Introduction

The State Innovations Models (SIM) initiative was a federal program operated by the Center for Medicaid and Medicaid Innovation (CMMI), part of the Centers for Medicaid & Medicare Services (CMS). The SIM initiative was designed for states that were committed to planning, designing, testing, and supporting the evaluation and implementation new payment and services deliver model for healthcare systems transformation that would improve health outcomes and lower costs in their states. The SIM initiative was comprised of 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 a grant to design a SHIP that would serve as a blueprint to redesign Idaho's healthcare delivery system and payment systems. The underlying goal of Idaho's SHIP was to transform the state's healthcare system from a fee-for-services (FFS), to a value-base-system driven by improved health outcomes. 

In July 2014, IDHW submitted a "model test" grant proposal and application to CMMI. In December 2014, CMMI announced Idaho was one of eleven 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 managed by IDHW. 

(Last Updated 3/19)

The Statewide Healthcare Innovation Plan (SHIP) was a broad statewide initiative designed to transform healthcare delivery in Idaho to achieve the Triple Aim of improves 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 coverage gap- they are not eligible for medicaid and ineligible for insurance through Your Health Idaho, Idaho's health insurance market place, most of the time due to lack of income.

While Medicaid redesign and expansion focuses on specific populations of people who are 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 3/19)

Ninety percent of the SHIP grant's funding was allocated to testing and implementing changes within Idaho's healthcare delivery system. This included supporting primary care practices in their transformation into 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 data pathways to improve health outcomes. The remaining ten percent of funding supported personnel and operating expenses used to implement SHIP.

(Last Updated 3/19)

SHIP grant funds were used to provide training and support to primary care practices who were committed to transformation their practices to the patient-centered medical home (PCMH)* model. Grant funds were additionally used to fund Idaho's public health districts in order to support healthcare stakeholder groups known as regional collaboratives (RCs), and to strengthen and build patient health data pathways.

*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 health and stabilizing patients with chronic conditions. 

(Last Updated 3/19)

Hospitalizations and long-term care account for most of the money spent on healthcare in the United States. Stakeholders in Idaho agreed that increasing healthcare spending was a concern and determine that this grant would provide a means to address the issue. The federal SIM grant set out to prove investing in primary care and focusing on preventative care would transform the healthcare delivery system in Idaho during Idaho's SIM model test. Idaho's Statewide Healthcare  Innovation Plan (SHIP) proved changing the reimbursement model to pay for health outcomes rather than volume of services was a wise investment.

(Last Updated 3/19)

Stakeholders associated with the Idaho Healthcare Coalition (IHC) and the SHIP Initiatives agreed the healthcare transformation work started with teh SHIP grant is critical. In mid-2018, a new IHC Transformation Sustainability Workgroup (TSW) was formed. The workgroup was tasked with creating creating a charter and business care for a new advisory body to succeed the IHC and work with the Office of Healthcare Policy Initiatives (OHPI) in moving healthcare transformation forward in Idaho after the SHIP grant ends.

The Transformation Sustainability Workgroup recommended the formation of the Healthcare Transformation Council of Idaho (HTCI). The HTCI consists of a 25 member advisory body whose members will be governor-appointed. The charge of the council is to :

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

The full charter document can be found HERE. The HTCI website as linked above includes information on the councils functions, membership and composition, meetings, subcommittees/working groups, and staff resources.

In October of 2018, a recommendation was made to allocate general funds to the OHPI for four full-time staff. An additional three full-time staff will be funded through grants.

(Last updated 3/19)

The Office of Healthcare Policy Initiatives recognized that specialty practices often provide primary care services to patients with complex medical conditions. Specialty clinics were invited to transform to a patient-centered model of care and apply to participate in SHIP.

Specialty practices are also key participants in the medical-health neighborhood (MHN) and participated in the Regional Collbaboratives (RCs).

