As conference attendees for the 2016 CFHA Annual Conference
traveled to Charlotte, North Carolina, a group of policy wonks, clinicians, lawmakers, and
administrators met just a mile away to share information and brainstorm new
ways for addressing the fragmentation of the US and, specifically, the NC health care system. The group
met in the beautiful Duke Endowment building, which is just a short walk away from
the Westin hotel, site of this year’s CFHA conference.
As Ben Miller,
Director of the Eugene S. Farley, Jr. Health Policy Center, put it during his opening
remarks, “We are dealing with fragmentation and integration is the solution. How
you do it, how you measure it, and how you train it: that’s up to you.” Dr.
Miller made the case that states need to be adaptive when it comes to designing
systems of integrated care because they have communities with unique resources
and needs. “However” he concludes, “If we lose sight of why we are doing this,
we will fail.”
The rest of the meeting included speakers representing
various stakeholders in North Carolina: although, a few hailed from other states.
Dave
Richard, Deputy Secretary, Division of Medical Assistance, spoke next,
giving an update on the state of integrated care from the perspective of the
state department of health and human services as well as a plan for the future.
“There are a lot of good things happening in North Carolina, just in pockets”
he began. State officials and administrators have spent the last three years
debating the NC Medicaid system and have come to a fairly strong consensus as
to what it will look like.
The next steps, he argues, are deciding how Medicaid
will work with other systems in the state as well as defining what integrated
care looks like. “The needs of people in North Carolina will drive change” he
argues. One interesting point he made is how the state defines good care as “person-centered
community care”. “If we just think about them as patients, then we miss a huge
part of their lives.”
Courtney Cantrell, Former Senior Director of the NC Division
of Mental Health, Developmental Disabilities, and Substance Abuse, spoke next
on a vision of integration for North Carolina. She points out that a lot of
work is happening on the ground, but providers are not getting paid the way
they should be. She says the biggest barriers to progress are policy-related. “To
move forward” she says, “we must get more data”. “You have to know your
population and you need to measure care outcomes”. Ben interjected at this
point saying “If you change the way you deliver care, you’ll need to change the
way you measure it.”
The group broke for a working lunch at this point and
listened to Alexander
Blount from the University of Massachusetts and Lesley Manson from Arizona State
University. Dr. Blount started by saying “I’m the humble guy coming from
out of state with a few ideas that may work for you”. He recounted the history
of integrated care in Massachusetts which included large Medicaid reform which
made integrated care viable overnight. “My phone was ringing off the hook” he
recalls.
Despite the successes, there were several problems. First, the
integration did not work unless care systems had a large Medicaid population
and received more training than just webinars and assembled meetings. “You need
boots on the ground”. He argues that administrators who want long-term
integration need to invest in workforce development. Systems need a core of
highly-trained integration champions instead of an army of semi-trained staff
members.
Lesley Manson from Arizona State University continued the working lunch by reviewing in detail
the new federal MACRA legislation which moves reimbursement from volume-based
to value-based, a significant shift in payments. Currently, many systems are
already reforming through various programs like PQRS, VBM, and MU. The
legislation gave birth to MIPS (merit based incentive payment system) which
systems can elect to participate in or, alternatively, follow the APM (Alternative
Payment Model) track. Overall, MACRA is a quality payment program and represents
a long-term investment of the federal government in incentivizing care systems
to reform their care models. Lesley concludes that integrated care is an
essential component of this reform.
The final segment of the meeting was a group breakout session
on three topics: 1) Envisioning Your Organizational Needs, 2) Workforce and
Educational Needs, and 3) Policy and Payment Reform. Each group was tasked with
discussing the topic and then identifying key action strategies. The first
group concluded that organizational vision takes time and requires keeping a
local focus and sharing stories of successful integration.
The second group determined
that a large portion of the current workforce needs retraining and that one
model for doing so is the ECHO telementoring model out of New Mexico. The group
believes that state agencies should invest in statewide interprofessional
training events and even design core competencies. The final group recognized
that stakeholders need to align their efforts with payers (both private and
public) and activate codes that support team-based, integrated care. Adam Zolotor,
President of the North Carolina Institute of Medicine, facilitated the group
discussion.
The state of integrated care in the Tar Heel state is
vibrant and promising. The synergy of the group was palpable and produced a
list of actionable items. The final word was by Cathy Hudgins, executive
director for the Center of Excellence for Integrated Care, who invited all the group
members to continue the conversation by attending the 2016 CFHA Conference
where other like-minded people will be discussing how they can improve health
care through collaborative, family-centered care.
