Texas State Healthcare Innovation Plan February 13, 2014 Table of Contents Executive Summary ........................................................................................................................ 1 Vision Statement for Health System Transformation ................................................................. 1 Current “As Is” Health Care Environment of Texas .................................................................. 2 Health Care System Performance ....................................................................................... 2 Health Care Cost Trends ..................................................................................................... 4 Health Care Delivery System.............................................................................................. 5 Delivery System Payment Models in Texas ....................................................................... 6 Health Information Technology .......................................................................................... 7 Multi-payer Collaboration .................................................................................................. 7 Future “To Be” Health Care System of Texas ............................................................................ 8 Transform the Delivery System to Models of Patient-centered Care ................................. 8 Transition Away from Fee-for-service to Quality-based Payment ..................................... 9 Build Capacity for Continuous, Ongoing Improvement and Innovation throughout the Health Care and Public Health Systems in Texas ............................................................... 9 State Health Care Innovation Plan ............................................................................................ 10 Model I: EHR and HIE Expansion and Sustainability Initiatives ..................................... 11 Model II: Clinical Care Transformation Programs ........................................................... 11 Model III: Spreading and Sustaining Innovations ............................................................ 12 Model IV: Community-Based Public Health Innovations ................................................ 13 Model V: Multi-Payer Engagement and Alignment ......................................................... 14 Implementation ......................................................................................................................... 18 Texas State Healthcare Innovation Plan ....................................................................................... 21 A. Goals for Health Care Transformation in Texas ...................................................................... 21 Vision Statement for Health System Transformation ............................................................... 21 Meeting Providers Where They Are ................................................................................. 22 Current “As Is” Health Care Environment of Texas ................................................................ 23 Health Care System Performance ..................................................................................... 23 Health Care Cost Trends ................................................................................................... 26 Health Care Delivery System............................................................................................ 26 Delivery System Payment Models in Texas ..................................................................... 28 Health Information Technology ........................................................................................ 28 Multi-payer Collaboration ................................................................................................ 29 Future “To Be” Health Care System of Texas .......................................................................... 29 Transform the Delivery System to Models of Patient-centered Care ............................... 30 i Transition Away from Fee-for-service to Quality-based Payment ................................... 30 Build Capacity for Continuous, Ongoing Improvement and Innovation throughout the Health Care and Public Health Systems in Texas ............................................................. 31 B. Description of State Health Care Environment ........................................................................ 32 Population Demographics ......................................................................................................... 32 Population Overview ........................................................................................................ 32 State Population Growth ................................................................................................... 32 Aging Population .............................................................................................................. 33 Race/Ethnicity ................................................................................................................... 34 High Poverty and Income Disparity ................................................................................. 34 Education and Income....................................................................................................... 35 Population Health Status of Texas ............................................................................................ 37 Perception of Poor Health ................................................................................................. 37 Infectious Diseases ............................................................................................................ 38 Prevalent Chronic Conditions and Mortality .................................................................... 38 Factors Impacting Health Status ............................................................................................... 42 Racial and Ethnic Disparities ............................................................................................ 44 Regional Disparities .......................................................................................................... 45 Special Needs Populations ........................................................................................................ 45 Special Needs Populations in Medicaid and Medicare ..................................................... 46 Special Needs Populations in Private Coverage ............................................................... 46 Factors Impacting Care and Costs .................................................................................... 47 Profile of Major Health Providers in Texas .............................................................................. 48 Providers ........................................................................................................................... 48 State Public Health System ............................................................................................... 59 Profile of Major Health Payers in Texas................................................................................... 62 Medicaid and CHIP........................................................................................................... 63 Children’s Health Insurance Program ............................................................................... 68 Medicare ........................................................................................................................... 70 County Health Indigent Care Program ............................................................................. 70 Teacher Retirement System of Texas ............................................................................... 71 Employees Retirement System of Texas .......................................................................... 71 Commercial Insurance Carriers ........................................................................................ 71 Delivery System Payment Methods in Texas ........................................................................... 72 Medicaid Payment Methods ............................................................................................. 72 Private-Sector and Federally-sponsored Payment Methods in Texas............................... 74 ii Health Care Delivery System Performance in Texas ............................................................ 80 Aggregate Measures of System Performance ................................................................... 80 Potentially Preventable Events ......................................................................................... 82 Birth Outcomes ................................................................................................................. 85 Quality Performance among Major Payers ............................................................................... 90 Medicaid Managed Care ................................................................................................... 90 Medicare ........................................................................................................................... 92 Commercial Carriers ......................................................................................................... 92 NCQA Accreditation in Public and Private Plans ............................................................ 93 Factors Affecting Performance