Continuing On The Road To Value - University Of Iowa

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Continuing on the Road to ValuePresented toICAHN Annual ConferenceChampaign, IllinoisNovember 14, 2019Keith J. Mueller, PhDGerhard Hartman Professor and HeadDirector, Rural Policy Research InstituteUniversity of Iowa

Squeeze the turnip Plant new seeds Water and fertilizer – change as needed Grow the new crop Linear but not mutually exclusive2

Policy imperative to find “savings” in the Medicare andMedicaid programsConsequence: Sequestration, scrutiny of allowablecost, little to no give on expanding the latterTight definitions of budget neutrality affect ability todemonstrate new approaches to sustaining servicesContinuous debates about certain programs, including340b3

Service line expansionNetwork affiliation to share costs andexpand service linesAddressing total cost of care in preparationfor new modelsIS IT ENOUGH/ -- NO4

Perhaps a hybrid seed: Frontier CommunityHealth Integration Program (still fee-for-service;extending cost-based reimbursement)New seed with basically untreated soil:Accountable Care Organizations (ACOs) with onesided riskNew seed: ACOs with two-sided riskNew seed: Global budgeting models (MD, PA)New seed: Changes in primary care payment –direct contracting, primary care first5

Think bold: Third Generation Hospitals (PaulKeckley report June 6, 2016: health focused,consumer driven; clinical leadership of clinicallyintegrated networks --- operating a retailbusinessHospitals without boundaries (Spectrum Health“Ecosystem of Health” Hospitals and HealthNetworks, Sept 14, 2016)Begin to address social determinants of healthForm and/or participate in communitycoalitions6

Example of changes to ACO program, includingnurturing new plants with demonstrations(water) and capital investments (fertilizer, couldbe in the same demonstrations)Infusions such as changes to wage indexEvolution of physician payment to includechronic care code, PCP and now the newprogramsInserting new services into MedicareAdvantage and ACOs7

Parallel the policy changes with newstrategies and efforts locallyWorking through local collaborationsWorking through regionalcollaborations8

Leverage community resources –Southeastern Hospital in Robeson CountyNCTransitional care team in Granville MedicalCenter in Oxford NCService line focus in Transylvania RegionalHospital in NC (services for elderly such asortho and emergency, but not labor anddelivery – moms sent to nearly hospital thatis affiliatedSource: Rural Hospitals Embrace Population Health in Quest for Relevance. North CarolinaHealth News. March 4, 2016.9

Partnerships to improvecommunity health Tobacco preventionprograms Wellness initiatives Care coordination andmedical homesSource: Population Health Strategies of Critical Access Hospitals. BriefingPaper #36. Flex Monitoring Team. August, 201610

Effective use of community healthworkersAddressing social determinants ofhealth – Accountable HealthCommunities, projects in StateInnovation Models,Working with Medicaid programs,managed care organizationsSource: Samantha Artiga and Elizabeth Hinton. Beyond Health Care: TheRole of Social Determinants in Promoting Health and Health Equity. IssueBrief. Kaiser Family Foundation. May, 201811

Lessons being learned by ICAHN in use of care coordination, use of data analytics,patient engagementIn Michigan (another rural model) lessons in strong governance, investing the sharedsavings, data analytics, chronic disease management (participating under theCaravan Health umbrella)12

Value-Based Care Assessment - Assess capacity andcapabilities to deliver value-based care. Receive an eightcategory readiness report.Physician Engagement - Score current engagement and buildeffective relationships to create a shared vision for asuccessful future.Board and Community Engagement - Hold value-based carediscussions as part of strategic planning and performancemeasurement.Social Determinants of Health - Learn and encourage ruralleaders/care teams to address issues to improve theircommunity's health.13

