rhode island state innovation model (sim) test grant · 2018-04-25 · a report describing the...
TRANSCRIPT
Rhode Island State Innovation Model (SIM)
Test Grant
An Overv iew of Rhode Is land’s Healthcare Transformation Landscape
April 2018
SIM Background• $20 million grant from the Centers for Medicare and
Medicaid Services (CMS)
• Transforms the way we deliver and pay for healthcare
• Enhances the way individuals are engaged in their health
2
The Ultimate Goal
Adapting the Triple AimHealthier People
Better Care Smarter Spending
Adapted from Institute for Healthcare Improvement, 2012
3
SIM Theory of Change
Empower Patients
Support Providers
Address Determinants
of Health
Improved Population
Health &
Progress Toward Triple
Aim
4
SIM Strategies
Linking Payment to Outcomes
Developing Infrastructure for Quality Care
Planning and Aligning for a Healthy Population
5
SIM funds are supporting 3 categories of activitiesSIM Investments
Practice & Workforce
Transformation
Patient Empowerment
Data Capacity & Expertise Expansion
Engage patients in positive health
behaviors and self-advocacy
Improve primary care and behavioral health
infrastructure
Expand the ability of providers and policy makers to use and
share data
Improved Population
Health
$7.1 M $2.2 M $5.3 M
6
Linking Payment to Outcomes
Aligned Approach to Payment Reform
SIM, Medicaid, OHIC, and the Governor’s Office are working together to reform the way healthcare is paid for in Rhode Island
8
Volume-Based Value-Based
Providers paid based on quantity of services
delivered
Link provider payments to quality and cost-
efficiency
SIM Aligned Measure Sets
OHIC Affordability
Standards
Reinventing Medicaid
Fee-For-Service
Developing Data Infrastructure for Quality Care
“Collect data once and analyze many times”
Healthcare Quality
Measurement Reporting &
Feedback System
Care Management Dashboards
Integrated Health and
Human Services Data Ecosystem
HealthFacts RI
SIM investments in Health Information Technology (HIT)
9
Integrating Physical & Behavioral Health
SIM Investments in Integrated Care
Integrated Behavioral
Health Pilot
Child Psychiatry Access Program
Screening, Brief Intervention and
Referral to Treatment
(SBIRT)
Provider Coaching
10
Healthcare Workforce Transformation
Needs Assessment Strategic PlanningStakeholder Engagement
• Gather input from diverse range of stakeholders
• Build consensus for promising strategies
• Develop lasting partnerships across sectors
• Identify health workforce transformation strategies
• Identify barriers to implementation
• Identify resources for implementation
• Profile current healthcare workforce
• Project future healthcare workforce NEEDS and OPPORTUNITIES
• Inventory educational and training capacity
Build Healthcare Career Pathways to Develop Skills
for Jobs that Pay• Entry-Level Workforce• Diversity and Cultural
Competence• Youth Initiatives• Provider Shortages
Teach Core Concepts of Health System and Practice
Transformation• Integrated
Team-Based Care• Health System
Transformation Concepts
Expand Home and Community-Based Care
• Community-Based Health Professional Education
• Healthcare Support Occupations and Emerging Roles
What is Population Health?
The Health of Populations Considering the Whole Person
Population Mean
Mortality
Population Mean Life
Expectancy
Population Mean Health
Related Quality of Life
Physical & Behavioral
Health Outcomes
Ou
tcom
es
Disp
arities A
cross A
ll
Physical Health
Behavioral Health
Mental Health
Substance Use
Including Oral Health
12
What determines Population Health?Determinants of Health
Social Supports
Safe Housing & Neighborhoods
Education & Employment
Health Literacy
Access to Care
Affordability
Genetics[30%]
Individual Behavior
[40%]
Social & Environmental
[20%]
Healthcare[10%]
Substance Use
Seeking Medical Care
Diet and Exercise
Adapted from Schroeder, SA. (2007).
13
A report describing the physical and behavioral health of Rhode Islanders using these 8 health focus areas:
Planning and Aligning for a Healthy Population
SIM Health Focus Areas
Obesity Tobacco Use
Chronic Disease
(i.e., Diabetes,
Heart Disease, &
Stroke)
Maternal & Child Health
Depression
Children with Social
& Emotional Disturbance
Serious Mental
Illness (e.g. Schizo-
phrenia)
Opioid Use Disorders
14
15
Health Focus Area
SIMIntegrated
Population Health Focus Area
HARICommunity
Health Needs Assessment
LifespanCommunity
Health Needs Assessment
HEZRegional Health
Needs Assessments
Chronic Disease ✓ ✓ ✓ ✓
Obesity ✓ ✓ ✓
Tobacco Use ✓ ✓
Maternal and Child Health
✓ ✓ ✓
Depression ✓ ✓ ✓ ✓
Children with Serious Emotional Disturbance
✓ ✓ ✓ ✓
Serious Mental Illness ✓ ✓ ✓ ✓
Substance Use ✓ ✓ ✓ ✓
SIM Alignment with Health Needs Assessments
SIM Integration & Alignment ProjectFacilitating and supporting Integrated Population Health
Collaborations in 1-2 Health Focus areas.
16
SIM
RIDOH
OHIC
HSRI
EOHHS/ Medicaid
EOHHS/ Health IT
DHS/DEA
BHDDH
DCYF
DHS
17
Example: Quality Measure Alignment
CMS Programs
Commercial Payers
Medicaid Managed
Care
OHIC PCMH Program
Provider
Other Programs
Before SIM Measure Alignment Work Group
Provider
SIM Aligned Measures
After SIM Measure Alignment Work Group
SIM Alignment with Other Initiatives
BHDDH
Mental Health & Substance Use Block Grants
Collaborative Agreement to Benefit Homeless Individuals
Project for Assistance in Transition from Homelessness Program
Healthy Transitions
Strategic Prevention Framework Partnerships for Success
Governor’s Office
Reinventing Medicaid
Working Group for Healthcare Innovation
EOHHS
Integrated Care Initiative
Medicaid 1115 Waiver
Medicaid Accountable Entities
Home Stabilization Services
Money Follows the Person
Medicaid Health Homes
Medicaid EHR Incentive Program
Adult Medicaid Quality Grant
RIDOH
Health Equity Zones
Community Health Workers Certification
Community Health Network
RIDOH Academic Center
OHIC
Care Transformation Advisory Committee
Alternative Payment Methodology Committee
Public Health Accreditation
Hospital Conversion Act
Opioid Overdose Task Force
SIM Core Staff Team
Used grant funds to embed staff across state agencies
20
SIM PROJECT DIRECTOR*
Marti Rosenberg
SIM LIAISON (RIDOH)*
James Rajotte
SIM LIAISON (BHDDH)*
Ann Detrick
SIM LIAISON (EOHHS)*
Melissa Lauer
SIM LIAISON (OHIC)*
Libby Bunzli
SIM LIAISON
(HealthSource)*
Betsy Kerr
SIM LIAISON (DCYF)
Heather Warner
SIM LIAISON (SBIRT)
Janie O’Donnell
SIM LIAISONS (HSTP)
Rick Brooks
Lauretta Converse
SIM CONSULTANT*
Jill Glickman
EOHHS SECRETARY
Eric Beane
OHIC COMMISSIONER
Marie Ganim
SIM LIAISON (Medicaid)
Debbie Morales
SIM Website
http://www.eohhs.ri.gov/Initiatives/StateInnovationModel.aspx
22