Maine Health Management Coalition Ellen Schneiter SIM Project

Payment Reform – Context MHMC is working to nurture a Value Based Design for

Payment Reform – Year One • Foundational data work • Maine. Care and Medicare

Payment Reform – Year One • Healthcare Cost Workgroup developed first set of recommendations;

2015 Objectives – Payment Reform • Continued work on VBID – pilot with one

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Maine Health Management Coalition Ellen Schneiter SIM Project Director

Payment Reform – Context MHMC is working to nurture a Value Based Design for Maine’s health care system • Value based insurance design – encourages the use of evidence-based, cost-effective benefits/services • Transparency of provider performance so high quality, efficient clinicians may be chosen by consumers to deliver value based services • A payment system that is supportive of clinicians and patients as they focus on the use of evidence based care These are interactive aspects of a high functioning health care system 2

Payment Reform – Year One • Foundational data work • Maine. Care and Medicare data in hand; incorporated into practice reports • Work on VBID plan progressing nicely, though a huge project! • Red/yellow/green coding identification; work on wellness incentives and administrative streamlining to support practices and payers as they implement VBID • Pathways to Excellence work underway • New PTE-Behavioral Health group convened and Initial set of quality measures published January 5, 2015 • TCI/RUI measures endorsed 3

Payment Reform – Year One • Healthcare Cost Workgroup developed first set of recommendations; presented to CEO Summit in October • Year over year growth caps for risk-based contracts, tracking towards Medical CPI • First edition of Data Book produced and distributed • Accountable Care Implementation Workgroup activities • Identification of core set of ~ 40 ACO performance metrics for contract development and potentially for public reporting • Doubling down on primary care • Focus on support of a high functioning, sustainable primary care delivery system through payment reform 4

2015 Objectives – Payment Reform • Continued work on VBID – pilot with one EHR vendor and one employee group • Expansion of BH quality reporting; development of first specialty metrics • Adoption of ACO core measures set by major payers • Healthcare Cost Workgroup recommendations • Role/responsibilities of all parties (providers/payers/purchasers) to hold down cost trend • Recommendations regarding delivery system infrastructure • Two add’l CEO Summits – one statewide, one regional • Two updates to Data Book • Deep dive into primary care payment reform 5