1. STATE INNOVATION MODEL: EMERGING PROFESSIONS LEARNING COMMUNITY PAYMENT UNDER CARE REFORM DECEMBER 2, 2015 NORTH MEMORIAL (Terrace Mall)

2. AGENDA  1:00 pm Welcome, Purpose of the Event, Introduction of Speakers – Joan Cleary (MNCHWA)  1:10 pmState Perspective: Heather Petermann, from Health Care Delivery & Payment Reform at Minnesota Department of Human Services  1:30 pmCommunity Paramedic Perspective: Jason Rusinak from North Collaborative Care at North Memorial Health Care  1:50 pm Community Health Worker Perspective: Joan Cleary, from MNCHWA  2:10 pmPayer Perspective: Ken Bence, Medica  2:40 pmMove to Action  2.55 pmWrap Up

3. ILLUSTRATION FROM PANELISTS  Heather Petermann, Manager of Health Care Delivery & Payment Reform at Minnesota Department of Human Services  Jason Rusinak, Manager of North Collaborative Care at North Memorial Health Care and Ambulance Services  Joan Cleary, Executive Director at Minnesota Community Health Worker Alliance  Ken Bence, Director of Public Health at Medica

4. HEATHER PETERMANN MN DEPARTMENT OF HUMAN SERVICES DECEMBER 2015 Integrated Health Partnerships Minnesota’s Medicaid ACOs

5. Continuum of Integrated Care Models and Features Measurement Success Indicators Data capturing & sharing Improved clinical processes Improved outcomes (costs down, patient experience up) Payment $15-service $5– quality Metrics/ Evaluation Some MU core set; some adult/child core sets measures Practice measurement changes and process measures that will lead to outcomes improvement Clinical processes and new benchmarks informed by data collection; benchmarks adjusted for continuous improvement Improved care outcomes, not volume; patient experience Process measures indicate improved care in future, yield data collection for policy development and baseline Care Models Possible bonus pool $5-service Made to individual PCP; fixed $ amount Made to individual providers or entity; upfront $, savings & FFS Made to entity; $ based on savings Full ICMs Population-Focused Individual Service-Focused Population health, functional status, total cost of care Little/No Accountability for Quality and Cost Outcomes Significant Accountability for Quality and Cost Outcomes PCC FFS Only PCCM Plus P4P PCMHPCMH + Health Home Network of PCMH ACOs Comprehensive ACOs Other ICMs $10-service $10– Quality/savings $15– Quality/savings Examples Oklahoma PCMH Missouri PCMH HH North Carolina CCNCs Colorado RICOs Minnesota ACOs Oregon CCOs Source: Centers for Medicare & Medicaid Services (CMS)

6. What is an Accountable Care Organization (ACO)? A group of health care providers with collective responsibility for patient care that helps coordinate services – deliver high quality care while holding down costs Creates an incentive through payment structures for providers to efficiently and effectively manage the full spectrum of care a patient receives throughout the care system There are a variety of ACO models, many with flexibility in their structure, payments and risk assumptions

7. Impetus for Accountable Care Organizations Impetus for ACOs Desired Outcomes Develop payment approaches to create incentives for value not volume Shift risk and rewards closer to point of care to foster local accountability Realize return on federal and state investments Improve access to care, outcomes and information for the enrollee Value = Better Quality + Lower Cost/“The Triple Aim” Integrated prevention, wellness, and community services Coordinate care across care cycle Data to monitor utilization, compare and share locally and across states New reimbursement structures, including incentives that encourage integrated care models Slide provided by Center for Health Care Strategies (CHCS)

8. IHPs authorized in 2010 by Minnesota Legislature Allow for broad flexibility and innovation under a common framework of accountability – away from incentive “to do more” IHPs voluntarily contract under two options Integrated or Virtual Framework of accountability includes:  Established provider requirements (delivery primary care, coordinate with specialty providers and hospitals, demonstrate ways they partner with community organizations and social service agencies)  Payment based on accountability for, total cost of care (TCOC)  Robust and consistent quality measurement Integrated Health Partnerships (IHP) Background and Goals

