November 18, 2014

Connecticut State Innovation Model Initiative

Presentation to the Health Care Cabinet

• CMMI request for revised budget received 11-6-14

• Response required by 11-12-14

• $19 million reduction in budget…from nearly $64 million to $45 million citing right-sizing to state population

• Appears similar requests received by other states

• No decision on award; still an open contest

Revised Budget Request

• Population Health Planning: The funding request to support population health planning has been reduced by 8.6% through a delay of the hiring of the Epidemiologist 2 and Prevention Service Coordinator positions, a reduction in a position class from Health Program Associate to Health Program Assistant 2, and reduced funding from $100,000 to $80,000 for a contractor to lead the stakeholders for population health priorities. In addition, the Organizational Development Specialist at DPH has been replaced by a Health Program Assistant 2 at DSS to better support Medicaid's participation in population health planning. The delay in hiring the Prevention Service Coordinator will result in a delay in implementation of Prevention Service Centers to Year 4, which will delay associated evaluation activities until after the period of performance.

Revised Budget Request

• Medicaid Quality Improvement and Shared Savings Program: Connecticut is also proposing to begin the sustainability plan for Medicaid QISSP in year 4 of the period of performance rather than after the close of the period of performance. Accordingly, the year 4 cost of the actuarial services contractor will be borne the State rather than included in our budget request. There is no change proposed in the scope or timing of the Medicaid QISSP implementation. This change results in a 16.8% savings.

Revised Budget Request

• Primary Care Transformation: The Advanced Medical Home Glide Path Program has been reduced by nearly 26% through a reduction in the number of practices targeted for transformation, from 500 to 370 over the period of performance. The request for the Community and Clinical Integration Program (CCIP) has been reduced by nearly 7%. The Innovation Awards have been eliminated entirely. The expectation is that the State will approach national or local foundations to undertake grant programs that align with our care delivery transformation goals and our original Innovation Award concept. We have revised the AMH Projection in Appendix C: Pace of Reform Accountability Metrics to comport with the reduced number of target practices.

Revised Budget Request

• Workforce: Two of the three proposed initiatives, Teaching Health Centers and Connecticut Service Track, have been eliminated from our budget request at a savings of 63%. We remain committed to these important and innovative initiatives and will support the project owners in identifying other sources of funds. Funding for the Community Health Worker initiative was retained in its entirety. If the OAGM determines that the remaining proposed Community Health Worker initiative is not appropriate for funding under this award, we would propose to reallocate requested funds to support the AMH Glide Path and CCIP programs.

Revised Budget Request

• Evaluation: The evaluation budget has been reduced by approximately 45%, including reductions in staff and percent effort. This reduction will limit the State's ability to undertake more sophisticated comparative studies such as an expanded evaluation of the effectiveness of VBID and value-based payment models alone and in concert with one another to see which is more effective and whether synergies can be achieved by offering the member incentive (VBID) and provider incentives in combination. It will also limit the ability to analyze e-licensing data regarding the physician workforce. The PMO will pursue other sources for funding these activities.

Revised Budget Request

• Consumer Engagement: We reduced engaged from 6 to 5 community organizations to assist in feedback and engagement loops with consumer stakeholders. We also eliminated travel to conferences for consumer advisory board members.

• SIM Program Management Office: Two of the six proposed SIM funded positions in the PMO were eliminated for resulting in a 31.5% reduction. The positions include a research analyst to support evaluation activities including oversight of the evaluation contractor and a health program associate assigned to oversee Innovation Awards. New state funded PMO staff will be assigned responsibility for supporting evaluation activities and oversight of the evaluation contractor in addition to other duties.

Revised Budget Request

Revised Model Test Grant RequestSIM Test Grant Request Federal Revised Total

Plan for Improving Population Health 6,832,588$ 8.6% 6,244,006$

Care Delivery/Payment Reform 29,712,331$ 30.9%Medicaid QISSP 9,470,456$ 16.8% 7,877,886$ AMH Glide Path 10,866,875$ 25.9% 8,056,445$ Clinical Community Integration 4,875,000$ 5.8% 4,592,928$ Innovation Awards 4,500,000$ 100.0% -$

Quality Alignment 617,400$ 0.0% 617,400$

Health Information Technology 14,380,983$ 25.1% 10,769,595$

Workforce Development 2,719,061$ 63.5% 992,998$

Value-based Insurance Design 325,576$ 0.0% 325,576$

Consumer Engagement 421,928$ 10.8% 376,568$

Program Evaluation 4,963,125$ 45.0% 2,700,000$

PMO Administration 3,585,197$ 31.8% 2,446,598$

Total 63,558,189$ 29.2% 45,000,000$

Percent Reduction

AMH Glide Path – Accountability Metrics

Target Percentage

2015 Population N1st Quarter 0 0%2nd Quarter 0 0%3rd Quarter 0 0%4th Quarter 25 7%

2016 Population N1st Quarter 140 38%2nd Quarter 185 50%3rd Quarter 185 50%

4th Quarter 185 50%2017 Population N

1st Quarter 185 50%2nd Quarter 185 50%3rd Quarter 235 64%4th Quarter 235 64%

2018 Population N1st Quarter 370 100%2nd Quarter 370 100%3rd Quarter 370 100%4th Quarter 370 100%

Note 1: Targets are cumulative totalsNote 2: AMH target practices may extend beyond MQISSP

370

370

370

YearPrimary Care Practices

370

Practice Transformation Task Force

• Advanced Medical Home Glide Path

• Use of NCQA PCMH 2014 standards as foundation for Advanced Medical Home (AMH) Glide Path Program

• Require NCQA PCMH recognition as a condition for completion of the AMH Glide Path Program

Practice Transformation Task Force

• Plus selected modifications:

– Tailor certain must pass elements and critical factors to emphasize key elements of our vision related to

• Patient centered care

• Health equity

• Integrated behavioral health

• Integrated oral health

– Keep in mind practice burden, avoid the “impossible lift”

– Use transformation vendors to achieve our vision by emphasizing certain capabilities, going “beyond the standards” in the transformation process

Practice Transformation Task Force

• Advanced Medical Home Pilot

– Test transformation methods aimed at improving practice and patient experience

– Allowing for flexibility in the application of these methods so that participating practices can help us to identify the optimal approach

• Released RFP for transformation services November 6, 2014

• Focus on defining the outputs and an extended roadmap with the goal of concluding the first phase of the Council’s work by May 2015

• Several design groups established: health equity, behavioral health, pediatrics, and care experience

• DSS is working with MAPOC Care Management Committee to prepare recommendations to Quality Council for supplementary Medicaid measures

Quality Council

• Arranging for consultation services support

• Anticipate intensive series of meetings culminating in report and recommendations for a package of consumer safeguards, March 2015

• DSS will work with MAPOC Care Management Committee to prepare recommendations to Equity and Access Council for supplementary Medicaid specific safeguards

Equity and Access Council

• Arranging for consultation services support

• Anticipate launch third week in December

• HIT will be the focus of our next Healthcare Innovation Steering Committee meeting

Health Information Technology Council

Questions