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Accounting for Social Risk Factors in Medicare Payment (2017)

Chapter: BA: Example Implementation Strategies and Case Studies

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Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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BA

Example Implementation Strategies and Case Studies

As described in Appendixes B1 and B2, the committee reviewed both the peer-reviewed and grey literature in order to identify strategies providers disproportionately serving socially at-risk populations have implemented to improve care and outcomes for their patients. As part of this effort, the committee reached out to organizations known to conduct research or represent providers disproportionately serving socially at-risk populations (Alliance of Community Health Plans, America’s Essential Hospitals, America’s Health Insurance Plans, and The Commonwealth Fund) who submitted 60 case studies. The committee also searched the published literature to identify additional examples. Based on a review of the case studies submitted, informed also by the literature and, in some cases, committee members’ empirical research or professional experience delivering care to socially at-risk populations, the committee identified commonalities from which it concluded that six community-informed and patient-centered systems practices show promise for improving care for socially at-risk populations.

This appendix includes a series of tables that provide a selection of implementation strategies and case studies in which these strategies were identified for each of the six systems practices. Table BA-1 includes examples regarding a commitment to health equity, Table BA-2 includes examples of data and measurement strategies, Table BA-3 has examples of components of comprehensive needs assessments, Table BA-4 provides examples of collaborative partnerships, Table BA-5 offers strategies for providing care continuity, and Table BA-6 lists examples of engaging patients in their care. These tables aim to illustrate the range and types of activities

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
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TABLE BA-1 Commitment to Health Equity: Example Implementation Strategies and Case Studies

Example Implementation Strategy Example Case Studies
Senior management and clinician leadership commitment to equity HealthPartners Minnesotaa
Kaiser Permanenteb
Integration of health equity into and communication of equity as part of common organization vision, mission, and goals HealthPartners Minnesotaa
Kaiser Permanenteb
Internal leaders designated responsibility for developing and overseeing a strategic plan to monitor and reduce health inequities HealthPartners Minnesotaa
Diverse workforce to provide culturally concordant and culturally competent care HealthPartners Minnesotaa
Hennepin Healthc
Kaiser Permanenteb
Tucson and Southern Arizonad
Workforce trainings and education to improve communication with patients, including cultural competence training and hiring language interpreters HealthPartners Minnesotaa
Interventions to reduce inequities HealthPartners Minnesotaa Kaiser Permanenteb
Identification and acknowledgment of health inequities and setting measurable goals to reduce them HealthPartners Minnesotaa
Expectations set and feedback provided regarding activities and practices to achieve equity HealthPartners Minnesotaa
Incorporation of health equity into compensation or incentives HealthPartners Minnesotaa
Financial and non-financial resources aligned and allocated to promote health equity HealthPartners Minnesotaa
Kaiser Permanenteb

SOURCES:

a Personal communication, Susan Knudson (HealthPartners) to Charles Baumgart (committee member), December 14, 2015.

b Meyers, 2008.

c Sandberg et al., 2014.

d Klein et al., 2014b.

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×

TABLE BA-2 Data and Measurement: Example Implementation Strategies and Case Studies

Example Implementation Strategy Example Case Studies
Regular, standardized collection of social risk factor data Denver Healtha
Analysis and monitoring of performance data disaggregated by indicators of social risk to identify existing health disparities within organizations HealthPartners Minnesotab
Enhanced risk prediction models Denver Healtha
Montefiore Medical Centerc

SOURCES:

a Hostetter and Klein, 2015.

b Personal communication, Susan Knudson (HealthPartners) to Charles Baumgart (committee member), December 14, 2015.

c McCarthy and Chase, 2010.

TABLE BA-3 Comprehensive Needs Assessment: Example Implementation Strategies and Case Studies

Example Implementation Strategy Example Case Studies
Proactive health assessment tool completed by patients Kaiser Permanente Colorado PATHWAAYa
Community Care of North Carolinab
Analysis of data from a variety of sources (including performance data, utilization data, clinical notes, patient observations, and patient-generated data) Denver Healthc
Kaiser Permanente Colorado PATHWAAYa
Information-exchange portal for clinical providers, social service agencies, public health agencies, and community organizations to share information (with patient permission) about social needs Colorado Coalition for the Homelessd
Parkland Hospitale

NOTE: PATHWAAY = Proactive Assessment of Total Health and Wellness to Add Active Years.

