Transforming Idaho's Healthcare system
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General SHIP Information

The State Innovation Models (SIM) initiative was a federal program operated by the Center for Medicare and Medicaid Innovation (CMMI), which is part of the Centers for Medicare & Medicaid Services (CMS). The SIM initiative was designed for states that were committed to planning, designing, testing, and supporting the evaluation and implementation of new payment and service delivery models for healthcare system transformation that would improve health outcomes and lower costs in their states. The SIM initiative was comprised of two phases to achieve healthcare transformation: the “model design” phase, and the “model test” phase.  

In April 2013, CMMI awarded the Idaho Department of Health and Welfare (IDHW) a $3 million “model design” grant to develop a Statewide Healthcare Innovation
Plan (SHIP). Idaho used the grant to design a SHIP that would serve as a
blueprint to redesign Idaho’s healthcare delivery and payment systems. The
underlying goal of Idaho’s SHIP was to transform the state’s healthcare system from a fee-for-service (FFS), 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 11 states to
receive a four-year “model test” award. Idaho’s grant, which totaled $39.6
million, was used to test and implement delivery system enhancements i.e.,
PCMH, increase health IT interoperability, and accelerate the implementation of
payment reforms as outlined in the seven project goals. The SHIP grant was supported by Governor Otter and was managed by the IDHW. 

(Last updated 2/19)

The Statewide Healthcare Innovation Plan (SHIP) was a broad statewide initiative designed to transform healthcare delivery in Idaho to achieve the Triple Aim of improved health outcomes, improved quality and patient experience of care, and reduced healthcare costs for all Idahoans.

Medicaid redesign reflects efforts to evolve Idaho Medicaid toward care management models for the 260,000 Idahoans currently enrolled in Medicaid. Medicaid expansion is focused on providing access to healthcare for the thousands of low-income Idahoans who fall in the coverage gap – they are not eligible for Medicaid and are ineligible for insurance on Your Health Idaho, Idaho’s health insurance marketplace, because their incomes are too low.

While Medicaid redesign and expansion focused on specific populations that were or could be covered by Medicaid, SHIP focused on all Idahoans and was designed to transform the entire primary care delivery system in Idaho. 

(Last updated 2/19)

Ninety percent of the SHIP grant funds was allocated to testing and implementing changes within Idaho's healthcare delivery system. This included supporting primary care practices in their journey toward transforming to the patient-centered medical home (PCMH) model of care; funding Idaho's public health districts to support healthcare stakeholder groups called regional collaboratives; and funding to strengthen and build patient health outcomes. The remaining funding (10%) supported personnel and operating expenses used to implement SHIP. 

(Last updated 2/19)

No. SHIP grant funds were used to provide training and support to primary care practices who committed to transforming their practices to the patient-centered medical home (PCMH)* model, to support Idaho's health district healthcare stakeholder groups known as regional collaboratives, and to strengthen and build patient health data pathways needed to improve health outcomes.

*PCMH is a care delivery model in which patient treatment is coordinated through primary care physicians to ensure patients receive care when and where they need it, in a manner they can understand. It focuses on preventative care, keeping patients healthy including patients with chronic conditions.

(Last updated 2/19)

IDHW embraced 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 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 advocated and supported coordination of program requirements, policies, and payment mechanisms across programs where services were 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 2/19)

Hospitalizations and long-term care accounts for most of the money spent on healthcare in the U.S. and Idaho. Stakeholders in Idaho agreed increasing healthcare spending in the state was a concern and determined the federal SIM grant would be able to provide a means to address this issue. The federal SIM grant proved during its model test by investing in primary care and focusing on preventative care Idaho could transform the healthcare delivery system. Idaho's Statewide Healthcare Innovation Plant (SHIP) that a reimbursement model which paid for healthy outcomes rather than volume of service was a wise investment. 

(Last updated 2/19)

Stakeholder Engagement

The Healthcare Transformation Council of Idaho (HTCI) is the successor stakeholder group to the Idaho Healthcare Coalition (IHC). It is charged with sustaining the transformation work taking place in Idaho. It is half the size of the IHC with 25 members. The HTCI is comprised of various stakeholders It has a “recommendation” ability. The charge of the HTCI is as follows:  

Promote the advancement of person-centered healthcare delivery system transformation efforts in Idaho to improve the health of Idahoans and align payments to achieve improved health, improved healthcare delivery, and lower costs. 

