Menu of “Leave Behinds” - HealthierHere€¦ · 18/09/2017 · • Welcome, introductions,...

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Menu of “Leave Behinds” A “Leave Behind” is a transformative and sustainable change in the health system that will impact the community’s health and well-being over the long term. All of the items below are important components of a transformed health care delivery system, but, in order to be effective, KCACH needs to prioritize where to focus efforts in the short term (over the five years of the Medicaid demonstration). We ask you to identify your priority items from the “Leave Behind” column. This list is not comprehensive, so we encourage you to add items that may be missing and you would like the board to consider. KCACH is looking for two to four practical, achievable, meaningful and transformative investments that will make a real difference and move us towards our vision. For this exercise, please pick two you think KCACH should focus on over the next five years. What’s different for people? How to make that difference (Leave Behind) I get care that addresses my health and social needs and it is coordinated across my providers.

1. HIT/HIE system that connects social service and clinical providers.

2. Programs and initiatives incorporate social service providers into clinical delivery and financing.

3. Access to patient-centered multi-disciplinary care teams exist regardless of where a person enters the system.

My provider and health system identify my needs as they emerge, rather than waiting until it is too late.

4. Data infrastructure that allows for Population Health Management at the system and provider level.

5. An early warning system in place that alerts providers who are associated with an individual’s care when s/he seeks emergency care or is admitted to a hospital (supports care transition and re-hospitalization).

I get most of the care I need from my primary care medical home, rather than having to go to different specialists.

6. An e-consult infrastructure is available to all providers for consultation on special health needs.

The health system is designed to keep me healthy rather than just providing me with treatment when I am ill.

7. Providers are ready to move from fee-for-service to value-based payment.

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My social needs are addressed by my provider, as well as my health needs.

8. Strengthened and expanded work force that collaborates effectively with clinical system to address social needs.

9. New payment models exist in the clinical delivery system that recognize the value of social service providers.

I can get the care I need when I need it. 10. Minimal to no-barrier access to most needed services.

11. Easy and reliable mobile and community-based services.

The care that I receive is delivered in a way that recognizes and respects my culture and language.

12. Workforce is more reflective of the people of King County.

13. Providers understand and are able to deliver culturally and linguistically-appropriate care.

I have a real voice in how I receive services. 14. An infrastructure that provides an effective mechanism for meaningful community and consumer involvement and voice in the continuous improvement of the delivery system.

15.

16.

17.

King County Accountable Community of Health -- Governing Board Meeting September 18, 2017

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Domain 1: Health and Community Systems Capacity Building Addresses core health system capacities to be developed or enhanced to transition the delivery system according to Washington’s Medicaid Transformation demonstration. The role of the ACHs in all Domain 1 areas is not as an implementer, but rather as an organization that can help assess needs/ gaps, convene partners to structure recommendations for how to address them, and bring resources. Example: workforce - the ACH isn’t expected to solve the workforce problem in their region, but they are expected to help assess the shortages and training needs and work with the state and other organizations to develop solutions – including possibly using funding to aid in recruitment, training or re-training initiatives.

I. Financial Sustainability through Value-based Payment Overarching Goal: Achieve the Healthier Washington goal of having 90% of state payments tied to value by 2021. Medicaid Value-based Payment (MVP) Action Team. The MVP Action Team will serve as a learning collaborative to support ACHs and MCOs in attainment of Medicaid VBP targets. It’s a forum to help prepare providers for value- based contract arrangements and to provide guidance on HCA’s VBP definition (based on the CMS Health Care Payment and Learning Action Network framework). Representatives include state, regional and local leaders and stakeholders. Role of ACH:

▪ Inform providers of various VBP readiness tools and resources.

▪ Connect providers to training and technical assistance developed and made available by the HCA and the statewide MVP Action Team.

▪ Support initial survey/attestation assessments of VBP levels to help the MVP Action Team substantiate

reporting accuracy.

▪ Disseminate learnings from the MVP Action Team and other state and regional VBP implementation

efforts to providers. Using the recommendations of the MVP Action Team, the ACHs will:

▪ Develop a Regional VBP Transition Plan that: o Identifies strategies to be implemented in the region to support attainment of statewide VBP

targets. o Defines a path toward VBP adoption that is reflective of current state of readiness and the

implementation strategies within the Transformation Project Toolkit (Domain 2 and Domain 3). o Defines a plan for encouraging participation in annual statewide VBP surveys.


