New Mexico Health System Innovation Design Phase Improving health outcomes and population health “For A Healthier New Mexico” STATE INNOVATION MODEL (SIM) INITIATIVE FUNDED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, CMS INNOVATION CENTER

What is the State Innovation Model [SIM] Initiative? Created by the Affordable Care Act (ACA); administered by the Centers for Medicare and Medicaid Services (CMS) Innovation Center To test innovative health delivery & payment models that reduce spending, enhance the quality of care & improve population health Since 2012, more than $1 billion awarded to 34 States, 3 territories and the District of Columbia Two phases: Design (1-2 years to develop the design of proposed transformation model); Testing of design (3 years) NM’s Design funding is through January 31, 2016. Funding for Test of Design will be dependent upon availability of funding & quality of the Design For more information, see: http://innovation.cms.gov/

New Mexico Health System Innovation The Design Based on “The Triple Aim” Enhancing the consumer’s experience of care Reducing health care costs Improving population health and health outcomes.

Examples of Triple Aim Goals Enhanced experience of care Improved primary care with patient-centered medical homes (PCMH) model - integration of primary care, behavioral health services and social services Reduction of costs Reimbursement of services is value (outcome)-based vs. fee-for-service (volume) May include reimbursement for “non-traditional” services, i.e., those provided by community health workers, social services, etc. Improving population health & health outcomes Local community health workers & paramedics who participate in the delivery of primary care Interoperability of health information systems HCs play a fundamental role in achieving the Triple Aim through linkages with health, behavioral health, social services, businesses & other organizations in the community. Achieving the Triple Aim is dependent primarily upon effective collaboration from local through State levels. These relationships provide the basis upon which a solid statewide system can be developed. Local HC membership should be re-examined to ensure the widest possible input on health issues in the community. For more on the “Triple Aim”, see: http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx

What does “health system transformation” look like? Two illustrations of the evolving health care system in the US; note “third era” or “3.0” where the system has become community-integrated; ultimate goal for SIM Initiative and New Mexico From: Halfon N et al. “Applying a 3.0 transformation framework to guide large-scale health system reform.” Health Affairs, v. 33, #11, November 2014 Appendix http://content.healthaffairs.org/content/suppl/2014/10/31/33.11.2003.DC1/2014-0485_Halfon_Appendix.pdf

What are the Objectives of NM’s Design? Alignment and integration of public health, behavioral health and primary care Reducing costs & slowing the rate of health care inflation Increasing the number of New Mexicans who have health insurance Building the healthcare workforce & supporting infrastructure Expanding the use & integration of health information technology (HIT) Alignment: Already happening in New Mexico, examples include Hidalgo Medical Services, Silver City; First Choice/South Valley Health Commons; La Clinica de Familia, Las Cruces – blended services under one roof that offer integrated “package” of service options for patients with multiple needs Reducing costs: via innovative payment models; reimbursement for “non-traditional services” such as those provided by CHWs, and paramedics/EMS providers; social services; etc. (all of which can reduce use of Emergency Departments as “primary care providers”) Healthcare workforce: by training for expanded roles of CHWs, EMS/paramedics, public health professionals that integrate with primary care; innovative & incentivizing recruitment efforts for physicians, nurses, etc. Increasing number of New Mexicans with health insurance: ongoing effort via efforts several organizations HIT: increased use & sharing of Electronic Health Records (EHRs); creation of All Payers Claims Database (APCD) where all payers and providers report compatible data into a seamless system

Extensive stakeholder engagement Who will participate? Extensive stakeholder engagement State agencies Local & tribal governments Health care providers Public payers (Managed Care Organizations (MCOs) and private commercial payers Social service providers Patient advocacy groups Local organizations Business community Local Community, in collaboration with HCs Note: If not already happening, HCs should consider inclusion of local HSD staff in their meetings and activities.

Suggestions for Community Representatives Behavioral health (individual providers/clinics, etc.) Business community/chamber of commerce Health consumers/general public EMS/paramedicine/emergency management Environmental/community planning organizations Food bank Health professional organization Higher education health clinic Hospital Insurer (public & private) Local government Patient advocacy/consumer Primary care (individual providers/FQHC/local private clinic, etc.) School-based health clinic Tribal health services Vulnerable population advocacy organization Suggestions only; should be appropriate to local needs; reach out to complementary medicine Practioners or associations. For example, there are cost-savings to be found using acupuncture, massage, chiropractic functional medicine. The functional medicine approach to using nutrition as medicine or acupuncture for smoking cessation, etc. There are many policy changes that could be incorporated into the planning, including Medicaid coverage for alternative/complementary medicine, etc.