 

The full charter and business case documents can be found on the HTCI webpage htci.dhw.idaho.gov. They include information on the council’s functions, membership, composition, meetings, subcommittees/ working groups, and staff resources.  
(Last updated 2/19)

 

The Idaho Healthcare Coalition (IHC) with its nearly 50 members and its seven Regional Collaboratives (RCs), worked to facilitate partnerships with local community organizations in order to adopt health improvement strategies which were developed locally or modeled after successful strategies used in other parts of the state or country. Community-based initiatives varied by region to reflect local needs identified through community needs- assessments. 

(Last updated 2/19)

The Office of Healthcare Initiatives (OHPI) recognized specialty practices often provide primary care services to patients with complex medical conditions. OHPI invited specialty practices who provide primary care to become a PCMH.

Specialty practices were a key participant in the medical-health neighborhoods (MHN) and participated in the regional collaboratives.

(Last updates 2/19)

Stakeholders represented 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. 

The 43-member Idaho Healthcare Coalition (IHC) was chaired by Dr. Epperly who began leading the group in the summer of 2013. IHC membership was made up of physicians, nurses, private and public payers, legislators, and 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 were active members, along with the Governor’s Office and the Director of DHW.

Other healthcare forums were active in advising on their respective areas of expertise. For example, the Idaho Medical Home Collaborative (IMHC), who promoted the medical home model across the State, agreed to advise the IHC on PCMH transformation processes. The IHC received topic-specific guidance from the Idaho Telehealth Council, the Health Quality Planning Commission, and the Idaho Health Professions Education Council. Internal IHC work groups included the Multi-Payer Workgroup, the Behavioral Health/Primary Care Integration Workgroup, the Data Governance Workgroup, and the Population Health Workgroup. This strategy of consulting with both internal and external working groups composed of subject matter experts brought more stakeholders into the process and leveraged existing resources around the State.

(Last Updated 2/19)  

Patient Centered Medical Homes

Prospective participants were recruited to become members of three separate Statewide Healthcare Innovation Plan (SHIP) PCMH cohorts spanned over a three-year period. Recruitment took place via outreach working with Medicaid and other partners across the state. Through a competitive process, a select number of primary care practices (PCPs) were chosen for each cohort. Selection was based on being an Idaho PCP, commitment to healthcare transformation, commitment to PCMH, and identification and commitment of a physician champion. Selection was made to ensure a broad cross-section of clinics around the state.

(Last updated 2/19)

In the 2013 Idaho Medical Home Collaborative (IMHC) pilot, clinics were required to contract with two or more payers (i.e.Medicaid, Blue Cross, PacificSource, Regence, etc.) and were paid a per member/per month (PMPM) fee from the payers for a small percentage of chronically ill patients.

The Statewide Healthcare Innovation Plan (SHIP) PCMH cohort participant clinics received lump sum incentive payments, individualized technical assistance support and coaching calls from PCMH vendors, and had support from public health districts and regional collaboratives.

A small number of clinics participated in both SHIP and the pilot project. The clinics recruited into the first SHIP cohort mentored the clinics selected for the last two cohorts.

(Last updated 2/19)

SHIP established a contract with Health Management Associates (HMA), who is a technical assistance contractor. HMA helped SHIP's primary care practices' (PCPs) build the knowledge, capacity, and expertise they needed to develop and implement Telehealth programs. HMA also created demand analysis and readiness assessment tools.

SHIP provided a funding opportunity for primary care practices and community health emergency medical services (CHEMS) agencies to implement Telehealth pilot projects to improve care, increase access to care, expand system capacity for serving patients with the care they need, and to promote the Triple Aim. The funding opportunities up to $2,500 for each participating clinic and CHEMS agencies who established or expanded the scope of Telehealth operations based on organizational and population health needs over a 12-16 month period.

Technical assistance, program development, and implementation was developed simultaneously with the funding opportunities and a separate contract with HMA.

