Transcript State Health Care Innovation Planning - My Doc Vault

State
Health Care
Innovation
Planning
A Five-Year
Plan for
Washington State
Inland Northwest State of
Reform Health Policy
Conference
September 12, 2013
Nathan Johnson,
HCA Division Director,
Health Care Policy
State Health Care Innovation Planning
Agenda

How did we get here?

What have we learned?

Where are we going?

Q&A / Discussion
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State Health Care Innovation Planning
HOW DID WE GET HERE?
 In
Washington State, personal health care
expenditures have grown from $3.8 billion in
1980 (7.3% GDP) to $45.4 billion in 2009 (13.6% GDP)
 Nationally*,
personal health care expenditures
have grown from $217.1 billion (8.0%) to
$2.1 trillion in 2009 (15.1% GDP)
*30% of expenditures attributed to wasteful spending,
poor care delivery, excessive administrative costs,
unnecessarily high prices and fraud
State Health Care Innovation Planning
The Affordable Care Act
Washington State Implementation Timeline
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State Health Care Innovation Planning
Why Washington Needs an Innovation Plan
 With
full implementation of ACA, 85% of
Washington’s uninsured adults will have
access to affordable coverage
(N = approx. 727,000)
 Assuring
quality care that is affordable
requires fundamental change in how
health care is delivered
 Extending
access without such changes
will not be financially sustainable
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State Health Care Innovation Planning
What are “SIM” and “SHCIP”?
SIM
SHCIP
The State Innovation Models initiative is
a national effort and grant program of
the Center for Medicare and
Medicaid Innovation (CMMI) to
identify and spread health practices
that result in better health and better
care at lower costs.
Washington State was one of three states
awarded a nearly $1 million model pretesting grant to fund collaborative
development of a five-year plan for health
innovation. Other states have received
“model design” grants, and are engaged
in similar work. The effort is called:
State Health Care Innovation Planning
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What SHCIP is…
An opportunity, with federal support, to refresh,
and align key Washington strategies to improve
health and healthcare delivery for our people and
communities.
Positions us to apply for a Testing Grant, and
potentially, $20-$60 million to support
implementation of our multi-payer delivery system
and payment reform model
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SHCIP Objectives
CMMI
Federal
Center for
Medicare &
Medicaid
Innovation
Washington
State
Test innovative payment and service
delivery models with the potential to lower
costs for Medicare, Medicaid and CHIP,
while:
•Maintaining or improving quality of care
•Raising community health status
•Reducing long term health risks for federal
beneficiaries
All of the above, for the rest of Washington
State’s population.
•Refresh our approaches for health and
health care improvement through
evidence-driven approaches, innovation,
collaboration and full use of the “levers”
at our disposal.
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State Health Care Innovation Planning
Project Oversight
Multiple state agencies involved in project oversight
Executive
Oversight
In-Kind
Experts &
Staff
State Core
Team
Project
Director
Consultant
Team
Cabinet Level
Representatives of:
Dept. of Commerce
Dept. of Health
Dept. of Social & Health
Services
Governor’s Office of
Health Policy
Health Care Authority
Health Information
Exchange
Labor & Industries
Office of Financial
Management
Office of the Insurance
Commissioner
State Board of Community
& Technical Colleges
State Health Care Innovation Planning
Coordinating the Work
Karen Merrikin
SHCIP Project Director
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
Hired from the private sector to lead the
state planning process
Long-time veteran of health policy
around payment and care delivery
Consultant Team
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
Bree Collaborative
Manatt Health Solutions
Mercer Consulting
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
Puget Sound Health Alliance
Strategies 360
University of Washington
Washington Park Consulting
Consulting Partners

Cedar River Group

CMMI

MacColl Institute
State Health Care Innovation Planning
Major Deliverable to CMMI
State Health Care Innovation 5-Year Plan
Five Phases

Discovery
Intensive & broad work on “As-Is” and “To Be”

Analysis
Review of findings & identification of key components
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Assessment & Feedback
Assess identified components & gather feedback
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Draft
Draft plan complete by September 30

Plan Refinement & Finalization
Refinement complete October – Mid-November
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State Health Care Innovation Planning
WHAT HAVE WE LEARNED?
“As-Is” environment

