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The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, healthy aging, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
Sarah J. Mills of Health Care Access Now, Rita Horwitz of Better Health Partnership, and Jenelle Hoseus of Health Impact Ohio provide an overview of the statewide network of resources for patients and families in Ohio. These interconnected programs simultaneously address the gaps in primary care workforce, access to care and the social determinants of health, such as housing, transportation, and other needs at the community level.
Review the slides
Watch the recording
Authors Maanasa Kona, JD, and Megan Houston, MPH, of the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms presented their Milbank Memorial Fund report and additional findings in subsequent case studies on primary care access for underserved populations (i.e., low-income, racial and ethnic minorities, rural). They discussed the impact of different initiatives and how they addressed each of the “Five As”: availability, accessibility, accommodation, affordability, acceptability. The authors provided information about two of their five case studies (Grant County, New Mexico, and Baltimore City, Maryland) and summarized which initiatives were proving to be effective in those locations.
In this seminar, we hear how three organizations are integrating behavioral health services into primary care practices and creating collaborative care models that bridge the gap across fragmented care. Behavioral health integration is a team-based transformation to primary care, not solely the addition of a specialized clinician to a practice. Stakeholder coordination, communication, and cultural change management are among the key drivers to successfully integrating behavioral health services into health practices. This session features speakers from Arkansas Behavioral Health Integration Network, Care Transformation Collaborative of Rhode Island, and Horizon Blue Cross Blue Shield of New Jersey.
Review summary and takeaways.
Watch the recording.
In December 2020, Milbank Memorial Fund conducted its second survey of its network of payers to understand how payers reacted to the COVID-19 pandemic, specifically with regard to their relationships with primary care practices. In this webinar, we explored findings from the survey analysis conducted by Mathematica and discussed payers’ changes to telehealth policies, quality and reporting requirements, payment mechanisms, and much more.
Review Key Survey Findings
Review Survey Analysis (Abridged)
Review Survey Analysis (Full)
Community-based organizations are utilizing new tools and platforms to better identify and address patients’ social needs. We know social determinants of health, such as access stable housing, food security, and others, can have a significant impact on a patient’s health; while clinical care is estimated to constitute 20% of the modifiable contributors of health, socio-economic, behavioral, and environmental factors constitute the remainder. In this seminar, we hear from organizations across the US and their experiences integrating new tools, such as AuntBertha and Healthify, into their workflow so patients receive appropriate referrals to local organizations based on their unique needs identified. Featured organizations include the Idaho Health Data Exchange, Kootenai Health, The Health Collaborative, CareSource, and MyHealth Access.
Review summary and takeaways
Review AHC’s Project Overview – Route 66 Consortium
Review The Health Generation GEN-H Connect slides
Review Idaho Health Exchange’s Spotlight on Social Needs slides
Oregon implemented a statewide accountable care model in 2012 with the launch of CCOs. CCOs are partnerships of payers, providers, and community organizations that work at the community level to provide coordinated health care for children and adult Oregon Health Plan Enrollees. Local networks of participating healthcare providers receive a global budget to serve enrollees. The legislation that created CCOs also required these networks to create at least one community advisory council (CAC) to integrate community and OHP member voices in their work. State agencies and healthcare systems are increasingly seeing the value in engaging consumers not only to direct patient care, but also to guide organizational decisions about that care to drive progress on improving health outcomes and stabilizing health costs. (See case study for additional information)
Review NCQA’s slides
Review Oregon Health Authority & Community Catalyst’s slides
Howard Haft, MD, and Chad Perman, MPP, of the Maryland Department of Health joined the Multipayer Primary Care Network for a timely discussion on the development of the Maryland Primary Care Program and their response to the COVID-19 pandemic. They discussed this unique federal–state partnership and the initial goals of the program which included expanding access to care, enhancing practices’ telemedicine capabilities, reaching vulnerable populations, supporting practices through Collaborative Care, and developing and using tools to identify patients most in need of care. In light of the COVID-19 pandemic, they also discussed how their program has prepared practices for providing telehealth and using the program’s tools to identify and assist patients most at risk. Additionally, they shared the specifics of their COVID-19 response which include daily webinars for providers to receive information and resources and have their questions answered to best treat their population.