In late 2016, in collaboration with the Telehealth Council, a Telehealth reimbursement matrix was developed. The reimbursement matrix outlined policies and procedures for payment of Telehealth services provided by insurance carriers. This matrix was last update in March of 2018. 

For more information please visit the Telehealth Council Advisory Group's site by clicking here.

(Last updated 2/19)

According to the National Committee for Quality Assurance (NCQA), a patient-centered medical home (PCMH) is a "model of care that puts patients at the forefront of care." Patient-centered medicals homes improve quality as well as patient and provider experience and reduce healthcare costs. Patient-centered medical homes move primary care from acute-focused, episodic care to a patient-centered approach to prevent care based on physician/patient relationship. Patient-centered medical homes are associated with:

  • Improved patient experience
  • Improved patient-centered access
  • Better-managed chronic conditions
  • Lower healthcare costs
  • Improved staff satisfaction
  • Alignment of payers

(Last updated 2/19)

The virtual PCMH model is a unique approach to developing PCMH in rural, medically under-served communities. The model tested the impact of Telehealth technology, community health workers (CHWs) and community health emergency medical services (CHEMS) personnel by extending the PCMH team-based care model in rural communities. The virtual PCMH model allowed for integration of behavioral health services in remote communities via Telehealth services. 

For more information on virtual PCMH, click here

(Last Updated 2/19)

Project ECHO was developed by the University of New Mexico to deliver medical education and care management to primary practitioners in rural and medically-underserved communities. Project ECHOs goal is to help alleviate physician shortages by providing specialty diagnosis and treatment knowledge to practitioners in their communities through the telehealth model. Idaho’s Project ECHO operates through the University of Idaho WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) Regional Medical Education Program, and was supported by SHIP funds.

The ECHO model transformed medical educated to increase workforce capacity by linking specialist – operating as “hubs” – with primary care clinicians in rural communities – the “spokes.” They participated in periodic virtual teleECHO clinics that is supported by teleconferencing technology.
The clinics and specialists present on a specific clinical topic, practitioner
present cases to each other and to the specialists who act as mentors and share their expertise. The model enables the provision of best-practice care to patients in their area.

SHIP helped the University of Idaho WWAMI Program bring a Project ECHO hub to Idaho in 2017.

For more information about Project ECHO please click here.

(Last updated 2/19)

SHIP provided the following reimbursement payments to clinics selected to participate:

  • A reimbursement of up to $10,000 for PCMH transformation related work (subject to requirements outlined in a signed memorandum of understanding (MOU) and Clinic Agreement).
  • A reimbursement of $5,000 was awarded for acquiring any national PCMH recognition or accreditation once we received proof of the accreditation or recognition.
  • A reimbursement up to $2,500 was provided to the clinics who received virtual PCMH designation. (Please see the description for a virtual PCMH below.)
  • SHIP provided a one-time waiver for connectivity charges for the clinic to connect their electronic health records (EHR) and to the Idaho Health Data Exchange (IHDE) in addition to a two year waiver of IHDE licensing.
  • Technical assistance, coaching, and quality improvement support through SHIP vendors and public health district staff was provided at no cost to the clinics.

(Last updated 2/19)

A collaboration between ISU and SHIP developed Idaho’s first community  emergency medical technicians (CEMT) curriculum and training modules. These training programs included community paramedics, community emergency medical technician trainings, learning collaboratives, and continuing webinars. Additionally, they were offered on-site technical assistance to assure a successful integration of these programs in their communities. 

CEMTs help fill the gaps in health care by using existing EMTs and advanced EMTs in expanded roles. The knowledge CEMTs develop as first responders proved to be valuable parts of the primary care team. The CEMT model, like community  paramedics can benefit rural EMS agencies by reducing requests for non-urgent services. 

In 201, SHIP contracted with the Idaho State University (ISU) to adapt and adopt the State of Massachusetts’ CHW curriculum to Idaho. Our states CHW program is a blended learning program consisting of instructor-led training and health specific modules (HSMs). Grant funds were allocation to train CHWs through seven training cohorts over a three-year window of time. Participants in the training were members of health and community-based organizations. 

