Support for Infrastructure

Support for infrastructure refers to a range of supports offered to accountable care projects by the state, including information technology, staff support, data feedback loops, and the convening of learning collaboratives.

 

Alabama

Regional Care Organizations (RCOs) and Alabama’s Patient Care Networks would be required to leverage the health information exchange (HIE) infrastructure under development in Alabama, One Health Record™. To ensure better integration of the Medicaid providers into the larger health care marketplace, the health information exchange (HIE) would be the primary vehicle through which Medicaid providers share and access clinical information.

 

Providers affiliated with RCOs would be expected to use the standardized continuity of care record (CCD), which is currently under development and will be a component of the providers’ electronic health records. HIE will provide real-time access to data that will support providers in predicting, planning for, and intervening when necessary in a beneficiary’s care management plan. In the interim, the state has approved other web-based tools to facilitate the efficient exchange of medical information between physician offices and health care facilities.

 

In the state’s 1115 Waiver Concept paper, it proposes that RCOs would be eligible to receive reimbursement for certain upfront development and implementation costs, such as:

  • Joint governance models to support the ability for multiple providers to oversee and have responsibility for the RCO services provided to its members.
  • Initial staff required to manage enrollment and rosters, connect patients with providers, process provider reimbursements, undertake quality management and finances, hire care managers and train staff.
  • Information technology (e.g., electronic health records, interoperability, referral management systems, patient tracking, metric reporting, and disease registries), including incentives for behavioral health and long-term care providers who have not qualified for meaningful use incentives.
Alaska No known activity at this time.
Arizona No known activity at this time.
Arkansas

The Arkansas Health Care Payment Improvement Initiative has created a HIPAA-compliant online database, the Provider Portal, to provide feedback to principal accountable providers (PAPs). Arkansas providers received a letter in July 2012 explaining the portal and the necessary steps to participate. The letter also explains that providers will gain access to the state’s statewide health information exchange, the State Health Alliance for Records Exchange (SHARE).

California
While the California Public Employees’ Retirement System (CalPERS) in its role as purchaser is not directly providing infrastructure supports to Blue Shield or the participating providers, the insurer and provider organizations have worked together to build the infrastructure for a better integrated system between them. 
 
Six key strategies being used by these partners to coordinate care were identified by the National Business Coalition on Health in a case study of the CalPERS accountable care organization pilot:
  • Development of CalPERS-specific utilization management through a coordinated operational infrastructure (e.g. earmarking nurses in the three organizations to coordinate timely sharing of information and developing a new integrated discharge planning process);
  • Elimination of unnecessary utilization and non-compliance through personalization population management;
  • Improvements to physician clinical and resource variation through quantitative analysis and targeted interventions;
  • Reductions in pharmacy costs and utilization through directed member outreach, drug purchasing and contracting strategies;
  • Facilitation of the rapid and efficient communication of patient medical information through information technology integration; and 
  • Development of a comprehensive dashboard of measurements.
  • Care management tools and protocols, including 24-hour nurse hotlines, care planning infrastructure, intervention services, etc.
  • Incentives for medical and health home models, including costs associated with care managers.
Colorado

Colorado has awarded a Statewide Data and Analytics Contract to Treo Solutions to support its Accountable Care Collaborative. The Statewide Data and Analytics Contractor is responsible for providing secure electronic access to clinically actionable data to the Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers.

 
Currently, the Statewide Data and Analytics Contractor data repository is storing Medicaid paid claims data, clinical risk group identifiers and predictive risk scores, and Behavioral Health Organization managed care encounter data. Proposals for future data elements to add to the Statewide Data and Analytics Contractor include: clinical data from RCCOs and/or Primary Care Medical Providers (such as data on member care coordination, referrals to non-medial services and medical management activities), disease and immunization registries data, national health survey data, and Colorado Regional Health Information Organization electronic health records data.

 
The Statewide Data and Analytics Contractor provides RCCOs and Primary Care Medical Providers with access to profiles of individual clients based upon predictive modeling; identification of areas for clinical process improvement at the client, provider, and RCCO levels; and aggregate reporting of cost and utilization performance indicators.