Review the slides.
The Multipayer Primary Care Network was joined by panel members Amy Tippett-Stangler of the Northeast Business Group on Health, Pooja Kothari of the United Hospital Fund of New York, NY State Department of Health leaders Marcus Friedrich and Lindsay Cogan, and Robert LaPenna of Empire Blue Cross Blue Shield as they discussed the ongoing challenges in multipayer collaboration, coming to an agreement on a how to credibly measure quality in health care while minimizing the burden placed on practices and payers. They spoke on specific aspects of the development and use of the New York State Primary Care Core Measure Set and mechanisms of through which collaboration was established between the health plans in order to achieve this success.
See the presentation slides here.
Watch the recording here.
Cory King, Director of Policy, Rhode Island Office of Health Insurance Commission joined the Multipayer Primary Care Network to share the work of the Rhode Island Office of Health Insurance Commission over the past decade as they created affordability standards for health insurers. He discussed the stages of implementation of these standards and the future directions of reform, including sustainable funding for primary care, a transition towards the integration of behavioral health into primary care, continued reform of payment models.
Dr. Kangovi joined the Multipayer Primary Care Network to discuss IMPaCT, a model for Community Health Workers from The Penn Center for Community Health Workers. She discussed some of the common pitfalls that other CHW models have fallen victim to, including hiring problems that lead to high turnover rates, a lack of standardized program infrastructure, and the creation of disease specific programs. With these pitfalls in mind, IMPaCT was designed using high-risk patient input and as a result, has been scientifically proven to improve primary care access and patient reported quality, as well as reduce total hospital stays. IMPaCT uses a specialized hiring algorithm that hires CHW based on quality traits as well as credentials and provides their CHW with the training, resources, and support they need to manage their case loads and collaborate with healthcare teams. This approach allows their CHW to better serve their patients and address the SDOH that many high-risk patients face.
Emily Johnson from CMS joined this special Multipayer Primary Care Network webinar to present information on multipayer alignment, an essential element of the Primary Care First Initiative. She described four core principles (moving away from fee-for-service, rewarding outcomes instead of process, the delivery of meaningful data reports to boost performance improvement, and driving adoption of value-based care models through multipayer alignment). Her detailed presentation provides payers with the opportunity to understand how CMS will be approaching the principles laid out in the PCF model, and how payers can potentially align their strategies accordingly.
Dr. Claire Neely, President and CEO of ICSI describes the approach used by the Minnesota Health Collaborative to advance the integration of behavioral health in primary care. The collaborative has supported organizations in making structural improvements which allowed for the adoption of Integrated Behavioral Health. They also adopted a strategy for sustainable integration that includes improving knowledge and reducing stigma, collaborating with groups to achieve better financial coverage of behavioral health services, and increasing the availability and accessibility of behavioral health providers. Through their work they have demonstrated a commitment to improving care and ease of access to behavioral health services and providing better support for care teams.
See the presentation slides here
Nancy Rockett Eldridge and Stefani Hartsfield of The National Well Home Network described the accomplishments of a population based, integrated care management system model, Support and Services at Home (SASH) in Vermont. Through partnerships between health care providers, payers, housing and home- and community-based services, this model achieved improved quality of care and a reduction in both Medicare and Medicaid spending by addressing the social determinants of health that have historically inhibited the achievement of effective health outcomes among this community. Based upon the success of this model, the U.S. Department of Housing and Urban Development has now launched the Integrated Wellness in Supporting Housing (IWISH) demonstration in seven states at 40 locations.
MyHealth is a nonprofit coalition of Oklahoma health providers who are using technology to link medical providers, exchange timely information, and improve the delivery of local health care. MyHealth Access Network in Tulsa, Oklahoma is using mobile screening delivered via text messaging to get information about patient risk factors at the time of a primary care office visit or emergency room visit. Hear how the tool was developed and approved for use and about its impact. Presented by Jennifer Faries of Oklahoma’s MyHealth Access.
