May 23rd Learning Session Record

Record of May 23, 2014 Healthcare Transformation Learning Session What will it take to successfully implement Ohio's Public-Private Healthcare Innovation Plan (SIM grant)?

BACKGROUND: A public-private partnership led by the Governor’s Office of Health Transformation has created a sustainable, patient-centered delivery and payment system that will be implemented over the next three to five years. During this time, the state, along with a multi-payer coalition that includes the four private payers who represent 80 percent of the commercial market and Medicaid managed care organizations will launch two models statewide: a patient-centered medical home (PCMH) model and an episode-based payment model.

RECORD of LEARNING: The Healthcare Collaborative of Greater Columbus (HCGC) hosted a regional healthcare transformation learning session with participation from 186 leaders representing business (47%), government (6%), healthcare (31%), and the social sector (16%).

Click here to view learning session packet.

Click here to listen to recording of learning session.

Welcome & Framing

Krista Stock, Healthcare Collaborative of Greater Columbus

Jeff Biehl, Healthcare Collaborative of Greater Columbus

Click here to view opening presentation slides www.hcgc.org

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Breaking News – CMS announces round two of SIM funding CMS anticipates awarding up to $700 million to fund up to 12 Model Test cooperative agreements.

Greg Moody, Director, Governor’s Office of Health Transformation

Round Two Model Test: • Applications are due: July 21, 2014 • Anticipated Award Date: Fall 2014 • Anticipated Period of Performance: January 1, 2015, to December 31, 2018.

Click here to view CMS funding opportunity announcement Sharing lessons learned from SW Ohio on implementing Comprehensive Primary Care in a multi-payer environment Discussion Panel:

Introduction:

Maria Courser, MD, Medical Director, Quality, Mount Carmel Medical Group Comprehensive Primary Care Speakers:

Richard Shonk, MD, PhD., Chief Medical Officer, the Health Collaborative

www.hcgc.org

Barbara B. Tobias MD, Medical Director, the Health Collaborative

Mark A. DiCello Regional Vice President, Network Management UnitedHealthcare

Janel D. Grover, MHA Director, Ambulatory Services, The Ohio State University Wexner Medical Center

Sarah M. Durfee, RN, Clinical Programs Officer, Ohio Public Employees Retirement System

Click here to view Comprehensive Primary Care presentation slides Please see attachment for reflections from audience.

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Sharing lessons learned on implementing episode-based payments in a multi-payer environment Introduction:

Bruce Wall, MD, Medical Director, OSU Health Plan

Episode-Based Payment Speaker:

Discussion Panel:

Greg Sawchyn, MD, MBA, Senior Director Clinical Guidance Councils, OhioHealth

Lisa Kaiser, CEBS, Director, Central Market & Programs, Health Action Council

Barbra Cannon, M.A., MBA, Network Director of Payment Innovation, Anthem Blue Cross and Blue Shield

Click here to view episode presentation slides Adi Kumar, McKinsey & Company

Please see attachment for reflections from audience.

Sharing reflections on the value of implementing Ohio's Public-Private Healthcare Innovation Plan in Greater Columbus Introduction:

Bill Wulf, MD, CEO, Central Ohio Primary Care

Discussion Panel:

Sean P. Gleeson, MD, MBA, Medical Director, Partners for Kids, Nationwide Children's Hospital

Mike Stull, MBA, Chief Operating Officer, Employers Health

Michelle Mathieu, Vice President, Network Management, Aetna

Please see attachment for reflections from audience. www.hcgc.org

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Upcoming Learning Sessions June 25th Webinar, 1:00 - 2:00 PM • Topic: Choosing Wisely - physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

• Featured Speakers Krista Stock & Jeff Biehl, Healthcare Collaborative of Greater Columbus Sarah Durfee, RN, Ohio Public Employees Retirement System Greg Sawchyn, MD, MBA, OhioHealth Register now!

July 23rd Webinar, 1:00 - 2:00 PM • Topic: Open Notes - inviting patients to review their visit notes written by their doctors, nurses, or other clinicians.

• Featured Speakers Jan Walker, RN, MBA, Assistant Professor of Medicine, Harvard Medical School, BIDMC Division of General Medicine and Primary Care, Co-Director of OpenNotes Cheryl Peppin, MD, Nationwide Children's Hospital Aarti Chandawarkar, MD, Nationwide Children's Hospital Register now!

Additional 2014 Learning Sessions • August 22nd (In-person attendance preferred) • September 24th (Webinar) • October 22nd (Webinar) • December 5th (In-person attendance preferred)

www.hcgc.org

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Record of May 23, 2014 Healthcare Transformation Learning Session ATTACHMENT: Participant Reflections Opening Poll

Reflections/Questions on Comprehensive Primary Care All Payers are participating but there is still a vast difference in each Payer's level of demonstrated commitment. This creates complexity on many fronts and an uncertainty in the sustainability of the model.

CMS is investing a HUGE amount per patient at a level that is unsustainable on large scale. How can practices be motivated to do what your CPC practices did when they do not get that same significant financial incentive?

Culture change Did you consider reporting for your groups and not requiring them to individually report Given that the relationship with the care team is critical to better outcomes what is the plan to engage more providers in participating?

How can we begin to better engage pediatricians as we look to expand primary care transformation efforts?

How do the models CPC or SIM acknowledge the additional costs/ lower productivity of teaching sites?

How have you convinced competing entities to share data that has historically been used to create a competitive advantage?

How is behavioral/mental health being integrated into CPC services? What can health centers do to have organizational change when the providers are resistant to coming on board with the PCMH model/philosophy?

