state innovation models initiative: medicaid delivery system innovation & payment redesign jim...
TRANSCRIPT
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State Innovation Models Initiative:Medicaid Delivery System Innovation
& Payment Redesign
Jim Roberts, Policy Analyst NW Portland Area Indian Health Board
Quarterly Board MeetingThunder Valley Casino Resort
July 7, 2015
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Objectives of the Affordable Care Act:
Insurance Market Reforms
Expand Medicaid Coverage
State & Federal
Insurance Exchanges
Workforce Developmen
t
Increase Access, Improve Quality, & Lower costs
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Center for Medicare & Medicaid Innovation
ACCESS, QUALITY, AND COST:
• Affordable Care Act (ACA) established the Center for Medicare & Medicaid Innovation Center 1. Test new innovative payment and service delivery
models to reduce program expenditures2. New models must preserve or enhance the quality
of care provided to Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) beneficiaries
• Eliminate waste, fraud, and abuse
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CMMI Payment & Service Model Categories
Defined in the ACA Section 1115A
1. Accountable Care2. Bundled Payments for Care Improvement3. Primary Care Transformation 4. Medicaid & CHIP Initiatives5. Initiatives focused on Medicare & Medicaid enrollees6. Initiatives to Speed Adoption of Best Practices 7. Initiatives to Accelerate the Development and
Testing of New Payment and Service Delivery Model
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State Innovation Model (SIMs)Grants to States & Facilities
• CMMI has provided over $1.3 billion in grants to States and Facilities (providers) to test payment and service delivery models o Round One: $640 million to 25 Stateso Round Two: $1 billion to 28 States, 3 Territories, & the
District
• States are eligible & received: o Model Pre-Testing Awards o Model Test Awards Round 1o Model Test Awards Round 2 o Model Design Awards Round 1 o Model Design Awards Round 2
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What are the SIMs Grants?Model Pre-testing
• Three states received pre-testing assistance and funding to work on a comprehensive State Health Care Innovation Plan.
• States that received pre-testing awards under the State Innovation Models initiative had six months to submit their State Health Care Innovation Plans to CMS.
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What are the SIMs Grants?Model Test Awards – Round 1
• Over $250 million in Model Test awards is supporting six states to implement their State Health Care Innovation Plans. o Oregon received $45 million
• A State Health Care Innovation Plan is a proposal that describes a state’s strategy to use all of the levers available to it to transform its health care delivery system through multi-payer payment reform and other state-led initiatives
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What are the SIMs Grants?Model Test Awards – Round 2
• Round Two SIM Initiative Model Test awards issued on December 16, 2014.
• 38 total SIM awardees (including 34 states, three territories and DC) o Idaho $40 million o Washington $65 million
• States will work to develop state-based innovation in health system transformation.
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What are the SIMs Grants?Model Design Awards – Round
1
• Sixteen states received Model Design awards under the first round of the SIMs Initiative. o Idaho received $3 million
• States will develop and use Health Care Innovation Plans to inform their applications for a Model Test Award or another Model Design Award under the second round of this initiative
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What are the SIMs Grants?Model Design Awards – Round
2
• The SIMs Initiative Model Design Awards will provide financial and technical support to awardees for their planning and design efforts.
• 18 States received $39.5 million • In planning and designing their proposals,
states must: o develop multi-payer payment and service
delivery models o engage a broad range of stakeholders.
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Why is this important for Tribes?
• State proposals will change Medicaid delivery systems and redesign payments; migration from FFS to volume and value-based purchasing
• State Health Care Innovation Plans (ID, OR and WA) had very little if any Tribal input or consultation
• Past experience in Medicaid system (managed care) and payment reform has been very disruptive for the Indian health system
• Key Indian states are in the wake of reform: (ID, OR, WA, MN) generally centered in Medicaid Expansion States
• Likely little impact on Encounter Rate but bundled services, value-based purchasing, and incentive payments will impact availability of services that can be billed.
• Delivery System Reform Incentive Payments (DSRIP) will increasingly become more important for the I/T/U
• Medicaid Managed Care will continue to become more rigid and network will become tighter
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Delivery System Reform Incentive Payment (DSRIP)
• Provides States with savings to support hospitals and providers and how they change providing care to Medicaid enrollees
• DSRIP payments are performance based incentives • Medicaid Providers MUST meet certain milestones or
performance metrics o Metrics are common across ALL providers and measured at early
years of the Waiver o Metrics include both infrastructure development or system
redesign and focus on health outcomes in later years o Infrastructure Example: implementation of chronic care registrieso System Redesign Example: Medical homes or integration of
physical and behavioral health o Outcome Measures: clinical indicators to improve health of
population
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Where do we go from here? • Healthier Washington Initiative and Global
Waiver: o Tribal Technical Workgroup o NPAIHB/AIHC Letter and White Paper recommendations
(handouts)o Series of meetings over next two months
• Oregon 1115 CCO Waiver Renewal is pendingo NPAIHB Meeting with OHA on 6/24th; develop a Tribal Chapter in
the Waivero Need to schedule meeting with Oregon THDs
• Idaho Health Care Innovation Plan and SIM Granto Pending discussion about engaging Tribes o Teleconference or webinar with State o Arrange Workgroup follow up meetings at Idaho State/Tribes
Meetings
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NPAIHB/NIHB Contract to evaluate CMMI
& State Implementation of SIM Process
• $50,000 Proposal submitted to NPAIHB to evaluate CMMI and State implementation to include Tribes in State Innovation Model work.
• Case Study approach: Minnesota and Washington • Follows Case study methodology that NIHB used in 1997 to
develop Medicaid Managed Care Study. • Develop advisory committee in each state to guide
development of case study reports • Identify common themes, issues and then develop
recommendations for each state as well as nationally• Will include recommendations for CMMI • Convene national venue to discuss findings, refine report
recommendations and then submit to CMS/CMMI
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Questions?