HCP LAN

1. HCP LAN Building a Patient-Centered Health System: LAN Learnings Webinar January 27, 2016 12:00 – 1:15 pm EST

2. Welcome Anne Gauthier LAN Project Leader, CMS Alliance to Modernize Healthcare (CAMH)

3. Session Objectives Learn: How to create a culture of patient engagement What is meaningful engagement How to take a ‘whole-person’ orientation How to design ‘with’ not ‘for’ patients Lessons from cancer care delivery reform

4. Agenda

5. Guiding Committee Report Mark Smith Co-chair, LAN Guiding Committee Visiting Professor, University of California at Berkeley and Clinical Professor of Medicine, University of California at San Francisco

6. Goals Adoption of Alternative Payment Models (APMs) 2016 30% In 2016, at least 30% of U.S. health care payments are linked to quality and value through APMs 2018 50% 2018 50% In 2018, at least 50% of U.S. health care payments are so linked. 2016 30% These payment reforms are expected to demonstrate better outcomes and lower costs for patients. Better Care, Smarter Spending, Healthier People

7. The Health Care Payment Learning & Action Network (LAN) has Established 7 Groups with Varying Purposes LAN Guiding Committee APM Framework & Progress Tracking Work Group Clinical Episode Payment (CEP) Work Group Purchaser Affinity Group State Engagement Group Population-Based Payment (PBP) Work Group Payer Collaborative Consumer and Patient Affinity Group

8. Release of APM Framework White PaperJan 12, 2016 The framework is a critical first step toward the goal of better care, smarter spending, and healthier people. • Serves as the foundation for generating evidence about what works and lessons learned • Provides a road map for payment reform capable of supporting the delivery of person-centered care. • Acts as a "gauge" for measuring progress towards adoption of alternative payment models • Establishes a common nomenclature and a set of conventions that will facilitate discussions within and across stakeholder communities

9. LAN Payer Collaborative Vision and Charge Vision • Share insights on APM adoption and health plan reporting capabilities • Provide feedback and clarifications on draft metrics and proposed methods for measuring progress • Engage in efforts to build and pilot measurement approach • Serve as advisors in the development of an approach for a full-scale, nationwide data collection effort of national and regional commercial, Medicaid and Medicare Advantage health plans   • Make recommendations for how best to gather data on the metrics • Participate in a longer-term, larger effort to understand where we are as a nation Brings together industry leaders of both public and private health plans to inform the LAN's approach for measuring progress of APM adoption against the LAN’s goals of 30 percent adoption by 2016 and 50 percent adoption by 2018. Charge

10. PBP and CEP Work Groups • Sprints Launched • Patient Attribution • Financial Benchmarking • Performance Measurement • Data Sharing Population-Based Payment (PBP) Work Group Clinical Episode Payment (CEP) Work Group • Sprints Launched • Elective Hip and Knee Replacement • Future Sprints • Maternity • Cardiac Care

11. LAN Communications Join work group affiliated communities to provide input on work group products PaymentNetwork@MITRE.org Keep updated on the latest LAN info through our newsletter Visit the LAN websiteto learn more and find resources

12. Save the Date: LAN Summit Spring 2016 • April 25 – 26, 2016, Sheraton Tysons, VA • Call for Abstracts & Registration opening soon • Updated information will be available onthe LAN Summit website.

13. What questions do you have about the Guiding Committee report? Use the chat window in your webinar dashboard Q & A

14. Moderator: Building a Patient-Centered Health System Alan Balch CEO, Patient Advocate Foundation

15. Panel: Building a Patient-Centered Health System Sara Van Geertruyden Executive Director, Partnership to Improve Patient Care (PIPC) Lauren Murray Director, Consumer Engagement and Community Outreach for the National Partnership for Women & Families Michael Kolodziej National Medical Director, Onology Solutions, Office of the Chief Medical Officer, Aetna

