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New Mexico Health System Innovation
Design Phase
Improving health outcomes and population health
“For A Healthier New Mexico”
STATE INNOVATION MODEL (SIM) INITIATIVE
FUNDED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, CMS INNOVATION CENTER
What is the State Innovation Model [SIM] Initiative?
• Created by the Affordable Care Act (ACA); administered by the Centers for Medicare and Medicaid Services (CMS) Innovation Center
• To test innovative health delivery & payment models that reduce spending, enhance the quality of care & improve population health
• Since 2012, more than $1 billion awarded to 34 States, 3 territories and the District of Columbia
• Two phases: Design (1-2 years to develop the design of proposed transformation model); Testing of design (3 years)
New Mexico Health System Innovation
The Design•Based on “The Triple Aim”
• Enhancing the consumer’s experience of care
• Reducing health care costs
• Improving population health and health outcomes.
Examples of Triple Aim Goals
Enhanced experience of care Improved primary care with patient-centered medical homes (PCMH)
model - integration of primary care, behavioral health services and social services
Reduction of costs
Reimbursement of services is value (outcome)-based vs. fee-for-service (volume)
May include reimbursement for “non-traditional” services, i.e., those provided by community health workers, social services, etc.
Improving population health & health outcomesLocal community health workers & paramedics who participate in the
delivery of primary care
Interoperability of health information systems
What does “health system transformation” look like?
What are the Objectives of NM’s Design?
• Alignment and integration of public health, behavioral health and primary care • Reducing costs & slowing the rate of health care inflation• Increasing the number of New Mexicans who have health insurance• Building the healthcare workforce & supporting infrastructure• Expanding the use & integration of health information technology (HIT)
Who will participate?Extensive stakeholder engagement
• State agencies • Local & tribal governments • Health care providers • Public payers (Managed Care Organizations (MCOs) and private
commercial payers • Social service providers • Patient advocacy groups • Local organizations • Business community• Local Community, in collaboration with HCs
Suggestions for Community Representatives
Behavioral health (individual providers/clinics, etc.)Business community/chamber of commerceHealth consumers/general publicEMS/paramedicine/emergency managementEnvironmental/community planning organizationsFood bankHealth professional organizationHigher education health clinicHospitalInsurer (public & private)Local governmentPatient advocacy/consumerPrimary care (individual providers/FQHC/local private clinic, etc.)School-based health clinicTribal health servicesVulnerable population advocacy organization
Stakeholders in the Public Health System
MCO’s
Home Health
Parks
Economic Development
Mass Transit
Employers
Nursing Homes
Mental Health
Drug Treatment
Civic GroupsCHCs
Laboratory Facilities
Hospitals
EMS Community Centers
Doctors
Health Department
Churches
Philanthropist
Elected Officials
Tribal Health
Schools
Police
Fire
Corrections
Environmental Health
Engagement StructureSix Stakeholder Committees and Local Communities -
• Population Health - to address health issues across the life continuum• Health Care• Health Care Workforce • Payers • Tribal• Health Information System (Health Information Technology; Health Information Exchange; Healthcare System Information; Health Status; Individual Health Info); and,• Ongoing Community Engagement (County & Tribal Health Councils)
Flow of Design Inputs
Input Compiled Input Compiled for Model Designfor Model Design
Stakeholder Stakeholder CommitteesCommittees
Community Engagement led
by Health Councils (HCs)
Work Groups
SIM Management
Team (OPA/HSD Admin. Staff)
Governor’s OfficeGovernor’s Office
Health System Health System Innovation Innovation Committee Committee
(HSIC)(HSIC)
Innovation: Priority Health Issues
•Obesity Prevention and Control •Diabetes Prevention and Control•Tobacco Use Prevention and Control
Important ConsiderationsSocial Determinants of Health
Important Considerations for HCs
Diffusion of Innovation seeks to explain how innovations are taken up in a population. An innovation is an idea, behavior, or object that is perceived as new by its audience. Diffusion of Innovations offers three valuable insights into the process of social change:•What qualities make an innovation spread.•The importance of peer-peer conversations and peer networks.•Understanding the needs of different user segments.