SOURCES:

a ACHP, n.d.-c.

b Klein and McCarthy, 2009.

c Hostetter and Klein, 2015.

d Klein, 2014.

e Personal communication, Doug McCarthy (The Commonwealth Fund) to staff, January 12, 2016.

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×

TABLE BA-4 Collaborative Partnerships: Example Implementation Strategies and Case Studies

Example Implementation Strategy Example Case Studies
Medical neighborhoods/accountable health communities Colorado Regional Care Collaborative Organizationsa

Hennepin Healthb

Minnesota Accountable Communities for Healtha

Oregon Coordinated Care Organizationsa

Care teams including non-medical professionals Citywide Colon Cancer Control Coalitionc

Hennepin Healthb

Truman Medical Centerd

Open-access/same-day appointments for ambulatory care The New York City Health and Hospitals Corporatione

Alaska Native Medical Centerf

Denver Healthg

New technologies (e.g., teleconference, videoconference, and mobile screening units) that bring clinical care to patients Montefiore Medical Centerh

West County Health Centersi

Community Health Centers, Inc.j

Project ECHOj

Regional collaborations with other health care providers Western New York, West Central Michigan, Southern Arizonak

Health Share of Oregonl

Hennepin Healthm

MetroHealth Care Plusn

Involvement and collaboration with social service and public health agencies and community organizations Colorado Coalition for the Homelessl

Hennepin Healthb

Montefiore Medical Centerh

Neighborhood Health Planp

UPMC for You Cultivating Health for Successq

Denver Healthg

SOURCES:

a Corrigan and Fisher, 2014.

b Sandberg et al., 2014.

c Itzkowitz et al., 2016.

d America’s Essential Hospitals, 2015.

e McCarthy and Mueller, 2008.

f Murray et al., 2003.

g McCarthy et al., 2007.

h McCarthy and Chase, 2010.

i Hostetter and Klein, 2014.

j Felland et al., 2013.

k McCarthy et al., 2014.

l Klein et al., 2014a.

m Hostetter and Klein, 2015.

n Cebul et al, 2015.

p Silow-Carroll and Rodin, 2013.

q Lovelace, 2016.

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×

TABLE BA-5 Care Continuity: Example Implementation Strategies and Case Studies

Example Implementation Strategy Example Case Studies
Coordinated care teams Priority Health Tandem 365a

Kaiser Permanente Colorado PATHWAAYb

Fallon Health NaviCare and Summit ElderCare Programsc

Hennepin Healthd

Denver Healthe

Truman Medical Centerf

Case management by trained clinical or lay person care coordinators/patient navigators Geisinger Health Plan Medically Complex Medical Homeg

The New York City Health and Hospitals Corporationh

Health Care Homes in Minnesotai

New technologies (teleconference, videoconference, shared data) to coordinate care between clinical and social service providers West County Health Centersj
Collocating clinical, behavioral health, and social services Priority Health Tandem 365a

Colorado Coalition for the Homelessk

Hennepin Healthd

Cherokee Health Systemsl

Truman Medical Centerf

Eskenazi Hospitalm

Patient education about care transitions Geisinger Health Plan Medically Complex Medical Homeg

NOTE: PATHWAAY = Proactive Assessment of Total Health and Wellness to Add Active Years.

SOURCES:

a ACHP, n.d.-d.

b ACHP, n.d.-c.

c ACHP, n.d.-a.

d Sandberg et al., 2014.

e McCarthy et al., 2007.

f America’s Essential Hospitals, 2015.

g ACHP, n.d.-b.

h McCarthy and Mueller, 2008.

i Felland et al., 2013.

j Hostetter and Klein, 2014.

k Klein, 2014.

l Personal communication, Doug McCarthy (The Commonwealth Fund) to staff, January 12, 2016.

m America’s Essential Hospitals, 2014.

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×

TABLE BA-6 Engaging Patients in Their Care: Example Implementation Strategies and Case Studies

Example Implementation Strategy Example Case Studies
Patient education about self-management, healthy behaviors, and care coordination Genesys HealthWorksa Cook
County Health & Hospitals Systemb
Culturally sensitive, targeted, and tailored patient education New York City Citywide Colon Cancer Control Coalitionc
UCare (UCare Response to CMS)d
Denver Healthe
Tailored care plans easily understood by patients Geisinger Health Plan Medically Complex Medical Homef
Kaiser Permanente Colorado PATHWAAYg
Clinician and non-clinician patient/health navigation Best Babies Zoneh
Genesys HealthWorksa
New York City Citywide Colon Cancer Control Coalitionc
New technologies (telephone consultation, videoconference, mobile screenings, smartphone apps, etc.) to promote healthy behaviors and reduce health risks Columbus Regionali
Genesys HealthWorksa
West County Health Centersi
Reach patients through community centers, homeless shelters, religious organizations, schools Best Babies Zoneh
Health Plan of San Mateoj
Hennepin Healthi
Denver Healthe

NOTE: CMS = Centers for Medicare & Medicaid Services; PATHWAAY = Proactive Assessment of Total Health and Wellness to Add Active Years.