9. Existing provider payment persists Gain-/loss-sharing payments made annually based on risk-adjusted TCOC performance, contingent on quality performance. Medicaid recipients (MA, MN Care, SNBC) across both FFS and all managed care organizations Core set of services included in TCOC; IHP may elect to include additional services Performance compares each IHP’s base year TCOC (year prior to start of demo) to subsequent years. How are IHPs Accountable? Total Cost of Care (TCOC)

10. How do we calculate TCOC shared savings? Total Cost of Care (TCOC) target (risk adjusted, trended) is measured against actual experience to determine the level of claim cost savings (excess cost) for risk share distribution GAIN: Savings achieved beyond the minimum threshold are shared between the payer and delivery system at pre- negotiated levels LOSS: Delivery system pays back a pre- negotiated portion of spending above the minimum threshold

11. Quality Measurement Performance on quality measures impacts the amount of shared savings an IHP can receive; phased in over 3-year demo  Year 1 – 25% of shared savings based on reporting only  Year 2 – 25% of shared savings based on performance  Year 3 – 50% of shared savings based on performance Core set of measures based on existing state reporting requirements – Minnesota’s Statewide Quality Reporting and Measurement System Core includes 7 clinical measures and 2 patient experience measures, totaling 32 individual measure components – across both clinic and hospital settings  IHPs have flexibility to propose alternative measures and methods Each individual measure is scored based on either achievement or year- to-year improvement

12. IHP Participation 204,119

13. IHPGeographic areaSize (# Attributed) Bluestone Physician Services (V)Minneapolis/St. Paul~1,000 CentraCare (I)Central MN, N of Mpls/SP19,712 Children’s Hospital (I)Minneapolis/St. Paul18,724 Courage Kenney (Allina Health) (V)Minneapolis/St. Paul1,699 Essentia Health (I)Duluth/NE MN37,482 FQHC Urban Health Network (10 FQs) (V)Minneapolis/St. Paul27,715 Hennepin Healthcare System/HCMC (I)Minneapolis/St. Paul30,000 Lake Region Healthcare (I)West Central MN3,833 Lakewood Health System (I)Central MN3,953 Mankato Clinic (V)Mankato8,564 Mayo Clinic (I)Rochester/SE MN5,239 North Memorial (I)Minneapolis/St. Paul4,696 Northwest Health Alliance (Allina/HealthPartners) (I)Minneapolis/St. Paul16,053 Southern Prairie Community Care (V)Marshall/SW MN24,385 Wilderness Health (V)NE MN10,664 Winona Health (I)Winona/SE MN4,410

14. Results to Date In 2013 the first six participating providers saved $14.8 million compared to their trended targets.  All beat their targets and met quality requirements; 5 received shared savings payments  $6 million in total payments, ranging from $570,000 to $2.4 million. 2014 interim TCOC savings estimated at $61.5 million.  All 9 providers to receive shared savings settlements – up to $22.7 million in total.  For 2014, a quarter of each IHP’s shared savings is dependent on quality measurement to be calculated with final settlement.

15. Role of Emerging Professions Use of Community Paramedics and Community Health Workers are examples of the innovative approaches that flexible payment models are intended to encourage Several IHPs have credited use of emerging professions in their care coordination efforts, improving patient engagement and reaching goals at reducing readmissions

16. What’s Next? Incorporate provider feedback to develop advanced model track Explore Medicare/Medicaid Integrated ACO model for under 65 duals Emphasis on integration of acute care and other care settings, behavioral health, and home and community based services/social services Support ACO strategies toward more community responsibility for health/accountable communities for health Work with new health financing taskforce on state purchasing reform and planning related to waiver options under the ACA to align requirements across affordability programs.