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Implement strategies to support VBP transitions in alignment with Medicaid transformation activities.

o By the End of Calendar Year 2017, achieve 30% VBP target at a regional level o By the End of Calendar Year 2018, achieve 50% VBP target at a regional level o By the End of Calendar Year 2019, achieve 75% VBP target at a regional level o By the End of Calendar Year 2020, achieve 85% VBP target at a regional level o By the End of Calendar Year 2021, achieve 90% VBP target at a regional level


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II. Workforce Overarching Goal: Promote a health workforce that supports comprehensive, coordinated, and timely access to care. Role of ACH:

▪ Consider workforce implications as part of project implementation plans and identify strategies to prepare and support the state’s health workforce for emerging models of care under Medicaid

Transformation.

▪ Develop workforce strategies to address gaps and training needs, and to make overall progress toward

the envisioned future state for Medicaid transformation: o Identify regulatory barriers to effective team-based care o Incorporate strategies and approaches to cultural competency and health literacy trainings o Incorporate strategies to mitigate impact of health care redesign on workforce delivering services

for which there is a decrease in demand

III. Systems for Population Health Overarching Goal: Leverage and expand interoperable health information technology (HIT) and health information exchange (HIE) infrastructure and tools to capture, analyze, and share relevant data, including combining clinical and claims data to advance VBP models. Population health management is defined as:

o Data aggregation

o Data analysis

o Data-informed care delivery

o Data-enabled financial models Role of ACHs:

▪ Convene key providers and health system alliances to share information with the state on:

▪ Provider requirements to effectively access and use population health data necessary to advance VBP

and new care models.

▪ Local health system stakeholder needs for population health, social service, and social determinants of health data. ACHs must address Systems for Population Health Management within their project

implementation plans. This must include: o Define a path toward information exchange for community-based, integrated care.

Transformation plans should be tailored based on regional providers’ current state of readiness and the implementation strategies selected within Domain 2 and Domain 3. Include plan for development or enhancement of patient registries, which will allow for the ability to track and

follow up on patients with target conditions.

o Respond to needs and gaps identified in the current infrastructure.

King County ACH Governing Board Meeting

September 18, 2017

Agenda for Today

• Welcome, introductions, goals and agenda overview • Context setting • Demonstration Project Committee (DPC) presentation – • Domain 1 investments review • Leave Behinds • Board lunch

• DSRIP calculator • Funds flow to ACHs • Board reflections and discussion on DSRIP calculator and funds flow • Summary, next steps and reflections

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Setting the Stage for Today

Governing Board Meeting September 18, 2017

Timeline for Project Application Completion

Sept. Oct. Nov.

Draft Projects + Domain I out

for review (10/16)

Portfolio Due to HCA

(11/16)

Consultants to work w/ DT

to revise project plans (now – 9/16)

Project recommendation

Due to GB (10/12)

Final GB Vote on Proj app (11/9)

Incorporate initial

feedback (10/23)

DPC to finalize recommendation

to GB (10/11)

Post projects for public comment

(10/16-10/30)

GB All-day Mtg (9/18)

Draft Project App out for

review (10/30)

Incorporate feedback

(11/6)

Finalize Application

(11/9 – 11/16)

Finance Committee

finalize recommendation

(10/10)

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Decision Making for Governing Board

• September 18th: GB decides on priority “Leave Behinds” Provides additional guidance to DPC • October 12th: DPC brings recommendation for project portfolio GB approves recommendation for project portfolio Finance Committee brings recommendation for Funds Distribution (use categories and amounts) GB approves funds distribution recommendation October 16th: First Draft of projects + Domain I distributed for review (due 10/23) October 30th: Final Draft Project Application Distributed (due 11/6) November 8th: Red-lined final version of Project Application Distributed November 9th: GB approves submission of Project Application

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A Framework for building a project

portfolio 9:00 – 9:15

Health and Human Services Transformation

By 2020, the people of King County will experience significant gain in health and well-being because our community worked collectively to make the shift from a costly, crisis-oriented response to

health and social problems, to one that focuses on prevention, embraces recovery, and eliminates

disparities.

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…to people and populations: What matters to people we serve? Equity. Navigability. Transparency. Activated community. Culturally competent care. Accessibility. “Did you get the service you need?”

“Did the service help?”

