Transforming Idaho's Healthcare system
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General SHIP Information

The State Innovation Models (SIM) Initiative is a federal program operated by the Center for Medicare and Medicaid Innovation (CMMI), under the Centers for Medicare & Medicaid Services (CMS). The SIM Initiative is designed specifically for states that are prepared for or and committed to planning, designing, testing, and supporting the evaluation of new payment and service delivery models in the context of larger health system transformation. More broadly, lessons from SIM will be used to accelerate innovations in other public health programs, including Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).  It will also assist commercial payers in identifying best practices in state-led transformation that are potentially scalable nationwide. In general, the SIM Initiative is composed of two phases to achieve health transformation: first, the “model design” phase, and second, the “model test” phase.  

In April 2013, CMMI awarded the Idaho Department of Health and Welfare (IDHW) with a “Model Design” grant to develop a State Healthcare Innovation Plan (SHIP).  Idaho used the grant to design a SHIP that will serve as a blueprint to re-design Idaho’s healthcare delivery and payment system.  The underlying goal of Idaho’s SHIP is to transform the State’s health care system from a fee-for-service, volume-based system to a value-based model driven by improved health outcomes.

In July 2014, IDHW submitted a “Model Test” grant proposal and application to CMMI. In December 2014, CMMI announced that Idaho was one of 12 states to receive the four- year “Model Test” award. Idaho’s grant, which totaled nearly $40 million, will be used to test and implement the payment and delivery reform models outlined in the SHIP developed from the “Model Design” grant.The SHIP grant was sponsored by Governor Otter, and managed by Idaho Department of Health and Welfare. (Last Updated 10/15)

The SHIP is a statewide plan that aims to improve the health of all Idahoans. Medicaid Redesign reflects current efforts to evolve Idaho Medicaid towards care management models for the 260,000 Idahoans currently enrolled in Medicaid. Medicaid Expansion is focused on providing access to healthcare for the 76,000 low income Idahoans who are ineligible for insurance on Your Health Idaho because their income is too low. (Last Updated 10/15)

90% of the grant's funding is dedicated to testing and implementing changes within Idaho's health care system. This includes contracts with a vendor to support the Patient Centered Medical Home (PCMH) practices in their transformation; funding for the health districts to support the regional collaboratives; and funding to strengthen and build data pathways to ensure timely outcomes reporting for clinics. The remaining funding (10%) supports personnel and operating expenses used to implement the SHIP. (Last Updated 10/15)

No, SHIP grant funds will be used primarily to provide training and support to primary care practices that commit to transforming their practices to the patient centered medical home (PCMH) model. (Last Updated 10/15)

IDHW will embrace the opportunity to develop program policies, establish contract requirements, and implement payment mechanisms across Medicaid primary care, public health, behavioral health, and long term care services and supports (i.e., home- and community-based services (HCBS)) to support the coordination and integration of these services within the PCMH and across the medical neighborhood.

Additionally, through education and outreach to its sister agencies administering elder care, correctional health services, education and juvenile justice programs, IDHW will further advance understanding and support of the PCMH model. IDHW will advocate and support coordination of program requirements, policies, and payment mechanisms across programs where services are to be integrated at the community level in order to best support improved community health.

Additional information can be found on our About Us page.
(Last Updated 7/15)

The focus of the SHIP is on shifting more resources in primary and preventive care to keep people healthy. Primary care accounts for only 10% of all healthcare spending. Our current system invests in other end of the care continuum; hospitalizations and long term care account for the vast majority of funds spent on healthcare. Investing in primary care will change the healthcare system focus to keeping people healthy. Changing the reimbursement model to pay for healthy outcomes rather than volume of services is a wise investment. (Last Updated 10/15)

Stakeholder Engagement

Idaho is proud of its history of community initiatives supported at the local level by faith-based organizations, civic groups, local public health districts and nonprofit organizations, all of which will be harnessed in the new model to improve the health status of Idahoans across the State. Idaho’s model builds off the experience and success of these local initiatives and supports the advancement of existing programs by partnering with these efforts to enhance and expand quality care. The IHC and its Regional Collaboratives (RCs) will facilitate partnerships with local community-based initiatives to deploy evidence-based community health improvement strategies developed locally or modeled from successful strategies used in other parts of the State or country. Community-based initiatives will vary by region to reflect local needs as identified through community needs assessments and will align with performance measures. (Last Updated 10/15)

