Payment Modeling Workgroup Breakout Session
March 17, 2015
Agenda
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Meeting Objectives
•
Introductions
•
Workgroup Purpose
•
Payment Modeling Transformation Sequence
•
Workflow Deliverables
•
Workflow Timeline
•
Next Steps
Meeting Objectives
•
Workgroup members get to know each other, members of the SHIP
team
•
Become familiar with workgroup specific transformation sequence,
initial set of deliverables, and related timelines.
o
Deeper, and workgroup specific, dive into content reviewed by Julie earlier
today
•
Review immediate next steps to begin work
Introductions
•
Introduce yourself and share your professional experience.
•
Why did you agree to participate in this workgroup?
•
Based on what you heard this morning, identify:
o
One opportunity we should capitalize on
o
One barrier we will need to address
Payment Modeling Workgroup – Purpose
The purpose of the Payment Modeling Workgroup is to develop
approaches to
payment, reimbursement, and investment
that will
support successful implementation of the
care delivery system
transformation and population health improvement
strategies
identified by those workgroups.
The Payment Modeling team will serve as a
resource to all SHIP
transformation teams,
including designating representatives from the
Payment Modeling team to serve as embedded members of the three
transformation teams.
•
Payment Modeling Transformation Sequence
•
Workflow Deliverables
•
Workflow Deliverable Timeline
Approach to Completing Workgroup Deliverables
Define What a
‘good’ Paymt
Model is/does
Inventory
Existing
Models
Note/Clarify
Redundancy
Sustainability
What needs/attributes describe a good payment model?
Transformation
Payment Needs
Assessment
Gap/Root
Cause
Analysis
Best Practice/
Implementation
Road Map
Payment Modeling Transformation Sequence
What payment models/experiments are currently active?
Build payment model inventory/menu.
Are there similar payment models being called different things?
Create unique and descriptive names for each basic model.
What are the attributes of the
payment models needed by the
transformation teams?
Identify gaps between current state and goals/identified
community best practice. What root causes underlie gaps?
How should current models be adapted? Redesigned?
What is the road map for designing and testing new payment/investment
models? What is the plan to disseminate and support implementation?
Examples of successful payment/investment models
applied to target pop, intervention? What
measurement, data issues do they raise?
Community
Best Practice
Step
Description
Purpose
What Is A “Good”
Payment Model?
Identify realistic, actionable and measurable goals for payment/investment that will advance the health and health care of this population. Consider
patient/person/population perspective at center.
To establish a set of common/core attributes that all stakeholders agree are appropriate, achievable, actionable and measurable. These attributes will serve to align the efforts of all stakeholders in the transformation of payment/investment for this population
Population Boundaries
Transformation Teams identify specific population of people/patients to be considered in this transformationstudy
To clearly define the attributes of those included in the study so that team members can focus the transformation effort
Discovery
Structured gathering of relevant evidence-based
information about the population being studied – here, payment/investment models currently being applied to this population. Confirm interventions being identified by Transformation Teams.
To develop a well founded understanding of the current approaches to payment/investment for populations and interventions identified by
Transformation Teams. Determine what kind of inventory of current models, results, etc. would add value.
Community Best
Practice
Identification of actions by stakeholder group, specific to payment/investment, that will positively advance the Shared Goals for this group of people/patients
Go and see” examples of payment/investment in desired interventions. Can current approaches meet the need, work for WI? Why/why not? Consider connections with Transformation Measurement and HTI workgroups.
Gap Analysis/Root
Cause Assessment
Identify gaps between the current state and future state of the payment/investment models that pertain to the health and health care of this population. Identify and document root cause(s) associated with the gap(s). Multiple,
stakeholder based root causes are likely to track to one gap.
Define the gaps to permit assessment of whether proposed interventions will address gaps/root causes. Identify circumstances for each stakeholder group that adversely impact the identified gap(s)
Step
Description
Purpose
Wisconsin Best Practice
Identify approaches to payment/investment that meet identified attributes of successful model and build on current/known community best practice. Provide
frameworks, other support as needed by those who will implement.
To develop a menu of approaches to designing/implementing approaches to payment/investment that advance the health/healthcare needs of target population and engage all relevant stakeholders
Implementation Road
Map
Establish sequence of events, key actors, dependencies, needs for implementation support, etc.To support successful, sustainable, scalable implementation of Wisconsin best practice approaches to payment/investment by wide array of necessary
stakeholders.
Population Boundaries
Sources of Potential Priority Areas
•
SIM FOA and Plan for Improving Population Health, including Metrics
•
Care Redesign, Behavioral Health, and Population Health Workgroups
Population Boundaries
Suggested Criteria for Choosing Sub-Populations
•
Big enough to matter
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Small enough to manage – get reports, digest, understand the data and the improvement
opportunities
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Data is available to understand the problem and the opportunity, and the data supports the
choice
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Some degree of homogeneity within the sub-population
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In the line of sight of stakeholders – they are already interested
•
Connect to clinical environment in some way
•
Pick to win – successful application of transformation model from top to bottom
•
Experienced "transformation leaders" and can apply and improve the model the first time
through
•
Not necessary to look first at biggest cost, highest variation
•
Private and public sector relevance
Population Boundaries
Early Thinking
•
Hypertension
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Obesity
•
Tobacco
•
Diabetes
12Population Boundaries
Why Hypertension?
