Population Health Management and Value Based Payment Models The Virginia CHC Leadership Institute February 10, 2016 Session Population Health Management and Value Based Payment Models The Virginia CHC Leadership Institute February 10, 2016 Population Health Management and Value Based Payment Models

Disclosures We have no actual or potential conflict of interest in relation to this program/presentation.

Introduction

The CHC Value Challenge Virginia community health centers (CHCs) are being challenged to demonstrate their value to multiple audiences, including patients, partners, plans, purchasers, and policymakers.

The Virginia CHC Value Model The Virginia Community Healthcare Association created the Virginia CHC Value Model to help CHCs define and communicate their value to key stakeholders. Virginia CHCs deliver value by: Addressing Local Health Needs; Providing Access to Vital Services; Keeping Patients and Families First; Delivering High Quality Health Care; Controlling Health Care Costs; Supporting Community and Economic Development; and Innovating for Excellence.

An Emerging Value Strategy Health care purchasers are adopting value-based payment models to reward population health management. Virginia CHCs can prepare by strengthening their capabilities to: Implement practical models of population health management for specific populations. Demonstrate results to optimize value based payment.

Learning Objective The primary learning objective of this session is to help participants understand the implications of population health management and value-based payment models for patient care, clinical leadership, and organizational strategy.

Format for this Session Two Segments: Population Health Management Value-Based Payment Models Format for Each Segment Overview Presentation Panelist Insights Audience Questions and Insights

Presenters & Panelists The Virginia CHC Leadership Institute February 10, 2016 Session Presenters & Panelists Presenters: Caitlin Feller and Stephen Horan, Community Health Solutions Panelists Dr. Torino Jennings, Medical Director, Capital Area Health Network Sheryl Garland, Director, VCU Office of Health Innovation Tony Herbert, Vice President, Managed Care Virginia, Bon Secours Health System Population Health Management and Value Based Payment Models

Part 1 Population Health Management

Background ‘Population health management’ is receiving increasing attention as a clinical strategy in response to purchaser demands for value. Medicare Medicaid Veterans Health Employer Plans Exchange Plans Health Grantmakers Providers need a practical model of population health management they can apply for defined populations.

The Practical PHM Model Practical PHM is a framework for designing population health management programs. Can be applied for any population. Can be used to design a new initiative or strengthen an existing program. More evolutionary than revolutionary: Aligned with PCMH and other popular models. Distinctive for its emphasis on total care for defined populations.

The Practical PHM Model Defining population health management The field has not adopted a single, standard definition of population health management. In the Practical PHM Model: Population health management can be defined as the daily practice of improving health and health care relative to cost for defined populations.

The Practical PHM Model Practical PHM provides a seven step model for optimizing health and health care relative to cost for defined populations. Identify the Population Assess Health Risks Define Care Needs Optimize the Care Model Collaborate for Impact Assure Quality Demonstrate Value

Step 1. Identify the Population Who is the defined population we want to serve? What are the population characteristics in terms of payer as well as relevant demographic and health indicators? Can we identify population members we are already serving? How can we identify the next population member who comes to us for care?

Step 2. Assess Health Risks What do we know about the health risks of the population we want to serve? Think broadly in terms of: Health status Health behaviors Health knowledge, motivation, and skills Social supports Financial capacity Access to health services Access to supportive community services Other environmental factors (home safety, transportation, etc.)

Step 3. Define Care Needs What health goals do we want to help our population achieve? Think about access, quality, experience, utilization, self- management, outcomes and costs. What services and supports do our population members need to help them achieve their health goals? Clinical care? Community supports? Care coordination? Other? Don’t leave anything out at this stage of discussion!

Step 4. Optimize the Care Model What essential services and supports do our population members receive right now? What are the assets or strengths we can build on? What are the gaps in services and supports that really need to be addressed? How do these services match up with the strategic direction for our organization? What do we know about ‘what works’ from our own experience and from promising programs in other places? How could we optimize the care model if we had the right partners? Document the optimal care model. Identify potential partners who are not already at the table.

Step 5. Collaborate for Impact The key to collaboration is that everyone involved has to win in some fashion. Who are the partners? What is the value proposition for each partner? What are the responsibilities of each partner? What are the key performance indicators for each partner and the project overall? What is the working structure and process for the partnership? How can everyone win including population members and partners?

Step 6. Assure Quality One challenge in population health management is that quality has to be assured for the defined population across service settings. What are the quality objectives for each partner and the project overall? What are the essential quality measures and how will they be produced and reported? How will any observed quality deficits be addressed?

Step 7. Demonstrate Value How will we define and demonstrate value? The definition of value may vary across key stakeholders (patients, partners, payers, purchasers, funders). A starting point: Are we demonstrating better health and health care relative to cost for the defined population? Can we customize this conceptual definition of “value” for particular stakeholders?

Discussion What are the implications of population health management for: Patient care? Clinical leadership? Organizational strategy?

Part 2 Value-Based Payment Models

Defining Value Based Payment Value-Based Payment (VBP) is a strategy used by purchasers to promote quality and value of health care services. (Health Care Incentives Institute) The goal is to improve health and health care while reducing costs of care. The strategy is to shift from pure volume-based payment to payments that are more closely related to outcomes. The tactics are to: Structure payments in ways that incentivize desired results. Use data to measure and reward (or penalize) performance.

Testing Value-Based Payment Most purchasers and payers are now exploring or testing value-based payment. Medicare Medicaid Veterans Health Employer Plans Exchange Plans Health Grantmakers Explore the Catalyst for Payment Reform website for an in-depth look at VBP evolution (not completely accurate but illustrates the scope)

What Purchasers Want Data on defined populations showing: Timely clinical preventive services Evidence-based care management Good clinical quality measures Low rates of ED utilization Low rates of preventable hospitalization Low rates of readmission Low rates of medication error Low rates of questionable services (Choosing Wisely) Evidence of positive patient experience Lower costs relative to trend for the population

Models of Value Based Payment A Growing Array of Models Bonus Payment Bundled Payment Capitation (full, partial, condition-specific) Episode-Based Payment Fee for Service with Performance Reporting Prospective Payment Pay for Performance Shared Savings Blended Payment (some combination of above) Learn more from Catalyst for Payment Reform

Using PHM to Optimize VBP Who are our patient populations in VBP models? What are the value expectations of the VBP model? What is the payment structure of the VBP model? How can we optimize our PHM model to meet the value expectations?

Discussion What are the implications of population health management and value-based payment for: Patient care? Clinical leadership? Organizational strategy?

A Summary Framework for Action Help defined groups of patients improve their health and health care relative to cost… By applying practical PHM… In response to VBP models from… Optimize their health Obtain need services Avoid hospitalization Avoid medical errors Avoid unnecessary services Have a positive care experience 1. Identify the Population 2. Assess Health Risks 3. Define Care Needs 4. Optimize the Care Model 5. Collaborate for Impact 6. Assure Quality 7. Demonstrate Value Medicaid Medicare Veterans Health Employer Plans Exchange Plans Uninsured Programs

Presenter Contacts Stephen Horan, PhD Caitlin Feller, MPP, PCMH CCE President, Community Health Solutions shoran@chsresults.com 804.673.0166 Caitlin Feller, MPP, PCMH CCE Principal, Community Health Solutions cfeller@chsresults.com