SOURCES:

a Klein and McCarthy, 2010.

b America’s Essential Hospitals, 2014.

c Itzkowitz et al., 2016.

d Personal communication, Mark Hamelburg (America’s Health Insurance Plans) to Charles Baumgart (committee member), December 18, 2015.

e McCarthy et al., 2007.

f ACHP, n.d.-b.

g ACHP, n.d.-c.

h Foubister, 2013.

i Hostetter and Klein, 2015.

j Personal communication, Doug McCarthy (The Commonwealth Fund) to staff, January 12, 2016.

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×

that individual health care providers have implemented to apply each of the six systems practices. This appendix should therefore be considered a series of illustrative examples rather than a comprehensive and exhaustive list of organizations and practical strategies identified in the published and grey literature.

REFERENCES

ACHP (Alliance of Community Health Plans). n.d.-a. Fallon Health NaviCare and Summit ElderCare programs. http://www.achp.org/wp-content/uploads/report-Innovation_ElderCare_FALLON.pdf (accessed December 14, 2015).

ACHP. n.d.-b. Geisinger Health Plan’s medically complex medical home program. http://www.achp.org/wp-content/uploads/report-Innovation_ElderCare_GEISINGER.pdf (accessed December 14, 2015).

ACHP. n.d.-c. Kaiser Permanente’s PATHWAAY program. http://www.achp.org/wp-content/uploads/report-Innovation_ElderCare5.8.15_KP.pdf (accessed December 14, 2015).

ACHP. n.d.-d. Priority Health’s TANDEM365 program. http://www.achp.org/wp-content/uploads/report-Innovation_ElderCare_PRIORITY.pdf (accessed December 14, 2015).

America’s Essential Hospitals. 2014. Community-focused steps to boosting nutrition, wellness. http://essentialhospitals.org/quality/community-focused-steps-to-boosting-nutrition-wellness (accessed March 18, 2016).

America’s Essential Hospitals. 2015. Improving care transitions for socially, medically complex patients. http://essentialhospitals.org/quality/improving-care-transitions-for-socially-medically-complex-patients (accessed March 18, 2016).

Cebul, R. D., T. E. Love, D. Einstadter, A. S. Petrulis, and J. R. Corlett. 2015. MetroHealth Care Plus: Effects of a prepared safety net on quality of care in a Medicaid expansion population. Health Affairs (Millwood) 34(7):1121–1130.

Corrigan, J. M., and E. S. Fisher. 2014. Accountable health communities: Insights from state health reform initiatives. http://tdi.dartmouth.edu/images/uploads/AccountHealthCommWhPaperFinal.pdf (accessed March 7, 2016).

Felland, L. E., A. E. Lechner, and A. Sommers. 2013. Improving access to specialty care for Medicaid patients: Policy issues and options. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2013/jun/1691_felland_improving_access_specialty_care_medicaid_v2.pdf (accessed March 8, 2016).

Foubister, V. 2013. Case study: Louisiana’s poor rankings make improving birth outcomes a state imperative. http://www.commonwealthfund.org/publications/newsletters/qualitymatters/2013/february-march/case-study (accessed February 4, 2016).

Hostetter, M., and S. Klein. 2014. In focus: Innovating care delivery in the safety net. http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/december-2014-january-2015/in-focus (accessed February 2, 2016).

Hostetter, M., and S. Klein. 2015. In focus: Segmenting populations totailor services, improve care. http://www.commonwealthfund.org/publications/newsletters/quality-matters/2015/june/in-focus (accessed March 8, 2016).

Itzkowitz, S. H., S. J. Winawer, M. Krauskopf, M. Carlesimo, F. H. Schnoll-Sussman, K. Huang, T. K. Weber, and L. Jandorf. 2016. New York Citywide Colon Cancer Control Coalition: A public health effort to increase colon cancer screening and address health disparities. Cancer 122(2):269–277.

Klein, S. 2014. Colorado Coalition for the Homeless: A model of supportive housing. http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/october-november/case-study (accessed February 2, 2016).

