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Striving Toward a Culture of Health: How Do Care and Costs for Non-Medical Needs Get Factored Into Alternative Payment Models? Workshop Summary & Lessons Learned

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Striving Toward a Culture of Health: How Do Care and Costs for Non-Medical Needs Get Factored Into Alternative Payment Models? Workshop Summary & Lessons Learned , Striving Toward A Culture Of Health: How Do Care And Costs For Non-Medical Needs Get Factored Into Alternative Payment Models? Workshop Summary & Lessons Learned January 26 - 27, 2017 Austin, TX Under the Auspices of: Payment Reform for Population Health Initiative Conducted by: AcademyHealth & Network for Regional Healthcare Improvement Sponsored by:The Robert Wood Johnson Foundation To learn more about the Payment Reform for Population Health initiative, visit www.academyhealth.org/p4ph Support for this report was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. Striving Toward A Culture Of Health: How Do Care And Costs For Non-Medical Needs Get Factored Into Alternative Payment Models? Table of Contents Introduction ........................................................................ 3 Addressing the Social Determinants of Health Through Payment Reform What Is the Opportunity Facing Communities? Elizabeth Mitchell President/CEO Network for Regional Healthcare Improvement (NRHI) Introductions of Collaboratives Cross-Sector Collaboration/Governance ................................................. 6 Elizabeth Mitchell President/CEO, NRHI Jane Brock, MD, MSPH Chief Medical Officer and Clinical Coordinator Colorado Foundation for Medical Care (CFMC) Metrics, Data and Evidence............................................................ 8 Jonathan D. Mathieu, PhD Vice President of Research & Compliance and Chief Economist Center for Improving Value in Health Care (CIVHC) Aaron Truchil, MS Director, Strategy and Analytics Camden Coalition of Healthcare Providers Care Delivery Requirements and Incentives ............................................. 10 Lisa Dulsky Watkins, MD Founding member of the Milbank Memorial Fund-supported Multi-State Collaborative Former Associate Director of the Vermont Blueprint for Health Payment and Financing.............................................................. 12 Tricia McGinnis, MPP, MPH Vice President, Programs Center for Health Care Strategies, Inc. (CHCS) Conclusion ........................................................................ 14 Workshop Participants .............................................................. 14 2 Striving Toward A Culture Of Health: How Do Care And Costs For Non-Medical Needs Get Factored Into Alternative Payment Models? Introduction improvement collaboratives (RHICs) to foster shared learning with each other as well as content experts to inform next steps in Addressing the Social Determinants of Health their own specific community-based collaborative projects. The Through Payment Reform workshop focused on four key topic areas and the related barriers In a time of significant health care transformation, many health insur- that potentially influence the conditions and collaborations ers and health care providers are moving toward payment models necessary to support non-clinical community-wide population based on the quality of care delivered in an effort to attain the Triple health services. Aim of better care, smarter spending, and healthier people. Right now, most of these value-based payment models focus on clinical ser- This report reflects the discussions had by participants, their shared vices and, more specifically, the needs and outcomes of a health care experiences with the topics and with each other, and the common provider’s patient panel, a health plan’s enrollees, or the purchaser’s barriers and facilitators identified in pursuing collaborative employee subscribers. Still other payment models focus on a targeted community-based population health interventions. sub-population of individuals with a defined chronic clinical condi- tion, such as patients with diabetes or depression. Defining Health As such, payment and financing models are not yet adequately sup- porting community-wide, geographically-based, population health Population Health (see side box). The incentives in these models do not yet reward “Health outcomes of a group of individuals, including the health care providers for creating healthy communities, nor do they distribution of such outcomes within the group” (Kindig and incentivize other sectors—e,g., transportation, housing, educa- Stoddart, 2003) tion—contributing to population health improvements. Determinants of Health As health care organizations continue to move along the continuum • 10% Physical Environment of paying for value, not volume, a pressing question is: how might - Environmental Quality the cost of non-medical support services be factored into alternative - Built