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CT SIM HEC Framework Technical Report

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CT SIM HEC Framework Technical Report CONNECTICUT STATE INNOVATION MODEL (SIM) HEALTH ENHANCEMENT COMMUNITY INITIATIVE PROPOSED FRAMEWORK Technical Report Revised: APRIL 30, 2019 TECHNICAL REPORT– REVISED 4/30/19 TABLE OF CONTENTS ACKNOWLEDGEMENTS .................................................................................................................................. 4 EXECUTIVE SUMMARY ................................................................................................................................... 5 1. BACKGROUND ...................................................................................................................................... 12 2. THE NEED FOR HEALTH ENHANCEMENT COMMUNITIES IN CONNECTICUT ......................................... 14 2.1. Need for a Place-Based Approach ............................................................................................. 15 2.2. Significance of the Priority Aims ................................................................................................ 16 2.3. Social Determinants of Health and Other Root Causes of Priority Aims.................................. 24 2.4. Current Cost of Health Care ....................................................................................................... 30 3. HEALTH ENHANCEMENT COMMUNITY DEFINTION AND KEY ELEMENTS .............................................. 35 3.1. Health Enhancement Community Initiative Goal ..................................................................... 35 3.2. HEC Definition ............................................................................................................................ 35 3.3. HEC Key Design Elements and Structure ................................................................................... 36 4. HEC MEASUREMENT AND PERFORMANCE ........................................................................................... 61 4.1. HEC Goals and Health Priority Aims .......................................................................................... 61 4.2. Statewide Prevention Measures and Benchmarks ................................................................... 61 4.3. HEC Outputs and Outcomes ....................................................................................................... 67 4.4. Measurement and Reporting ..................................................................................................... 69 4.5. Evaluation ................................................................................................................................... 71 4.6. Challenges and Mitigation Strategies Regarding Measures ..................................................... 71 5. REFERENCE COMMUNITIES ENGAGEMENT IN HEC DESIGN ................................................................. 73 5.1. Participating Reference Communities ....................................................................................... 73 5.2. Reference Community Engagement Process ............................................................................. 74 5.3. Reference Community Input and Feedback .............................................................................. 76 6. SUPPORT FOR HECs .............................................................................................................................. 79 6.1. Data Infrastructure: IT and Data Infrastructure to Support HECs ............................................ 79 6.2. Workforce ................................................................................................................................... 84 6.3. Opportunities for Leveraging Existing Assets ............................................................................ 86 6.4. Current Policy and Regulatory Environment................................................................................. 96 7. HEC FINANCING ................................................................................................................................... 98 7.1. Existing Value-Based Models ........................................................................................................ 99 7.2. HEC Financing Model ................................................................................................................. 105 7.3. Savings and Benefits .................................................................................................................. 129 2 TECHNICAL REPORT– REVISED 4/30/19 8. STATE AND FEDERAL ENABLING ACTIONS .......................................................................................... 137 8.1. Role of State in Administering the HEC Initiative.................................................................... 137 8.2. Statewide Support .................................................................................................................... 138 8.3. State-Level Statutory and Regulatory Levers .......................................................................... 139 8.4. Federal Regulatory Levers ........................................................................................................ 141 9. HEC DESIGNATION ............................................................................................................................. 145 9.1. HEC Procurement Process ........................................................................................................ 145 9.2. Implementation Roadmap ....................................................................................................... 145 10. APPENDICES ................................................................................................................................... 150 APPENDIX 1. PROVISIONAL MEASURES LIST ............................................................................................... 151 APPENDIX 2. PLANNING PROCESS APPROACH AND STAKEHOLDER ENGAGEMENT .................................... 157 APPENDIX 3. REFERENCE COMMUNITY ENGAGEMENT FRAMEWORK ........................................................ 181 APPENDIX 4. CHILD WELL-BEING INTERVENTION EXAMPLES ..................................................................... 190 APPENDIX 5. HEALTHY WEIGHT AND PHYSICAL ACTIVITY INTERVENTION EXAMPLES ................................. 200 APPENDIX 6. ADDITIONAL SIM WORKGROUPS AND WORK STREAMS ........................................................ 206 APPENDIX 7. ADDITIONAL REFERENCE MATERIALS .................................................................................... 207 3 TECHNICAL REPORT– REVISED 4/30/19 ACKNOWLEDGEMENTS The Population Health Council, charged with making recommendations regarding the establishment of Health Enhancement Communities, submits this report to the Healthcare Innovation Steering Committee. The Health Enhancement Community (HEC) strategy is an initiative of the Connecticut State Innovation Model (SIM), which is jointly implemented by the Office of Health Strategy (OHS) and the Department of Public Health (DPH). The HEC team comprised Mark Schaefer, PhD; Faina Dookh; Mehul Dalal, MD; Mario Garcia, MD; Kelly Sanchez; Amy Smart; Kristin Sullivan; and Trish Torruella. Report contributors: Diane Aye, Yongwen Jiang, Celeste Jorge, Laura Hayes, Lloyd Mueller, Laurie Ann Wagner, and Xi Zheng. This report was prepared by Health Management Associates (HMA), a leading independent national research and consulting firm. Its primary authors were Deborah Zahn; Rob Buchanan; Mary Goddeeris; Liddy Garcia-Bunuel; Tom Dehner; Melissa Corrado; Jessica Foster; Capri Dye; Maria Dominiak of Airam Actuarial Consulting; and Elise Miller, Kristin Giantris, and Norah McVeigh of the Nonprofit Finance Fund. HMA contributors were Cathy Homkey; Art Jones, MD; Cara Henley; Ellen Breslin; Hope Plavin; Heidi Emerson; Tim Beger; and Emma Sinkoff. 4 TECHNICAL REPORT– REVISED 4/30/19 EXECUTIVE SUMMARY Introduction Improving the health and well-being of all residents in Connecticut and reducing the rising trends of Connecticut’s health care costs depends on improving community health and health equity1 and preventing people who live, work, learn, and worship in communities2 from experiencing poor health. The proposed Health Enhancement Community (HEC) Initiative presented COMMUNITY HEALTH in this framework and described in more detail in the accompanying HEC Community health means that the social, economic, Technical Report, is aimed at and physical conditions within a community enable supporting the health and well-being individuals and families to meet their basic needs, of individuals and families in achieve their health and well-being goals, and thrive throughout their lives. communities across the state by improving community health and HEALTH EQUITY healthy equity and preventing poor health. This will be achieved through Equity in health refers to how uniformly services, having Health Enhancement opportunities and access are distributed across groups Communities (HECs) form and operate and places, according to the population group. Equity in health implies that ideally everyone could attain throughout the entire state. The HECs their full health potential and that no one should be would work collaboratively to improve disadvantaged from achieving this potential because the social, economic, and physical of their social position or other socially determined conditions within communities that circumstance. Efforts to promote equity in health are enable individuals and families to meet therefore aimed at creating opportunities
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