16. Building a Patient-Centered Health SystemPresentation to LAN Participants January 27, 2016

17. PIPC Today • Founded in 2008, PIPC began as a coalition focused on patient-centeredness in research, advocating strongly for the creation of PCORI. • PIPC has evolved into the leading stakeholder hub for patient-centeredness in research, payment, and delivery of healthcare. • PIPC’s membership has grown to 53 advocacy groups • PIPC has engaged another 15-20 non-member patient groups in our roundtables • PIPC has earned the reputation as the authentic voice of patients

18. Creating a Culture of Patient Engagement • Formalize avenues to provide a meaningful voice to patients in research and the creation and testing of APMs; • Ensure value and quality definitions driven by value to patients; • Foster informed choices from the range of clinical care options through shared decision-making, and by empowering patients with accessible, understandable evidence to achieve their personal treatment goals.  • Avoid a singular focus on cost-containment and protect against a “one-size-fits-all” approach to patient care.  • Support access to new medical advances.

19. Achieving Outcomes that Matter to Patients • Considerations include: • The range of endpoints, care outcomes and treatment goals that matter to patients;  • Factors that influence differences in value to patients within populations;  • Differences in perspectives and priorities between patients, caregivers, people with disabilities, consumers and beneficiaries;  • How patients want to be engaged in their health care and treatment decisions, and characteristics of meaningful shared decision-making to support this.  • Patient engagement at the policy-development level.

20. The Challenge: APMs Provide Value to Whom? • Value to the patient should be reflected in APMs. • Policies should support patients to be active and informed participants in their own care. • Shared decision-making tools should inform patients and caregivers on all treatment options, as well as impacts based on patient needs, preferences, and outcomes. • There is no one algorithm for value!

21. Patient Advisory Panel: Pathway to Meaningful Input • Identify key areas that would benefit from patient input • Consider a number of patient-centered factors: • process for monitoring and updating patient care plans; • preferences and choices of applicable individuals; and whether models place the applicable individual at the center of the care team.  • Assist with the evaluation of APMs • Funding provided in MACRA for measure development and endorsement – focus on outcomes that matter to the individual patient.   • Develop and apply the required patient-centeredness criteria to APMs. • Section 1115A of the Affordable Care Act calls for evaluation of payment models against “patient-centeredness criteria” (i.e. updating care plans). • Provide a structured patient-focused framework to guide CMMI’s work. • Does model deny or limit coverage of benefits for Medicare beneficiaries?

22. Take Home Message • Patients and patient groups should be engaged in the development, implementation and evaluation of APMs based on criteria for patient-centeredness developed by patients – not surrogate voices.

23. Panel: Building a Patient-Centered Health System Sara Van Geertruyden Executive Director, Partnership to Improve Patient Care (PIPC) Lauren Murray Director, Consumer Engagement and Community Outreach for the National Partnership for Women & Families Michael Kolodziej National Medical Director, Onology Solutions, Office of the Chief Medical Officer, Aetna

24. Meaningful Patient/Family Engagement in Alternative Payment Models Lauren Murray Director, Consumer Engagement & Community Outreach Health Care Learning Action Network Webinar January 27, 2016

25. About Us National Partnership for Women & Families The National Partnership for Women & Families is a nonprofit, nonpartisan consumer advocacy group dedicated to promoting fairness in the workplace, access to quality health care, and policies that help women and men meet the dual demands of work and family. We have been working for more than 40 years to improve access to high quality, affordable care for all. Signature Health Care Initiatives Coalition for Better Care Engage patients and consumers in health care payment and delivery system reform policy initiatives and in the design of new models of payment and care delivery. Consumer Partnership for eHealth Advance health IT initiatives and policies that meet the needs of patients and families. Consumer Purchaser Alliance Leading collaboration of consumer and employer groups focused on improving care and reducing costs through performance measurement and payment More information is available at www.NationalPartnership.org.

