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Michigan Department of Community Health
Director James K. Haveman
Strategic Use of the Rear-View Mirror
on the Integration Highway
Lessons Learned: Benefits, Exchanges, Enrollment
July 29, 2014
Lynda Zeller, Senior Deputy Director
Behavioral Health & Developmental Disabilities Administration
Where We Are Today
Benefits & Funding Structures
Physical Health and Behavioral
Health General Population
(Mild-Moderate BH)
Specialty Behavioral
Health & Developmental
Disabilities
Managed CareMedicaid
-Competitively Bid
-13 Medicaid Health Plans
-Multiple plans within regions
(Majority in managed -Includes Mild/Moderate BH
care plans=except NH- -Model consistent for 17 years
LTC)
-CMH First Opportunity
through regional PIHP
-PIHP Sole Sourced
-10 Regions
-Shared Risk, A-87
-1915 (b)(c) concurrent
-CMH SMI, SUD, DD, SED
Services
Healthy Michigan Plan -Repeat items above
(Medicaid Expansion) -Added: Savings Acct, Personal
ABP-SPA & 1115
Incentives, Contributions
-Repeat items above
-Added: Broader addiction
& recovery services
Non Medicaid Funds
-SUD federal, state, local
(SUD Coordinating Agency
merging with PIHP)
-CMH state, local, federal
SMI, DD, SED
-Michigan Marketplace
(Exchange-EHB include BH)
Where We Are Today
Exchanges, Expansion
• Michigan Health Insurance Marketplace
(Exchange) www.michigan.gov/difs
– 4 Plan Levels, as many as 12 companies
• Healthy Michigan Plan (Expansion)
– Began April 1, 2014
– Unique model (incentives for healthy behaviors,
health account contributions, etc.)
– Enrollment April to early July – 322,000
– September 30 goal met in July
– www.michigan.gov/healthymichiganplan
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Where We Are Today
Information Exchange & Analytics
• Health Information Currently
– Electronic Health Records
• All 46 CMH use EHR for clinical record real time
• All 46 submit claims data to statewide data warehouse
– Care Connect 360 Analytics
• Analyzes claims/encounters both physical and
behavioral health – individual and population level
– Health Information Networks & Exchange
• www.mihin.org
• Behavioral Health – Physical Health Meaningful Use
Cases
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“Care Connect360”
Claims Analytics - Physical & CMH
• Provide access to available data in order to:
– Improve care coordination and case management
– Report chronic conditions
– Measure results statewide
•
•
•
•
•
Outcomes
Effectiveness of care
Quality
Performance
Population health
– Improve risk and outcome management
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– Support forecasting
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SCREEN SHOT- CARE CONNECT 360- Demographic Information and Chronic Conditions
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MI HIN
Network of Networks:
Health Plan QOs (more coming)
Federal
MSSS
HIE QOs
(Qualified sub-state HIEs)
State-wide
Shared Services
MDCH Data Hub
Data
Warehouse
Virtual QOs
Medicaid
Doctors &
Community
Providers
Pharmacies
(more coming)
Single
point of
entry/exit
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for
state
Copyright 2012-2014 Michigan Health Information Network
State
LABS
Checking the Rear View Mirror
Why & How Did We Get Here?
• Looking Back and Learning
– Pre Specialty Carve Out Through CMH
• Medical Model-HMOs – Lacking Specialty Service
• Large Institutions – State & Community
• Narrow Community Service Continuum (SMI, DD, SED)
– Pre Marketplace (Exchange), Parity
• CMH only provider for both SMI and MildModerate/general uninsured population
• Indigent funding (state, local, federal) grant structured,
& limited for CMH and SUD Coordinating Agency
Services
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Our Next Stop on the Highway
(2014-2015)
• MI Health Link (Medicare-Medicaid Dual Demo)
– Integrated Care “Model 4” –Build on Carve Out
– http://www.michigan.gov/mdch/0,4612,7-1322939__2939__2939-259203--,00.html
• Health Information Networks & HI Exchanges
– Uniform Consent Format (Paper and Electronic)
– Behavioral Health CCD (FIRST!)
