The State Innovation Model National Efforts to Transform Health Care in Iowa 100 E. Grand Ave., Ste. 360 Des Moines, IA Office: Fax:

Outline the Iowa SIM project objectives in healthcare transformation Describe the different health care stakeholders Summarize the role and commitments for synergy of the stakeholders in execution of the SIM project Objectives

Healthier Communities Cost and Sustainability Better Health Care Three-Part Aim

Public Health Providers Payers Healthier Communities Cost and Sustainability Better Health Care Three-Part Aim

Public Health Providers Payers Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Healthier Communities Cost and Sustainability Better Health Care Three-Part Aim

Public Health Providers Payers Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Healthier Communities Cost and Sustainability Better Health Care Population based, Community Applied Three-Part Aim

Focus on Harm Reduction and Care Coordination Continue the Partnership for Patients aims Reduce preventable harm by 40% Reduce 30 day readmissions by 20% Expands into some new topics (Sepsis, C-Diff., Radiology overuse, Worker safety) Community platform for care coordination with admission, discharge and transfer focus Hospital Engagement Networks (HENs) 2.0

Hospital Engagement Network (HEN)* Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Falls Pressure Ulcers Obstetrics HAI Cardiovasc. VTE Alignment of Federal Program Investments in Iowa

“HEN for Docs” Enhance outpatient skill in population-based care to “thrive in value-based reimbursement” Five Phases of Transformation Iowa PTN (Compass PTN) is a multi-state application with rural focus Aligns content and strategy with SIM and Medicaid Modernization process Transforming Clinical Practice Initiative (TCPI)

Transforming Clinical Practice (TCPI)* Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Asthma Cardiovasc. VTE Prevention (Tobacco, Obesity) Diabetes Alignment of Federal Program Investments in Iowa

Development and testing of state-led, multi-payer health care service delivery and payment models Balanced approach…ACO/MCO Preparing communities to thrive under a value- based reimbursement world. State Innovation Model (SIM)

Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Obstetrics HAI Social Determinants of Health Prevention (Tobacco, Obesity) Diabetes Alignment of Federal Program Investments in Iowa

Hospital Engagement Network (HEN)* Transforming Clinical Practice (TCPI)* State Innovation Model (SIM) Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Falls Pressure Ulcers Obstetrics HAI Social Determinants of Health Asthma Cardiovasc. VTE Prevention (Tobacco, Obesity) Diabetes Alignment of Federal Program Investments in Iowa March 3, 2015

Hospital Engagement Network (HEN)* Transforming Clinical Practice (TCPI)* State Innovation Model (SIM) Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Falls Pressure Ulcers Obstetrics HAI Social Determinants of Health Asthma Cardiovascular VTE Prevention (Tobacco, Obesity) Diabetes Population based, Community Applied

Population-based, Community applied

Cardiovascular and Stroke (2008) Healthcare-associated Infection (2009) Palliative Care-IPOST (2012) Obstetrics (2013) Diabetes (June 2015) Medication Safety (July 2015) Statewide Strategies

Diabetes Social Determinants of Health Clinical Focus (What) Operational Focus (How) Community Care Coordination Patient and Family Engagement Medication Safety and Effectiveness Obstetrics Tobacco Obesity HAI State Innovation Model (SIM) Clinical Improvement

Diabetes Social Determinants of Health Clinical Focus (What) Operational Focus (How) Community Care Coordination Patient and Family Engagement Medication Safety and Effectiveness Obstetrics Tobacco Obesity HAI State Innovation Model (SIM) Clinical Improvement

Why is Leveraging Social Determinants of Health Important? Source: Slide from Dr. Bezold PhD, Chairman and Senior Futurist, Institute for Alternative Futures (IAF), Alexandria, Virginia

Public Health Providers Payers Care Coordination Medication Safety Patient and Family Cost and Sustainability Provider Improvement Healthier Communities Cost and Sustainability Better Health Care Three-Part Aim