Environment payment models to advance population health? How might those non-medical support services impact the overall quality and cost of • 20% Health Care health in communities? And what are the barriers to progress facing - Access to Care communities? - Quality of Care With support from the Robert Wood Johnson Foundation, • 30% Health Behaviors AcademyHealth’s Payment Reform for Population Health (P4PH) - Tobacco Use initiative aims to develop a comprehensive understanding of - Diet & Exercise current efforts and successes related to payment reform activities - Alcohol Use that support community-wide population health improvement. To - Unsafe Sex inform this effort, AcademyHealth collaborated with the Network for Regional Healthcare Improvement (NRHI) to explore challenges and • 40% Socioeconomic Factors successes related to how health care purchasers, plans, and providers - Education could support strategies for sustainable investment in non-clinical - Employment community-wide population health activities. - Income - Social Support On January 26-27, 2017, AcademyHealth and NRHI hosted a - Community Safety two-day, highly interactive workshop called “Striving Toward a Source: County Health Rankings, Population Health Institute, University of Culture of Health: How Does Care and Costs for Non-Medical Wisconsin-Madison. Needs Get Factored into Alternative Payment Models?” This workshop convened five multi-sector teams led by regional health 3 Striving Toward A Culture Of Health: How Do Care And Costs For Non-Medical Needs Get Factored Into Alternative Payment Models? What is the Opportunity Facing Communities? Participating Regional Health Care Elizabeth Mitchell, President and CEO of the Network for Regional Healthcare Improvement (NRHI), described the problems we are Improvement Collaboratives (RHICs) currently facing in health care and the role of financial incentives. We are, in fact, getting what we are paying for—high volume and high priced services that are not achieving health. To change this incentive structure we will need to change our thinking and our payment systems and align across communities and sectors to promote health. “In the current system, no one gets paid if people stay healthy. We cannot bring down costs until we restructure the payments and incentives to reward Community First, Hilo, Hawaii Greater Detroit Area Health Council, Detroit, MI Health Care Improvement Foundation, Philadelphia, PA health.” The Health Collaborative, Cincinnati, OH Washington Health Alliance, Seattle, WA The rising cost of health care is a growing threat for families, The Network for Regional Healthcare Improvement (NRHI) is a employers, government, and the U.S. economy. The money going network comprising more than 30 regional health improvement to health care is coming from investments in what could pro- collaboratives (RHICs) and three state-affiliated partners. RHICs mote better health. Ten years of U.S. wage growth has been lost are non-profit, multi-stakeholder organizations working in regions to health care cost increases and more families are losing their and collaborating across regions to transform the health care discretionary incomes for housing, food and recreation to out- delivery system and achieve the Triple Aim. of-pocket health care expenses. Though the national debate has focused largely on insurance coverage and access, recognition is The RHICs are accomplishing this transformation by working growing that coverage will not be affordable unless health care is directly with physicians and other health care providers, provider affordable. And keeping people healthy will require redirecting organizations, commercial and government payers, employers, our investment outside of the health care system. Savings from consumers, and other health care related organizations. health care could be reallocated upstream to pay for non-medical support services to advance health. Teams from five communities were invited to attend the workshop and participate in interactive sessions focusing on issues related The Medicare Access and CHIP Reauthorization Act of 2015 to addressing non-clinical needs within the health care payment (MACRA) was passed with bipartisan support and promises to system. With representation from diverse communities spanning fundamentally change the way the United State evaluates and pays the country, these five teams worked together closely, sharing expe- for health care. It includes specific provisions to help build commu- riences and grappling with tough questions. A description of each nity-wide payment models, creates the Physician-Focused Payment community’s project is below: Model Technical Advisory Committee (PTAC) to vet alternative payment models (APMs) from the field, and encourages aligned • Community First in Hilo, HI is developing a new payment model multi-payer approaches. To the extent MACRA creates incentives for emergency
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