Nevada State Innovation Model (SIM) Collaborative Initiatives
The Nevada State Innovation Model (SIM) aims to transform the healthcare delivery and payment system through a multi-payer collaborative approach. Launched in 2015, the SIM project focuses on population health management and stakeholder engagement to enhance care quality and reduce costs. With a grant of $2 million, Nevada is developing innovative models to improve healthcare outcomes and lower program expenditures.
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Presentation Transcript
Nevada State Innovation Model (SIM) Multi-Payer Collaborative September 30, 2015 Division of Health Care Financing and Policy
Agenda Introductions State Innovation Model (SIM) Background Key Nevada SIM Initiatives SIM and Population Health Management Role of Multi-Payer Collaborative Next Steps Discussion DHHS, DHCFP - Nevada State Innovation Model (SIM) Project Prepared by Myers and Stauffer 2
State Innovation Model (SIM) Background DHCFP was awarded $2 Million SIM Model Design Grant on December 16, 2014 One year grant period beginning February 1, 2015 and ending January 31, 2016 Grant deliverable is a State Health System Innovation Plan (SHSIP) The SHSIP will be the Nevada roadmap for transformation of the healthcare delivery and payment system DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 3 Prepared by Myers and Stauffer
State Innovation Model (SIM) Background SIM Funding Opportunity Provides financial and technical support to states to design or test innovative payment and service delivery models that will improve health, improve care and lower costs Premise State innovation with broad stakeholder input and engagement, including multi-payer models, will accelerate delivery system transformation to provide better care at lower costs Goal Identify delivery models that reduce program expenditures and enhance the quality of care and outcomes DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 4 Prepared by Myers and Stauffer
State Innovation Model (SIM) Background Multi-Payer Focus Public: Medicaid and Public Employees Benefit Program (PEBP) Private: fully and self-insured Employers Delivery System and Payment Transformation Leverage Health Information Technology (HIT) Sustainability Planning Reinvestment of Savings DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 5 Prepared by Myers and Stauffer
Stakeholder Engagement Activities Activities to Date 3 Kickoff meetings 8 Community meetings 9 Taskforce meeting 13 Workgroup meetings 4 Stakeholder update webinars Survey Tool Deployed Website Content Numerous DHCFP presentations and individual stakeholder meetings DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 6 Prepared by Myers and Stauffer
SIM and Population Health Management All Payers in Nevada Face Similar Health Care Challenges: Access to Health Care in Rural and Frontier Markets Health Care Workforce Shortages Critical Health Issues Cancers Heart Disease and Strokes Obesity Diabetes Behavioral Health (Mental Health and Substance Use Disorder) Tobacco Use Prevention and Wellness Inappropriate Emergency Department Utilization DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 7 Prepared by Myers and Stauffer
Key SIM Initiatives Patient-Centered Medical Home (PCMH) New legislation recognizing/defining PCMHs Goal: Expand the number of PCMHs across NV Community Paramedicine Expand to support care coordination on statewide basis Community Health Workers (CHWs) Promote usage of CHWs to improve care coordination and health literacy Telemedicine Increase the number of sites and appropriate use Project ECHO Ensure that primary care providers have access to specialists to support treatment decisions DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 8 Prepared by Myers and Stauffer
Key SIM Initiatives Medicaid Health Home Targeted segments of the Medicaid population Providing intensive care coordination through an integrated care team Two or more chronic diseases Population Health Management Multi-Payer Engagement Leverage Existing Efforts Role of PCMHs, Community Paramedicine, CHWs, Telemedicine, etc. Value-Based Purchasing (VBP)/Reimbursement: Value over Volume Develop reimbursement model for PCMHs that includes tiered Per Member Per Month (PMPM), quality incentives and infrastructure support Leveraging Health Information Technology DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 9 Prepared by Myers and Stauffer
Multi-Payer Collaborative (MPC) Concept Brings together payers, employers and providers in the state invested in reaching consensus to develop goals, measures and provider payment models through the SIM project Creates environment of collaboration versus competition Enables leveraging of existing infrastructure DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 11 Prepared by Myers and Stauffer
Roles and Responsibilities Create common themes and unified efforts that are payer neutral Establish common population health improvement goals Achieve common messaging to providers and members Pooling payer resources to support transformation Design a flexible VBP approach recognizing improved clinical outcomes Establish performance measurement parameters for simplified reporting and accountability DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 12 Prepared by Myers and Stauffer
MPCs: National Landscape States approaches vary based on market specifics Population health statistics Proposed delivery system and payment models Health outcome goals Degree of payer/employer participation States seek alignment with payers in order to successfully implement innovative payment models DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 13 Prepared by Myers and Stauffer
MPCs: National Landscape Lessons Learned: No cookie cutter approach must be market specific Avoid underestimating the amount of time and resources needed to effect change through innovation Health Information Exchange (HIE) infrastructure is critical in the support to delivery system and payment models For performance measure monitoring, MPCs need timely and easily accessible data Providers need detailed cost and quality information must also be timely and easily accessible DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 14 Prepared by Myers and Stauffer
Examples of State MPCs State Participants Payment Model State employees Medicaid Commercial payers Fee for Service (FFS)+ PMPM Fees Shared savings Arkansas Medicaid Managed Care Commercial payers including Blue Cross/Blue Shield of Michigan Medicaid Commercial insurers Self-insured employers FFS + PMPM Fees Care Management fee Michigan FFS + PMPM Fees Community Health Teams reimbursed by payers Vermont Medicaid Commercial payers Self-insured employers Wisconsin DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 15 Prepared by Myers and Stauffer
Proposed MPC Roadmap An effective MPC roadmap involves Creation of MPC charter and governance structure Sustained involvement of key stakeholders: private payers, fully funded and self-funded employers, public payers and providers Development of subcommittees, for example Delivery system and multi-payer payment models Quality measures and outcomes Provider support and PCMH expansion Learning collaboratives HIT infrastructure and data Joint performance measurement monitoring and reporting Development of planning and implementation objectives for phased approach DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 16 Prepared by Myers and Stauffer
Tools To Support MPCs Health Information Technology Meaningful use of Electronic Health Records (EHR) A HIE is critical to support the transition of care management and coordinated care among all health care providers Promotion of provider and payer participation in statewide HIE Support and technical assistance for provider practice transformation Leverage existing resources DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 17 Prepared by Myers and Stauffer
Proposed NV MPC Stakeholders Medicaid and CHIP NV Public Employees Benefit Program (PEBP) Managed care plans (Amerigroup and UHC) Employers (fully and self-insured) Indian Health Services Culinary Health Fund Include other payers as they express interest DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 18 Prepared by Myers and Stauffer
Next Steps Continued outreach to stakeholders Foster commitment from key payers, employers and providers for participation in the MPC Discuss payers current activities in NV Convene participants to develop charter and governance DHHS, DHCFP - Nevada State Innovation Model (SIM) Project 19 Prepared by Myers and Stauffer