Connecticut No known activity at this time.
Delaware No known activity at this time.
District of Columbia No known activity at this time.
Florida No known activity at this time.
Georgia No known activity at this time.
Hawaii
The Accountable Healthcare Alliance of Rural Oahu (AHARO) has proposed the establishment of a $5 per member per month matching fund by Medicaid managed care organizations that would fund health information technology and care coordination activity.
 

AHARO is using a data exchange and data repository that combines information from electronic health records at participating health centers and those of the two Medicaid health plans to create real-time dashboards reflecting the status of performance by providers. Incentives are proposed linked to improved performance on selected metrics by each individual health care home.

No known activity at this time.
The state has developed a matchmaking database to help potential collaborators to identify other entities that may be interested in participating in a Coordinated Care Entity  (CCE) or Managed Health Care Network (MCCN).
 
The state may also advance a portion of the care coordination fees to fund start- up costs, such as investments in health information technology (HIT); advance payments made will be recouped from future care coordination payments on a negotiated schedule.
 
Accountable Care Entities (ACEs) are expected to build infrastructure (including HIT and data analytics) to support care management among providers participating in the ACE’s network.
Indiana No known activity at this time.
Under a draft accountable care organization (ACO) agreement released by Iowa Medicaid, the Department of Human Services will:
 
  • Provide the ACO with periodic cost and utilization reports to enhance health care management and coordination that will support member education efforts, and allow primary care providers—known as patient managers (PMs)—to compare peer utilization levels.
  • Examine peer utilization and establish standards (through a managed health care advisory committee) for acceptable levels of utilization, consult and make recommendations for action on quality of care issues, and make recommendations for corrective action measures to take with PMs when quality deficiencies are identified.
  • Ensure that enrollments, disenrollments, requests for exception to policy, appeals, and access to the state’s fair hearing system are in compliance with state and federal laws and regulations.
  • Establish protocols for (1) PMs to use in authorization of medical services in routine, urgent, and emergent situations, (2) reviewing and acting upon utilization review reports, and (3) other procedures necessary for the administration of the Wellness Plan.
  • Provide tools and reports of the Iowa Wellness Plan members attributed to the PMs within the ACO (these tools will be expanded over time with input from the ACOs).
  • Provide PMs with a monthly report of Wellness members attributed to them.
  • Provide the ACO with a monthly report of all Wellness members attributed to the PMs within the ACO.
  • Provide PMs and ACOs with dashboard reports via Treo Solutions Value Index Score measurements. These will be updated monthly.
Kansas No known activity at this time.
Kentucky No known activity at this time.
Each CCN-S is required to provide technical support and appropriate incentives to assist primary care practices with their transition to a patient-centered medical home model. The CCN-S is also required to facilitate the data interchange between the network and the department.
The Department of Health and Human Services plans to provide participating providers with quarterly:
  • Aggregate reports on metrics, utilization and expenditure data
  • Reports of assigned members

The state has partnered with the Maine Health Management Coalition (MHMC) as part of its State Innovation Plan. It will use the State Innovation Model testing grant funds to provide:

  • Data analytics
  • Public reporting of quality measures
  • Accountable Care Organization learning collaborative support through an Accountable Care Implementation Committee
  • Continuing work and learning support around the development of value based insurance design

The MHMC’s Foundation, the lead agency for public reporting of quality information in the state, will continue to provide performance measurement and feedback to providers, employers, and insurers under this initiative.

For the innovation model, Maine’s health information exchange HealthInfoNet will provide several services, including emergency department notifications to community care teams, and capturing Health Homes clinical outcomes from electronic health records for reporting and analysis.

No known activity at this time.

The independent Health Policy Commission will help accountable care organizations (ACOs) to identify best practices by creating a designation process for model ACOs. This designation will be granted to ACOs that meet standards of excellence for quality improvement, cost containment and patient protections.

 

The Commission will administer the state’s Healthcare Payment Reform Fund, which will allow health care entities to participate in a competitive process for incentives, grants, technical assistance, and evaluation assistance or partnerships to develop, implement, and evaluate promising models of health care payment and service delivery.

