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Public Hospital Redesign and Incentives in Medi-Cal (PRIME) 5-Year PRIME Project Plan

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Public Hospital Redesign and Incentives in Medi-Cal (PRIME) 5-Year PRIME Project Plan Public Hospital Redesign and Incentives in Medi-Cal (PRIME) 5-Year PRIME Project Plan Application due: by 5:00 p.m. on April 4, 2016 1 Table of Contents General Instructions ....................................................................................................................... 3 Scoring .......................................................................................................................................... 3 Section 1: PRIME Participating Entity Information ........................................................................ 4 Section 2: Organizational and Community Landscape ................................................................... 5 Section 3: Executive Summary ...................................................................................................... 8 Section 4: Project Selection ......................................................................................................... 16 Section 4.1 -- Domain 1: Outpatient Delivery System Transformation and Prevention ............. 17 Section 4.2 -- Domain 2: Targeted High-Risk or High-Cost Populations................................... 31 Section 4.3 – Domain 3: Resource Utilization Efficiency ......................................................... 44 Section 5: Project Metrics and Reporting Requirements .............................................................. 46 Section 6: Data Integrity .............................................................................................................. 47 Section 7: Learning Collaborative Participation ............................................................................ 47 Section 8: Program Incentive Payment Amount ........................................................................... 47 Section 9: Health Plan Contract (DPHs Only) .............................................................................. 48 Section 10: Certification............................................................................................................... 48 Appendix- Infrastructure Building Process Measure ...................................................................... 49 Appendix – Supplemental Tables and Endnotes.......................................................................... 50 2 General Instructions Thank you for your interest in the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program. Your response to this 5-Year PRIME Project Plan (“Plan”) will enable the Department of Health Care Services (DHCS) to assess if your entity can meet the requirements specified in the waiver Special Terms and Conditions (STCs) and has the capacity to successfully participate in the PRIME program. This 5-Year PRIME Project Plan is divided into 10 sections which are structured around the Medi-Cal 2020 Waiver’s Special Terms and Conditions (STCs). Additional information about the PRIME program requirements can be found in the PRIME Projects and Metrics Protocol (Attachment Q) and Funding Mechanics (Attachment II) of the STCs. Scoring This Plan will be scored on a “Pass/Fail” basis. The state will evaluate the responses to each section and determine if the response is sufficient to demonstrate that the applicant will be able to effectively implement the selected PRIME Projects while simultaneously conducting the regular business of operating the hospital system. In the event that a response to a Plan section is not sufficient and fails to meet review criteria, the applicant will have an opportunity to revise the response(s) to meet the state’s satisfaction. Applicants will have three (3) days to complete the revisions upon receiving feedback from the state. Please complete all sections in this 5-Year PRIME Project Plan, including the Appendix (the infrastructure-building process measure plan as applicable), and return to Tianna Morgan at [email protected] no later than 5:00 p.m. on April 4, 2016. 