17. ILLUSTRATION FROM PANELISTS  Heather Petermann, Manager of Health Care Delivery & Payment Reform at Minnesota Department of Human Services  Jason Rusinak, Manager of North Collaborative Care at North Memorial Health Care and Ambulance Services  Joan Cleary, Executive Director at Minnesota Community Health Worker Alliance  Ken Bence, Director of Public Health at Medica

18. Community Paramedic Payment Reform December 2 nd,2015 Terrace Mall- North Memorial

19. Improving Care, Health & Cost  Effective Community Paramedic programs inherently support the Triple Aim framework to optimizing health system performance

20. Primary Care Focus PROVIDERS ARE UNDER INCREASED PRESSURE TO CONTROL COSTS Reduce ED utilization Reduce admissions and readmissions Expand primary care Encourage health care home usage for complex patients Community benefit plan - broad goals to improve population health

21. The Value of CP in Accountable Care Enabling Legislation, Credentialing Reimbursable CP Practitioner Services Identified Implementation – Stakeholders ED Utilization Hot Spotting Patient Primary Care Plan, Medical Home ● ● Linking Primary Care & EMS

22. CP: ACOs How ACOs work  Doctors, hospitals, and other health care providers who volunteer to work together in an ACO are able to access medical records to help coordinate care.  Providers also receive data from Medicare (medical history, medical conditions, prescriptions, medical visits) to be better able to improve care and manage financial risk.  When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.  Several models of ACOs exist across the Country…

23. Health Care Financing Models  Fee-for-service payment is reimbursement for specific, individual services provided to a patient.  This model involves payment for specified care coordination services, usually to certain types of providers. The most typical example of this is the medical or health care home model whereby the medical home receives a monthly payment in exchange for the delivery of care coordination services that are not otherwise provided and reimbursed.  Pay for performance can be defined as a payment or financial incentive (e.g. a bonus) associated with achieving defined and measurable goals related to care processes and outcomes, patient experience, resource use, and other factors.  Episode or bundled payments are single payments for a group of services related to a treatment or condition that may involve multiple providers in multiple settings.  The comprehensive care or total cost of care payment model involves providing a single risk-adjusted payment for the full range of health care services needed by a specified group of people for a fixed period of time.

24. Hospital Stars Rating  The healthcare industry is under intense pressure to boost the transparency of quality data and provide information consumers can use to make more informed decision about their care.  CMS first applied star ratings in 2008 to nursing homes. Last year, the agency rolled out similar programs for home health providers, large group practices and dialysis facilities.  The survey asks patients about factors such as the responsiveness of hospital staff to their needs, the quality of care transitions and how well information about medications is communicated. The survey is sent out within a few days of discharge. It also asks the patient about the cleanliness of the hospital and whether the patient would refer the hospital to others.

25. Why a Hospital would use a CP  Hospitals are at risk for up to 4.5% of their total Medicare payments based on readmissions (3%) and value-based purchasing (VBP) measures (1.5%). All-cause readmissions are measured for patients discharged with MI, heart failure and pneumonia diagnosis related groups (DRGs). In October 2014, COPD and hip and knee replacements were added to the list of DRGs. The three-year trend for most hospitals has seen increasing readmission penalties.  CMS added the metric of Medicare spending per beneficiary (MSPB). This evaluates the average spent by Medicare for the three days preadmission, during the inpatient stay and for 30 days post discharge. If the MSPB is higher than the state or national average, the hospital may face additional financial penalties. For some hospitals, the financial incentive to reduce high readmission penalties may outweigh the actual payments they receive for the admission.

26. Partners for EMS in the CP World  Integrated Health Care Systems  Home Health Care  Hospice  Hospitals and Payers trying to control utilization  Long Term Care

27. Engaging Potential CP Payers  The realignment of fiscal incentives within the healthcare system has created an environment that encourages providers and payers to work together to right-size utilization.  Providers and payers are often unaware of the true value EMS agencies can bring to their patients through proactive and innovative patient navigation services.  To work in the new environment, you need to become well-versed in healthcare finance, specifically as they relate to the partners to whom you’ll be proposing. Be sure you know things like readmission rates and penalties, value-based purchasing penalties, HCAHPS scores, MSPB and other motivating factors you can use to help build the business case for your CP program.