(Last Updated 3/19)

The Idaho Healthcare Coalition (IHC) with its nearly fifty members and its seven Regional Collboratives (RCs) facilitated partnerships with local community organizations to adopt health improvement strategies developed locally or modeled after successful  strategies used in other part of the state or country. Community-based initiatives vary by region to reflect local needs identified through community needs assessments.

(Last Updated 3/19)

The Healthcare Transformation Council of Idaho (HTCI) is the successor stakeholder group of the Idaho Healthcare Coalition (IHC). It is charges with sustaining the transformation work taking place in Idaho. It has half the number of members as the IHC with only twenty-five members. The HTCI is comprised of various stakeholders and the members will be governor-appointed. The HTCI has the ability to make recommendations. The full charge of the 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 here on the HTCI web page. This page includes information on the council's functions, membership, composition, meetings, subcommittees, workgroups, and staff resources.

(Last Updated 3/19)

The nearly fifty member Idaho Healthcare Coalition (IHC) was co-chaired by family physician Dr. Ted Epperly and on of Idaho's Department of Health and Welfare (IDHW) Deputy Directors, Lisa Hettinger.IHC members included:

• Providers
• Private and Public Payers
• Legislators
• Representatives of Healthcare Systems
• Provider Membership Associations
• Representatives from each of Idaho's public health districts and regional collaboratives
• Key state officials
• Community service representatives, and 
• a representative from the Governor's office

The IHC also received active advice from seven workgroups based on their respective areas of expertise. The workgroups are as follows:

• Community Health EMS
• Idaho Medical Home Collaborative
• Data Governance
• Multi-Payer Workgroup
• Behavioral Health
• Population Health, and 
• Transformation Sustainability Workgroup.

And two advisory groups; Community Health Workers and Telehealth Council. Each group had a specific charge related to implementing SHIP goals in Idaho. At the end of the SHIP grant there were more than 270 unique individuals active in the IHC and its related groups.

The SHIP grant ended on January 31, 2019, the last meeting for the IHC was held on January 9, 2019. 

For information on Idaho's transformation sustainability click here.

(Last Updated 3/19)

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

(Last Updated 3/19)

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) and were paid a per member/per month(PMPM) fee from the payers for a small percentage of chronically ill patients.

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

A small number of clinics participated in both the pilot project and SHIP. The clinics who participated in the pilot and were accepted into SHIP mentored those who were selected into the other cohorts.

(Last Updated 3/19)

A collaboration between Idaho State University (ISU) and the Statewide Healthcare Innovation Plan (SHIP) developed Idaho's first community emergency medical technician (CEMT) curriculum and training modules. CEMTs fill in the gaps in local health care by using existing EMTs and advanced EMTs in expanded roles. The knowledge CEMTs have gained as first responders was proven to be a valuable part of the primary care team. The CEMT model can benefit rural EMS agencies in the same manner as community paramedics by reducing requests for non-urgent services.

CHEMS training programs consisted of community paramedics and CEMTs training, learning collaboratives, and continued education webinars. On-site technical assistance was provided to assure successful integration of these programs into their communities.

In 2016, SHIP contacted with ISU to adopt and adapt the State of Massachusetts' CHW curriculum. Idaho's CHW program is a blended learning program with instructor-led training and health specific modules (HSMs). Grant funds were used to train CHWs through seven training cohorts over a three-year period of time. Participants in the training included members of health and community based organizations.

Twenty HSMs were developed with ten of those modules being translated into Spanish. (Of the training CHWs in Idaho, one-fifth of them speak Spanish, of those Spanish speaking CHWs one-third speak Spanish as their primary first language.) The translated modules help those individuals obtain a better understanding of their populations and accurate terminology. All of the HSMs were created using Grant Funds.

(Last Updated 3/19)

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

SHIP provided the funding opportunities for PCPs and community health emergency medical services (CHEMS) agencies to implement Telehealth pilot projects to improve care they need, and to promote the Triple Aim. The funding opportunities for single awards of up to $25,000 was available to each clinic and CHEMS agency who established or expanded the scope of Telehealth operation based on organizational and population health needs over a 12-16 month period of time.