In general, information gathered from various
“streams” of inquiry indicates there is support for
improving Washington’s health system—thoughts vary
on how
“To be” environment – the potential future

The process has and continues to help identify:
 Key focus areas and strategies for transformation
 The “levers” to move transformation forward
(activities, tools, policies, legislative adjustments)
 Performance measures needed to assess the value
of the reforms
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State Health Care Innovation Planning
WHERE ARE WE GOING?
Draft Vision
All people in Washington achieve
and maintain better health*
Draft Broad Aim
By 2019, the people of Washington state will be healthier
because our state has collectively shifted from a costly,
disconnected non-system for health care to aligned
health approaches focused on achievable targets for
better care, lower costs, prevention and reduction of
disparities.*
*Under review; not finalized
State Health Care Innovation Planning
State Health Care Innovation Plan
Draft Preliminary Outline
 11-page
document, but direction is changing
by the day, as feedback is provided. Available at:
http://www.hca.wa.gov/shcip/Documents/
outline.pdf
 Outlines
specific components, following
guidelines of the CMMI grant
 Rough
30
draft of the plan due to CMMI September
 Available
for review. Email your thoughts on the
outline to: [email protected]
State Health Care Innovation Planning
Project Priorities
 Transformational,
tactics
 Sharp
focused strategies and
financial analysis and evaluation plan
 Clearly
defined infrastructure needs
 Commitment
sought among key influencers
 Strategic
multi-year legislative and regulatory
strategies
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State Health Care Innovation Planning
Two Streams of Focus for Transformation
Focus narrowed to drive the work
1. Promote well-being and eliminate
systemic barriers to health and
recovery for individuals at risk for or
experiencing mental health and
substance abuse challenges
2. Multipayer, purchaser and
provider transformation
 Payment approaches supporting
coordinated care
 Evidence-based care reducing
unwarranted variation
 Consumer engagement
 Infrastructure
 Strengthen purchaser alignment
and influence
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1. Physical & Behavioral Health Aims
 Bi-directional seamlessness/integration of
physical and behavioral health care and social
supports for individuals with co-morbidities
 Enhanced early disease
prevention and mitigation
throughout the lifespan –
toward accountable
communities of health.
The material on this page is considered DRAFT and is available for review and comment by key stakeholders.17
2. Multipayer Aims
 Three draft key objectives for health care delivery system
transformation in Washington State:
 Effective prevention and screening to improve health and
avoid chronic disease and major acute conditions;
 Effective chronic disease management, particularly for
complex patients; and
 Preferred use of lowest cost, highest quality care for acute
conditions.
 One common measure set
needed for each objective
to align efforts and evaluate
progress on a statewide basis.
The material on this page is considered DRAFT and is available for review and comment by key stakeholders.18
2. Multipayer Aims
 Four-part strategy is recommended to help achieve each of
the three objectives.
1. Redesign healthcare delivery to reduce cost, improve quality
and improve patient experience
2. Restructure healthcare payment systems to support and reward
providers who deliver high-value care
3. Restructure healthcare benefit design to enable and
encourage patients to improve their health and use high-value
healthcare services
4. Educate and encourage state residents to improve their health
and use high-value healthcare services
Important “headlines” include:
 Phase out fee-for-service payment;
 Give consumers clear financial incentives (through benefit
design)
The material on this page is considered DRAFT and is available for review and comment by key stakeholders.19
State Health Care Innovation Planning
Toward a Healthier Washington
Working together,
providers, consumers,
health plans, employers,
state agencies, and
other partners can
transform health care to
a system that better
serves everyone.
A State Plan will help us…
ROW
TOGETHER
for a healthier
Washington
State Health Care Innovation Planning
Next Steps

Register for October 15
webinar, 11 am – 12:30 pm

https://www2.gotomeeting.
com/register/680518578

Focused strategies & tactics
are in analysis phase—nothing
finalized

Outline of the draft plan is
complete and being circulated
for comment. Located at:
http://www.hca.wa.gov/shcip/P
ages/resources_and_document
s.aspx

Sign up for the Feedback
Network to receive updates:
[email protected]
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State Health Care Innovation Planning
Q & A / Discussion
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