No known activity at this time.
Data feedback to providers:. The Department of Human Services will make available to participating providers a variety of enrollee data to support care management. The enrollment and complexity indicators the DHS will report on are detailed in a memorandum from the department and include elements like: 
  • Chronic condition counts;
  • Condition indicators;
  • Frailty flags; and
  • Mental illness flags.

 

Community Care Teams. Under the state’s State Innovation Model grant, three existing multidisciplinary, locally-based Community Care Teams will be expanded to support fifteen Accountable Communities for Health. They will leverage community partnerships to focus on including non-health care providers in the state’s accountable care organizations, integrating care, and building on the state’s patient-centered medical Health Care Home model.

Mississippi No known activity at this time.
No known activity at this time.
Montana No known activity at this time.
No known activity at this time.
Nevada No known activity at this time.
New Hampshire No known activity at this time.
Infrastructure supports have not been detailed by the state at this time.
No known activity at this time.
New York’s ACO law, NYS Public Health Code Article 29-E, establishes that the Department may directly, or through contracts with not-for-profit organizations, provide:
  • Consumer assistance to patients served by the ACO regarding matters relating to ACOs;
  • Technical and other assistance to health care providers participating in an ACO
  • Assistance to ACOs to promote their formation and improve their operation, including HEAL NY capital grants to encourage improvements in the operation and efficiency of the health care delivery system
  • Information sharing and other assistance among ACOs to improve the operation of ACOs
No known activity at this time.
North Dakota No known activity at this time.
Ohio No known activity at this time.
No known activity at this time.
Each Coordinated Care Organization is required by regulation to participate in a learning collaborative established (in ORS 442.210) by the Office for Oregon Health Policy and Research as part of the state’s patient-centered primary care home program.
 

Under its State Innovation Model award, Oregon plans to create a Transformation Center to support a statewide “Rapid Learning Health System” that facilitates the spread of the state’s model to other payers. A Patient-Centered Primary Care Home Technical Assistance Institute will reside under the Transformation Center is planned for launch in the fall of 2013.

An incentive pool for rewarding CCO performance on quality, access, and efficiency will be implemented by the middle of 2013.

 

The Oregon Health Authority’s Office of Health Analytics will support the Transformation Center that will be established under Oregon’s State Innovation Model grant. The Office of Health Analytics has access to health-related data sets containing claims or encounters, data on long-term services and supports outside of CCOs, surveys (including the Consumer Assessment of Healthcare Providers and Systems survey), the state’s All-Payer All-Claims database, and a Client Process Monitoring System that contains clinical information on mental health/chemical dependency services. The office will use this data to support the improving and targeting of services, performance measurement, and communication on performance.

No known activity at this time.
No known activity at this time.
South Carolina No known activity at this time.
South Dakota No known activity at this time.
Tennessee No known activity at this time.
Texas No infrastructure support for health care collaboratives has been offered by the state at this time.
Information on supports offered by the state to support the infrastructure for ACOs is forthcoming as the ACO contracts currently being negotiated become publicly available.
Vermont’s State Innovation Model project narrative describes key elements of an integrated health data system in place in the state to support accountable care organizations:
 
  1. A multi-payer claims dataset (VHCURES) that contains claims from public and private payers and has been mapped to key measures of utilization, expenditures and quality tracked by the Blueprint for Health;
  2. A statewide health information exchange (VHIE) with capacity to produce care summaries and continuity of care documents (CCD), lab and other diagnostic reports, demographics related to admissions, discharges, and transfers and to query or pull clinical data from participating providers’ Electronic Health Record (EHR) systems;
  3. A “central registry” that captures a defined set of clinical data from Vermont health care practices;
  4. Trainers who work with individual provider sites to develop the data input capacity and quality controls necessary to produce reliable data sets for analysis and feedback.
Virginia No known activity at this time.
No known activity at this time.
No known activity at this time.
Wisconsin No known activity at this time.
Wyoming No known activity at this time.