20 HSMs were developed and ten of those modules were translated into Spanish, this was all done using grant funds. (One-fifth of Idaho’s training CHWs speak Spanish and one-third of those CHWs speak Spanish as their first language.) The Spanish modules help facilitate an understanding of CHW’s populations by providing accurate terminology. 

(Last updated 2/19)

Regional Collaboratives & Medical Neighborhoods

Effective as of summer 2015, Idaho's seven public health districts created regional collaboratives (RCs), or local healthcare stakeholder workgroups. The workgroups are designed to provide support with an aim to promote learning, sharing of best practices, and peer support among primary care practices and partners to improve, population health within the regions.  Membership of these RCs included physicians and stakeholder representatives from regional healthcare sectors.

(Last updated 2/19)

A MHN is the clinical-community partnership that includes the medical, social and public health support necessary to enhance health and the prevention of disease in communities. The patient’s PCMH serves as the primary “hub” and coordinator of healthcare delivery with a focus on prevention and wellness. Their PCMH works with services outside the clinic setting including: medical specialists; dietitians; behavioral health specialists; home health; dental professionals; community health workers; community health emergency medical services; education; social services; and community services such as food, housing and transportation; etc. These collaborations help to provide wrap‐around, community-level support for the primary care practices and patients in order to achieve better health outcomes and wellness.
For more information on the MHN, CLICK HERE

(Last updated 2/19)

Health Information Technology

One of the primary goals of SHIP was to improve care coordination through the exchange of patient health information across the medical-health neighborhood (MHN). IHDE's roll was to facilitate the exchange of patient data. IHDE had already established electronic health record (EHR) connections with many hospitals, labs, imaging facilities and clinics. With SHIP, IHDE was able to establish bi-directional connections with the clinics participating in SHIP to support improved patient care while reducing duplication of services. The bi-directional connected involved: 1) the clinic sent transcriptions and continuity-of-care documents (CCDs) to IHDE, and 2) IHDE sent relevant patient labs and radiology reports and transcriptions from other connected systems back to the clinic. IHDE provides an online portal where providers can view patient medical records online.

In addition, the grant was able to provide funds to IHDE to support heir critical infrastructure which allows the organization to continue to provide services as healthcare transformation continues to evolve.

(Last updated 2/19)

Establishing and maintaining a bi-directional electronic health record (EHR) connection with IHDE results in four types of costs. Clinics who participated in the Statewide Healthcare Innovation Plan (SHIP) had several of the cost waived. The fees are:

1) A one-time connect fee to connect the clinic to IHDE. This fee was waived for participating clinics who established this connection during the SHIP grant.

2) A one-time connection fee to connect the clinics EHR. IHDE paid for this fee as long as the participating clinic established the connection during the SHIP grant.

3) There is an annual licensing fee for IHDE services. The licensing fee covers bi-directional connections and an online clinical portal. Participating clinics received a waiver of these fees for the first two years.

4) On-going maintenance fees for the clinics EHR. These fees were not waived for any SHIP participants. 

(Last updated 2/19)

Patient registries are organized systems that collect data and can be used to evaluate health outcomes. 

(Last Updated 10/15)

A critical first step in the development of a reporting structure for individual practice feedback as well as regional and state-level
population health management functions, SHIP contracted 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 outcome data to PCMH practices on the selected                                                      quality measures.

This represented a significant innovation for Idaho which did not previously have a shared healthcare data system. As the model matured and ongoing value of the product was evaluated, the DHW and IHC determined the most appropriate ongoing HIT infrastructure to provide aggregation and analytic support to facilitate Idaho’s population health management functions.

(Last Updated 2/19)

Workgroups & Advisory Entities

Payment for value involves movement from a volume-driven health care delivery system to one that pays for outcomes, measured by the quality of health care, the health of the population, and efficiency.  The Multi-Payer Workgroup, under the direction of the IHC, and through collaboration across payers and providers worked on a plan to transform payment methodology from fee for service to value based payments. 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 clinic’s current level of transformation readiness.  

Additional information can be found on the MPW page locate HERE.