Stakeholders in the Public Health System MCO’s Home Health Parks Economic Development Mass Transit Employers Nursing Homes Mental Health Drug Treatment Civic Groups CHCs Laboratory Facilities Hospitals EMS Community Centers Doctors Health Department Churches Philanthropist Elected Officials Tribal Health Schools Police Fire Corrections Environmental Health From: The Centers for Disease Control Through collective impact efforts engaging non traditional partners, land use codes and policies with a health lens can be supported. Community development, for example that blends places to live and work with easy access to better lit streets, sidewalks, bike paths and convenient public transportation make a difference in improved health outcomes for everyone in a neighborhood.

Engagement Structure Six Stakeholder Committees and Local Communities - Population Health - to address health issues across the life continuum Health Care Health Care Workforce Payers Tribal Health Information System (Health Information Technology; Health Information Exchange; Healthcare System Information; Health Status; Individual Health Info); and, Ongoing Community Engagement (County & Tribal Health Councils) Population Health: led by subject matter experts to address major indicators in New Mexico with a focus on prevention Health Care: to develop the NM version of the Patient, or community Centered Medical Home (PCMH) model to be promoted statewide, to develop recommendations for new and innovative payment models that reimburse for value of care vs volume of services; explore expanded use of Telehealth, etc. Work Force Development: to explore new professional roles for all health care providers, i.e. public health participation in primary care; behavioral health is integrated throughout the continuum of services, new roles for CHWs/paramedics/EMS, peer support, etc. Payers: led by private and public payers and hospitals. etc. who will consider new payment models for services Tribal: Committee Members will be embedded in all Committee meetings and planning activities; provide input & recommendations on needs specific to tribal communities Health Information System: to assess the information technology (IT) infrastructure statewide; to develop recommendations for improved sharing of Electronic Health Records, reporting & use of health data, and, development of an All Payer Claims Database (APCD), etc. Community Engagement: to obtain input on local health care needs & recommendations on the design model to developed by the Stakeholder Committees; collaboration of HCs with local community stakeholders, health & non-health, social services, businesses, etc.; with assistance from DOH Health Promotion Managers and NM Alliance of Health Councils

Health System Innovation Committee (HSIC) Flow of Design Inputs Governor’s Office Health System Innovation Committee (HSIC) Input Compiled for Model Design SIM Management Team (OPA/HSD Admin. Staff) How the information is expected to flow among the Steering Committee (HSIC), the Stakeholder Committees (and their focus groups), and the Community. Design recommendations will flow up and down among stakeholder committees and communities and HSIC. When final, will go to Governor. Stakeholder Committees Community Engagement led by Health Councils (HCs) Work Groups

Innovation: Priority Health Issues Obesity Prevention and Control Diabetes Prevention and Control Tobacco Use Prevention and Control Indicators that the Design must address per CMS requirements. Other indicators important to your community should be discussed and communicated to Stakeholder Committees. Note: Proposed design should be evaluated according to how well these indicators are addressed and measured, and how the design meets the specific needs of your community.

Important Considerations Social Determinants of Health This illustration suggests the types of organizations/individuals who should be “at the table” in the community, in addition, to health so that entire needs of patients’/persons’ can be addressed. Where you Live, Learn, Labor and Leisure impact one’s overall health outcomes. Significant evidence showing that PLACE MATTERS, and Health In All Policies ultimately improve outcomes. Health In All Policies – Examples include: Toolkits incorporating health – US Parks Service DOT - - “Bike to work day” Health in land use policies – HIA’s – Environmental issues – Bernalillo, Torrance, and McKinley counties, etc. Low income neighborhoods have heightened community risks and lower life expectancy; it isn’t just about motivation, talent, or hard work…. It depends on race and income… and where one lives. For example those living in neighborhoods with heightened environmental risks; life expectancy is age 77, whereas it’s age 82 in neighborhoods with fewer environmental risks.

Important Considerations for HCs Diffusion of Innovation seeks to explain how innovations are taken up in a population. An innovation is an idea, behavior, or object that is perceived as new by its audience. Diffusion of Innovations offers three valuable insights into the process of social change: What qualities make an innovation spread. The importance of peer-peer conversations and peer networks. Understanding the needs of different user segments. The community and the collaborative process of the HCs are seen as key to introducing, discussing, and adapting ideas or “innovations” to local needs. The HCs are the only geographically-based stakeholders, the only who fully understand the nature and components of their own communities, and who are able to provide input on how activities/ideas/or “innovations” will affect them – positively or negatively.

Timeline May 19: Stakeholder Summit (kick-off), Albuquerque May-July: Community orientations & development of engagement plans for three succeeding community engagement sessions July – October 5: With DOH Health Promotion Teams, conduct community engagement sessions to provide input to Design October 15: Draft Community Stakeholder Design recommendations by theme provided by NM Alliance of Health Councils Red items pertain to HC deliverables Note: HCs are invited but not required to attend the statewide meetings (May 19 etc.)

