Landgraf CSG ERC

7/23/2019 Landgraf CSG ERC

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Delaware Health and Social Services

Council of State Governments Eastern Regional ConferencesAnnual Meeting and Regional Policy Forum: Aug. 18, 2015

Rita Landgraf, Secretary, Delaware Department of Health and Social Services

The Impact of Health CareInnovation in Delaware


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Providerslack time andresources toproactivelycoordinate care

Health care is confusing for

Patients, and premiums are rising

Employersare facingincreasing costs, an unhealthyworkforce, and complexdecisions

faces health carecosts that consumeapproximately 25%of the state budget

The State ofDelaware


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4.3% ofadults

consideredsuicide in 2011

Health care costs consume

25%of state budget

Diabetesincidence rate of

11.1%

31.1%of Delawareansare obese

1 in 5Delawareans aresmokers

Health care costsgrowing at

6% per yearhistorically

Per capita costs

25%higher than U.S.average

More than

$8Bannual spend onhealthcare in Del


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Our Vision for 2018! All Delawareans will have a primary care provider, and it will be easy forthem to access care when they need it.

! When patients from a primary care practice need to go to the ER, theoffice will be notified on arrival or check-in (if not by the patient before).

!

Care coordination will be integrated with primary care rather than aremote system disconnected from care delivery.

! When a mother needs help caring for her child with asthma, she willknow where to turn.

! Doctors offices will be paid for care coordination in between officevisits, and rewarded for quality and efficiency of care.

! Providers will work more closely together so that patients will feel as

though the individuals caring for them, including behavioral healthproviders, are part of a team.

! Employers will be able to continue providing health insurance to their

employees.


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Governor

Department ofHealth & SocialServices

Payers and other

purchasers

Delaware HealthInformationNetwork (DHIN)

Payment ModelMonitoringCommittee

Workforce andEducationCommittee

ClinicalCommittee

DelawareCenter for HealthInnovation (DCHI)

Patient/Consumer

AdvisoryCommittee

TechnicalAdvisory Group

HealthyNeighborhoodsCommittee

Health CareCommission(HCC)

Consumers and

patientsProviders

State of Delaware

Public-private

Private sector


7/16Delaware Health and Social Services

WorkforceandEducation

! Innovative two-year learning and development program with commoncurriculum on team-based, integrated care

! Development of the health professional residency consortium

Clinical

! Transformation of primary care through Patient-Centered MedicalHomes (PCMHs) and Accountable Care Organizations (ACOs)

!

Support for primary care practice transformation & care coordination

HealthyNeighbor-hoods

!

Integration of community-based health initiatives with deliverysystem focused on priority health needs

! Scorecard, tools, data, and resources to support neighborhoods

Payment

! Multi-payer value-based payment models offered statewide: Pay-4-Value

(P4V) and Total Cost aligned with CMS models! QHP standards, Medicaid MCO RFP, & state employees driving adoption

HIT! First in the country multi-payer performance scorecard! Nationally leading HIE to enable integrated clinical and claims data

over time

Patient /ConsumerAdvisory

! Patient at center of everything Delaware does! Patient engagement tools to support individuals to engage in their

own health



Aspirations for Triple Aim

!Become 1 of the 5 healthiest

states in the U.S.!Achieve top performance forquality/patient experience

!Bring health care spendinggrowth more closely in line

with growth of economy!PLUS ONE: Achieve highprovider experience

Specific Goals Reflected in Plan

!

Create >$1 billion in total savings to thesystem through 2020

!Reinvest about half of savings in caredelivery to ensure sustainability forproviders

!

Pass about half of savings on to consumersand purchasers to preserve affordability

Goals for Adoption to Achieve Plan

!Participation by all payers: Commercial,

Medicaid, Medicare by 2016

!Participation by >70% of self-insuredemployers by 2018

!Adoption by >90% of PCPs by 2018

!Meaningful changes in capabilities/processes

Aspirationsand Goals

Total investment: $130million over 4 years



Pay for Value

Total Costof Care

Two Types of Value-Based Payment Models! Total cost of care models look at the overall spending as a

key metric, and look to reduce wasted healthcare spend

(with the savings shared between payer and provider)

! These models also have a requirement to meet quality and

patient experience goals

! Pay-for-value enables providers to earn bonuses for meetingboth a set of quality measures and managing resource

utilization

!

As a common goal, pay-for-value models look for a decreasein the growth of overall costs

Delaware is targeting to have 80% of payments and 90% of primary careproviders going through these models in the next 4 years



Work Ahead in InnovationCommon Scorecard forproviders. Measures include:

Diabetes care

High blood pressure

Screening for clinical

depression

Tobacco use

Influenza immunization

Patient hospitalizationadmissions per 1,000

patients

ER visits per 1,000 patients

Sampling of Timeline:

2015: Test and refinescorecard; begin practice

transformation; engageconsumers and providers

2016: Funding for carecoordination more widely

available; HealthyNeighborhoods initiatives

launched; workforce strategy

implemented.



30%

10%

20%

20%

10%

65%

0%

Spending

Multiple chronic

5%

Single chronic

Healthy

Severe chronic

Non-Claimants2

Population

30%

10%

Percentage of population, and spending

NON-MEDICARE, EXCLUDING LTSS1

1 LTSS: Long term services and supports of Medicaid

2 May have some associated spend (e.g. cap rates paid), however no medical claims

Source: AHRQ Chart Book, Delaware Medicaid Claims data analysis by McKinsey Health Care Value Analytics

Those focused onmaximizing ROI from care

coordination may focus onthe 10% highest-risk

patients who account for60-70% of spending.

Some may argue that well-executed care coordination

can deliver positive ROI fora broader share of the

population.10%

Segmentation of Population



INNOVATIONS IN MEDICAIDNew Ways to Serve Vulnerable Populations, Resulting in Better Outcomes



Serving Vulnerable Seniors Transitioned Medicaids long-term care

seniors to MCOs in April 2012 to better

coordinate care and supports.

Began reimbursing for telemedicine-delivered services in July 2012, including

wellness checks for individuals with

Parkinsons, telepsychiatry and hospital

trauma cases.

Partnered with St. Francis Hospital to openLIFE Center in Wilmington in 2013 under

Program for All-Inclusive Care for the

Elderly. Exploring 2ndcenter in Sussex.



Another Impact: Aging Population

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** By 2030,Delaware isprojected to

have the9th-highestproportionof peopleage 65 andolder in the

U.S.



Serving Vulnerable Populations Pathways to Employment: Brings together

state agencies, including Medicaid, to

increase options in support of low-income

individuals with disabilities who want towork.

PROMISE (Promoting Optimal MentalHealth for Individuals through Supports and

Empowerment): In additional toemployment, the goal is to improve clinical

and recovery outcomes, reduce

unnecessary institutional, and reduce

growth in overall program costs.

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