28. ACO: CP Value MEDICARE ACO MEDICAID ACO  Withholds  ER 5%  Medical Home-Care coordination payments for managing complex chronic conditions  Improve financially on Medical Assistance reimbursement  Avoid Withholds  Increase Patient Satisfaction Scores  Quality Measures  Reduce avoidable readmissions  Opportunity to share in the savings produced Opportunities for CP to impact the ACO achievement of Triple Aim Goals: Improved Patient Care, Enhanced Patient Experience, Reduced Cost of Care

29. North Memorial CP Medicaid Demo High-risk patients served by North Memorial are getting home visits from community paramedics, who help them avoid the emergency room by providing care in coordination with their doctor’s offices and clinics. North Memorial uses data from the Department of Human Services to identify those who are most at risk and includes them in its groundbreaking community paramedic program. Bonus Payments of: $800,000, $1.5 million in year 2.

30. Initial Data Review-Population

31. Questions Contact: Jason Rusinak Jason.Rusinak@NorthMemorial.com

32. ILLUSTRATION FROM PANELISTS  Heather Petermann, Manager of Health Care Delivery & Payment Reform at Minnesota Department of Human Services  Jason Rusinak, Manager of North Collaborative Care at North Memorial Health Care and Ambulance Services  Joan Cleary, Executive Director at Minnesota Community Health Worker Alliance  Ken Bence, Director of Public Health at Medica

33. Payment Under Health Reform Opportunities and Outlook for Community Health Worker Programs SIM Emerging Professions Learning Community December 2, 2015 Joan Cleary, M.M., Executive Director Minnesota Community Health Worker Alliance

34. Presentation Outline Background and Context Current Payment Payment Models Considerations

35. About the Alliance We’re a broad-based partnership of CHWs and stakeholder organizations, governed by a voluntary nonprofit board. \ www.mnCHWalliance.org Our Vision Equitable and optimal health outcomes for all communities Our Mission Build community and systems’ capacity for better health through the integration of community health worker strategies

36. What are we trying to accomplish? Adapted from NM Department of Public Health presentation Full Integration of CHWs in MN Systems of Care Reduce Health Inequalities Advance Triple Aim

37. CHW Definition A Community Health Worker (CHW) is a trusted frontline health professional who applies his or her training and unique understanding of the experience, language and/or culture of the populations he or she serves in order to carry out one or more of the following roles: Providing culturally-appropriate health education, information and outreach in a variety of settings such as homes, clinics, hospitals, schools, shelters, local businesses, and community centers; Bridging/culturally mediating between individuals, communities and health and human services, including actively building individual and community capacity; Assuring that people access the services they need; Providing direct services, such as informal counseling, social support, care coordination and health screening; and Advocating for individual and community needs.

38. American Public Health Association Community Health Worker Definition “ A community health worker (CHW) is a trusted public health worker who is a member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. ”

39. Who is a CHW? Adapted discussion tool used with permission by the CHW Initiative of Sonoma County, CA.

40. CHWs are uniquely equipped to advance health equity and the Triple Aim Reducing Ethnic/Racial Asthma Disparities in Youth (READY) For more information, visit: successwithchws.org/asthma They typically reside in the communities they serve, and share the same language; ethnic, cultural and educational background; and/or life experience. Adapted from NM Department of Public Health presentation

41. An Emerging Workforce Adapted from NM Department of Public Health presentation. Tribal CHRs Lay Health Advisors Promotores(as) Patient Navigators Community Health Advocates CHWs Community Educators Care Guides Outreach Workers

43. Recognized by Leading Public and Private Authorities American Public Health Association (APHA) Centers for Disease Control (CDC) Center for Medicare and Medicaid Services (CMS) Community Preventive Services Task Force Health Affairs Health Resources and Services Administration (HRSA) Institute of Medicine (IOM) Institute for Clinical and Economic Review (ICER) U.S. Dept. of Labor Standard Occupational Classification (DOL)