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×

Klein, S., and D. McCarthy. 2009. North Carolina’s ABCD program: Using community care networks to improve the delivery of childhood developmental screeing and referral to early intervention services. http://www.commonwealthfund.org/publications/issue-briefs/2009/aug/north-carolinas-abcd-program-using-community-care-networks-to-improve-the-delivery (accessed March 8, 2016).

Klein, S., and D. McCarthy. 2010. Genesys HealthWorks: Pursuing the triple aim through a primary care-based delivery system, integrated self-management support, and community partnerships. http://www.commonwealthfund.org/publications/case-studies/2010/jul/genesys-healthworks (accessed February 2, 2016).

Klein, S., D. McCarthy, and A. Cohen. 2014a. Health Share of Oregon: A community-oriented approach to accountable care for Medicaid beneficiaries. http://www.commonwealthfund.org/publications/case-studies/2014/oct/health-share-oregon-aco-case-study (accessed February 2, 2016).

Klein, S., D. McCarthy, and A. Cohen. 2014b. Tuscon and southern Arizona: A desert region pursuing better health and health system performance. http://www.commonwealthfund.org/publications/case-studies/2014/apr/tucson-and-southern-arizona-a-desert-region-pursuing-better-health-and-health-system-performance (accessed March 8, 2016).

Lovelace, J. 2016. Integrating health care and supported housing to improve the health and well-being of the homeless: A population health case study. http://nam.edu/integrating-health-care-and-supported-housing-to-improve-the-health-and-well-being-of-the-home-less-a-population-health-case-report (accessed March 29, 2016).

McCarthy, D., and D. Chase. 2010. Montefiore Medical Center: Integrated care delivery for vulnerable populations. http://www.commonwealthfund.org/publications/case-studies/2010/oct/montefiore-medical-center (accessed March 8, 2016).

McCarthy, D., and K. Mueller. 2008. The New York City Health and Hospitals Corporation: Transforming a public safety net delivery system to achieve higher performance. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2008/oct/the-new-york-city-health-and-hospitals-corporation--transforming-a-public-safety-net-delivery-system/mccarthy_nychlthospitalscorpcasestudy_1154-pdf.pdf (accessed February 4, 2016).

McCarthy, D., C. Beck, R. Nuzum, and A. Gauthier. 2007. Denver Health: A high-performance public health care system. http://www.commonwealthfund.org/publications/fund-reports/2007/jul/denver-health--a-high-performance-public-health-care-system (accessed March 18, 2016).

McCarthy, D., S. Klein, and A. Cohen. 2014. Opportunity for regional improvement: Three case studies of local health system performance. http://www.commonwealthfund.org/~/media/files/publications/case-study/2014/apr/1737_mccarthy_regional_case_study_synthesis_v2.pdf (accessed March 8, 2016).

Meyers, K. 2008. Beyond equal care: How health systems can impact racial and ethnic health disparities. http://share.kaiserpermanente.org/media_assets/pdf/communitybenefit/assets/pdf/our_work/global/BeyondEqualCare2001_08.pdf (accessed February 2, 2016).

Murray, M., T. Bodenheimer, D. Rittenhouse, and K. Grumbach. 2003. Improving timely access to primary care: Case studies of the advanced access model. Journal of the American Medical Association 289(8):1042–1046.

Sandberg, S. F., C. Erikson, R. Owen, K. D. Vickery, S. T. Shimotsu, M. Linzer, N. A. Garrett, K. A. Johnsrud, D. M. Soderlund, and J. DeCubellis. 2014. Hennepin health: A safety-net accountable care organization for the expanded Medicaid population. Health Affairs (Millwood) 33(11):1975–1984.

Silow-Carroll, S., and D. Rodin. 2013. Forging community partnerships to improve health care: The experience of four Medicaid managed care organizations. http://www.commonwealthfund.org/publications/issue-briefs/2013/apr/forging-community-partnershipsto-improve-care (accessed February 2, 2016).

Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 303
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 304
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 305
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 306
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 307
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 308
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 309
Suggested Citation:"BA: Example Implementation Strategies and Case Studies." National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for Social Risk Factors in Medicare Payment. Washington, DC: The National Academies Press. doi: 10.17226/23635.
×
Page 310
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Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver.

Accounting For Social Risk Factors in Medicare Payment is the fifth and final report in a series of brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report aims to put the entire series in context and offers additional thoughts about how to best consider the various methods for accounting for social risk factors, as well as next steps.

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