Scaling Integration Through Health Policy:
North Carolina Policy Summit
Posted By Matthew P. Martin, Thursday, October 13, 2016
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.