Idaho will transform its healthcare delivery system from a disease-focused, volume-driven model to a value-based model that builds a system of primary care as the foundation of the PCMH model. PCMHs will be integrated with the larger healthcare delivery system through coordinated care between the PCMH and specialist and ancillary providers. Collaborative quality improvement efforts at the regional will also be implemented to improve health outcomes. Idaho’s model will be patient-centered, delivering care that is individualized, culturally sensitive, and responsive to the patient’s needs. Services delivered through the model will include the full range of primary care services for all age groups, across multiple payers, and will include prevention and wellness activities, routine healthcare services and evidence-based care of chronic and complex conditions. (Last Updated 10/15)

Stakeholders represent the entire healthcare delivery spectrum; public and private payers, providers, patients, legislators, representatives from public health, long-term services and support, behavioral health, tribal organizations, local health agencies, schools, consumer advocacy organizations, and community-based organizations.

Today, the 43 member Idaho Healthcare Coalition (IHC) is chaired by Dr. Epperly who has led the group since the summer of 2013. IHC membership includes physicians, nurses, private and public payers, legislators, representatives from the Idaho Hospital Association, the Idaho Medical Association, the Idaho Academy of Family Physicians, and the Idaho Primary Care Association, as well as key state officials and community service representatives. The CEOs of Idaho’s four largest healthcare systems are also active members, along with the Governor’s Office and the Director of DHW.

Other more focused healthcare forums are currently active in advising on their respective areas of expertise. For example, the Idaho Medical Home Collaborative (IMHC), which promotes the medical home model across the State, has agreed to advise the IHC on the PCMH transformation process. The IHC is also receiving topic-specific guidance from the Idaho Telehealth Council, the Health Quality Planning Commission, and the Idaho Health Professions Education Council. Internal IHC workgroups include the Multi-payer Workgroup, The Behavioral Health/Primary Care Integration Workgroup, the HIT/Data Analytics Workgroup, the Clinical Quality Measures Workgroup and the Population Health Workgroup. This strategy of consulting with both internal and external working groups composed of subject matter experts brings more stakeholders into the process, and leverages existing resources around the State. (Last Updated 10/15)  

Patient Centered Medical Homes

Payment for value involves movement from a volume-driven health care delivery system to one that pays for outcomes, as measured by the quality of health care, the health of the population, and efficiency.  The IHC Multi-Payer Workgroup, under the direction of the IHC, and through collaboration across payers and providers has worked on a plan to transform payment methodology from volume to performance based value. Reforming the fee-for service payment model is integral to the proposed health system transformation and the Multi-Payer workgroup supports multiple reimbursement models that adapt to each practices current level of transformation readiness.  Listed below are links to participating payer websites where you will find information specific to each payer’s value based reimbursement models.
Additional information can be found on the MPW page locate HERE.
(Last Updated 9/15)
A recruitment plan and process has been draft and will be presented to the IHC at the August meeting for approval. Once this plan has been adopted as final, additional information will be provided on the IMHC page. (Last Updated 7/15)
in the 2013 IMHC Pilot, clinics were required to contract with 2 or more payers (Medicaid, Blue Cross, Pacific  Source, & Regence) and were paid a PMPM from the payers for a small percentage of  chronically ill patients.  

SHIP participant clinics will receive: lump sum incentive (and in some instances a PMPM); more individualized technical assistance support from a  PCMH vendor; and have access to a defined local medical neighborhood support system. (Last Updated 7/15)

According to the National Committee for Quality Assurance (NCQA), a patient-centered medical home (PCMH) is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into "what patients want it to be." PCMHs can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care. 

PCMHs move primary care from acute-focused, episodic care to a model of pro-actively coordinated preventive care based on the physician/patient relationship.