26. What Patients/Families Want • “Whole person” Orientation: clinicians understand the full range of factors affecting a person’s ability to get and stay well; treatment recommendations align with patients’ values, life circumstances and preferences • Coordination and Communication: Patients & families are considered central members of the care team, and a clinical team member serves as “quarterback” – helping coordinate care, navigate the system and facilitate communication between all members of the team • Patient Support and Empowerment: expanding patients’ and caregivers’ capacity to get and stay well and support for self-management tools and services that are developed with them (not for them) • Ready Access: getting appointments when needed, accommodating barriers such as language or physical or cognitive problems. Consumers also see the high cost of health care and insurance as an access problem

27. We Want the Same Things • Better Care • Better Health Outcomes • Better Experience • Lower Costs • Patients/Family Caregivers care about: • Clinicians • Getting better • Waste and inefficiency

28. Commonly Held Views of “Patient Engagement” • Meaningful engagement is not: • Compliance • Improved Self-Management and Healthy Behaviors • Smart Consumerism • Education Campaigns • Provision of Financial Rewards • Doing “What’s Best for Patients” • Designing Patient-Centered Care Without Patients

29. Engagement Redefined • “Patients, families, their representatives, and health professionals working in active partnership at various levels across the health care system – direct care, organizational design and governance, and policy making – to improve health and health care.” • SOURCE: Carman, Kristin; Dardess, Pam; Maurer, Maureen; Sofaer, Shoshanna, Adams Karen; Bechtel, Christine; Sweeney, Jennifer. “Patient and Family Engagement: A Framework for Understanding The Elements And Developing Interventions and Policies.” Health Affairs 32 No.2 (2013): 223-231.

30. Every Level, Every Stage • Partnership to improve health and care: • Engagement in Care – partnership to better manage care and improve health status based on patient’s own goals • Shared decision making, joint goal setting, developing care plans • Engagement in Redesign – working to redesign care • Care coordination and transitions in care, phone call volume, wait times, improving patient experience • Engagement in Governance – setting policy for initiatives or organizations • Board of Directors, setting job descriptions, setting national qualification criteria or payment policies for medical home initiative, etc. • Engagement in Communities – working with community groups in redesigning care and governing systems/organizations/policies • Advising on community resources and facilitating connections to community supports, serving on governing boards, etc.

31. Framework for Engagement

32. Example • Comprehensive Primary Care Initiative What Patients and Family Caregivers Say They Want: • “Whole-Person” Care • Coordination and Communication • Patient and Family Support • Ready Access CPC Goals: • Manage High Health Care Needs and Deliver Preventive Care • Coordinate Care Across the Medical Neighborhood • Engage Patients and Caregivers • Ensure Access to Care =

33. Options for Patient/Family Engagement ^Program years spans calendar years. Year 1 – 2013-14, Year 2 – 2014-15, Year 3 – 2015-16. ** Survey/PFAC Council combination option not officially specified for Year 1

34. PFAC Improvement Initiatives • Access to Care • Wait times • Extended hour availability • Walk-in visits • Communication • Accessibility of information • Phone system navigation • Care Coordination • Whiteboards • Patient/Family Engagement • Online patient portal use • Patient education materials • Self-management support • Shared decision making tool implementation • Advance Directives

35. Partnering to Achieve CPC Milestones • Work with patients and families to: • Assess and re-design or enhance patient self-management support programs (Milestone #2) • Identify barriers accessing care (Milestone #3) • Review, analyze, and discuss patient experience data (Milestone #4) • Test the best ways to implement the shared decision-making tools (Milestone #7) • Design (or help re-design) the electronic patient portal (Milestone #9) • Identify existing challenges within the practice and ask patient and family advisors to meet to discuss solutions More information on CPCI Milestones.

