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State Healthcare Innovation Plan

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State Healthcare Innovation Plan December 30, 2013 Dear Connecticut Stakeholder, I am pleased to share with you our State Health Innovation Plan. This Plan, created under the State Innovation Model (SIM) Grant from the Center for Medicare and Medicaid Innovation (CMMI) represents the culmination of your participation and input into each stage of the development process. As a part of the wide range of individuals and organizations that contributed to this effort, you have truly helped bring the State of Connecticut closer to its goal of improved access to higher quality healthcare that produces better health outcomes at a reduced cost. Together with your collaboration, we have produced an ambitious framework for making Connecticut a healthier state through a more efficient healthcare system that is whole-person centered, and targets the elimination of longstanding and persistent health disparities. We are depending on your active participation as we move forward with planning and implementation, and hope you will continue to lend your efforts. You can stay up-to-date and involved by visiting www.healthreform.ct.gov and expressing your comments and suggestions via email to [email protected]. With kindest regards, Nancy Wyman Lieutenant Governor TABLE OF CONTENTS I EXECUTIVE SUMMARY .......................................................................................................................................................... 6 II CONTEXT FOR HEALTH SYSTEM TRANSFORMATION 1. CONNECTICUT’S HEALTHCARE ENVIRONMENT .................................................................................... 22 2. FOUNDATIONAL STRENGTHS AND INITIATIVES ................................................................................... 44 III OUR VISION FOR OUR FUTURE HEALTH SYSTEM OUR VISION FOR THE FUTURE .......................................................................................................................................... 55 1. STATE GOALS AND TRANSFORMATION DIAGRAM ................................................................................ 55 2. PRIMARY CARE PRACTICE TRANSFORMATION ...................................................................................... 59 3. COMMUNITY HEALTH IMPROVEMENT ....................................................................................................... 70 4. CONSUMER EMPOWERMENT ........................................................................................................................... 85 IV ENABLING INITIATIVES 1. OVERVIEW OF ENABLING INITIATIVES ...................................................................................................... 93 2. PERFORMANCE TRANSPARENCY ................................................................................................................... 94 3. VALUE-BASED PAYMENT STRATEGY ........................................................................................................... 96 4. HEALTH INFORMATION TECHNOLOGY .................................................................................................. 102 5. HEALTHCARE WORKFORCE DEVELOPMENT ........................................................................................ 109 V FINANCIAL ANALYSIS 1. FINANCIAL ANALYSIS ....................................................................................................................................... 126 VI MANAGING THE TRANSFORMATION 1. STATE INNOVATION MODEL DESIGN PROCESS ................................................................................... 138 2. FUTURE GOVERNANCE STRUCTURE ......................................................................................................... 146 3. TRANSFORMATION ROADMAP..................................................................................................................... 149 4. USE OF EXECUTIVE, REGULATORY AND LEGISLATIVE LEVERS .................................................. 154 5. EVALUATION PLANS .......................................................................................................................................... 157 VII APPENDICES APPENDIX A: GLOSSARY .................................................................................................................................................... 176 APPENDIX B: NATIONAL CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (NCLAS STANDARDS) ........................................................................................................................................................................... 180 APPENDIX C: POPULATION HEALTH MEASURES .................................................................................................. 