Shifting the focus

Move the conversation about sustainable change from

Organizations…

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High Performing Social Services

System (Social Determinants)

High Performing Healthcare

Delivery System

Strong Community Services that Support Health

Strong bi-directional partnership between delivery

system and community resources 9

Healthier Washington’s Goals • Bi-directional integration of

Physical and Behavioral Health by 2020

• Value-Based Payment: 90% of state payments by 2021

• Regional efforts to achieve better health and better patient experiences at lower costs via community-care linkages

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Build Project

Portfolio

Achieve Outcomes

Earn Incentive Funds

Invest in Transformation

How do we get to Transformation

2) Move the needle on required outcome metrics to earn incentive funds

1) Pick projects from the toolkit that can achieve outcomes

3) Incentive funds can: • Pay organizations • Support the ACH • Invest in

infrastructure • Invest in long term

vision

4) Prioritize and invest in 2 to 4 long term sustainable changes that help us move towards our vision

Community Values Principles & RHNI 11

Demonstration Project

Committee

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9:15 – 10:00

Role of DPC Provide leadership and guidance to the development of proposed

demonstration projects Establish a process and framework for building a project portfolio Conduct analysis of proposed projects in relationship to required outcomes,

likelihood of success, investments needed to complete project, potential ROI, and ability to leverage incentive funding Determine what Domain I investments are needed to make projects

successful Make a recommendation to the Governing Board on a balanced portfolio

that achieves goals of community (including # and types of projects) • May provide a couple of options

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DPC Membership

• Elise Chayet, Harborview • Doug Crandall, CPC • Michael Erikson, Neighborcare • Anne Farrell-Sheffer, YWCA • Jeff Hummel, Qualis • Amina Suchoski, UHC • Ingrid McDonald, PHSKC • Susan McLaughlin, KCACH • Caitlyn Safford, Amerigroup • Lee Che Leong, KCACH • Marguerite Ro, PHSKC

• Kayla Down, Coordinated Care • Shelley Cooper-Ashford, HKCC • Sherry Williams, Swedish • Brad Finegood, KC DCHS • Siobhan Brown, CHPW • Nicole Macri, DESC • Andrea Yip, City of Seattle ADS • Laurel Lee, Molina • Sybil Hyppolite, SEIU • Lois Bernstein, Multicare

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Approach and Process to Date • Weekly Meetings for two hours • Guidance and support to Project Design Teams (8) • Assessment of initial project scopes (July 2017) • Presentations by each Design Team • Analysis of projects and development of portfolio

• How many • Which ones • Target population & Scope alignment • Measure alignment

• Analysis of Domain I infrastructure needs (HIE, Workforce, VBP) for each project and overall

• Develop Recommended project portfolio to Governing Board

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1. Align with the tool kit?

2. Address health disparities and promote equity?*

3. Have a realistic chance of collectively hitting the outcomes?

4. Have reasonable costs?

5. Demonstrate sufficient ROI so that someone will pay for it after 2021?

6. Maximize earning potential for reinvestment?

7. Contribute to our overall vision and values?

*see CCV Health Equity Tool for more information

Does the portfolio:

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DPC Next Steps

Determine which projects and how many (consensus on no fewer than 6)

Support HMA and Design Teams to refine project proposals to align metrics, target populations, and activities

Analyze Domain I needs across projects (HIE/IT, Workforce, VBP) and make recommendation for investments

Review and edit project application drafts

Prepare recommendation and rationale for Governing Board

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Overview of Project Proposals

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Domain 2: Care Delivery Design • Project 2A: Bi-directional Integration of Physical and Behavioral Health

through Care Transformation (required) • Project 2B: Community Based Care Coordination • Project 2C: Transitional Care • Project 2D: Diversion Interventions Domain 3: Prevention and Health Promotion • Project 3A: Addressing the Opioid Use Epidemic (required) • Project 3B: Reproductive and Maternal/Child Health • Project 3C: Access to Oral Health Services • Project 3D: Chronic Disease Prevention and Control

DRAFT Medicaid Transformation Summary Prepared for King County ACH 19


Required Project 2A: Bi-directional Integration of Physical and Behavioral Health through Care Transformation Read the proposed Design Team Approach Can earn up to $9.94m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/bi-directional-integration.ashx


Optional Project 2B: Community-Based Care Coordination Read the proposed Design Team Approach can earn up to $6.83m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/community-based-care-coordination.ashx


