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Changing the Way We Do Business: The Potential Role Grantees Play in Shaping a Changing Healthcare System

Changing the Way We Do Business: The Potential Role Grantees Play in Shaping a Changing Healthcare System. Presented by: CIHS Staff SAMHSA GPO. Target : Enrollment=100% Reassessment=100% Grant Requirement Cutoff: Reassessment=80% Administrative Review Cutoff: Enrollment=70%

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Changing the Way We Do Business: The Potential Role Grantees Play in Shaping a Changing Healthcare System

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  1. Changing the Way We Do Business: The Potential Role Grantees Play in Shaping a Changing Healthcare System Presented by: CIHS Staff SAMHSA GPO

  2. Target : Enrollment=100% Reassessment=100% Grant Requirement Cutoff: Reassessment=80% Administrative Review Cutoff: Enrollment=70% Reassessment=50%

  3. National DataEnrollment n=56

  4. National DataReassessment N=56

  5. Technical Assistance ThemesOctober – December 2011 n=54, HIT Supplemental TA (n=63) not included

  6. How You Can Use the Data You’re Collecting • Data at your disposal • NOMs, including Section H data, demographic data, clients served, reassessment rates • IPP data • Quarterly reports • How you can use this data • Measure burden of illness in the population you serve (Section H) • Identify and prioritize populations at risk (Demographic Data) • Plan effective and targeted wellness interventions (Section H and NOMS Data) • Evaluate specific wellness activities and outcomes (Section H, NOMS, IPP) • Develop and/or change policies that improve client recruitment, engagement (IPP Data, Clients served and Reassessment Rates) • Requesting funds (ALL DATA)

  7. Using Data for Decision Making:-GPO Perspective-Grantee Perspective

  8. Health Home Services – Section 2703 • 90% Federal match rate for the following services during the first 8 fiscal year quarters when the program is in effect: • Comprehensive care management • Care coordination and health promotion • Comprehensive transitional care from inpatient to other settings • Patient and family support • Referral to community and social support services • Use of health IT to link services (as feasible/appropriate)

  9. Health Home Update • State with Planning Grants: • DC (in process); AL; AZ; AK; CA; ID; ME; MI; NC; NJ; NM; NV; WA; WI; WV • States with approved State Plan Amendments: • Missouri • Ohio • Rhode Island (2 SPAs) • “On the clock:” MO (2nd SPA); NY; NC; WA

  10. Key to Supporting New Service Deliveryand Payment Models:Accountable Care Organization

  11. ACOs Defined • Generally – ACOs are a group of providers who are held accountable for improving health care quality while lowering the rate of growth in health care spending • Medicare Shared Savings Program ACO – a legal entity that is recognized and authorized under applicable State law…comprised of an eligible group of ACO participants that work together to manage and coordinate care for Medicare fee-for-service beneficiaries…established a mechanism of shared governance that provides all ACO participants with an appropriate proportionate control over the ACOs decision-making process

  12. Accountable Care Organization Update • 1. Allina Hospitals & Clinics Minnesota and Western Wisconsin • 2. Atrius Health Services Eastern and Central Massachusetts • 3. Banner Health Network Phoenix, Arizona Metropolitan Area (Maricopa and Pinal Counties) • 4. Bellin-Thedacare Healthcare Partners Northeast Wisconsin • 5. Beth Israel Deaconess Physician  Eastern Massachusetts • 6. Bronx Accountable Healthcare Network (BAHN) New York City (the Bronx) and lower  Westchester County, NY • 7. Brown & Toland Physicians San Francisco Bay Area, CA • 8. Dartmouth-Hitchcock ACO New Hampshire and Eastern Vermont • 9. Eastern Maine Healthcare System Central, Eastern, and Northern Maine3 • 10. Fairview Health Systems Minneapolis, MN Metropolitan Area • 11. Franciscan Health System Indianapolis and Central Indiana • 12. Genesys PHO Southeastern Michigan • 13. Healthcare Partners Medical Group Los Angeles and Orange Counties, CA • 14. Healthcare Partners of Nevada Clark and Nye Counties, NV • 15. Heritage California ACO Southern, Central, and Costal California • 16. JSA Medical Group, a division of HealthCare Partners Orlando, Tampa Bay, and surrounding South Florida • 17. Michigan Pioneer ACO Southeastern Michigan • 18. Monarch Healthcare Orange County, CA • 19. Mount Auburn Cambridge Independent Practice Association (MACIPA) Eastern Massachusetts • 20. North Texas Specialty Physicians Tarrant, Johnson and Parker counties in North Texas • 21. OSF Healthcare System Central Illinois • 22. Park Nicollet Health Services Minneapolis, MN Metropolitan Area • 23. Partners Healthcare Eastern Massachusetts • 24. Physician Health Partners Denver, CO Metropolitan Area4 • 25. Presbyterian Healthcare Services -Central New Mexico Pioneer Accountable Care Organization Central New Mexico • 26. Primecare Medical Network Southern California (San Bernardino and Riverside Counties) • 27. Renaissance Medical Management Company Southeastern Pennsylvania • 28. Seton Health Alliance Central Texas (11 county area including Austin) • 29. Sharp Healthcare System San Diego County • 30. Steward Health Care System Eastern Massachusetts • 31. TriHealth, Inc. Northwest Central Iowa • 32. University of Michigan Southeastern Michigan

  13. PBHCI Grantee Engagement in Health Homes and ACOs • Discussion

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