SUPPORTING THE INTEGRATION OF COMMUNITY HEALTH WORKERS IN MINNESOTA JUNE 5, 2014 The Minnesota Accountable Health Model (SIM Minnesota)

Outline SIM Background Emerging Professions Work Definitions Data Collection Integration Grants Toolkit Contracts Emerging Professions Workgroups Best Practices Overall Goals, specific to CHWs

State Innovation Model (SIM)Initiative SIM is a Center for Medicare and Medicaid Innovation (CMMI) initiative to test and implement health care payment and delivery reform ideas Goal: Better quality in health care, improved experience, and lower costs (Triple Aim)

National SIM Grants Minnesota awarded largest testing grant in the country ($45.3 million), February 2013 Five other states also received SIM testing grants from CMMI: Massachusetts., Maine, Vermont, Oregon and Arkansas.SIM testing grants from CMMI 16 states received design grants

SIM Background “Minnesota Accountable Health Model” Joint MDH/DHS project 3 years, $45 million Staff coming on board Multiple grants, contracts, workgroups (internal and external) already underway Collaborative Agreement with CMMI Testing Grant

What are We Testing? Can we improve health and lower costs if more people are covered by Accountable Care Organizations (ACO) models? If we invest in data analytics, health information technology, practice facilitation, and quality improvement, can we accelerate adoption of ACO models and remove barriers to integration of care (including behavioral health, social services, public health and long-term services and supports), especially among smaller, rural and safety net providers? How are health outcomes and costs improved when ACOs adopt Community Care Team and Accountable Communities for Health models to support integration of health care with non-medical services, compared to those who do not adopt these models?

Q: What is an Accountable Care Organization? A: Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their patients. The goal of coordinated care is to ensure that patients – especially the chronically ill – get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds in both delivering high quality care and spending health care dollars more wisely, it will share in the savings it achieves.

Impetus for Accountable Care Organizations 10 Impetus for ACOs Develop payment approaches to create incentives for value not volume Shift risk and rewards closer to point of care to foster local accountability Realize return on federal and state investments Improve access to care, outcomes and information for the beneficiary Desired Outcomes Value = Better Quality + Lower Cost/“The Triple Aim” Integrated prevention, wellness, screening and disease management Coordinate care across care cycle Data to monitor utilization, compare and share across states New reimbursement structures, including incentives that encourage integrated practice models

Leadership structure

Model Drivers Diagram

Emerging Professions Work Definitions Emerging professions: Community Health Worker Community Paramedic Dental Therapist/Advanced Dental Therapist Future may also include Doula, Certified Peer Support Specialist MDH is hiring a full-time Emerging Professions Coordinator Three-year position, funded by the SIM grant

Emerging Professions Work What is the current state of the Community Health Worker Profession? Data Collection Available or Potential Data Sources: # of graduates, and work location # of current students, and projected pipeline # of CHWs enrolled with DHS # of Medicaid claims submitted to DHS on behalf of CHWs Data from Health Plans Clinical or other non-claims data from CHW employers E.g., encounters with uninsured patients, public health encounters Data from CHW-related grants and projects

Emerging Professions Work: Integration Grants Grant Program to supplement the salary of Emerging Professions practitioners in new positions CHW Grants are intended to fund salaries of New hires MnSCU-approved curriculum graduates Who can apply? Any potential employer of a CHW Medical clinic, public health agency, hospital, county social service agency, dental clinic, nursing home, inpatient mental health facility, etc, etc, etc.

Emerging Professions Work: Integration Grants What kinds of application are most likely to get funded? Projects that best align with the goals of the SIM grant Priority will be given to projects that build connections between: Mental health Long-term care Public health Social services Projects that serve a clearly defined population Projects that plan for sustainability after the grant

Emerging Professions Work: Integration Grants 3 annual rounds Round 1: funding for two CHW positions, $30,000 each Applications due TODAY Round 2: funding for one CHW position, $25,000 RFP to be published in July (est.) Round 3: funding for one CHW position, $20,000 Round 1 contracts begin in July.

Emerging Professions Work: Integration Grants What does the state get in exchange for the grant? We want to evaluate “Practice Transformation” What services does the CHW provide? Who does the CHW care for? What does having a CHW mean for other team members? What new services can an employer take on with the addition of a CHW? What is the return on investment? What best practices are developed that can be shared with others? What additional training should be in the CHW curriculum?

Emerging Professions Work: Toolkits MDH will contract for development of a CHW Toolkit Designed for potential employers, to answer: What is a CHW trained to do? What is the core skill set? What are the potential benefits of hiring a CHW? What CHW services are covered by insurance? Who can supervise a CHW? What information is available for return on investment? What are examples of work currently being done by CHWs? RFP will be published in July (est.) Contracts will be for around $100,000 each, over two years.

Emerging Professions Work: Workgroups MDH has convened an informal SIM CHW Workgroup The advisory workgroup will help Monitor progress of the Grants Develop evaluation criteria for the Grants Collect and analyze data Share information about current CHW projects and future trends

Emerging Professions Work: Best Practices MDH will ask current CHW programs and employers about specific examples: What services CHWs are providing? What populations are CHWs serving? What settings are they working in? How are CHWs working in team-based environments? What part of CHW training is most valuable? What have CHWs learned on the job? What barriers are CHWs encountering? What structures are in place to ensure CHWs can reach their potential? What we learn will be shared widely

Emerging Professions: Overall Goals Better data about the CHW profession Better understanding of current best practices Integration of best practices with curriculum development Policy changes Information about Return On Investment Not just about money

Emerging Professions: Overall Goals Greater “Uptake” of CHWs More CHWs working and using the full breadth of their training Greater CHW participation in ACO models Change of payment away from fee-for-service Understanding of “Practice Transformation” What does hiring a CHW mean for the employer? For the patient? For the care team? For the community?

Emerging Professions Questions? Will Wilson, Supervisor Minnesota Department of Health Office of Rural Health and Primary Care (651)