In response to requests from many of Multi-State Collaborative, CMS and Milbank offered a demonstration of the CPC+ Data Feedback Tool (DFT), the data platform that it created for practices participating in CPC+. The DFT enables practices to view CPC+ performance data and includes dynamic functionality for practices to analyze their data, develop insights, and plan improvement activities. The tool displays performance compared to practices within and across regions, along with drilled-down information to provide details on the performance factors that drive variation.
This demonstration provided CPC+ payer partners the opportunity to understand the types of data and analytic capabilities that CPC+ practices receive from CMS, and how they align with payers’ own data reports and tools.
The Milbank Memorial Fund Multi-State Collaborative held a webinar to discuss both Primary Care First (CPC+ “Track 3”) and Direct Contracting. The conversations was joined by CPC+ staff members who shared their insights, and responded to comments and questions from the Multi-State Collaborative.
Mark Humowiecki and Lauran Hardin of the National Center for Complex Health and Social Needs described the Blueprint for Complex Care, a strategic plan to unite the broad set of individuals and organizations experimenting with innovative care models to improve care for individuals with complex health and psychosocial needs. They discussed how the Blueprint was developed and outline recommendations for expanding this important field, so relevant to high-quality primary care.
Debra Hurwitz and Pano Yeracaris from the Care Transformation Collaborative of Rhode Island (CTC-RI) describe their recently concluded three-year pilot program focused on integrating behavioral health in primary care practices. The model includes universal screening for depression, anxiety, and substance use disorder; a team member who is an onsite behavioral health clinician; and monthly team meetings with a clinical psychologist. This presentation walks through the qualitative study that shows a high degree of acceptance/satisfaction by primary care providers and improvements in patient outcomes. The RI all-payer claims database shows lower inpatient and emergency department utilization, and a lower total cost of care than in a comparison group.
See the presentation here.
Psychiatrist and advocate Henry Harbin, and health economist Michael Schoenbaum of the National Institute of Mental Health, discuss the efficacy and centrality of behavioral health access, tracking, and measurement in the CPC+. Mental illness and substance use are major drivers of disability and costs. Effective treatments exist, but currently there are not enough specialty providers to provide the necessary care. By effectively integrating behavioral health care with primary care we can increase access to care, improve health outcomes, and lower costs.
See presentation slides here.
See Medicare Learning Network Fact Sheet here.
See New England Journal of Medicine article here.
See The Kennedy Forum article here.
See the Collaborative Care Model here.
Richard F. Shonk, MD, PhD, of The Health Collaborative, shares the results of the extensive analysis of member outcomes from CPC Classic. In contrast to the minimal impacts observed in Medicare fee-for-service beneficiaries, Dr. Shonk’s presentation describes the substantial increases in utilization, cost decreases in the participating Ohio payers’ commercial and Medicare Advantage populations, and the importance of looking at results across payer types when evaluating outcomes. Dr. Shonk and Dr. Laura Sessums recently published their findings in a Health Affairs Blog post, The Comprehensive Primary Care Initiative: Another Side of the Story. This post provides their perspectives as physicians active in primary care transformation and offers insights gleaned in discussions with private payers and physicians who participated in CPC.
Guest speaker Craig Jones, MD, formerly the director of the Vermont Blueprint for Health, and now an independent consultant for Deloitte as well as with the Office of the National Coordinator at the U.S. Department of Health and Human Services is doing technical and cultural assessments of CPC+ regions’ information technology capacity, and has found some compelling and informative patterns. He shared the important results of his multiple site visits and interviews.
See the discussion topics here.
Dr. Johnson, Vice President for Enterprise Data & Analytics Blue Cross Blue Shield of Kansas City, presented a summary of her study on the BCBS Kansas City Medical Home Program. Her study, which is the basis of her doctoral dissertation, examines three important questions: 1) How do basic characteristics of medical homes and non-medical homes differ? 2) Does medical home implementation influence physician practice patterns? 3) Does medical home ownership influence total cost of care or utilization rates for high-cost services? Dr. Johnson and participants in the webinar discuss the implications this study has for building a strong primary care foundation and the potential roles that payers have in enhancing financial incentives, reducing administrative burdens, implementing benefit design that promote primary care, and focusing on accountable care agreements that move beyond primary care.
