Maine DHHS Maine DHHS Introduction to CMS Center for

Maine DHHS Maine DHHS Introduction to CMS Center for Innovation Community Health Access & Rural Transformation (CHART) Model Lisa M. Letourneau MD, MPH Senior Advisor, Maine DHHS – Sept 2020 Augus

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Maine DHHS - 8 Major Initiatives Improve Health Care & Coverage Affordability Support Rural Health Transformation Lead Maine’s Opioid Response Conduct Behavioral Health “Map and Match” Initiative Adapt to Maine’s Aging Population Promote Early Childhood Development Support At-Risk Youth Promote Opportunity through Education 3

DHHS Rural Health Transformation Framework: Key Elements Ensure community engagement Promote statewide efforts to strengthen infrastructure Develop regional models of care – perinatal/maternity care Support new payment models that support improved models for rural health care Maine Department of Health and Human Services 4

Rural Health Transformation Strategies Engage Communities Conducted listening sessions in rural communities: Caribou, Calais/Machias/Eastport, Farmington, Lincoln, Bethel, Skowhegan “Listening to Maine’s Communities” Report Convened multi-stakeholder Rural Health Transformation Team Openly communicated work: ME DHHS Rural Health website Listening to Maine’s Rural Communities Maine Department of Health and Human Services 5

Rural Health Transformation Prepare for CMS Rural Payment Model Identified rural care model key components Anticipated CMMI demonstration/pilot to test innovative payment arrangements for rural areas Studied other state payment models (PA, VT, MD, OR) Identifying laws, regulations that may need changes/waivers Identifying rural areas that could participate in payment pilots, engage local leaders and stakeholders Maine Department of Health and Human Services 6

https://innovation.cms.gov/webinars-and-forums/chart-overview Maine Department of Health and Human Services 7

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CMS CHART Model Community Transformation Track: Key Questions for Rural Communities & Hospitals Vision for transforming care in community Readiness to commit to community-based, collaborative, cross-sector approach Ability to meet CMS requirement of at least 10,000 Medicare FFS beneficiaries in region Willingness to accept capitated payment (with details TBD) for Medicare, Medicaid Interest in developing innovative approaches that leverage opportunity for CMS flexibility, waivers Maine Department of Health and Human Services 23

Medicare FFS Beneficiaries by County July 2020 Enrollment Cumberland York Penobscot Kennebec Aroostook Androscoggin Hancock Somerset Oxford Washington Knox Waldo Lincoln Sagadahoc Franklin Piscataquis Total Rural Counties FFS Medicare Mbrs* 33,210 30,682 22,541 16,508 13,896 12,039 10,219 8,858 8,803 7,380 6,933 6,423 6,070 5,286 3,874 3,530 196,252 Maine Department of Health and Human Services *CMS Data 24

MaineCare Members by County County Cumberland Penobscot York Androscoggin Kennebec Aroostook Oxford Somerset Hancock Washington Waldo Knox Franklin Lincoln Sagadahoc Piscataquis Grand Total Rural Counties MaineCare Member Counts - July 2020 Full Benefit Limited Benefit Total Members 44,175 12,118 56,293 35,923 9,173 45,096 32,630 9,199 41,829 29,731 6,659 36,390 28,560 6,626 35,186 19,106 6,034 25,140 15,402 4,014 19,416 14,606 3,987 18,593 10,227 2,818 13,045 10,234 2,463 12,697 9,626 2,446 12,072 7,962 2,138 10,100 6,906 1,967 8,873 6,454 1,713 8,167 5,686 1,385 7,071 4,508 1,448 5,956 281,736 74,188 355,924 Maine Department of Health and Human Services 25

MaineCare Members by Zip Maine Department of Health and Human Services 26

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CMS CHART Model: ME DHHS Goals Align with CMS goals: – – – – Improve access to care in rural areas Improve quality of care & health outcomes Increase adoption of alternative payment models Improve financial sustainability of rural providers Reflect needs of rural communities, per DHHS Rural Health Listening Sessions: – – – – Provide adequate primary care, specialty care, prevention svcs Ensure access to after-hours emergency care, EMS svcs Coordinate care across settings Provide care in home and/or as close to home as possible Maine Department of Health and Human Services 32

CMS CHART Model: ME DHHS Framework Adhere to ME DHHS guiding principles – e.g. – – – – Identify clear vision for transforming health & health care in community Commit to implementing multi-payer new VBP payment model Be community-focused, reflecting community needs & assets Utilize evidence-based approaches Incorporate key elements for improving rural health care – – – – Primary care-based Expanded use of telehealth Use new workforce models Identify regional models of care Include focus on key clinical areas: – High-prevalence chronic diseases: COPD, HF, CVD, diabetes, dementia – Behavioral health (mental health, SUD) – Incorporate serious illness care, palliative care approaches Maine Department of Health and Human Services 33

CMS CHART Model: ME DHHS Process Share information widely Ensure transparent, inclusive process Encourage participation in both tracks: – Support successful Maine application for Community Transformation Track – Encourage ACOs to participate in ACO track Support inclusive process for selecting Maine rural community/hospital(s) for participation in Community Transformation Track Maine Department of Health and Human Services 34

CMS CHART Model: ME DHHS Timeline Community Transformation Track participation: Sept: share information re: opportunity for participation, model expectations Early Oct: request indication of interest from interested rural communities/hospitals Mid Oct: host community discussions with interested communities/hospitals End Oct/Early Nov: Select community/hospital(s), identify Lead Organization for Maine application Nov – Jan: Develop proposal Feb 5: CMS proposal deadline Maine Department of Health and Human Services 35

Rural Health Transformation Questions? Discussion! Maine Department of Health and Human Services 36

Questions? Lisa Letourneau MD, MPH Senior Advisor, Healthcare Delivery System Change [email protected] C: 207-415-4043 Nicole Breton Director, ME CDC Office of Rural Health, Primary Care & Oral Health [email protected] W: 207-287-5503 Maine Department of Health and Human Services 37