Changing the Way We Do Business: The Potential Role Grantees Play in Shaping a Changing Healthcare System Presented by: CIHS Staff SAMHSA GPO

Target : Enrollment=100% Reassessment=100% Grant Requirement Cutoff: Reassessment=80% Administrative Review Cutoff: Enrollment=70% Reassessment=50%

National Data Enrollment n=56

National Data Reassessment N=56

Technical Assistance Themes October – December 2011 n=54, HIT Supplemental TA (n=63) not included

How You Can Use the Data You’re Collecting Data at your disposal  NOMs, including Section H data, demographic data, clients served, reassessment rates  IPP data  Quarterly reports How you can use this data  Measure burden of illness in the population you serve (Section H)  Identify and prioritize populations at risk (Demographic Data)  Plan effective and targeted wellness interventions (Section H and NOMS Data)  Evaluate specific wellness activities and outcomes (Section H, NOMS, IPP)  Develop and/or change policies that improve client recruitment, engagement (IPP Data, Clients served and Reassessment Rates)  Requesting funds (ALL DATA)

Using Data for Decision Making: -GPO Perspective -Grantee Perspective

90% Federal match rate for the following services during the first 8 fiscal year quarters when the program is in effect: Comprehensive care management Care coordination and health promotion Comprehensive transitional care from inpatient to other settings Patient and family support Referral to community and social support services Use of health IT to link services (as feasible/appropriate) Health Home Services – Section 2703

Health Home Update State with Planning Grants: DC (in process); AL; AZ; AK; CA; ID; ME; MI; NC; NJ; NM; NV; WA; WI; WV States with approved State Plan Amendments: Missouri Ohio Rhode Island (2 SPAs) “On the clock:” MO (2 nd SPA); NY; NC; WA

Key to Supporting New Service Delivery and Payment Models: Accountable Care Organization

ACOs Defined Generally – ACOs are a group of providers who are held accountable for improving health care quality while lowering the rate of growth in health care spending Medicare Shared Savings Program ACO – a legal entity that is recognized and authorized under applicable State law…comprised of an eligible group of ACO participants that work together to manage and coordinate care for Medicare fee-for-service beneficiaries…established a mechanism of shared governance that provides all ACO participants with an appropriate proportionate control over the ACOs decision-making process

Accountable Care Organization Update 1. Allina Hospitals & Clinics Minnesota and Western Wisconsin 2. Atrius Health Services Eastern and Central Massachusetts 3. Banner Health Network Phoenix, Arizona Metropolitan Area (Maricopa and Pinal Counties) 4. Bellin-Thedacare Healthcare Partners Northeast Wisconsin 5. Beth Israel Deaconess Physician Eastern Massachusetts 6. Bronx Accountable Healthcare Network (BAHN) New York City (the Bronx) and lower Westchester County, NY 7. Brown & Toland Physicians San Francisco Bay Area, CA 8. Dartmouth-Hitchcock ACO New Hampshire and Eastern Vermont 9. Eastern Maine Healthcare System Central, Eastern, and Northern Maine3 10. Fairview Health Systems Minneapolis, MN Metropolitan Area 11. Franciscan Health System Indianapolis and Central Indiana 12. Genesys PHO Southeastern Michigan 13. Healthcare Partners Medical Group Los Angeles and Orange Counties, CA 14. Healthcare Partners of Nevada Clark and Nye Counties, NV 15. Heritage California ACO Southern, Central, and Costal California 16. JSA Medical Group, a division of HealthCare Partners Orlando, Tampa Bay, and surrounding South Florida 17. Michigan Pioneer ACO Southeastern Michigan 18. Monarch Healthcare Orange County, CA 19. Mount Auburn Cambridge Independent Practice Association (MACIPA) Eastern Massachusetts 20. North Texas Specialty Physicians Tarrant, Johnson and Parker counties in North Texas 21. OSF Healthcare System Central Illinois 22. Park Nicollet Health Services Minneapolis, MN Metropolitan Area 23. Partners Healthcare Eastern Massachusetts 24. Physician Health Partners Denver, CO Metropolitan Area4 25. Presbyterian Healthcare Services -Central New Mexico Pioneer Accountable Care Organization Central New Mexico 26. Primecare Medical Network Southern California (San Bernardino and Riverside Counties) 27. Renaissance Medical Management Company Southeastern Pennsylvania 28. Seton Health Alliance Central Texas (11 county area including Austin) 29. Sharp Healthcare System San Diego County 30. Steward Health Care System Eastern Massachusetts 31. TriHealth, Inc. Northwest Central Iowa 32. University of Michigan Southeastern Michigan

PBHCI Grantee Engagement in Health Homes and ACOs Discussion