Optional Project 2C: Transitional Care Read the proposed Design Team Approach can earn up to $4.04m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/transitional-care.ashx


Optional Project 2D: Diversion Interventions Read the proposed Design Team Approach can earn up to $4.04m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/diversion-interventions.ashx


Required Project 3A: Addressing the Opioid Use Epidemic Read the proposed Design Team Approach can earn up to $1.24m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/addressing-opioid-use.ashx


Project 3B: Reproductive and Maternal/Child Health Read the proposed Design Team Approach can earn up to $1.55m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/reproductive-mch.ashx


Project 3C: Access to Oral Health Services Read the proposed Design Team Approach can earn up to $0.93m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/oral-health-access.ashx


Project 3D: Chronic Disease Prevention and Control Read the proposed Design Team Approach can earn up to $2.48m in Y1

http://www.kingcounty.gov/elected/executive/health-human-services-transformation/ach/medicaid-demo-planning/%7E/media/elected/executive/constantine/initiatives/hhs-transformation/documents/ach/survey/chronic-disease-prevention-control.ashx

Domain I Investments - Overview 37

Domain 1: Health & Community Systems Capacity Building Addresses the core health system capacities to be developed or enhanced

to transition the delivery system according to Washington’s Medicaid Transformation demonstration. Financial Sustainability through Value-Based Payment

Goal: Achieve the Healthier Washington goal of having 90% of state payments tied to value by 2021.

Systems for Population Health Management Goal: Leverage and expand interoperable health information technology (HIT) and health information

exchange (HIE) infrastructure and tools to capture, analyze, and share relevant data, including combining clinical and claims data to advance VBP models.

Workforce Goal: promote a health workforce that supports comprehensive, coordinated, and timely access to

care.

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Leave Behinds Exercise

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Health and Human Services Transformation

By 2020, the people of King County will experience significant gain in health and well-being because our community worked collectively to make the shift from a costly, crisis-oriented response to

health and social problems, to one that focuses on prevention, embraces recovery, and eliminates

disparities.

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DSRIP Calculator and Funds Flow

1:15 – 1:45

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Process and Approach

• October 12th Finance Committee recommendation on funds distribution by use category

• Many things that our earned incentive dollars need to support • Project oversight, monitoring, and administration • Partnering providers • Domain I investments in IT infrastructure, workforce, etc. • System transformation

• Decisions we make about projects and how we perform on metrics impacts how much incentive funding we earn per year

• Cash flow (when incentive payments come) impacts when and how we can invest

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Finance Committee

Meeting regularly

Working with HMA Consultants to support funding distribution recommendation

Developed guiding principles for funds distribution

Working on “Use Categories”

Will assign percentages to various use categories based on guiding principles

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King County Accountable Community of Health DRAFT Funds Flow Guiding Principles

• Defining the KCACH funds flow will be a collaborative process with partnering organizations engaged in design, development, and implementation.

• The approach to defining and administering the funds flow will be transparent to all stakeholders, while maintaining confidentiality and propriety of information where required.

• The funds flow methodology will be adaptable and responsive to variability in amount of funds available (statewide or regionally) due to actual performance, or unforeseen changes in project execution. Funds flow will anticipate varied needs based on the timing of transformation activities, e.g.:

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King County Accountable Community of Health DRAFT Funds Flow Guiding Principles • Distribution will be made in a thoughtful, objective manner, consistent with

the goals of the demonstration: • Funds flow will contemplate patient populations impacted by projects and relevant

regional, community, or local needs. • System impact will be prioritized over provider parity in distribution decisions. • Distribution will ensure adequate resources are dedicated to KCACH operations to

support and coordinate project activities. • Funds flow will include distribution(s) explicitly for activities to address

health disparities and social determinants of health, complementary to those inherent in the demonstration project portfolio.

• The funds flow will reflect joint accountability of King County ACH and its partnering organizations for achieving targets required to earn DSRIP funds, and shared financial responsibility for seeing the demonstration through to fruition.