44. What are We Learning from Recent CHW Studies on Return on Investment? 3 1 Net Return Carl Rush, “CHWs: A National Perspective,” Indiana CHW Coalition Community Symposium, 10/15/2012

45. Minnesota CHW Building Blocks Scope of Practice Statewide Standardized Competency Based Curriculum Payments Under Minnesota Health Care Programs

46. Current CHW Coverage under Minnesota Health Care Programs (MHCP) Specific to diagnostic-related patient education services Face-to-face services, individual and group, FFS & PMAP Signed order for patient education in patient record Standardized patient education curriculum consistent with established or recognized health or dental care standards Provide service with clinical supervision in clinical setting, home or community; document services provided Alliance & partners seeking coverage improvements in follow- up to 2007 statute; monthly cap raised to 12 hrs/mo and increase in group size for patient education expected in 2016 For more on coverage, contact: Susan.Kurysh@state.mn.us Visit: http://successwithchws.org/mental-health/2014/12/23/community-health-worker- enrollment-coverage-and-payment-under-minnesota-health-care-programs/

47. Provider types authorized to bill for CHW services under MHCP Advance Practice Nurses Certified Public Health Nurses in a unit of government Clinics Dentists Family Planning Agencies Hospitals IHS and Tribal Health Facilities Mental Health Professionals Physicians

48. Strengths Includes both 1:1 and group education Covers patient education in different settings including home and community Allows many provider types to order and supervise CHW services Benefit for both FFS and managed care enrollees MN is one of only several states with Medicaid coverage of CHW services through a state plan amendment

49. Limitations Covers single function of broader CHW role Monthly cap Rate Encounter-based Leaves out FQHCs and community-based CHW employers

50. Provider Experience Where CHW programs are seeded in provider organizations, they take root and often grow (e.g. HCMC, HealthEast) Many Medicaid-eligible CHW employers are not as yet using MHCP funding for a variety of reasons Challenges with both FFS and managed care claims payment Current coverage does not support CHW services provided by FQHCs and community-based CHW employers

51. National Trends: Growing interest in CHW Workforce and Sustainable Financing Federal Level: CMS Work Group on CHW Care Coordination CMS rule change proposed in May 2015: CHW services may be counted as cost of “quality improvement” or “cost control” efforts and therefore not administrative State Level: FL, ME, MA, MI, MD, OR, NV, SC, TX, VT, UT For more info: State Reforum website: https://www.statereforum.org/weekly- insight/community-health-workers-in-a-reformed-healthcare- system National Academy for State Health Policy website for national map of state CHW models including financing and legislation: http://www.nashp.org/state-community-health-worker-models/

52. State Spotlight: Michigan Medicaid Contractor must provide or arrange for the provision of CHW or peer support specialist services to enrollees who have significant behavioral health issues and complex physical co- morbidities who will engage with and benefit from these services Contractor agrees to establish a reimbursement methodology for outreach, engagement, education and coordination services provided by CHWs or peer support specialists to promote behavioral health integration Contractor must maintain a CHW to Enrollee ratio of at least one FT CHW per 20,000 Enrollees

53. State Spotlight: NM Medicaid Medicaid contracts must encourage use of CHWs for care coordination MCO contractors required to describe CHW role in providing patient education MCO contractors must include CHW services in list of services in Medicaid benefit package CHW care coordination services are factored into the cost of services State has waiver to cover CHW care coordination

54. Examples of Evidence-based CHW Models Molina Health, New Mexico Reduced ER utilization Pathways Community HUB, Ohio and under replication Improved birth outcomes, chronic conditions & other benefits Sinai Pediatric Asthma Intervention, Illinois Improved child asthma management, reduction in asthma symptoms and ER use GRACE Model, Indiana, and IMPaCT, University of Pennsylvania Reduction in hospital readmission rates and improved post-hospital outcomes Arkansas Community Connectors Program Averted nursing home placement

55. Payment Models Higher Risk – Greater Provider Integration and Accountability Accountable Care Models Capitation and PBC Shared Risk Shared Savings Centers of Excellence Bundled/Episode Payments Performance-Based Arrangements Performance-Based Contracts (PBC) Primary Care Incentives FFS

56. “Are we there yet?”