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Prevalent
•
Root cause/driver of poor health
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Gaps in outcomes
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Costly – to healthcare, to employers, to families and communities
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Amenable both to clinical and also community interventions
•
Existing momentum nationally, in the state
•
DHS/CDC
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Million Hearts
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CHNA/CHIP Top 8 (Root Causes – Nutrition/PA/Obesity/Tobacco)
Population Boundaries
Many Questions to be Answered
•
Adults?
•
Working age – 18 – 64?
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Seniors – 65+?
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Kids?
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Geographic focus area – urban, suburban, rural?
•
Focus by socioeconomic status or educational attainment?
•
Focus by racial or ethnic group?
•
Focus on greatest gaps, by any of these definitions of the population?
Community Conditions that Facilitate Healthy
Choices
Best Clinical Practice Including Patient Population
Health Management Strategies, Registries, Etc.
Patients’
Health Needs
and Goals
Care Redesign Workgroup Begins Here
Population Health Workgroup Begins Here
Payment Models, Measures, Data
Our goal will be to ground the SHIP Plan for Improving Population Health in
health care improvement
priorities
, while planning to act at the
intersection of health care and community,
as well as plan for
community level changes that are connected back
to the clinical transformation priorities.
P/S/E* Changes to
Support Healthier
Choices, Reduced
Risks
Clinic-Community
Linkages
Health Care
Transformation
Clinical improvement priority with clinical redesign recommendations including population medicine/clinical population health activities
Clinic- community linkage strategies, including other partners (collective impact
model)
Community P/S/E that supports optimal health, reduced risk factors, makes
aligned activities possible Community P/S/E that supports optimal health, reduced risk factors, makes
aligned activities possible Clinic- community linkage
strategies, including other partners (collective impact
model)
Community P/S/E that supports optimal health, reduced risk factors, makes
aligned activities possible
*P/S/E = Policy, Systems, and Environmental
What is a Good Payment Model?
Successful Payment Models Will…
•
Create incentives for healthcare providers and (as appropriate)
community partners to deliver optimal care to patients/consumers while
minimizing waste.
•
Support staff and infrastructure necessary to deliver identified best
practice
•
Require financial participation by all those with a stake in the outcome
•
Be risk adjusted and sized to the target – right payment for right
patients/consumers, right services
What is a Good Payment Model?
Successful Payment Models Will Be…
•
Supported by a demonstrated ROI – we are paying for what works, and
we can measure positive ROI on agreed-upon terms [may not all be
financial, in same time frame, savings may not accrue directly to the
payer/funder/investor]
•
Supported and viewed as feasible by majority of relevant public and
private payers/purchasers/funders – resulting in aligned approaches and
incentives
•
Developed and implemented in a context, with an understanding of how
this strategy contributes to the goal of better health with less disparity
What is a Good Payment Model?
What Do We Want to Finance?
What is a Good Payment Model?
Discussion
•
What attributes would you add to or subtract from the straw model?
•
Does the “healthcare 1.0/2.0/3.0” construct help to advance the
dialogue? Why or why not?
What Is A “Good”
Payment Model?
Identify realistic, actionable and measurable goals for payment/investment that will advance the health and health care of this population. Consider
patient/person/population perspective at center.
To establish a set of common/core attributes that all stakeholders agree are appropriate, achievable, actionable and measurable. These attributes will serve to align the efforts of all stakeholders in the transformation of payment/investment for this population
Discovery
Healthcare Payment - Current Conditions
•
Pluralistic insurance marketplace – commercial and Medicaid
•
Majority of $$ still paid on a FFS basis
•
Pay for value picking up steam, but not coordinated, not at
scale in the commercial market
•
Medicare moving (effectively?) into value based payment
•
What else do we need to know to understand the current
state?
Discovery
Investments in Health - Current Conditions
•
Health outcomes are heavily influenced by non-clinical factors,
particularly education and income
•
Investments in these determinants come not just from
healthcare payers, but also from federal, state, and local
government, business, philanthropy
Community Best Practice
Approaches to Consider
Community Best Practice
Approaches to Consider
Discovery
Discussion
•
How can we quickly arrive at a
clear and relevant
picture of the
current state?
o
What aspects of the current payment/investment environment do we need to
better understand?
o
What can we get started on now vs. waiting for the Transformation
Workgroups to refine their thinking?
•
Implementation will be among our biggest challenges – how can we
start thinking now re: how best to test feasibility, build engagement?
Discovery
Structured gathering of relevant evidence-based
information about the population being studied – here, payment/investment models currently being applied to this population. Confirm interventions being identified by Transformation Teams.
To develop a well founded understanding of the current approaches to payment/investment for populations and interventions identified by
Transformation Teams. Determine what kind of inventory of current models, results, etc. would add value.