In late 2016, in collaboration with the Telehealth Council, a Telehealth reimbursement matrix was developed. The reimbursement matrix outlined insurance carriers' policies and procedures for paying for Telehealth services. This matrix was updated in March 2018.

For more information on the Telehealth Council click here.

According to the National Committee for Quality Assurance (NCQA), a patient-centered medical home is a "model of care that puts patients at the fore front of care." Patient-centered medical homes improve quality as well as patient and provide experience and reduce healthcare costs. Patient-centered medical homes move primary care from acute-focused, episodic care to a patient-centered approach to preventative care based on the 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 satisfactions
• Alignment with payers

For information on PCMH click here.

(Last Updated 3/19)

The virtual PCMH model is a unique approach to developing PCMHs in rural, medically-under-served communities in Idaho. Specifically, the model has been testing the impact of Telehealth technology, 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 has allowed for integration of behavioral health services in remote communities via Telehealth services. 

For more information click here.

(Last Updated 3/19)

Developed by the University of New Mexico Health Sciences Center, Project ECHO (Extension for Community Health Outcomes) was created to deliver medical education and care management to primary care practitioners in rural, medically-under-served communities.In Idaho, Project ECHO operated and continues to through the University of Idaho (UI) WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Regional Medical Education Program. Before the end of SHIP Project ECHO in Idaho was supported with funds from the SHIP grant.

The ECHO model has transformed medical education to increase workforce capacity by linking specialists - operating as "hubs" - with primary care clinicians in rural communities - the "spokes." They participate in periodic virtual TeleECHO clinics that are supported by teleconferencing technology. During the clinics, specialists present on a specific clinical topic then practitioners present cases to each other and to the specialists present on a specific clinical topic then practitioners present cases to each other to the specialists who act as mentors, sharing their expertise. The model enables the provision of best-practice care to patients right where they live.

SHIP help the University of Idaho WWAMI program bring a Project ECHO hub to Idaho in 2017.

For more information about Project ECHO click here. 

(Last Updated 3/19)

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

• 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 PCMH recognition/accreditation reimbursement of $5,000 for acquiring any national PCMH recognition and accreditation (upon receipt of proof accreditation).
• A reimbursement of up to $2,500 for those clinics that qualified with a virtual PCMH designation. (Please see the definition of a virtual PCMH).
• A waiver of the one time connection charge for the clinic's electronic health record (EHR) to the Idaho Health Data Exchange (IHDE) and two years of IHDE licensing fees waived
• Technical assistance, coaching, and quality improvement support through SHIP vendors and public health district staff

(Last Updated 3/19)

Beginning in the summer of 2015, Idaho's seven Public Health Districts created regional collaboratives (RCs), or local healthcare stakeholder workgroups, designed to provide support with an aim to promote learning, sharing best practices, and peer support among primary care practices. All of this was to assist with improving population health with in the regions. Membership of these RCs included physicians and stakeholder representatives from the regional healthcare sectors. 

For more information on RCs click here.

(Last updated 3/19)

The Medical Home Neighborhood is the clinical-community partnership including medical, social, and public health supports necessary in enhancing health and the prevention of disease in communities. The PCMH serves as the patients primary "hub" and their coordinated healthcare delivery system with a focus on prevention and wellness. This worked with services outside the clinic settings including:

• Medical Specialists
• Community Services such as food, housing, and transportation
• Dietitians
• Behavioral health specialist
• Home health
• Dental professionals
• community health workers and community health emergency medical services
• Education
• Social service, etc.

All of these provide wrap-around community-level supports for the primary care practices and patients to achieve better health outcomes and wellness.

For more information on MHN click here.

(Last updated 3/19)

As part of improving the exchange of information, the IHDE has worked to establish bi-directional connections with each clinic's electronic health records (EHR) to support improved patient care while reducing duplication of services.