Timeline• May 19: Stakeholder Summit (kick-off),
Albuquerque• May-July: Community orientations & development of
engagement plans for three succeeding community engagement sessions• July – October 5: With DOH Health Promotion Teams,
conduct community engagement sessions to provide input to Design • October 15: Draft Community Stakeholder Design
recommendations by theme provided by NM Alliance of Health Councils
Timeline• Week of October 19: All Stakeholder Committees to meet
in Albuquerque• Week of November 2: Health System Innovation
Committee (HSIC) reviews proposed design from Stakeholder Committees & local communities• Week of November 16: Stakeholder Committees
convene in Albuquerque• December 1: Final design sent to HSIC• December 15: Final Community Stakeholder Design
recommendations by Theme due from NM Alliance of Health Councils• December 15: Stakeholder Summit to occur in
Albuquerque to present final design
Community Engagement Planning
• Health Councils review existing membership & identify additional representation for community input sessions
• DOH Health Promotion Teams collaborate with Health Councils & NM Alliance to gather recommendations for Health System Innovation Design
• Statewide standardized approach that includes flexibility to accommodate local needs
Community Engagement Planning
• Overall Goal: To provide recommendation on proposed innovation design
• Question to consider: “Does the proposed design achieve the Triple Aim in your community?”
• NM Alliance of Health Councils & DOH Health Promotion Teams collaborate to assist HCs with input session format, materials, process, and agenda
• Succeeding sessions to provide recommendation to the design
Get Ready
• Identify three dates & locations for the community engagement sessions during July 1 - October 5, 2015
• Review existing Health Council membership to ensure widest possible input
• Identify list of invitees (Individuals & Organizations) & begin to distribute “save the date” notices
• Materials, templates, and more information will be available in June
Preliminary Community Engagement Plan Outline
GOALS:
1. Ensure maximum input and engagement in the Health System Innovation planning process by New Mexico counties and tribal communities
2. Develop community health planning processes that will benefit communities, resulting in increased understanding of:
• Community assets• Community health needs, gaps, issues• Locally identified health priorities• Stakeholder involvement strategies
3. Prepare communities for possible participation in a SIM Implementation Phase
Stages of Community Engagement
1. Orientation to the NM Health System Innovation planning process:
• Power Point presentation to health councils and community groups
• Discussions of strategies for involvement of all sectors and stakeholders
• Preliminary discussions of the kinds of input being sought
Stages of Community Engagement
2. Development of methods for community/stakeholder engagement:
a)Identification of sectors currently represented on health councilsb)Identification of sectors & stakeholders who should be at the tablec)Methods for reaching & engaging community stakeholders:• Expanded health council meetings• Regional, multi-council meetings• Focus groups• Other community coalitions, networks• Community surveys• Other potential groups: e.g., community coalitions, volunteer
groups, schools, business groups, faith communities, advocacy groups
Stages of Community Engagement
3. Community Input: Identify information to be gathered prior to development of design
4. Community Input: Responses to proposed design
Community Input Information Framework
Research Questions:
•How can the Triple Aims be achieved in your community?•How do each of the factors below help or hinder achieving the Triple Aim?
Aims & Objectives
1. Improve Population Health:• Integration of population health, prevention, & primary care•Address social determinants of health•Create environments that offer health choices
Aims & Objectives
2. Enhance Patient Experience of Care:•Patient-centered care• Integration of primary care, behavioral health, & oral health•Chronic disease management•Access, health care workforce development
Aims & Objectives
3. Reduce Health Care Costs:•Reform payment systems• Increase health insurance coverage•Expand health information technology
Factors that Help/Hinder Achieving the Triple Aim
•Environmental (Geographic, social & cultural factors)•Current Strengths, Resources•Community Needs/Gaps/Barriers•Health Priority Areas•Potential Solutions
The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services.
The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.