The results of the most recent CPC+ Market Update Tool indicate several payer milestones that are proving to be challenging to achieve, notably in data aggregation and in Track 2 payment. We heard about strategies being used and progress being made in these areas in two CPC+ regions.
The CMS Innovation Center (CMMI) released a Request for Information (RFI), seeking input on the concept of Direct Provider Contracting (DPC). The public comment period for this is quite brief, ending on May 25, 2018. This presents us with a critical and time-sensitive opportunity to inform the future focus of CMMI by sharing your organizations’ and personal opinions.
Several colleagues generously offered to share their experience and opinions about DPC in a panel presentation set up by the Fund, to be followed by an facilitated question and answer session.
Rachel Block, Milbank Memorial Fund Program Officer, and report co-author Mark Friedberg of the Rand Corporation will discuss the methods and findings of a study, published in 2017 by the Fund, on Standardizing the Measurement of Commercial Health Plan Primary Care Spending.
Our colleagues from Blue Cross and Blue Shield of Kansas City, Qiana Thomason, Vice President for Population Health Solutions, and Karen Johnson, Vice President for Healthcare Insights & Partnerships, share their experiences bringing their administrative services only lines of business into the CPC+ effort.
UAMS faculty members Wendy Ward, Stephanie Gardner, Mark Jansen, and Kathryn Neill describe their groundbreaking innovative curriculum and its implementation.
See the presentation slides.
Click here and here for additional resources.
The Multi-State Collaborative hosted a webinar featuring Diane Bechel-Marriott, DrPH, CPC+ Michigan Convener and Manager of Multipayer Initiatives at the University of Michigan, and Ann Greiner, President and CEO of the Patient-Centered Primary Care Collaborative. They discussed the role of patient and caregiver engagement in transforming primary care. Patient and caregiver engagement represents one of the five functions of CPC+. The others are access and continuity, care management, planned care and population health, and comprehensiveness and coordination.
Both Greiner and Bechel-Marriot explain how patients can become involved in practice design that leads to care that is more responsive to patient needs. They also highlight patient and clinician education as an important first step. While patient and caregiver engagement is only one of the five CPC Plus function domains, Bechel-Marriot notes its potential for benefiting the other four.
Go to the PCPCC’s TCPI resource page, which provides free tools for practice transformation coaches and practices related to patient and family engagement. See Bechel-Marriot’s presentation slides here.
The Multi-State Collaborative (MC) hosted a webinar featuring researchers from Mathematica Policy Research. Erin Taylor, director of health research, Grace Anglin, researcher, and Debbie Peikes, senior fellow, discussed findings from the third annual evaluation report on the Comprehensive Primary Care (CPC) initiative, which ended in December 2016. They shared information about multi-payer collaboration and how payers can come together to support best practices in improving patient care. The presenters also discussed lessons learned that could be applied to the Comprehensive Primary Care Plus (CPC+) initiative, which started its first of five years in January 2017.
(The webinar begins at the 2:50 mark; it is sound only.)
The webinar focuses on some of the challenges faced by CPC regions: aligning quality measures across payers (given that different payers may serve different enrolled populations); overcoming the unanticipated complexity of the process of payer data aggregation; and engaging self-insured payers in the region in transforming care delivery.
The speakers highlighted several lessons from CPC that payers may apply to CPC+ or other multi-payer initiatives:
Read CPC’s third annual evaluation report.
The Multi-State Collaborative (MC) hosted a webinar on data aggregation, analytics and reporting in multi-payer environments. David Jorgenson and Melanie Pinette of Onpoint Health Data shared their experiences developing and building data integration, analytics, and reporting systems in the Multi-Payer Advanced Primary Care Practice (MAPCP) demonstrations in Vermont and Rhode Island. The presentations were followed by a Q&A session facilitated by Lisa Dulsky Watkins, MC Director. Read an additional resource with background information from the webinar presenters.
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