1. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. 1

2. Michigan’s Approach to the State Innovation Model Connecting Michigan for Health June 8, 2016 2 Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life.

3. Agenda Vision and Overview Goals and Objectives Strategic approach for roll-out Update and Timeline 3

4. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Vision and Overview Our vision is a system that coordinates care within the medical system to improve health outcomes, and link with community resources to address the social determinants of health. 4

5. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Vision and Overview 2013 Developed conceptual framework for healthcare payment and delivery system transformation: Michigan’s Blueprint for Health Innovation. 2014 Submitted Blueprint and developed funding proposal for testing implementation of the concepts in the Blueprint. 2015 Received 4-year award for planning and implementing healthcare payment and delivery system reform. 5

6. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Vision and Overview With the Blueprint for Health Innovation as our vision, we developed strategies and priorities that would account for our partners and move Michigan towards that vision Michigan’s State Innovation Model (SIM) project will be a simultaneous effort of: Putting payment policies, measurement infrastructure, and key investments into place. Developing a coordinated communication and committee process that assesses these policies and investments with our partners on an ongoing basis. 6

7. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Strategies Patient Centered Medical Home Community Health Innovation Region Accountable System of Care Health Information Exchange/Health Information Technology Collaborative Learning Network Stakeholder Engagement Committee Structure 7

8. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Goals and Objectives Patient Centered Medical Home (PCMH) Our goals are to support the existing PCMH foundation in our State; and support the increase of PCMH adoption. Introducing and testing more performance-based measurement and payment. Developing policies to broaden elements such as the level of flexibility for PCMH eligibility and staffing for their medical or community-based teams for providing care. 8

9. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Goals and Objectives Community Health Innovation Region (CHIR) Leverage well-developed, existing capacity in communities to bring partners together in a local area to identify and address community health needs. CHIRs will develop and implement linkages between healthcare and community-based agencies to address social determinants of health. CHIRs will pursue local policy and built environment efforts; and other services to encourage health and wellness. Our vision is to achieve a high level of organization and sophistication in terms of governance, partnership, data collection and information sharing, and integrated service delivery. 9

10. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Goals and Objectives Accountable Systems of Care (ASC) ASCs are a group of primary care providers and other key providers that agree to work together to improve health outcomes and contain costs by leveraging the PCMH effort to coordinate care across patient populations. Testing the benefits of supporting groups of providers in sharing information, understanding their patient population, and providing the right team-based and community-based care to address their patients’ needs. 10

11. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Regional Roll Out Strategy Fund development and execution of local health improvement plans Use existing community health needs assessments and improvement plans Designate a single backbone organization as the accountable manager Focus activities and partnerships on reducing ED utilization Allow local groups to identify and address root causes specific to their region Contain scope in a way that demonstrates value in three years Clinical-community linkage partnerships with ASCs (bi-directional) Policy and environmental change efforts Provide support to facilitate focus on SIM objectives, yet accounts for the variation across the regions and the organizations

12. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Payment Reform Strategy Pursuing the SIM Medicare Custom Participation Option for multi- payer alignment of PCMH Authorized, as a SIM State, to negotiate customized participation of Medicare in multi-payer payment model Must be a new, novel, and unique demonstration Designing system-level payment strategies to support PCMH

13. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Health Care Payment Learning & Action Network Framework 13

14. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Payment Reform Strategy Recent announcements: Comprehensive Primary Care Plus (CPC+) Potential for duplication of payment issues (ACOs and PCMHs) New bar for new, novel, and unique Medicare Access and CHIP Reauthorization Act (MACRA) Definitions for Advanced Payment Models (APMs) (Categories 3B and 4) Shared savings upside only is not an APM Medicaid managed care pass thru payment regulations (still exploring) Reassessing implications of announcements on SIM payment reform strategy Interim PCMH Payment Model Design and negotiate Medicare PCMH custom participation agreement Leveraging APM definitions at policy level

15. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Foundational Use Cases (Building Blocks) Statewide Active Care Relationship Service (ACRs) A physician-patient centric attribution that is based on declared relationships established directly from the physician or provider organizations. Health Provider Directory (HPD) A statewide directory of healthcare providers that collects demographic, contact, and electronic service information. Common Key Service (CKS) A statewide service that enhances patient matching to facilitate the exchange of health information across disparate data systems. 15

16. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Updates No Cost Extension Status of Year-One Activities Finalizing the Operational Plan 16

17. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Timeline January—May 2016: Stakeholder engagement and operational plan June—July 2016 Community Health Innovation Region (CHIR) engagement and planning Health Information Exchange/Health Information Technology planning Plan and implement interim PCMH payment model program Finalize payment reform strategy and design: Custom Medicare Participation Option for PCMH Advanced Payment Models (APMs) strategy August—December 2016 CHIR Regional plan development and review Stakeholder committee structure execution Custom Option and APM implementation planning January 2017: Execute Interim PCMH Initiative Early 2017: Execute CHIR Initiative 17

18. Putting people first, with the goal of helping all Michiganders lead healthier and more productive lives, no matter their stage in life. Thank You Tom Curtis MDHHS SIM Specialist curtist2@michigan.gov 18