan
!
Create >$1 billion in total savings to thesystem through 2020
!Reinvest about half of savings in caredelivery to ensure sustainability forproviders
!
Pass about half of savings on to consumersand purchasers to preserve affordability
Goals for Adoption to Achieve Plan
!Participation by all payers: Commercial,
Medicaid, Medicare by 2016
!Participation by >70% of self-insuredemployers by 2018
!Adoption by >90% of PCPs by 2018
!Meaningful changes in capabilities/processes
Aspirationsand Goals
Total investment: $130million over 4 years
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Pay for Value
Total Costof Care
Two Types of Value-Based Payment Models! Total cost of care models look at the overall spending as a
key metric, and look to reduce wasted healthcare spend
(with the savings shared between payer and provider)
! These models also have a requirement to meet quality and
patient experience goals
! Pay-for-value enables providers to earn bonuses for meetingboth a set of quality measures and managing resource
utilization
!
As a common goal, pay-for-value models look for a decreasein the growth of overall costs
Delaware is targeting to have 80% of payments and 90% of primary careproviders going through these models in the next 4 years
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Work Ahead in InnovationCommon Scorecard forproviders. Measures include:
Diabetes care
High blood pressure
Screening for clinical
depression
Tobacco use
Influenza immunization
Patient hospitalizationadmissions per 1,000
patients
ER visits per 1,000 patients
Sampling of Timeline:
2015: Test and refinescorecard; begin practice
transformation; engageconsumers and providers
2016: Funding for carecoordination more widely
available; HealthyNeighborhoods initiatives
launched; workforce strategy
implemented.
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30%
10%
20%
20%
10%
65%
0%
Spending
Multiple chronic
5%
Single chronic
Healthy
Severe chronic
Non-Claimants2
Population
30%
10%
Percentage of population, and spending
NON-MEDICARE, EXCLUDING LTSS1
1 LTSS: Long term services and supports of Medicaid
2 May have some associated spend (e.g. cap rates paid), however no medical claims
Source: AHRQ Chart Book, Delaware Medicaid Claims data analysis by McKinsey Health Care Value Analytics
Those focused onmaximizing ROI from care
coordination may focus onthe 10% highest-risk
patients who account for60-70% of spending.
Some may argue that well-executed care coordination
can deliver positive ROI fora broader share of the
population.10%
Segmentation of Population
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INNOVATIONS IN MEDICAIDNew Ways to Serve Vulnerable Populations, Resulting in Better Outcomes
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Serving Vulnerable Seniors Transitioned Medicaids long-term care
seniors to MCOs in April 2012 to better
coordinate care and supports.
Began reimbursing for telemedicine-delivered services in July 2012, including
wellness checks for individuals with
Parkinsons, telepsychiatry and hospital
trauma cases.
Partnered with St. Francis Hospital to openLIFE Center in Wilmington in 2013 under
Program for All-Inclusive Care for the
Elderly. Exploring 2ndcenter in Sussex.
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Another Impact: Aging Population
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** By 2030,Delaware isprojected to
have the9th-highestproportionof peopleage 65 andolder in the
U.S.
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Serving Vulnerable Populations Pathways to Employment: Brings together
state agencies, including Medicaid, to
increase options in support of low-income
individuals with disabilities who want towork.
PROMISE (Promoting Optimal MentalHealth for Individuals through Supports and
Empowerment): In additional toemployment, the goal is to improve clinical
and recovery outcomes, reduce
unnecessary institutional, and reduce
growth in overall program costs.
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