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HEALTH MANAGEMENT ASSOCIATES

BUDGET & FUNDS FLOW

Health Management Associates

46

Overview of State of Washington DSRIP Waiver Funding

Health Management Associates 47

WA State DSRIP Funds

$1.12 billion

Design Pool $54 million – WA

$6 million - KCACH

Project Pool $847 million – WA

$191 million - KCACH

VBP Incentive Pool $169 million - WA

Managed Care Integration Pool $70 million – WA

$17 million - KCACH

MCO Challenge Pool

$56 million - WA

VBP Adoption $43 million - WA

State Administration $52 million

Delivery System Reform Incentive Payment (DSRIP) Funding Pools

HEALTH MANAGEMENT ASSOCIATES 48


Design Pool Project Pool VBP Incentive Pool

• Design Pool– Support ACH-level investments required to coordinate project plan development, such as human resources, engagement activities, technology, tools.

• Project Pool—Incentivize critical regional initiatives in health systems and community capacity building (Domain 1) care delivery redesign (Domain 2), and prevention and health promotion (Domain 3)

• Value-Based Payment Incentive Pool—Reward timely integration of physical and behavioral health managed care and adoption of value based purchasing

Design Pool - King County ACH Budget Projections

• Phase I Certification: $1 million • ACH administration (50%): staffing - beginning with the Executive Director in July and

expanding to six full time staff by the end of 2017; temporary staff and consulting contracts; rent and fiscal sponsorship

• Project plan development (50%): contract with Health Management Associates to support project planning, conduct funds flow analysis and apply lessons learned from DSRIP in other states; does not include payment for King County Backbone staff which is deferred to the end of 2017 and will be covered with Phase II Design Funds

• Phase II Certification: up to $5 million • Project planning (51%): KCACH staff time, PHSKC contract to support project planning with

subject matter expertise, convening and community engagement; extension of the Health Management Associates contract

• KCACH administration (27%): KCACH direct staff costs and fixed operational expenditures • Enhanced community engagement (10%) • Early investments in health information technology (12%)


Project Pool

• Maximum potential ACH Project funding proportional to Medicaid attribution: King County ACH = $191 million (22.5%)

• Factors affecting actual Project funding • Year 1 : Project plan application, number of projects selected • Year 2: 100% Pay-for-Reporting • Year 3: 75% Pay-for-Reporting, 25% Pay-for-Performance • Year 4: 50% Pay-for-Reporting, 50% Pay-for-Performance • Year 5: 25% Pay-for-Reporting, 75% Pay-for-Performance

• Potential High Performance Incentive if six or greater projects selected (see Reinvestment Pool)


Project Pool


Accountable Community of

Health Project Pool

Domain 2: Care Delivery

Redesign

2A: Bi-Directional

Integration

2B: Care

Coordination

2C: Transitional

Care

2D: Diversion

Intervention

Domain 3: Prevention and

Health Promotion

3A: Opioid Use

3B: Maternal & Child Health

3C: Oral Health

3D: Chronic Disease

Domain 1: Health Systems and Community Capacity Building 1A: Financial Stability Through VPB 1B: Workforce 1C: Systems for Population Health Management

Required Projects Listed in Red

Value Based Payment Incentive Pool • Managed Care Integration: KCACH = $16.9 million

• CMS payment of Year 4 and 5 DSRIP funds is subject to Washington achieving statewide integrated physical and behavioral health managed care by January 2020

• Phase 1: 40% of potential ACH revenue earned if a binding letter of intent (LOI) to integrate physical and behavioral health managed care is submitted to the state Medicaid director by September 15, 2017

• Phase 2: 60% of potential ACH revenue earned if implementation of new, integrated MCOs is underway by January 2019

• VBP Adoption • State DSRIP funding depends in part on achievement of statewide VBP adoption targets • Eligible ACH partnering providers may receive incentives based on provider-level progress and

attainment in meeting VBP targets (methodology in development) • Funds must be spent on demonstration objectives (parameters in development)

• MCOs eligible for VBP Incentive “Challenge Pool”


Reinvestment Pool

• The Reinvestment Pool will be used to re-distribute un-earned funds from other pools based on quality performance (methodology in development)



Project Design Project Incentives

Value-Based Payment

Incentives

Reinvestment Pool

Funds Flow – King County ACH


PROJECT POOL $191 million

MAX

FINANCIAL EXECUTOR

Disburses funds per ACH funds

flow

DESIGN POOL $6 million

MAX

Year 1 only CERTIFICATION PHASE I CERTIFICATION PHASE 2

Year 1 PROJECT SELECTION

PROJECT PLAN SCORE

Year 2-5 PAY FOR REPORTING

PAY FOR PERFORMANCE

USE CATEGORIES

• Project Management and Administration • Project Costs • Domain 1 Investments

• Financial Stability Through VPB • Workforce Development • Population Health Management