PCMH Concepts: 

  • Enhance Access and Continuity
  • Identify and Manage Patient Populations
  • Plan and Manage Care
  • Provide Self-Care Support and Community Resources
  • Track and Coordinate Care
  • Measure and Improve Performance (Last Updated 7/15)

The virtual PCMH model is a unique approach to developing PCMHs in rural, medically underserved communities. Specifically, the model will test the impact of telehealth technology and community health workers (CHWs) and community health emergency medical services (CHEMS) personnel in extending the PCMH team-based care model in rural communities. The virtual PCMH model will also allow for integration of behavioral health services in remote communities via telehealth services. (Last Updated 10/15)

 - Application reimbursement for obtaining PCMH Recognition/Accreditation through any organization (Based on the cost of 2014 NCQA PCMH application costs)
 - Sign-up Incentive ($10,000) + Memorandum of Understanding (MOU)
 - Assistance in connectivity charges to the Idaho Health Data Exchange
 - Additional incentives for meeting performance based measures (under development)
 - Participation in unique payer models (under development) 
(Last Updated 7/15)

Regional Collaboratives & Medical Neighborhoods

Effective in the summer of 2015, Idaho’s seven regional Public Health Districts will create Regional Collaboratives (RCs) that will, provide support, technical assistance and will connect practices to resources as they transform into a PCMH. (Last Updated 10/15)

 

Idaho recognizes that individual health is greatly impacted by factors beyond medical services, notably culture, lifestyle, nutrition and socio-economic factors. The SHIP model acknowledges the importance of the medical neighborhood, which helps address these other factors.  The medical neighborhood includes community services and supports, hospitals, specialty services, behavioral health, public health, long term services and supports and other organizations. The SHIP model requires that linkages and coordination of services occur across the medical neighborhood in order to establish and maintain “complete picture” of the individual’s health status and care across all service providers. 

The PCMH will be responsible for establishing formal communication protocols with other service providers and organizations within the medical neighborhood, and will be supported in this effort by the RCs. Coordination of care will occur with all existing service delivery systems in the State that are involved in the care of patients enrolled within the PCMH, including the VA system, tribal clinics, Indian Health Services (IHS), public health clinics, behavioral health centers, school-based services, and long term service and support providers. Clinical care coordination will be performed by a variety of different practitioners, including registered nurses, social workers, or licensed advanced practice nurses.

The RCs will facilitate development of the medical neighborhoods to strengthen patient care coordination and will convene a regional stakeholder advisory board. The RC stakeholder advisory boards will have direct input to the IHC through the PHD directors and RC board chairs, so regional and local concerns can be raised at the state level. In the management of RCs, Idaho’s PHDs will lead integration of public health and population management into the model, and will bring an intimate familiarity with local healthcare resources to develop the medical neighborhood. Communities will participate in community needs assessments and will work with the RCs to align specific performance metrics for the PCMHs in their region with identified areas of need. (Last Updated 10/15)

Health Information Technology

 

As a 501(c) (6) nonprofit corporation, Idaho Health Data Exchange (IHDE) was established to govern the development and implementation of a Health Information Exchange in Idaho. IHDE is governed by a Board of Directors that includes representation from the public and private healthcare payers. Initial funding was appropriated through the state legislative process and has since been supplied by IHDE participants. IHDE also received a grant from the Office of the National Coordinator (ONC)—the health information technology division of the U.S. Department of Health and Human Service—to develop and advance the IHDE. 

IHDE offers connected providers the use of clinical results and e-prescribing, as well as clinical messaging, or clinical results delivery, and a clinical data repository (which consists of laboratory, radiology, and hospital transcription information) through a clinical portal. Through the web portal, providers are able to view their patient’s medical records.  

Statewide Health Information Technology (HIT) that is interoperable will integrate (PCMHs) into the larger healthcare system, empowering providers to transform care by improving care coordination with individual patients and across the Medical Neighborhood. HIT will also enable the systematic and statewide measurement of population health targets, and the payers’ ability to reward outcomes through new payment mechanisms.