57. Payment reform + transformation in health systems 20 th c health system will not get us there…CHW services integral to culturally-competent, equitable and accountable health model

58. Bridging Strategy Community Health Worker programs need to work in a variety of financing contexts. Shreya Kangovi, MD, MS U Penn Center for CHWs

59. Next Steps (1) Seek coverage for CHW Care Coordination Statutory authority Major CHW function and core competency Strong interest by CHW employers Opportunity to move away from encounter-based payment Door is open (2) Improve CHW enrollment process and claims payment (3) Create CHW Awareness Campaign (4) Launch CHW Leadership Development Pilot

60. Challenges and Opportunities Drivers of CHW Integration Increasingly diverse and rapidly aging population ACA increasing access to thousands of previously uninsured with projected primary care shortage Focus on Triple Aim and team-based care Payment shift from fee-for-service to value-based purchasing and total cost of care Incentives and penalties under health reform Greater emphasis on performance measurement and reporting by race, ethnicity, preferred language and country of origin, statewide and by region Health equity growing in priority Recognition of the impact of social determinants of health

61. CHWs Address the Social Determinants of Health Adapted from Dahlgren and Whitehead, 1991

62. For more information, please contact Joan Cleary, M.M., Executive Director Minnesota Community Health Worker Alliance joanlcleary@gmail.com www.mnCHWalliance.org www.successwithCHWs.org/asthma www.successwithCHWs.org/mental-health Thank you!

63. ILLUSTRATION FROM PANELISTS  Heather Petermann, Manager of Health Care Delivery & Payment Reform at Minnesota Department of Human Services  Jason Rusinak, Manager of North Collaborative Care at North Memorial Health Care and Ambulance Services  Joan Cleary, Executive Director at Minnesota Community Health Worker Alliance  Ken Bence, Director of Public Health at Medica

64. Date s Payment Under Care Reform: Emerging Professions Community Health Workers & Community Paramedics Kenneth Bence, M.H.A., M.B.A. Director of Public Health

65. About Medica Full service insurer Primary service area includes MN, ND, SD, WI Second largest health plan in the state overall and in public programs 1.5 million members total; 200,000 in public programs Ranked 18 th best Medicaid health plan in the US by NCQA/Consumer Reports, #1 in Minnesota Long history of quality improvement work Strong public health orientation

66. You belong. Medica’s Programs and Value-add Services

67. Medica: How we are different You belong. Comprehensive and innovative behavioral health and chemical dependency support for members 24/7 The only health plan that has social services coordinator positions Largest, open access network of providers - 96% of providers are in our network

68. Medica’s Key Messages Medica SPP truly believes its members deserve a better healthcare experience. An experience that not only treats each member as the important individual they are, but also one that grows with them as their life and needs continually change. Medica SPP’s coverage and service offerings are always designed with the member’s needs in mind. You belong to a health plan that is on a mission to become the best plan for you.

69. What Makes Medica, Medica? We are listening to the needs of our members, partners and stakeholders. And, we are making changes based on what we hear to make sure they feel confident and understood. We believe that our relationships with members and stakeholders are unique. What works with one, doesn’t with everyone. We get that. Our commitment to the community is long-lasting and sincere. We invest in members and the health of their communities because it makes a difference; today and tomorrow.