• Additional use categories as determined by ACH:

ORGANIZATION TYPES

• KCACH/subcontractors • Providers traditionally paid by Medicaid • Providers not traditionally paid by Medicaid • Tribes/ITU • Other

Inflow

VBP INCENTIVE POOL

Methodology TBD

KCACH

Outflow

Inflow Outflow

• KCACH Administration

• PHSKC contract

• HMA Contract

• Provider Engagement

• Initial IT Investment

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Timing Considerations


Source: Manatt Funds Flow 103

Project Incentives: Earned vs. Paid


Project Incentives Earned

Y1 Y2 Y3 Y4 Y5

2017 2018 2019 2020 2021

$31.05 $43.43 $42.53 $39.38 $34.20

Project Incentives Paid

Y1 Y2 Y3 Y4 Y5 Post-Demo Y1 Post-Demo Y2

2017 2018 2019 2020 2021 2022 2023

Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec

Project Plan $31.05

P4R $21.71 $21.71 $15.95 $15.95 $9.84 $9.84 $4.28 $4.28

P4P $10.63 $19.69 $25.65

$0.00 $0.00 $31.05 $21.71 $21.71 $15.95 $15.95 $9.84 $20.48 $4.28 $23.96 $0.00 $25.65 $0.00


DISCUSSION



REVENUE CALCULATOR

Health Management Associates

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DSRIP Calculator v3


Projected DSRIP Revenue

P4P Metrics

P4R Metrics

Algorithm-driven model for projecting potential DSRIP revenue given assumptions for project selection and metrics performance

Year 1 Project Incentives—Project Selection & Project Plan Score


Project Plan Score 100% Project Plan Score 100%

Projects Selected 8 Projects Selected 6

Preliminary Project Plan Application to Year 1 Funds

Base Valuation

Project Selection

Bonus

Total Y1 Valuation

Year 1 Project Incentives (Millions)

Eligible for Share of Unearned Y1

Funds?


Base Valuation

Project Selection

Bonus

Total Y1 Valuation



Funds?

90% 20% 100% $31.05 yes 90% 10% 100% $31.05 yes

Project Plan Score 75% Project Plan Score 75%

Projects Selected 8 Projects Selected 6


Base Valuation

Project Selection

Bonus

Total Y1 Valuation



Funds?


Base Valuation

Project Selection

Bonus

Total Y1 Valuation



Funds?

70% 20% 90% $27.95 yes 70% 10% 80% $24.84 yes

8 PROJECTS 6 PROJECTS

100%

PRO

JECT

PLA

N

75%

PRO

JECT

PLA

N

Total valuation capped at 100%

Project Selection bonus reduced

Base valuation tiered in 10% increments

Both Base Valuation and Selection Bonus affected

Year 2-5 Project Incentives—P4R* & P4P


8 PROJECTS 6 PROJECTS

100%

P4P

90

% P

4P

* All scenarios shown assume 100% P4R

Y2 Y3 Y4 Y5 Y2 Y3 Y4 Y5 2A: Bi-Directional Integration of Care $ 13.90 $ 13.61 $ 12.60 $ 10.94 2A: Bi-Directional Integration of Care $ 16.54 $ 16.20 $ 15.00 $ 13.03

2B: Community-Based Care Coordination $ 9.55 $ 9.36 $ 8.66 $ 7.52 2B: Community-Based Care Coordination $ 11.37 $ 11.14 $ 10.31 $ 8.96 2C: Transitional Care $ 5.65 $ 5.53 $ 5.12 $ 4.45 2C: Transitional Care $ 6.72 $ 6.58 $ 6.09 $ 5.29

2D: Diversions Interventions $ 5.65 $ 5.53 $ 5.12 $ 4.45 2D: Diversions Interventions $ - $ - $ - $ - 3A: Addressing the Opioid Use Crisis $ 1.74 $ 1.70 $ 1.58 $ 1.37 3A: Addressing the Opioid Use Crisis $ 2.07 $ 2.03 $ 1.88 $ 1.63