(Last Updated 3/19)

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 role was to facilitate the exchange of this patient data. IHDE has already established electronic health record (EHR) connections with many hospital, labs, imaging facilities, and clinics. As part of SHIP they have established bi-directional connections with the clinics participating in SHIP. This bi-directional connection typically involves:

1. The clinic sending transcriptions and continuity of care documents (CCDs) to IHDE,
2. IHDE sends relevant patient labs, radiology reports, and transcriptions from other connected systems back to the clinic.

IHDE has also provided an online portal where providers can view patient medical records online.

In addition, the grant provided funds to support critical IHDE infrastructure that is allowing the organization to provide needed services as healthcare transformation evolves.

(Last Updated 3/19)

Establishing and maintaining a bi-directional electronic health record (EHR) connection  with IHDE resulted in four types of costs. Clinics who participated in the Statewide Healthcare Innovation Plan (SHIP has several of these costs waived:

1. The one-time connection cost from IHDE was waived for SHIP participants if the connection was established during the SHIP grant.
2. The one-time connection cost from the clinic's EHR was pad for by IHDE if the connection was established during the SHIP grant.
3. The annual licensing cost form IHDE (for the bi-directional connection and for the online clinical portal) was waived for the first two years.
4. The on-going maintenance costs from the EHR are the responsibility of the clinic- there was no waiver for these costs.

(Last Updated 3/19)

Implementing the Statewide Healthcare Innovation Plan (SHIP) in Idaho required transformation on multiple fronts. To support this change, the IHC recruited advisory groups with various components for this effort. Each advisory and workgroup had a charge related to implementing the SHIP goals in Idaho. Additional information on each advisory and workgroup can be found here.

(Last Updated 3/19)

Stakeholders associated with the Idaho Healthcare Coalition (IHC) and the SHIP initiative agreed continuing the healthcare transformation work the IHC and SHIP started is critical. In-mid 2018 a new IHC Transformation Sustainability Workgroup (TSW) was formed. The workgroup was tasked with creating a charted and business case for a new advisory body who would succeed the IHC and work with the Office of Healthcare Policy Initiatives (OHPI) in moving healthcare transformation forward in Idaho upon the close of the SHIP grant.

The TSW recommended the formation of the Healthcare Transformation Council of Idaho (HTCI), is made up of twenty five members who will be governor-appointed. The charge of the council is to:

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 document can be found here.

For more information about the HTCI click here.

(Last Updated 3/19)

Clinical Quality Measures, or CQMs are tools to help measure and track the quality of healthcare services provided by practitioners, hospitals and critical access hospitals. These measure use data associated with providers ability to deliver high quality care or relate to long-term goals for quality healthcare. Additional information about national CQMs can be found here.

(Last Updated 3/19)

To find more information about CQMs for SHIP click here.

The Statewide Healthcare Innovations Plan (SHIP) is using clinical quality measures (CQM) reports from a variety of sources to track quality of care in the clinic and critical health trends in Idaho. These include the following:

• Medicaid's CQM reporting through its analytic provider, Truven;
• The Childhood Immunization Status measures 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.

Clinical quality measure data submission for the selected SHIP measures take place through connections with Medicaid (for Medicaid patients), the IRIS registry, and the SHIP State Evaluation Teak patient interviews. In addition, the Departments public health division facilitates the statewide data collection for the Behavioral Risk Factor Surveillance Survey (BRFSS) measures.

(Last Updated 3/19)

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

(Last Updated 3/19)

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)

Payment for value involves movement from a volume-driven healthcare delivery system to one which pays for outcomes, as measured by the quality of healthcare, the health of the population, and efficiency.

The Multi-Payer Workgroup (MPW), 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 (FFS) payment model has been integral to the health system transformation and the MPW support multiple reimbursement models that adapt to each practices current level of transformation. 

For more information about the Multi-Payer Workgroup click here.

(Last Updated 3/19)

At intervals during the SHIP Model Test period, data has been collected from Medicaid, Medicare, and three of the four largest commercial payers in the state 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 presents 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 2017, payers reported an increase in beneficiary attribution to programs with quality and value payments, gain-sharing, and population-based payments from 58% to 85%.

(Last Updated 3/19)