The Rural Health Value team recently released a new resource outlining eightcommonly used change management methodologies that are rural-relevant. It isintended as a guide to help rural health care leaders identify which approach(es)might be most useful to them and their organizations.Please share this resource as makes sense for your networks and stakeholders: Management Methodologies and Value-Based Strategies: An Overview forRural Health Care Leaders - Offers rural health leaders an overview of eightcommonly used management methodologies to help guide change, plusadditional resources and references for further exploration. (June 2019)14

Predictive Analytics Shape Care Processes: Identify patients with highest riskand plan interventions to support care management, using predictiveanalytics software in a health information exchangeRural Health Network Thrives on Innovation in Whole-Person Care:centralize coordination of efforts to ensure health and social services areavailable and benefit the public15

From Seema Verma on March 4, 2019Rural problem (hospital finance)“won’t be solved with money alone”“our vision is to transform the healthcaresystem into a patient centered, consumerdriven model where providers compete forpatients on the basis of lower cost and quality.”Three objectives: empowering patients, focusing onresults, unleashing innovationFinal phase of the transition CMS has beenadvocating, shared by the Learning and Actionnetwork16

Health Care Payment Learning and Action Network (HCP LAN)Alternative Payment Model FrameworkSource: ager.pdf17

Considerations from the RUPRI Health Panel after an assessment ofthe landscapeCombined with themes related to successful innovationAnd policy considerations put forth by successful innovatorsSources:1. Taking Stock: Policy Opportunities for Advancing Rural Health. RUPRI Health Panel. January, 2018. K-2018.pdf2. Toward a High Performing Rural Health Care System: Key Issues and Recommendations from Rural Health Care System Innovators. April,2019. 8

Support development of rural-relevant quality measuresDevelop comprehensive cross-agency approach to ruralhealth care quality improvement and technical assistanceOffer quality initiatives specifically design to meet ruralneeds and opportunities19

Quality measures which reflect the care and services in rural: Support the work of the NQF rural workgroup regarding the implementation ofexisting rural-relevant measures and development of new measures A comprehensive and aligned program of rural-focused qualityimprovement TA: Coordinated through contracting, management, and oversight across the multipleagencies of HHS with responsibility for health care and rural health. New health care quality pilot programs: Designed specifically to test methods to improve quality and value for the uniquerural environment Address the barriers to participation by CAHS and RHCs20

Ensure affordability of clinical and community-based preventive servicesProvide stable long-term funding to support locally-appropriate publichealth prevention programsEnsure availability of comprehensive and integrated services throughpolicies that target workforce adequacy development to achieve healthequity21

Incent integrated preventive and clinical servicesIntegrate population health goals into financingstrategies and payment policy formulation22

Exciting times of transforming finance, delivery organizationsAll the while benefitting from advances in science of medicineAnd benefitting from understanding of social determinants ofhealth and actions to takeWe can move to a system focused on health that draws the besttalent from multiple disciplines and perspectivesPolicy actions can facilitate (or inhibit) progress toward a highperformance rural health system23

The RUPRI Center for Rural Health Policy Analysishttp://cph.uiowa.edu/rupriThe RUPRI Health Panelhttp://www.rupri.orgRural Telehealth Research Centerhttp://ruraltelehealth.org/The Rural Health Value Programhttp://www.ruralhealthvalue.org24

Department of Health Management and PolicyUniversity of Iowa College of Public Health145 Riverside Drive, N232A, CPHBIowa City, IA 52242319-384-1503keith-mueller@uiowa.edu25

The Rural Health Research Gateway provides access to allpublications and projects from eight different research centers.Visit our website for more information. ruralhealthresearch.org Sign up for our email alerts!ruralhealthresearch.org/alertsCenter for Rural HealthUniversity of North Dakota501 N. Columbia Road Stop 9037Grand Forks, ND 5820226

Think bold: Third Generation Hospitals (Paul Keckley report June 6, 2016: health focused, consumer driven; clinical leadership of clinically integrated networks ---operating a retail business Hospitals without boundaries (Spectrum Health “Ecosystem of Health” Hospitals and Health Networks, Sept 14, 2016)

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