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Shifting Landscape and Implications

for Future Plans

Feb 2, 2017

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But where is the puck going to be????

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Shifting Political and Health

Care Landscape - uncertain

Likely some changes to the Affordable Care Act Full repeal will be hard, defunding certain elements more easy

Medicaid expansion for NC?

Some elements of value-based payments likely to continue ? Future of Centers for Medicare and Medicaid Innovations?

May be changes in how Medicaid is administered at the federal and state level Proposal of block grants (i.e. a capitated set amount) given to the states to cover Medicaid costs

? Status of Medicaid 1115 Innovation Waiver at CMS?

Expectation of more privatization of Medicaid and Medicare. i.e. stronger presence of

Managed Care Organization (MCOs) and perhaps on a shorter time line

Evolving Pre-paid Health Plans (PHPs)/MCOs Provider MCOs– Hospital-system/Presbyterian (P19), NCMS/NC Community Health Center/Centene

Corporate MCOs

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Pre-paid Health Plan (PHP)

Corporate, Provider

Payor/ insurance product

Adequate network of high value providers/ enhanced medical homes

Care management/

Population management infrastructure

Community/ Medical

Neighborhoods/ Social

Determinants of health

PHP

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(Uncertain) Scenario-based

planning

Pivot the

other 20%

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What’s the 80%?

What strengths can be expanded and

brought to the table?

Access to care

Community partnerships, relationships, and collaborations – Social Capital

Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management

Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)

QI and practice support to help transformation to value-based care (Practice Transformation Network)

Statewide footprint

Proven track record of cost savings and quality improvement

These are the foundational strengths on which we will build The 20% pivot will be with whom we contract

Place logo

here

What’s the 80%?

What strengths can be expanded and

brought to the table?

Access to care

Community partnerships, relationships, and collaborations – Social Capital

Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management

Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)

QI and practice support to help transformation to value-based care (Practice Transformation Network)

Statewide footprint

Proven track record of cost savings and quality improvement

These are the foundational strengths on which we will build The 20% pivot will be with whom we contract

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Patient OutcomesEnhanced Patient Centered Medical Homes/Behavioral Health Integration

INTEGRATED CARE

Screening

Evidence Based

Practice

Population Management

Practice Support

Collaborative Care

Integrated Care

Management

9

Enhanced Patient

Centered Medical Home

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Connections made to the local Medical and

Health Neighborhood;

Social determinants of health addressed

Embedded and Community-based

Multidisciplinary Team; Holistic, inclusive of

Behavioral Health and Pharmacy; emphasis

on Motivational Interviewing

Analytic-enabled care management tailored

to Medicaid and Health Choice –

guides interventions and prioritization

Patient OutcomesNCQA Complex Care Management

Patient OutcomesPatient SatisfactionQuestion Weighted Mean

Score

The Care Manager helped show you how to manage

your health.95.4

You are satisfied with the Care Manager’s ability to

understand your needs.95.6

You are satisfied with your level of involvement in

developing your care plan to better improve your health.95.0

The Care Manager assisted in coordinating your care. 94.6

When you needed help, the Care Manager was readily

available and responsive to your concerns.93.9

Overall, you are satisfied with the services provided by

the Care Manager.95.2

Total Average 94.7

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What’s the 80%?

What strengths can be expanded and

brought to the table?

Access to care

Community partnerships, relationships, and collaborations – Social Capital

Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management

Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)

QI and practice support to help transformation to value-based care (Practice Transformation Network)

Statewide footprint

Proven track record of cost savings and quality improvement

These are the foundational strengths on which we will build The 20% pivot will be with whom we contract

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Statewide Provider Network Community Care Physician Network

Statewide - 1,417 primary care clinicians in 408 Practices

Locally - 265 primary care clinicians in 77 practice sites

Board of Manager Representation – Dr. Larry Mann, Jeffers, Artman, and Mann

Beginning recruitment of Specialists – OBs and Behavioral Health

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Statewide Community Pharmacy Enhanced Services Network (CPESN)

Established 2014

CCNC created Network of over 246

community pharmacies in NC willing to

provide enhanced services and

coordinate care with the broader care

team

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Support medication adherence

Conduct medication reconciliation after hospital discharge

Prevent medication wastage by verifying patient need prior to each fill

Provide clear and clinically relevant communication with the provider and care team

Offer comprehensive medication review, care plan development, reinforcement, and longitudinal follow up

Reinforce patient care plan and offer disease and medication management education

Enhanced care coordination and additional monitoring between provider office visits for patients with chronic medical conditions

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here

What’s the 80%?

What strengths can be expanded and

brought to the table?

Access to care

Community partnerships, relationships, and collaborations – Social Capital

Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management

Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)

QI and practice support to help transformation to value-based care (Practice Transformation Network)

Statewide footprint

Proven track record of cost savings and quality improvement

These are the foundational strengths on which we will build The 20% pivot will be with whom we contract

Practice Transformation Network

Engine to help practices move to Value Based Care

This train is leaving the station with or without us!

