Harvard Pilgrim Quality Programs September 12, 2018

Network Medical Management Team Physician leaders are key agents of change in the medical system Network Medical Management team fosters and facilitates two-way communication between Harvard Pilgrim and individual physician thought leaders around key topics of mutual interest, their patients and Harvard Pilgrim members Provide consultation, strategy and practice supports to contracted entities in the areas of quality, satisfaction, utilization and patient safety to improve care outcomes and to mitigate medical cost trends.

Quality Advance Program Quality Grants CT Quality Programs Quality Programs: Quality Advance Program Quality Grants

Elements QAP (Quality Advance Program) -CT Rewards for excellence Submit HEDIS performance (all payer data) -1 process measure, 3 outcome measures Results are compared to the National Quality Compass Infrastructure -Two initiatives required: Prevent unplanned hospital admissions Reduce avoidable Emergency Department visits Conduct annual patient experience survey – CMS Medicare Shared Savings Program survey results Health Equity Select one initiative from 2 options; added social determinates

The HPHC Quality Grants For the past 19 years, Harvard Pilgrim has funded more than 235 initiatives totaling more than $20 million dollars Program topics are updated annually to meet HPHC business strategies and best health care practices Initiatives align with state market health care strategies Last year’s program funded 13 initiatives designed to improve care delivery and reduce costs within a variety of care delivery models  

Quality Grants Program Timeline Funding approval annually – October Program areas of focus are updated annually Notices to contracting managers HPHC & LCU contacts Program updates to website HPHC Quality Grants Grant proposals submitted – February 2019 Notifications of funding April 2019 Grant cycle May – May 2019

Topics of interest 2018 The 2018 Suggested Topic Areas for Focus Substance Abuse Avoidance and Intervention Care Transitions Integration of Behavioral Health into Primary Care Setting Health Equity & Health Care Disparities Chronic Illness & Health Care Proxies Emergency Room Utilization

Funded Grants for 2018 LCU/Institution State Proposal Name Topic (s) Addressed in Proposal Community Health Center Association of Connecticut Submission Project Echo CT Building an Integrated Approach to Pain Management and Opioid Addiction in Federally Qualified Health Centers through Project Echo Substance Abuse Avoidance and Intervention Connecticut Center for Primary Care and ProHealth Physicians Integrating Primary & Behavioral Health Care with eConsults Integration of Behavioral Health and Primary Care Boston Children’s Hospital MA Integration of substance use services in pediatric primary care Identification and management of substance use problems and disorders in pediatric primary care. Lowell General PHO Chronic Kidney Disease Program a. Care transitions to prevent unnecessary ED visits and readmissions b. Chronic illness and documentation of HCPs Upham’s Corner Health Committee, Inc. Streamlining Transitions of Care In A Value-Based Model of Care Care Transitions Valley Medical Group/ Baycare Health Improving the Mission of Advance Care Planning at Valley Medical Group Chronic Illness and Documentation of Health Care Proxies InterMed ME NICU to Home Transitions Maine Quality Counts Project ECHO Medication Assisted Treatment: Building Competency and Capacity for Primary Care Teams in Northern New England Substance Use Avoidance and Intervention: Initiatives that enhance integration of SUD‐related behavioral health into the primary care setting MaineHealth Accountable Care Organization Strengthening the ties that bind – delivering wrap-around ambulatory care for high risk patients with COPD and CHF Penobscot Community Health Care in collaboration with St. Joseph Healthcare Improving Transitions of Care Through Innovative Community Provider Partnerships Partnering across the care continuum to improve care delivery and outcomes for patients transitioning home or to a skilled nursing facility after a hospital stay Cheshire Medical Center/ Dartmouth-Hitchcock NH Prescribe for Health: Transforming Care though Clinical-Community Integration Behavioral Health, Substance Misuse, Health Equity and Health Care Proxies for those with One or More Chronic Illnesses

Connecticut Grants awarded 2018 Community Health Center Association of Connecticut- Building an integrated approach to Pain Management Connecticut Center for Primary Care and ProHeatlh Physicians – Integrating Primary and Behavioral Health care with eConsults