(Last Updated 2/19)

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

(Last Updated 2/19)

At intervals during the SHIP Model Test period, data had been collected from Medicaid, Medicare, and three of the four largest commercial payers in Idaho regarding payments made across the continuum that advances from FFS to VBP strategies. Data was submitted using a common reporting template developed by the Multi-Payer Workgroup (MPW) and in collaboration with payers.  The template presented a continuum for payers to report on calendar year data across all lines of business on:        

  • Percentage of beneficiaries per payment structure, e.g., FFS, FFS with quality incentives, etc.         
  • Total percentage of payments (paid or accrued) to providers per payment structure. 
  • Total payments paid to providers.

From 2015 to 2018, payers reported an increase in beneficiary attribution to programs with quality and value payments, gainsharing, and population-based payments from 58% to 85%. 

The last payer report can be found HERE.

(Last updated 2/19)

Implementing the SHIP in Idaho required change on multiple fronts. To support this change, the IHC recruited advisory groups and created workgroups to assist with various components of effort. Each advisory and workgroup had a charge related to implementing the SHIP goals in Idaho. Additional information can be found on the Work Groups Page

(Last Updated 2/19)


Payment and delivery models across public and private payers offered an opportunity to accelerate health transformation. The reform models were designed to reduce reliance on volume-based care and encourage movement toward payment based on outcomes. This model was reinforced by the expectation that providers and payers must engage in order to create meaningful delivery and payment system reforms. Insurance companies and other payers participated in the Multi-payer Workgroup.

(Last Updated 2/19)

CHW and CHEMS training programs included staff training and on-site technical assistance to assure successful integration of staff into the PCMH team. The CHEMS staffing model was based on successful Idaho programs that demonstrated 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 CHW program was a blended learning program consisting of in-person trainings, offered at regional locations statewide, and on-line sessions. Through this model, Idaho is evaluating the effectiveness of CHW and CHEMS personnel in rural communities with very limited resources. Grant funds were 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 2/19) 

Clinical Quality Measure

Clinical quality measures, CQMs, are tools used to measure and track the quality of healthcare services provided by practitioners and hospitals. The measures use data associated with the providers ability to delivery high-quality care or relate to long-term goals for quality healthcare. Additional information about nations CQMs can he found here

To find more information about CQMs with SHIP, Click here.

(Last updated 2/19)

As you can see here, four measures were 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.

The Statewide Healthcare Innovation Plan (SHIP) used clinical quality measure (CQM) reports from a variety of sources in order to track quality of care in the clinic and critical health trends in Idaho. Those included the following:      

  • Medicaid’s CQM reporting through its analytic provider, Truven;      
  • The Childhood Immunization Status measure from IRIS (Immunization Reminder Information System);      
  • The Access to Care measure through the SHIP State Evaluation Team patient interviews; and        
  • Tobacco Use and Obesity Prevalence through Idaho’s Behavioral Risk Factor Surveillance Survey (BRFSS).

The complete set of SHIP measures can be found HERE

(Last updated 2/19)

Clinical quality measure data submissions from the selected SHIP measures took place through the clinic connections with Medicaid (for Medicaid patients), the IRIS registry, and the SHIP State Evaluation Team patient interviews. In addition, the Department’s public health division facilitated the statewide data collection for the Behavioral Risk Factor Surveillance Survey (BRFSS) measures.

(Last updated 2/19)

Measuring and reporting clinical quality measures (CQMs) provides a metric for providers to track progress over time in meeting quality outcomes. The measures help ensure that Idaho’s healthcare system is delivering effective, safe, efficient, patient-centered, equitable, and timely care.

(Last updated 2/19)

Population Health

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It is an approach to health that “aims to improve the health of an entire human population.” It refers to the health of a population as measured by indicators and as influenced by social, economic, and physical environments. 
The Population Health Workgroup (PHW) of SHIP identified public health issues that were priorities for both Get Healthy Idaho* and SHIP. They included: access to care, diabetes, tobacco use, heart attack and stroke, and obesity. 
You can find more information about Population Health by clicking here.
*Get Healthy Idaho consists of two integral parts: an annual plan to improve population health and an assessment of the current state of the health of Idahoans.
(Last updated 1/19)

Additional information on population health can be found on the Population Health Workgroup page located here. (Last Updated 7/15)

Advisory & Workgroup Pages