– Behavioral Health & DD Use Cases (ADT, Autism)
• Health Homes (2703) SMI, Co-Location
• State Innovation Model Implementation
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Intended Use of the Rear View Mirror
2014-2015
– Looking back, is there now more or less:
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•
•
•
•
•
•
•
•
Recovery systems and orientation?
Trauma informed systems?
Access to physical health care (SMI, SUD)?
Inpatient recidivism (physical and behavioral health)?
Dollars getting to service? (medical loss)
Gaps between PIHP and Medicaid Health Plans?
Integration between CMH and PH providers?
Gaps between SUD and MH services?
Success managing chronic illness (diabetes, etc.)?
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Our Next Big Destination 2018-2019
Michigan’s Blueprint For Health Innovation
(State Innovation Model Product)
Better
Health
Better
Care
Lower
Cost
• Fewer early deaths
• Less chronic disease and obesity
• Improved mental health and reduced substance abuse
• Healthy babies
• Healthy child development
• Adequate nutrition and exercise
• Reduced health disparities
• Access to a patient-centered medical home
• Person-centered care
• Coordinated care
• Fewer hospitalizations and emergency department visits
• Reduced administrative complexity
• Constraining the rise in health insurance premiums
• Reduced expenditures by payers due to a healthier
population and reduced administrative complexity
• Slowing the rate of spending increase through better
utilization and efficiency
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Planning The Trip
Plan
(2013- 2014)
• Establish
transformation
governance
• Engage
stakeholders
• Select pilots
• Refine testing
strategies
Test
(2015-2018)
• Execute plan in
pilot sites
• Engage
stakeholders
• Create state
level
infrastructure
• Evaluation
Disseminate
(2018-2019)
• Scale up and
disseminate
model
successes
• Engage
stakeholders
• Evaluation
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Destination Highlights
Accountable Systems Of Care
•Provider network – comprehensive medical, behavioral,
social for defined population
•Share financial risk and rewards – performance based
•Support primary care transformation & infrastructure
development
•Create systems that coordinate complex care
•Share resources for greater efficiency
•Link with Community Health Innovation Regions for
better performance outcomes
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Destination Highlights
Community Health Innovation Regions
• Engage all relevant stakeholders for a collective impact of
improved health outcomes, including public health, business,
payers, providers, community members, community
development, philanthropy
• Address strategic priorities of the community/prosperity
region
• Link to Accountable Systems of Care to integrate healthcare
delivery, social care, and prevention and wellness activities
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Intended Use of the Rear View Mirror
– Looking back, is (are) there now more or less:
• Disparity in health status from social determinants?
• Incentives and payment structures that encourage
cross system accountability for population health?
• Consumer satisfaction?
• Positive trends in morbidity statistics for special
populations (SMI, SUD)?
• Administrative complexity within and across system
components?
• Of all 2014-2015 Rear View Check Items (Slide 10)?
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Vision & Mission
Our Guide On The Integration Highway
Our vision is to improve the experience of
care, improve the health of populations,
and reduce per capita costs of health care.
Our Mission is to protect, preserve, and
promote the health and safety of the people of
Michigan with particular attention to providing
for the needs of vulnerable and under-served
populations.
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Lessons Learned
Benefits, Exchange, Expansion
• Service-Funder Grids are a great first step
• Learn the differences: EHR, HIE, Analytics
• Model, model, model to anticipate how new
services interface, duplicate, impact others
• After the new benefit begins:
– Expect gaps and confusion and address quickly
– Use personal stories as your “flashlight”
– Balance detail and big picture measures
– Celebrate improved access and health status!
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Thank you,
And safe & happy travels….
Lynda Zeller
[email protected]
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