182 APPENDIX D: FOUNDATIONAL INITIATIVES ........................................................................................................... 187 APPENDIX E: CURRENT WORKFORCE RESIDENCY PROGRAMS ..................................................................... 202 APPENDIX F: PLAN DEVELOPMENT PARTICIPATION ......................................................................................... 206 APPENDIX G: STAKEHOLDER ENGAGEMENT EVENTS ........................................................................................ 213 EXHIBITS EXHIBIT 1: State Innovation Model Goals EXHIBIT 2: Our State Innovation Model at- a-glance EXHIBIT 3: Future Governance Structure EXHIBIT 4: Private Insurer Market Share EXHIBIT 5: Connecticut Population Demographics EXHIBIT 6: Population Health Measures and Indicators EXHIBIT 7: Population Health Indicator – unhealthy days EXHIBIT 8: Diabetes ED Visits by Race and Ethnicity EXHIBIT 9: Population Health Indicator by Payer– eye exams for people with diabetes EXHIBIT 10: NCQA Health Plan Rankings EXHIBIT 11: Txt 2b Heard Video link--CHCACT EXHIBIT 12: Change in EHR Adoption EXHIBIT 13: Current use of IT Components EXHIBIT 14: Use of HIT Components TEFT Grant Proposal EXHIBIT 15: Connecticut State Innovation Model: Project Driver Diagram EXHIBIT 16: Primary Drivers Pyramid EXHIBIT 17: Connecticut Transformation Glide Path EXHIBIT 18: Targeted Pace of Primary Care Practice Transformation EXHIBIT 19: Clinical Integration Models to Attain Scale and Capabilities EXHIBIT 20: Primary Drivers Pyramid with Enabling Initiatives EXHIBIT 21 HIT Adoption by Town Type EXHIBIT 22: Data Integration: data types, data sources, and outcomes EXHIBIT 23: Sequencing for Rolling out the HIT Strategy EXHIBIT 24: Institute of Medicine Findings – healthcare spending EXHIBIT 25: Gross Savings as Percent of Total Cost of Care EXHIBIT 26: Statewide Investment in Practice Transformation EXHIBIT 27: Program Investments EXHIBIT 28: Potential Financial Impact EXHIBIT 29: Model Design Process Governance Chart EXHIBIT 30: Stakeholder Participation Diagram EXHIBIT 31: Care Delivery, Payment, and HIT workgroups: questions considered EXHIBIT 32: Future governance structure EXHIBIT 33: Timeline for Transformation EXHIBIT 34: Primary Care Transformation and Enabling Initiatives- major milestones EXHIBIT 35: Community Health Improvement and Consumer Empowerment- major milestones EXHIBIT 36: Performance Dashboard Targets EXHIBIT 37: Performance and Pace Data Sources Ron Preston Christmas Eve Edition Executive Summary INTRODUCTION Connecticut’s Healthcare Innovation Plan (“Innovation Plan”) is the product of a shared vision of a broad range of stakeholders to establish primary care as the foundation of care delivery that is consumer and family centered, team based, evidence driven and coordinated, and in which value is rewarded over volume. We envision a healthcare system rooted in primary care and prevention, integrated with community resources, and truly accessible to our residents. We recognize that providers in the care delivery system are one among many community participants that must work together to achieve the broader goal of improved community health. Most importantly, achieving our goals of better health and better healthcare require the involvement of empowered and informed consumers who take an active role in the continuous pursuit of a healthier lifestyle and effective management of chronic conditions. Our Innovation Plan is possible because, as we learned through many months of broad stakeholder engagement, many are already striving to improve health and our healthcare system. There is utility in combining our disparate efforts in support of the collective good. Connecticut’s Innovation Plan leverages current public and private sector investments in healthcare reform initiatives, such as our state’s health insurance marketplace, prevention efforts and value based payment reforms. Our plan is distinctive; it strongly promotes health equity throughout all its initiatives, ties provider payment to consumer experience, builds Health Enhancement Communities, leverages healthcare workforce development programs serving disparity populations in urban areas, and powers all through the effective use of health information technology. We are forming a collaborative community of stakeholders across Connecticut for fulfilling this plan. We are ready to launch. BACKGROUND In March 2013, Connecticut received a $2.8 million planning grant from the Center for Medicaid and Medicare Innovation (CMMI) to develop a State Healthcare Innovation Plan. CMMI’s charge was to design a model for healthcare delivery supported by value-based payment methodologies tied to the totality of care delivered to at least 80% of our population within five years. Moreover, the Innovation Plan must promote the Triple Aim for everyone in Connecticut:
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