Medicaid Innovation: Testing Experience and Functional Tools (TEFT) Demonstration and the Innovation Accelerator ProgramFacilitated by Kristin YoungerTechnical Director, Division of Quality, Evaluation and Health Outcomes

The CMS Healthcare Quality ConferenceBaltimore, MD | December 2 – 4, 2014

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Agenda

• TEFT in Community Based Long-Term Services and Supports (LTSS)– Jennifer Burnett and Kerry Lida

• Accelerating Innovation in Medicaid– Karen LLanos

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TEFT in Community Based Long-Term Services and Supports (LTSS)

Jennifer BurnettDirector, Division of Community Systems Transformation, Disabled and Elderly Health Programs Group, CMS

Kerry LidaTeam Lead, Testing Experience and Functional Tools Demonstration, CMS

Why is LTSS Important?

• As part of the Affordable Care Act (ACA), Congress has provided incentives to promote the use of community-based LTSS and promoted the movement from institutions to communities for people who require LTSS:– Money Follows the Person (Deficit Reduction Act and

extended through ACA, Section 2403)– Community First Choice (ACA, Section 2401)– Balancing Incentive Program (ACA, Section 10202)– Person-Centered Planning and Self-Direction in Home

and Community-Based Services (ACA, Section 2402(a))• These programs target diverse beneficiary populations, most

of whom are eligible for services provided by the states

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Why is LTSS Important?

All Other Spending270.2

Home and Community

Based Services$69.3

Institutional $70.6B

Medicaid Expenditures, FFY 2012 (billions)Long-term Services and Supports - Institutional & Home and Community Based Long-term Services

Source: Medicaid Expenditures for Long-Term Services and Supports in FFY 2012, April 28, 2014 (Available at Medicaid.gov)

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CMS Medicaid Alignment with the National Quality Strategy

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CMS TEFT Program: Background

• Introduced in Affordable Care Act (ACA) Section 2701• Required the Department of Health and Human

Services (HHS) to identify and publish initial voluntary core set of adult quality measures for adults eligible for Medicaid

• CMS established the TEFT in Medicaid Community-based LTSS Planning and Demonstration Grant Program

• March 2014: CMS awarded Demonstration Grants to 9 states: AZ, CO, CT, GA, KY, LA, MD, MN, NH

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Grant-Programs/TEFT-Program-.html7

CMS TEFT Components

• Test a beneficiary experience survey within multiple community-based LTSS programs for validity and reliability

• Test a modified set of Continuity Assessment Record and Evaluation (CARE) functional assessment measures for use with beneficiaries of community-based LTSS programs

• Demonstrate use of personal health record systems with beneficiaries of community-based LTSS

• Identify, evaluate, and harmonize an electronic LTSS standard in conjunction with the Office of the National Coordinator for Health IT’s (ONC) Standards and Interoperability Framework

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State Grantees and TEFT Components

State Experience of Care Survey LTSS CARE

Health IT (Personal Health Record and

eLTSS Record)

AZ * * *

CO * Pending *

CT * * *GA * * *

KY * * *LA * (Round 1) blank Blank

MD * Blank *MN * * *

NH * blank blank

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Home and Community Based Services (HCBS) Experience of Care Survey

• Cross-disability survey• Elicits beneficiary feedback on experience with

Medicaid HCBS– Addresses dimensions of quality valued by program

beneficiaries

• Aligns with existing Consumer Assessment of Healthcare Providers and Systems Surveys (CAHPS)

• Will seek CAHPS trademark• Will seek National Quality Forum endorsement

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LTSS CARE Assessment Items

• Adapt a subset of CARE assessment items for LTSS populations

• Standardize assessment across populations and care settings and support person-centered care across settings

• Facilitate comparisons across settings and states

• Facilitate quality monitoring across providers and settings

• Leverage existing standards developed for the interoperable exchange of CARE items

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Personal Health Record (PHR) Demonstration Requirements

• PHR System functionality must enable:– Collection of Medicaid adult core quality measures– Collection of community-based LTSS information – Collection of “Treatment” outcomes identified through

eLTSS record– Dissemination of this information among individuals,

their families/guardians, case managers and providers

• Grantees can choose to use the following PHR systems:– Dept. of Defense provided PHR Systems– Commercial PHR– State-sponsored and developed PHR (i.e. State

Health Information Exchange Patient Portal)

