Collaboration Between Health Care and Public Health Workshop Summary (2016) / Chapter Skim
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2 Collaborating to Advance Payment Reform
2 Collaborating to Advance Payment Reform
Pages 5-18
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From page 5... ...
This is noteworthy, Linde said, because this is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments. The first goal is that by 2016, 30 percent of all Medicare provider payments should be in alternative payment models that are tied to value, rather than volume.
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From page 6... ...
Initiative funds states to develop innovative linkages between advanced primary care and public health through avenues such as financing data exchange, integration, performance monitoring, and others. Following the introduction by Linde, Theodore Wymyslo, chief medical officer of the Ohio Association of Community Health Centers, and Mary Applegate, medical director of the Ohio Department of Medicaid, discussed health care transformation and payment reform in Ohio as an example of successful collaboration between health care and public health organizations.
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From page 7... ...
In February 2011, Wymyslo was appointed director of the Ohio Department of Health and was directed to expand the PCMH model statewide. The four main priorities for improved health for the state of Ohio included expanding PCMH across the state, curbing tobacco use, decreasing infant mortality, and reducing obesity.
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From page 8... ...
The following month, Ohio received a planning grant from the CMMI SIM Initiative. In January 2014, Ohio expanded its Medicaid program under the ACA, and in December 2014, the state received a CMMI SIM Initiative Testing Grant for $75 million.
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From page 9... ...
COLLABORATING TO ADVANCE PAYMENT REFORM 9 to be focused on a population, she stressed, with specific measurement targets. The plan should be based on sound evidence of the best clinical practice and carried out in the context of public health and sociopolitical systems.
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From page 10... ...
Applegate likened the emerging health system under the ACA to a relay race. The first runner is health care coverage; the next is smart use of data to target special populations; the third leg is addressing the disparate outcomes and issues of health equity at the neighborhood or local health district level; and the final runner is community coordination.
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From page 11... ...
Paying for Value As mentioned by Wymyslo, at the end of 2014 Ohio received a CMMI SIM Initiative Testing Grant, and one area of focus was paying for health care value. Applegate reiterated that the payment reform initiative is a public–private partnership, including the five largest payers in the state, along with Medicaid, the state employees' insurance plan, and numerous other stakeholders.
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From page 12... ...
There is no change in pay if costs fell in the mid-range or if costs are below threshold but quality did not pass metrics. Principal accountable providers will be able to access standardized Episode of Care Payment Reports through an online portal starting in 2015.
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From page 13... ...
DISCUSSION During the discussion that followed, participants and panelists discussed how to identify the challenges to collaboration, engage public and private payers, link to social services, work across state lines, and focus and streamline safety net services. Challenges to Collaboration To start the discussion, moderator Linde asked the speakers to identify the main challenges to collaborating.
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From page 14... ...
Wymyslo responded that the state started by leveraging Medicaid, which covers more than 2.2 million Ohio patients, and the state employees' insurance plan, which covers 500,000 state workers, to demonstrate that these payment reform principles work. The state then challenged other insurers to do the same thing.
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From page 15... ...
Process measures include adolescent well checks (i.e., preconception health) , vaginal progesterone as an intervention for preterm birth, early elective deliveries, postpartum visits, safe sleep environments for infants, and social determinants (e.g., tobacco exposure)
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From page 16... ...
For example, a physician seeing a child in the office could potentially access data on the basis of the child's zip code and know if the child lives in an area with high lead levels, low fluoride, a high crime rate, housing concerns, poor air quality, and so forth. These data exist, he said, but they are not readily accessible in the exam room where the provider seeing the patient can use them to make public health–informed recommendations to the patients who are there for a traditional clinical care.
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From page 17... ...
These centers currently provide care for 565,000 patients in 55 of Ohio's 88 counties and are a very important part of the total health care delivery system. The free clinics often refer patients needing ongoing care to the community health centers, where the patients can receive continuous primary care services.
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From page 18... ...
. These themes included shared goals, community engagement, aligned leadership, a focus on sustainability, and shared data and analysis.
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