The SHIP calls for the development and/or expansion of Electronic Health Records (EHR) and IHDE technology to support: 1) statewide data collection and performance analysis needed to improve quality and establish value-based payments; 2) shared data to facilitate coordinated care, and; 3) patient portals to increase patient –provider communication and patient self-management. (Last Updated 10/15)

Patient registries are organized systems that collect data and can be used to evaluate health outcomes. (Last Updated 10/15)

A HIT Workgroup has been tasked with providing the IHC with recommendations on how:  1) the HIT solutions and system architecture can be developed, 2) to integrate comprehensive HIT solution(s); 3) to support the Request for Proposals (RFP) development process and selection of external HIT vendors, 4) to advise on how to support the quality reporting initiatives outline in the Model Test Proposal; and 5) to assist with developing a sustainability plan. (Last Udpated 10/15)

As a critical first step in developing a reporting structure for individual practice feedback as well as regional and state-level population health management functions, SHIP will contract with a data analytic consultant to build a structure to:

1. Interface with the IHDE;
2. Analyze and report on selected clinical quality measures;  
3. Interface with population health databases to analyze and report population health measures; &
4. Provide real time outcomes data to PCMH practices on the selected quality measures.

This represents a significant innovation for Idaho which does not presently have any type of shared healthcare data systems. As the model matures and ongoing value of the product is evaluated, the DHW and IHC will determine the most appropriate ongoing HIT infrastructures to provide aggregation and analytic support to facilitate Idaho’s population health management functions. (Last Updated 7/15)

Workgroups & Advisory Entities

Implementing the SHIP in Idaho requires changes on multiple fronts. To support this change, the IHC has recruited advisory groups and created workgroups to assist with various components of this effort. Each advisory and workgroup has a charge related to implementing the SHIP goals in Idaho. Additional information can be found on the Work Groups Page. (Last Updated 7/15)

Payment and delivery models across public and private payers offer the opportunity to accelerate health transformation. The reform models are designed to reduce reliance on volume-based care and encourage movement toward payment based on outcomes. This model is reinforced by the expectation that providers and payers must be engaged in order to create meaningful delivery and payment system reforms. (Last Updated 10/15)

Idaho will use telehealth technology to increase the trained workforce in underserved areas across the range of primary care and associated health professions that will comprise the virtual PCMHs. Partnerships with community, county, and State organizations with videoconference technology will be facilitated by the RCs to provide access to telehealth training. (Last Updated 10/15)

Proposed CHW and CHEMS training programs will include staff training and on-site technical assistance to assure successful integration of these staff into the PCMH team. The CHEMS staffing model is based on current, successful Idaho programs that demonstrate a reduction in unnecessary emergency department visits, improved medication reconciliation, and increased vaccination rates through the deployment of CHEMS personnel in community health settings. Idaho’s proposed CHW program is a blended learning program consisting of in-person trainings, offered at regional locations statewide, and on-line sessions. Through this model, Idaho will evaluate the effectiveness of CHW and CHEMS personnel in rural communities with very limited resources. Grant funds will be used to train CHWS and CHEMS, to provide on-site assistance to support virtual PCMH team development, to assure implementation of relevant metrics to evaluate program effectiveness, and to establish telehealth technology to supplement training and technical assistance needs. (Last Updated 10/15) 

Clinical Quality Measure

Clinical quality measures, or CQMs, are tools that help measure and track the quality of health care  services provided by eligible professionals, eligible hospitals and critical access hospitals  within our health care system. These measures use data associated with providers’ ability to deliver  high-quality care or relate to long term goals for quality health care. Additional information about national CQMs can be found here. (Last Updated 7/15)

Here is the link for the first four measures for this grant year. The 12 remaining measures for the SHIP are currently under review by the Health Information Technology (HIT) Workgroup for the SHIP. This workgroup is reviewing the original 16 measures that were articulated as part of the SIM Model Test application and providing recommendations to the Clinical Quality Measures (CQM) Workgroup to align them with national measure standards and update them to increase ease of implementing the measures. It is anticipated that the remaining 12 measures will be updated in the coming months based on the coordinated efforts of these workgroups. 

Additional information about the CQM Workgroup can be found here, last updated 4/17.


As you can see here, four measures will be received in the first cohort year, then an additional six in the second cohort year and then an additional six in the third cohort year.

Population Health

A presentation that defines and links population health to projects like SHIP was created by John Auerbach with the CDC; we have included a copy here.  (Last Updated 7/15)
Additional information on population health can be found on the Population Health Workgroup page located here. (Last Updated 7/15)

Advisory & Workgroup Pages