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Develop a Standard for e-LTSS Record

• Office of National Coordinator for Health Information Technology leading development efforts

• Grantees will participate in development of a new electronic standard for LTSS record

• Grantees will pilot and test the standard with select providers and beneficiaries

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Contact Information

• Jennifer Burnett• Jennifer.Burnett@cms.hhs.gov

• Kerry Lida• Kerry.Lida@cms.hhs.gov

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Accelerating Innovation in MedicaidKaren LLanos, Acting Director Medicaid Innovation Accelerator Program (IAP)Center for Medicaid and CHIP Services

Medicaid Innovation Accelerator Program (IAP)

• Joint Innovation Center-CMCS venture with agency and department collaboration

• Medicare-Medicaid Coordination Office also key partner

• Technical assistance for all states interested in advancing innovations in Medicaid that will result in improved health, improved health care delivery, and lower costs

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Medicaid Innovation Accelerator Program (IAP)

• Opportunity to advance on specific areas identified through input from states and stakeholders

• Enhances state capacity and efforts to adopt and disseminate new models

• Complements state efforts for delivery and payment system reform, such as the Innovation Center’s State Innovation Model (SIM) initiative

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Medicaid Innovation Accelerator Program (IAP)• IAP will focus on 3-5 priority programmatic areas

– Must be areas of need, opportunity, and synergy– Substance use disorder (SUD) first programmatic area– Additional areas to-be determined

– Three in-person meetings and a national webinar (September through October) designed to hear from states and stakeholders about areas of interest and technical support needs

– Discussions currently ongoing within CMS to identify areas of synergy and opportunity

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Substance Use Disorder (SUD) and IAP

Three options for states to engage:

1. High-intensity learning collaborative for states ready to invest in data systems and change policies– 12 month “deep dive” for states– Shared learning network with peer states– Expert resources on data analytics, strength of evidence,

care models and delivery systems– Technical assistance on federal authorities

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Substance Use Disorder (SUD) and IAP

2. Targeted Learning– Technical assistance and support on a limited set of topics

based on states’ interest (e.g., data, quality metrics, federal authorities, etc.)

3. SUD Learning Diffusion– Disseminate tools on IAP website and conduct webinars– “How to” resources on issues like linking Prescription Drug

Monitoring Programs and Medicaid claims– Data tools (e.g., templates for identifying high utilizers, etc.)– Quality metrics (e.g., metric suites to promote alignment,

support state implementation of new measures, etc.)

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Next Steps: High-Intensity Learning Collaborative

• Letter of Interest due November 21, 2014 – 23 states submitted letters

• November/December “Office Hours” – 1:1 calls with states interested in participating

• Kick-off meeting with states held first week of January 2015

• First Learning Collaborative session late January 2015– Monthly learning sessions through December 2015

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Programmatic Areas

• SUD• Other programmatic areas under consideration:

– Population health – Behavioral health– LTSS and community integration– Superutilizers– Perinatal health

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IAP Functional Areas

• As part of each programmatic area, IAP offers technical assistance to states in the following functional areas: – Model development– Data analytics– Quality measurement– Rapid-cycle improvement

• For data analytics and quality measurement there will be programmatic and non-programmatic based IAP activities

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Coordinated Points of Contact

• Coordinated points of contact leverages CMCS’ State Operational and Technical Assistance process to coordinate across components– Opportunity for states to identify interest in engaging in

IAP– Way for other CMS components to identify and refer

states to IAP resources, especially SIM and Medicare-Medicaid Coordination Office

• Opportunity for states to coordinate with multiple components within CMS

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Next Steps

• CMS identifies the next 2-3 program priority areas (December 2014)

• First SUD Learning Collaborative learning session (late January 2015)

• Work on quality metrics and data analytics begins (first quarter 2015)

• Work plans developed for additional program priority areas (first quarter 2015)

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Next Steps, cont’d

• Launch projects on additional program priorities (2015)

• Further engagement with states and stakeholders (throughout 2015 and beyond)

• IAP quarterly release of updates and resources/tools/webinar (throughout 2015 and beyond)

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For More Information on IAP

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• Look for updates to be posted on the IAP page on www.Medicaid.gov

• Submit questions or comments to: MedicaidIAP@cms.hhs.gov and karen.llanos@cms.hhs.gov

• Follow IAP on Twitter #MedicaidIAP through @CMSgov

Discussion

Question and Answer

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