3 Section 1: PRIME Participating Entity Information Health Care System/ Hospital Name Ventura County Health Care Agency/Ventura County Medical Center Health Care System Designation(DPH or DMPH) DPH 4 Section 2: Organizational and Community Landscape The purpose of this section is to provide DHCS with an understanding of the demographic makeup of the community the applicant serves, the target population that will benefit from the PRIME activities, and any other relevant information that will help inform the state’s review of this Plan. 2.1 Community Background. [No more than 400 words] Drawing on available data (e.g., DHCS, Office of Statewide Health Planning and Development, U.S. Census Bureau), summarize the health care needs and disparities that affect the health of your local community. The Ventura County Health Care Agency (VCHCA) is located in Ventura County, California, the 13th largest of California’s 58 counties by population. The county’s health care needs and disparities are summarized as follows: Physical Health: • Diabetes: More than half of adults either have diabetes (6%) or pre-diabetes (47%).1 With a death rate 1.5 times that of other races/ethnicities, 9% of Latinos have diabetes.2 • Heart Disease and Stroke: Approximately 25% of residents have been diagnosed with high blood pressure and 31.4% over 65 years of age have heart disease. The leading cause of premature death for most age and race/ethnic groups in Ventura County is coronary heart disease.3 • Cancer: Among males, the most commonly diagnosed cancer is prostate cancer, yet 78% of Latino men 40 years and older have never received a prostate- specific antigen test. The death rate from breast cancer is 21.3 per 100,000 residents compared to 20.7 for California as a whole.4 See cause of death statistics in Table 1. • COPD: Of the 28,516 residents with COPD, approximately 10,900 are low- income. COPD/respiratory distress caused 8.7% of all ED encounters and 4.7% of all inpatient admissions at Ventura County Medical Center (VCMC) in 2015, a rate higher than other California hospitals.5 Behavioral Health: Among VCMC admissions, 12.6% were for mental health disorders. California death statistics show that the suicide rate among county residents (11.6) and drug-induced death rate (13.9) exceed that of California (10.2 and 11.1, respectively).6 Alcohol-impaired driving deaths in 2013 were 33% of all driving deaths, compared to 29% for California.7 Health Disparities: More than 22% of residents are foreign-born and 41.5% are Latino,8 a population disproportionately affected by cardiovascular disease, cancer, diabetes, and asthma. Nearly 62% of VCHCA’s patient population is Latino. The overall poverty rate is 11.1%, but 27.6% of seniors and 23.7% of persons younger than 25 live in poverty.9 Both of these populations have a higher risk for multiple health disparities 5 due to reduced access to health care.10 The infant mortality rate among Latino women (4.9 per 1,000 live births) exceeds that of California (4.7) and the Ventura County rate among all races/ethnicities (4.6).11 Coverage: Approximately 15.2% of residents have no health insurance, and 67% of VCHCA’s patients are uninsured or on Medi-Cal. Moreover, Ventura County Latinos had the lowest rate of health insurance – just 74.2% compared to 91.9% of non-Latino whites.12 2.2 Population Served Description. [No more than 250 words] Summarize the demographic make-up of the population included in your hospital’s service area, including information about per capita income, age, race, ethnicity, primary language, etc. Per Capita Income: Per capita income in Ventura County is $33,308, compared to $28,555 for California.13 This differential is primarily due to the high cost of living in the county. The Cost of Living and Cost of Housing Indexes in Ventura County are 163.50 and 276, compared to 100 for the U.S., which increases the financial pressure on residents.14 Although the median household income in Ventura County was $77,335,15 67.31% of patients served by VCHCA are on Medi-Cal with incomes below 138% of the Federal Poverty Level (FPL). Overall, the county unemployment rate was 5.1% in February 2016.16 Age: The population is slightly older than the state overall, with an average age of 36.9 years, compared to 35.6 statewide.17 The age breakdown is as follows: • 0-18 years (25.7%) • 19-64 years (62.6%) • 65 and over (11.7%) Race/Ethnicity: Ventura County is home to 846,178 residents, comprised of 47.3% white, 41.5% Latino, 7.3% Asian, 2.2% black or African American, and 1.7% other races/ethnicities.18 VCHCA’s safety-net population is 61.3% Latino, 36.7% white/non- Hispanic, and 2.0% other races/ethnicities or unknown. Primary Language: Although English is the primary language spoken in Ventura County (61.8%), 38.2% of the Ventura County population over the age of 5 spoke a language other than English at home in 2014, and 30.2% of the population spoke only Spanish at home.19 2.3 Health System Description. [No more than 250 words] Describe the components of your health care system, including license category, bed size, number of clinics, specialties, payer mix, etc. Health Care System: VCHCA is a fully-integrated, comprehensive designated public health care system with two hospitals, 41 clinics including eight urgent care sites (see Attachment 1 and Table 2), Ventura County Behavioral Health Department (VCBH) with 6 six mental health and substance abuse clinics, Ventura County Public Health Department (VCPH) with two clinics and multiple population health programs, Emergency Medical Services, Medical Examiner, and the Ventura County
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