71.  Health Plans Minnesota’s Healthcare Landscape  Hospitals & Health Systems A system of NON-PROFIT payers (BY LAW) & provider systems All licensed health plans MUST participate in state healthcare programs, BY LAW, and produce public health collaboration plans every 5 years All Medica providers MUST participate in all product lines, BY CONTRACT A system of NON-PROFIT payers (BY LAW) & provider systems All licensed health plans MUST participate in state healthcare programs, BY LAW, and produce public health collaboration plans every 5 years All Medica providers MUST participate in all product lines, BY CONTRACT Collaboration is “in the water” County-Based Purchasing © 2015

72. Insurance Trends in Minnesota 20032004200520062007200820092010201120122013 Public:25.3%25.6%25.8%25.9%25.8%26.4%27.5%28.8% 30.1%30.5%31.0% Medicare13.4%13.5%13.7%13.9%14.0%14.3%14.6%14.8% 15.0%15.5%16.0% Medical Assistance 7.2%7.5%7.7%7.9%8.0%8.4%9.1%9.7% 11.2%11.5% MinnesotaCare3.0%2.8%2.6%2.4%2.2% 2.3%2.6% 2.7%2.3%2.4% GAMC0.7% 0.4% 0.5% 0.0% TriCare1.1% 1.0%1.1% 1.2%1.1% Private:67.6%66.7% 67.0%66.3%63.4%62.0% 60.8% Fully Insured28.4%27.8%28.0%27.8%27.2%27.1%25.5%24.2% 23.3%23.1% Self-Insured39.1%38.9%38.6%39.0%39.8%39.3%37.9%37.8% 37.5%37.7% Uninsured7.2%7.7%7.5%7.4%7.2%7.3%9.0%9.2% 9.1%8.7%8.2% Total100% Distribution of Minnesota Population by Primary Source of Insurance Coverage, 2003 to 2013 Source: MDH, Health Economics Program, Oct. 2015

73. Mandated Benefit Set Under the Affordable Care Act (ACA), health plans must cover ten benefit categories called Essential Health Benefits (EHB) 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care

74. State Reform  Statewide Health Improvement Program (SHIP) - Obesity/overweight - Tobacco use  Health Care Homes  Quality, Cost and Payment Reform - Quality measures - Provider peer grouping - Baskets of care - Health Care Delivery System demonstrations (ACOs) - State Innovation Model (SIM) grant

75. The Emerging Professions You belong.

78. Minnesota Community Measurement Dedicated to accelerating improvement of health by publicly reporting health care information Idea was born in 2000 High degree of variation in quality, measurement Started as an initiative of Minnesota’s health plans, aggregate their data Added Minnesota Medical Association as a partner, later Minnesota Hospital Association First report in 2003 Diabetes Optimal care (D5) Community alignment 501(c)(3) formed in 2005 Direct Data Submission - 2006 Disparities Report – 2007 SQRMS – 2008 Health Equity Report - 2015 Continuous evolution MNHealthScores.org

79. An Emerging Workforce Adapted from NM Department of Public Health presentation. Tribal CHRs Lay Health Advisors Promotores(as) Patient Navigators Community Health Advocates CHWs Community Educators Care Guides Outreach Workers

80. Address the Social Determinants of Health Adapted from Dahlgren and Whitehead, 1991

81. Medica Innovations  First Total Cost of Care (TCOC) arrangement in the state, other ACOs  First private insurance exchange in the US  First plan to offer transportation, language lines, social service coordinators, mobile dental services, gift card incentives to Medicaid enrollees  Medica Foundation and Delta Dental of MN Foundation grants to improve access to preventive services, with focus on oral health, early childhood health, behavioral health and greater MN  Clinical pilots  Integrated Care by Medica  Integra Service Connect  Integrated Care Coordination  Healthy Savings Program  Medica Mobile

84. Contact Information Kenneth Bence Director of Public Health State Public Programs Division Medica PO Box 9310, CP-340 401 Carlson Parkway Minneapolis, MN 55440 952-992-8380 Kenneth.bence@medica.com @KenBence

85. MOVE TO ACTION  What did you hear that was most compelling, surprising, or interesting to you?  Based on what you learned from today, what new idea could you or your agency adopt or adapt to, around payment?  What do you see as the most pressing payment issue going forward?

86. UPCOMING EVENTS DateLearning TeamTimeLocation February 3Closing Event1 – 3 PMTBD

87. THANK YOU!