3B: Maternal and Child Health $ 2.17 $ 2.13 $ 1.97 $ 1.71 3B: Maternal and Child Health $ 2.58 $ 2.53 $ 2.34 $ 2.04 3C: Access to Oral Health Services $ 1.30 $ 1.28 $ 1.18 $ 1.03 3C: Access to Oral Health Services $ - $ - $ - $ -

3D: Chronic Disease Prevention / Control $ 3.47 $ 3.40 $ 3.15 $ 2.74 3D: Chronic Disease Prevention / Control $ 4.14 $ 4.05 $ 3.75 $ 3.26 $ 43.43 $ 42.53 $ 39.38 $ 34.20 $ 43.43 $ 42.53 $ 39.38 $ 34.20

Unearned Incentives $ - $ - $ - $ - Unearned Incentives $ - $ - $ - $ -

Y2 Y3 Y4 Y5 Y2 Y3 Y4 Y5 2A: Bi-Directional Integration of Care $ 13.90 $ 12.76 $ 11.03 $ 8.89 2A: Bi-Directional Integration of Care $ 16.54 $ 15.19 $ 13.13 $ 10.59

2B: Community-Based Care Coordination $ 9.55 $ 8.77 $ 7.58 $ 6.11 2B: Community-Based Care Coordination $ 11.37 $ 10.44 $ 9.02 $ 7.28 2C: Transitional Care $ 5.65 $ 5.18 $ 4.48 $ 3.61 2C: Transitional Care $ 6.72 $ 6.17 $ 5.33 $ 4.30

2D: Diversions Interventions $ 5.65 $ 5.18 $ 4.48 $ 3.61 2D: Diversions Interventions $ - $ - $ - $ - 3A: Addressing the Opioid Use Crisis $ 1.74 $ 1.59 $ 1.38 $ 1.11 3A: Addressing the Opioid Use Crisis $ 2.07 $ 1.90 $ 1.64 $ 1.32

3B: Maternal and Child Health $ 2.17 $ 1.99 $ 1.72 $ 1.39 3B: Maternal and Child Health $ 2.58 $ 2.37 $ 2.05 $ 1.65 3C: Access to Oral Health Services $ 1.30 $ 1.20 $ 1.03 $ 0.83 3C: Access to Oral Health Services $ - $ - $ - $ -

3D: Chronic Disease Prevention / Control $ 3.47 $ 3.19 $ 2.76 $ 2.22 3D: Chronic Disease Prevention / Control $ 4.14 $ 3.80 $ 3.28 $ 2.65 $ 43.43 $ 39.87 $ 34.45 $ 27.79 $ 43.43 $ 39.87 $ 34.45 $ 27.79

Unearned Incentives $ - $ 2.66 $ 4.92 $ 6.41 Unearned Incentives $ - $ 2.66 $ 4.92 $ 6.41

P4P Metrics


P4P Metric Max Potential Projects w/

Metric Projects

Antidepressant Medication Management 1 2.a

Plan All-Cause Readmission Rate (30 Days) 3 2.a, 2.b, 2.c

Follow-up After Discharge from ED for Mental Health (7 day, 30 day) 3 2.a, 2.b, 2.c

Follow-up After Discharge from ED for Alcohol or Other Drug Dependence (7 day, 30 day) 3 2.a, 2.b, 2.c

Follow-up After Hospitalization for Mental Illness 3 2.a, 2.b, 2.c

Outpatient Emergency Department Visits per 1000 Member Months 8 2.a, 2.b, 2.c, 2.d, 3.a, 3.b 3.c, 3.d