Transforming Clinical Practice Initiative/

Practice Transformation Network (PTN)

TCPI Aims

1) Support more than 140,000 clinicians

2) Build the evidence base so effective solutions can be scaled

3) Improve health outcomes for millions of patients

4) Reduce unnecessary hospitalizations for 5 million patients

5) Sustain efficient care delivery by reducing unnecessary tests and procedures

6) Generate $1 to $4 billion in savings to the federal government and commercial payers

7) Transition 75% of practices to participate in Alternative Payment Models

CCNC PTN practices

292 practices, 1,396 clinicians

We exceeded Year 1 Enrollment Targets!

Starting Year 2 Recruitment and Activities

Primary Care, OBs, Behavioral Health

Behavioral Health Integration

Pharmacy Integration

Themes from Initial Practice Assessments (First 207 practices)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Patient and Family Engagement

Team Based Relationships

Population Management

Community Partner

Coordinated Care

Organized Evidenced-Base Care

Enhanced Access

Engaged and Committed Leadership

Quality Improvement Strategy Supporting Culture of Quality

Transparent Measurement and Monitoring

Optimize Health Information Technology

Strategic Use of Revenue

Workforce Vitality and Joy in Work

Capability to Analyze and Document Value

Operational Efficiency

Pers

on a

nd F

am

ily-C

ente

red C

are

De

sig

n

Co

ntin

uou

s, D

ata

Driven Q

ualit

yIm

pro

ve

me

nt

Su

sta

ina

ble

Busin

ess

Op

era

tio

ns

% of PTN Practices with Completed Milestone

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What’s the 80%?

What strengths can be expanded and

brought to the table?

Access to care

Community partnerships, relationships, and collaborations – Social Capital

Focus on Patient Outcomes Enhanced Patient Centered Medical Homes (evolving capacity and behavioral health integration) Person Centered Health Neighborhoods NCQA accredited analytic-enabled complex, holistic, multi-disciplinary care management

Provider network Primary Care (Community Care Physician Network) Adding specialists (starting with OBs and Behavioral Health -CCPN) Pharmacies (Community Pharmacy Enhanced Services Network)

QI and practice support to help transformation to value-based care (Practice Transformation Network)

Statewide footprint

Proven track record of cost savings and quality improvement

These are the foundational strengths on which we will build The 20% pivot will be with whom we contract

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Key Performance Indicators

(KPI’s) YE September 2016

Total Costs PMPM

CCWJC

CCNC

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CCWJC

ED Visits

CCNC

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hereInpatient Admissions

CCNC

CCWJC

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Potentially Preventable

Readmissions

CCNC

CCWJC

Quality Clinical Metrics

Diabetes

57.9%

28.0%

64.8%59.6%

28.3%

64.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

HbA1c Control < 8.0 HbA1c Poor Control > 9.0(lower is better)

Blood Pressure ControlBP < 140/90

FY 2015 FY 2016 HEDISMean

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Quality Clinical Metrics

Asthma

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Asthma Medication Ratio

FY 2014 FY 2015 FY 2016

HEDIS Mean

Quality Clinical Metrics

Developmental and Behavioral Screenings

92.3%

75.9%

21.6%

28.2%

91.7%

79.1%

26.2%

35.0%

91.0%

71.3%

25.8%

34.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

ABCD/Dev MCHAT/Autism School Age Adolescent

FY2014 FY2015 FY2016

Quality Clinical Metrics

Pediatric Oral Health Measures

Result Notes

CCNC consistently performs higher than benchmark on the Annual Dental Visit measures

Measures rose consistently year-to-year except for the 19-20 year old ADVs

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

ADV 2-3Yr ADV 4-6Yr ADV 7-10Yr ADV 11-14YrADV 15-18YrADV 19-20Yr ADV Total 4+Varnishings

Oral Health

FY2014 FY2015 FY2016 HEDIS Mean

Quality Clinical Metrics

Maternal Health Measures

Result Notes

- Timeliness of Prenatal care and Risk screening during pregnancy results mirror each other 2014-2016 trends

- Tobacco Cessation counseling increased over time

- Progesterone injections measures declined in 2015 but bounced back in 2016

- Unintended Pregnancy has experience a steady decline

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Timeliness ofPrenatal Care

Risk Screeningduring Pregnancy

Tobacco CessationCounseling Received

during Pregnancy

ProgesteroneInjections forPreterm BirthPrevention

UnintendedPregnancy Rate

Pregnancy Measures

FY2014 FY2015 FY2016 BENCHMARK

Quality Clinical Metrics

Delivery Outcomes

29.1%

7.1%

10.0%

1.7%

29.2%

8.1%

10.7%

1.8%

28.9%

7.5%

10.4%

1.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Cesarean Delivery Rate Elective Deliveries before39 Weeks of Gestation

Low Birth Weight Very Low Birth Weight

FY2014 FY2015 FY2016

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Enormous amount of uncertainty,

but really doesn’t change core

work

Access to care

Community partnerships, relationships, and collaborations – Social Capital

Focus on Patient Outcomes (Enhanced Medical Homes, Connected Health Neighborhoods, Complex

Care Management)

Provider networks (CCPN, CPESN)

QI and practice transformation to value-based care support (Practice Transformation Network)

Statewide footprint

Proven track record of cost savings and quality improvement

These are the 80% core foundational strengths on which we will build

The 20% pivot will be with whom we contract (e.g. MCOs, PLE, the state)