How to make "comprehensive" truly comprehensive and include wellness mindfulness and integrative medicines (e.g. massage therapy acupuncture nutrition naturopathy etc). Patients are already spending out of pocket for this. Why not include these services in the PCMH neighborhood? how will you ensure consistency in quality care across providers I think what you said is correct we need to make practice centric verses facility centric. How do we accomplish this?

Is the money invested going to show the return?

Is there any consideration of other types of practices being included such as FQHC's free clinics health departments? and other safety net organizations?

Patient engagement was one of the bubbles in the martini glass but of little focus in the talk. What/how can we achieve higher or better engagement and where is that tied in the APCCCD Physician engagement is critical to the success of any value-driven model. What are some ways you've been successful in driving this?

Question in consumer-asked form: How will my pharmacist in the community and the prescriptions that I fill be included in my comprehensive primary care?

Real value of a practice is "relationship" Standardization is such a problem with payer quality models as well as things such as risk stratification.

How willing are payers to standardize?

The significance of the statement that the primary care practice is the new functional unit in health care.

Transparency.....data sharing at all levels When and how will oral health become part of the transformation?

When will you invite in organized consumer organizations as full partners in this work along with payers and providers? When will you invite the community into dialogue? I haven't met a Cincinnati resident who knows about CPC and I know many people who would love to be a patient in such a practice.

When will you tell the rest of the community about what you're doing?

Where are we with HIE in Ohio and what barriers are there to getting it up and running?

Why don't you consider my cost when sending me for testing?

Will the PMPM payments be adjusted in the future based on outcomes? Are the PMPM payments covering the required investment by the practice?

Will you invite organized consumers into designing your All Payer Claims Data Base so that it will collect the quality and cost data consumers need to have to assess progress toward IOM goals of patientcentered equitable health care?

Reflections/Questions on Episode-based Payments Any thoughts on implementing leading indicators for monitoring episodic care instead of review of lagging indicators?

Appears to raise payors short-term cost with only indirect long term benefit which is also shared with payors who sit on the sideline Are providers ready in Ohio? How do we Inform engage and gain consensus?

Can you speak to how the various health care professionals who provided care associated with beneficiaries of the episode-based payment from the freestanding facility that did the MRI preop to the surgeon who did the joint replacement Does the retrospective model address sharing payouts across multiple providers involved in the same episodes of care?

Have the physicians/systems providing high cost services in Arkansas changed their costs How can PCMH and Episode strategies be synergistic?

How do retrospective episode payments affect patient responsibility in a high deductible health plan design?

How do the physicians learn the cost of care specifically related to hospital contracts and how that affects their decisions on the setting of care? Example DRG reimbursement would be the

same regardless of length of stay.

How do we get the right reports that pull in the correct data in for an episode of care?

How does McKinsey address the claim from providers that "my/our patients are sicker"...to justify their higher costs in aggregate?

How does this model coexist with the PCMH model?

How is the cost of medical education and training incorporated in this model Is gain sharing supposed to be 100% funded by give backs from below average providers?

Is there typically a requirement for the principal provider to share rewards with other providers? How can physicians and hospitals share rewards if they are not contractually clinically integrated?

Please explain how an employer with a self-insured group health plan is expected to make funds available for gain sharing. Is there a hold back from claims payment? If yes where are the funds held between the hold back and distribution?

Referring to the prevention source of value what data do you have related to medical episodes rooted in untreated oral health needs and where does oral health fit in the episodic model. should patients and the public know what quality measures are being used to assess value of episode?

Why filter profiles on episodes by cost first rather than quality?

Will consumers be aware that this is happening? If so how?

With the retrospective episodes how do payors claw back $ from the "risk-sharing" providers in order to pay the ones who qualify for gain-sharing?

With the timing involved in retrospective episodic payments (particularly at the onset of changing over to this model)... have you considered any impact to a practice or health system's A/R? Reflections/Questions on Implementing Ohio’s Innovation Plan Aligning payment with high quality care and outcomes across multiple providers and payers.

Building relationships Efforts towards transparency for all involved in patient care and assurance that there is a clear understanding of the data needed to meet the quality desire. How can the role that payers play in patient care be better understood? Many consumers have a negative view of payers which can confuse the direction of patient care.

For what is the family physician the quarterback?

How do we implement change when some providers can create push-back to integration and collaboration?

I am struck by how the energy in Ohio seems rooted in urban areas. I heard nothing about southeast Ohio. How will the needs of Appalachia be addressed? power of effective collaboration and a strong champion hoping that the momentum continues and evolves into successful patient care 2 responses from one person Still determining how to get the resources and consistency to be successful in this methodology

for both providers and payors.

The actual collaboration of providers payers and employers and developing a team approach and trust to work together learn and build a system that is meaningful to all parties and delivers quality cost effective care.

The need for Coordination of care coordination of payment and coordination of data.

The sharing of the data (full transparency of the details) across all parties (provider payor and purchasers) is the key positive initiative to be gained in implementing Ohio's Innovation Plan there exists great potential for "spin-off" connections and collaboration for "peripheral" initiatives; e.g. children readiness; behavioral health etc.

There is concern about the way specialists are paid and the lack of attention to quality. Having payers come together and achieve some standardization is significant. Is there any interest in moving towards capitation?

3 responses from one person This is a team sport ; PCP and Specialty physicians hospitals patients and payers.

Time frame of an episode is important. Well before the joint replacement is primary care which if good will postpone the surgery. For that part the FP is quarterback.

To provide better quality Healthcare for the people of Ohio; To promote competition among providers centered around value; to educate the consumer. Next is how do we continue to ramp up efforts to address low health literacy and apathy to this topic among the general public.

Closing Poll