Inpatient Hospital Utilization 5 2.a, 2.b, 2.c, 3.a, 3.d

Mental Health Treatment Penetration (Broad Version) 3 2.a, 2.b, 3.b

Substance Use Disorder Treatment Penetration 3 2.a, 2.b, 3.b

Child and Adolescents’ Access to Primary Care Practitioners 2 2.a, 3.d

Comprehensive Diabetes Care: Eye Exam (retinal) performed 2 2.a, 3.d

Comprehensive Diabetes Care: Hemoglobin A1c Testing 2 2.a, 3.d

Comprehensive Diabetes Care: Medical Attention for Nephropathy 2 2.a, 3.d

Medication Management for People with Asthma (5 – 64 Years) 2 2.a, 3.d

Percent Homeless (Narrow Definition) 3 2.b, 2.c, 2.d

Percent Arrested 1 2.d

Medication Assisted Therapy (MAT): With Buprenorphine or Methadone 1 3.a

Patients on high-dose chronic opioid therapy by varying thresholds 1 3.a

Patients with concurrent sedatives prescriptions 1 3.a

Substance Use Disorder Treatment Penetration (Opioid) 1 3.a

Childhood Immunization Status (Combo 10) 1 3.b

Chlamydia Screening in Women Ages 16 to 24 1 3.b

Contraceptive Care – Access Measures (Improvement in 1 of 3 measures) 1 3.b

Timeliness of Prenatal Care: Prenatal Care in the First Trimester 1 3.b

Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life 1 3.b

Well-Child Visits in the First 15 Months of Life 1 3.b

Dental Sealants for Children at Elevated Caries Risk 1 3.c

Ongoing Care in Adults with Chronic Periodontitis 1 3.c

Periodontal Evaluation in Adults with Chronic Periodontitis 1 3.c

Primary Caries Prevention Intervention 1 3.c

Utilization of Dental Services by Medicaid Beneficiaries 1 3.c

Statin Therapy for Patients with Cardiovascular Disease (Prescribed) 1 3.d

Illustration of P4P Impact


ESTIMATED PERFORMANCE-ADJUSTED PROJECT INCENTIVES DSRIP REVENUE BY PROJECT (MILLIONS)

Calendar Year 2017 2018 2019 2020 2021 Program Year Y1 Y2 Y3 Y4 Y5

2A: Bi-Directional Integration of Care $9.94 $13.90 $13.61 $12.60 $10.94 2B: Community-Based Care Coordination $6.83 $9.55 $9.12 $8.42 $7.21

2C: Transitional Care $4.04 $5.65 $5.30 $4.94 $4.21 2D: Diversions Interventions $4.04 $5.65 $5.18 $4.27 $3.33

3A: Addressing the Opioid Use Crisis $1.24 $1.74 $1.70 $1.58 $1.37 3B: Maternal and Child Health $1.55 $2.17 $2.13 $1.97 $1.71

3C: Access to Oral Health Services $0.93 $1.30 $1.28 $1.18 $1.03 3D: Chronic Disease Prevention / Control $2.48 $3.47 $3.40 $3.15 $2.74

Incentives Earned $186.83 $31.05 $43.43 $41.72 $38.10 $32.54

Incentives Not Earned $3.75 $0.00 $0.00 $0.81 $1.28 $1.66

Calendar Year 2017 2018 2019 2020 2021 Program Year Y1 Y2 Y3 Y4 Y5

2A: Bi-Directional Integration of Care $9.94 $13.90 $13.61 $12.60 $10.94 2B: Community-Based Care Coordination $6.83 $9.55 $9.36 $8.66 $7.52

2C: Transitional Care $4.04 $5.65 $5.53 $5.12 $4.45 2D: Diversions Interventions $4.04 $5.65 $5.53 $5.12 $4.45

3A: Addressing the Opioid Use Crisis $1.24 $1.74 $1.70 $1.58 $1.37 3B: Maternal and Child Health $1.55 $2.17 $2.13 $1.97 $1.71

3C: Access to Oral Health Services $0.93 $1.30 $1.28 $1.18 $1.03 3D: Chronic Disease Prevention / Control $2.48 $3.47 $3.40 $3.15 $2.74

Incentives Earned $190.58 $31.05 $43.43 $42.53 $39.38 $34.20

Incentives Not Earned $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

100% on all P4P metrics

50% on “Percent Homeless” and “Percent Arrested”

Board Reflections and Discussion

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Reflections and Thoughts • What are your takeaways from the

presentations on the DSRIP calculator and funds flow?

• What is different than what you’ve assumed? • How does what you heard influence your

thinking about the project plan, the metrics and the available dollars?

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Decision Making for Governing Board

• September 18th: GB decides on priority “Leave Behinds” Provides additional guidance to DPC • October 12th: DPC brings recommendation for project portfolio GB approves recommendation for project portfolio Finance Committee brings recommendation for Funds Distribution (use categories and amounts) GB approves funds distribution recommendation October 16th: First Draft of projects + Domain I distributed for review (due 10/23) October 30th: Final Draft Project Application Distributed (due 11/6) November 8th: Red-lined final version of Project Application Distributed November 9th: GB approves submission of Project Application

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Reflections on the day

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Menu of “Leave Behinds” - HealthierHere€¦ · 18/09/2017 · • Welcome, introductions,...

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