36. Best Practices • Leadership – Walk the Talk;  Identify Champions • Careful Selection – Right Fit; All stakeholders • Coaching/training – Continuous feedback and support • Good Practice – Trust, Transparency, Relationships • Meaningful Engagement – No Window-Dressing/Rubber Stamping • Don’t wait – Early Engagement; Priorities, Principles • Avoid Tokenism/Don’t Marginalize – No new silos • Beware Stereotypes – “Old culture” thinking • Don’t ignore - Time, Resources, Power

37. For More Information Contact us: Lauren Murray Director, Consumer Engagement & Community Outreach lmurray@nationalpartnership.org (202)986-2600 Follow us: www.facebook.com/nationalpartnership www.twitter.com/npwf Find us: National Partnership Website

38. Panel: Building a Patient-Centered Health System Sara Van Geertruyden Executive Director, Partnership to Improve Patient Care (PIPC) Lauren Murray Director, Consumer Engagement and Community Outreach for the National Partnership for Women & Families Michael Kolodziej National Medical Director, Onology Solutions, Office of the Chief Medical Officer, Aetna

39. Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Can reimbursement reform be patient centered? Learnings from cancer delivery reform Michael Kolodziej, M.D., FACP National Medical Director, Oncology Solutions, Aetna

40. Why health plans are concerned about cancer care 1. NCI Cancer Prevalence and Cost of Care Projections. 2012. Represents medical costs only. 2. MedStat Cancer Cost Data. 2012 3.Journal of Oncology Practice, “Improving Wait Time for Chemotherapy in an Outpatient Clinic.” January 2012. 4. Interviews with community Oncologists. September 2012. 1. NCI Cancer Prevalence and Cost of Care Projections. 2012. Represents medical costs only. 2. MedStat Cancer Cost Data. 2012 3.Journal of Oncology Practice, “Improving Wait Time for Chemotherapy in an Outpatient Clinic.” January 2012. 4. Interviews with community Oncologists. September 2012. • Challenge #1: Expense • Cancer treatments cost $137B in medical spend and growing. 1 • The bulk of costs are driven by care delivered during diagnosis and end-of-life phases.2 • There is no obvious relationship between cost and quality • Challenge #2: Delivery • Despite more efficient care at lower costs in the community setting, an increasing percent of care is being delivered in the hospital outpatient department.3 • New care delivery models, like medical homes, can improve quality and reduce costs but may be challenging for practices to implement. 4

41. Traditional managed care solutions have had minimal impact • Pay less • Manage more (prior auth) • Narrow networks • Shift responsibility to member (co-pay) • Pay for performance (process measures) • Shift risk (capitation) Impact has been small Aggravation has been large

42. Aetna Oncology Solutions: our goals • Get the right treatment to the right patient at the right time. • Optimize the patient experience and the patient outcome. 42

43. Medical Rx 23% 43% Aetna's top cost drivers Inpatient 19% 23% in cancer care 2014 Radiology 23% 14% Specialist Physician 12% 8% Although we spend more on cardiac care, cancer is the most costly medical condition per case $55 B 1000% $123 B Cancer care is the leading edge of medical cost trend. 0% 2010 1996 ALL PTS CHEMO PTS Source: www.cancer.gov/newscenter/pressreleases/2011/CostCancer2020 Source: 2014 CY Claims; Commercial & Medicare; All Funding; Excludes AGB/SH/SRC And its cost is increasing at 2 to 3 times the rate of other costs.

44. Oncology reimbursement reform must: Payers are pursuing two dominant reform models • Clinical Pathways and • Oncology Medical Home • Control cost and • Improve quality

45. There is a disconnect between the cost of innovation and the value it brings Source: The JAMA Network. Five years of cancer drug approvals: innovation, efficacy, and costs. Available at: http://oncology.jamanetwork.com/article.aspx?articleid=2212206. Accessed January 12, 2016.

46. Clinical pathways are one approach to promoting evidence based, value driven care

47. How can pathways be patient centric?

48. Aetna, Inc.

49. What are the PCMH joint principles? • Personal physician • Each patient has an ongoing relationship with a personal physician • Personal physician leads a team of individuals that takes responsibility for the ongoing care of patients • Personal physician is responsible for providing for all the patient’s health care needs or arranging care with other qualified professionals • Care is coordinated across health care system • Quality and safety are hallmarks of the medical home • Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication • Payment recognizes the added value provided to patients who have a patient-centered medical home

50. Practice quality reporting is mandatory Patient Support Services Satisfaction Advanced Care Planning