Timeline Week of October 19: All Stakeholder Committees to meet in Albuquerque Week of November 2: Health System Innovation Committee (HSIC) reviews proposed design from Stakeholder Committees & local communities Week of November 16: Stakeholder Committees convene in Albuquerque December 1: Final design sent to HSIC December 15: Final Community Stakeholder Design recommendations by Theme due from NM Alliance of Health Councils December 15: Stakeholder Summit to occur in Albuquerque to present final design Red items pertain to HC deliverables Note: HCs are invited but not required to attend the statewide meetings (May 19 etc.)

Community Engagement Planning Health Councils review existing membership & identify additional representation for community input sessions DOH Health Promotion Teams collaborate with Health Councils & NM Alliance to gather recommendations for Health System Innovation Design Statewide standardized approach that includes flexibility to accommodate local needs NOTE: This slides repeats some of the previous slide but is worth repeating so that HCs understand role Community engagement template to be developed by NM Alliance and shared with HPT & HCs – to include: Suggested focus questions; Options for gathering input from which HCs can choose most appropriate to their needs; Standard format for recording input and sending it back to SH Committees; Logistical considerations, etc.

Community Engagement Planning Overall Goal: To provide recommendation on proposed innovation design Question to consider: “Does the proposed design achieve the Triple Aim in your community?” NM Alliance of Health Councils & DOH Health Promotion Teams collaborate to assist HCs with input session format, materials, process, and agenda Succeeding sessions to provide recommendation to the design Assistance to NM Alliance and HCs from DOH OPA and HP Managers will be provided regarding expected deliverables, i.e., focus questions for engagement sessions, process for coming to consensus, template for providing report to Stakeholder Committees, etc. Materials will be distributed and discussed with HP Managers in June.

Get Ready Identify three dates & locations for the community engagement sessions during July 1 - October 5, 2015 Review existing Health Council membership to ensure widest possible input Identify list of invitees (Individuals & Organizations) & begin to distribute “save the date” notices Materials, templates, and more information will be available in June After Summit on May 19, some details may change. However, overall deliverables and dates will remain.

Preliminary Community Engagement Plan Outline GOALS:   Ensure maximum input and engagement in the Health System Innovation planning process by New Mexico counties and tribal communities Develop community health planning processes that will benefit communities, resulting in increased understanding of: Community assets Community health needs, gaps, issues Locally identified health priorities Stakeholder involvement strategies Prepare communities for possible participation in a SIM Implementation Phase To give you an idea of what kinds of questions you’ll be asking of community members… (This is a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Stages of Community Engagement 1. Orientation to the NM Health System Innovation planning process: Power Point presentation to health councils and community groups Discussions of strategies for involvement of all sectors and stakeholders Preliminary discussions of the kinds of input being sought   To give you an idea of what kinds of questions you’ll be asking of community members… (This is a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Stages of Community Engagement 2. Development of methods for community/stakeholder engagement: Identification of sectors currently represented on health councils Identification of sectors & stakeholders who should be at the table Methods for reaching & engaging community stakeholders: Expanded health council meetings Regional, multi-council meetings Focus groups Other community coalitions, networks Community surveys Other potential groups: e.g., community coalitions, volunteer groups, schools, business groups, faith communities, advocacy groups   To give you an idea of what kinds of questions you’ll be asking of community members… (This is a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Stages of Community Engagement 3. Community Input: Identify information to be gathered prior to development of design 4. Community Input: Responses to proposed design   To give you an idea of what kinds of questions you’ll be asking of community members… (This is a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

This is a draft of the form that brings all those questions together. (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Community Input Information Framework Research Questions: How can the Triple Aims be achieved in your community? How do each of the factors below help or hinder achieving the Triple Aim? The primary “research” questions… (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Aims & Objectives 1. Improve Population Health: Integration of population health, prevention, & primary care Address social determinants of health Create environments that offer health choices First of the “triple aims” with related objectives. (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Aims & Objectives 2. Enhance Patient Experience of Care: Patient-centered care Integration of primary care, behavioral health, & oral health Chronic disease management Access, health care workforce development Second of the “triple aims” with related objectives. (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Aims & Objectives 3. Reduce Health Care Costs: Reform payment systems Increase health insurance coverage Expand health information technology Third of the “triple aims” with related objectives. (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Factors that Help/Hinder Achieving the Triple Aim Environmental (Geographic, social & cultural factors) Current Strengths, Resources Community Needs/Gaps/Barriers Health Priority Areas Potential Solutions These are the questions/factors in the columns… (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

Again…The draft of the form that brings all those questions together Again…The draft of the form that brings all those questions together. This provides a way of organizing the feedback that we get from our communities so that it can more easily be compiled for presentation to the Stakeholder/Steering Committees. (This is all from a preliminary outline of a framework for community engagement from the NM Alliance of Health Councils.)

The project described was supported by Funding Opportunity Number CMS-1G1- 14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.  The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.