1. UPCOMING STATE INITIATIVES WHAT IS ON THE HORIZON? MERCED COUNTY HEALTH CARE CONSORTIUM Thursday, October 23, 2014 Pacific Health Consulting Group

2. INITIATIVES ON THE HORIZON  WHOLE PERSON CARE  1115 WAIVER RENEWAL  PAYMENT REFORM  SECTION 2703 – HEALTH HOMES  CalSIM

3. WHOLE PERSON CARE: What is it?  Approach to addressing vulnerable individuals’ health, behavioral health and social needs together  Coordination of health, behavioral health and social services in a patient-centered manner with the goals of improved health outcomes and more efficient and effective use of resources  Stems from social determinants of health

4. COMPONENTS OF WHOLE PERSON CARE  Collaborative leadership  Target population  Financial flexibility  Shared data  Coordination of services across sectors  Patient- centered care

5. WHOLE PERSON CARE: Why now?  Medi-Cal expansion under ACA  Expanded substance use disorder coverage  Realignment: restructured financing for counties  Expanded role of Medi-Cal managed care health plans in provision of mental health services  Coordinated Care Initiative (CCI) for dual eligibles  1115 Waiver renewal focus  State Innovation Model (CalSIM)

6. SECTION 1115 WAIVER RENEWAL  Allow states flexibility to design demonstration projects that promote objectives of Medicaid program  Typically approved for 5 years  Must be budget neutral  Current waiver ends October 31, 2015  Need to submit new proposal 6 months in advance

7. BRIDGE TO REFORM WAIVER 2010-2015  Strengthen safety net  Maximize opportunities to reduce number of uninsured  Optimize opportunities to increase federal financing to address uncompensated care  Promote long term, efficient use of state funds  Improve health care quality and outcomes  Promote home and community-based care  Included the Low Income Health Program, DSRIP, SPD transition to managed care, rural managed care transition, Healthy Families transition and other components

8. NEW 1115 WAIVER RENEWAL  Strengthen primary care delivery and access  Avoid unnecessary institutionalization and services through an integrated delivery system  Address social determinants of health  Use Medi-Cal program as incubator to test innovative approaches to whole person care  Find synergy with CalSIM and other state initiatives “The focus of the Waiver Renewal will be on improving and reforming our Medi-Cal payment and delivery systems and ensuring ongoing support for the safety net” - DHCS Concept Paper (July 2014)

9. INITIAL WAIVER RENEWAL CONCEPTS  Federal/State Shared Savings  Payment and Delivery Reform Incentives  Safety Net Payment Reforms  FQHC Payment Reform  DSRIP Successor Program  CCS Program Redesign  Shelter for Vulnerable Populations  Workforce Development

10. PAYMENT REFORM – FQHC Alternative Payment Methodology (APM)  Pilot program proposed (urban areas only)  Community health center FQHCs and County FQHCs  Transition to Medi-Cal managed care plans as payor of FQHC services  No risk = FQHCs assured reimbursment at no less than the PPS rate and plans protected from risk  Purpose: transition delivery of care at FQHCs from current volume-based system to one that better aligns financing and delivery of services

11. NEXT STEPS  Legislative authority to operate APM  Administrative approval beyond DHCS  Populations to be determined  System and operational readiness at health plans and FQHCs  Timing and duration of pilots  Choice of counties and FQHCs to participate  DATA  Rate setting

12. ACA SECTION 2703 HEALTH HOMES  Health Home optional Medicaid benefit  For intensive care coordination for people with chronic conditions  New benefit includes package of 6 care coordination services and does NOT fund direct medical or social services  90% federal match for 8 quarters (2 years) and 50% thereafter

13. 2703 SERVICES  Comprehensive care management  Care coordination and health promotion  Comprehensive transitional care  Individual and family supports  Referral to community and social services  Use of health IT, data and evaluation

14. AB 361 – enacted in 2013  Authorizes implementation of ACA Section 2703 in California – requires that DHCS implement only if no additional General Fund moneys used  Requires inclusion of specific target population of frequent users and those experiencing homelessness  For target population, program must include providers with experience serving frequent hospital/ED users and homeless members

15. CALIFORNIA STATE INNOVATON MODEL - CalSIM  California received SIM Design Grant March 2013, which supported development of State Health Care Innovation Plan  Draft Plan submitted to CMS March 2014 (often called Let’s Get Healthy California)  Up to 12 State Innovation Model (SIM) Testing Grants from $20 million to $100 million, for a total of $700 million  4 year grants (including a year of planning)  Projected start date is January 1, 2015, and grants will run through December 31, 2018  CMS Innovations Center: “The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care furnished to individuals under such titles.”

16. CalSIM PROPOSAL OVERVIEW  Plan for Population Health  4 Initiatives  Maternity Care  Health Homes for Patients with Complex Needs  Palliative Care  Accountable Communities for Health  Building Blocks  Workforce  Health Information Technology and Exchange  Enabling Authorities  Cost and Quality Transparency Database  Public Reporting  Payment Reform Incubator

17. TIMES ARE CHANGING….. INTEGRATED AND CONNECTED  The future is about population health and integration!  Time to look ahead not in the past  What are the common characteristics of these efforts?

18. MORE INFORMATION CalSIM: http://www.cchs.ca.gov/pages/pritab.aspx Whole Person Care: http://www.blueshieldcafoundation.org/sites/default/files/publications/downl oadable/Opportunities_for_Whole-Person_Care_9_2014.pdf http://www.blueshieldcafoundation.org/sites/default/files/publications/downl oadable/Opportunities_for_Whole-Person_Care_9_2014.pdf 1115 Waiver: http://www.dhcs.ca.gov/PROVGOVPART/Pages/waiverrenewal.aspx http://www.dhcs.ca.gov/PROVGOVPART/Pages/waiverrenewal.aspx Section 2703- Health Homes: http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical- Assistance/Health-Homes-Technical-Assistance/Downloads/Health-Homes- FAQ-5-3-12_2.pdf Payment Reform: CPCA Pilot Projects http://www.cpca.org/index.cfm/policy-advocacy/policy/payment-reform/ http://www.cpca.org/index.cfm/policy-advocacy/policy/payment-reform/