Testing States

Connecticut

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State's SIM website
  • Enhanced Behavioral Risk Factor Surveillance Survey (BRFSS) sampling will provide baseline and ongoing capability to conduct small area analyses for tobacco, obesity and diabetes and other identified health priorities. Other data sources include mortality data, hospital and ED discharge data and existing community health needs assessments. (p. 2)
  • Each of the five counties awarded Community Transformation Grant funding created a comprehensive Needs Assessment (p. 6)
  • A health and wellness district jointly sponsored by Charter Oak Communities, City of Stamford and Stamford Hospital is aimed at revitalizing the economic health and well-being of Stamford’s West Side residents. Informed by a local Community Health Needs Assessment (CHNA) and a collaborative strategic planning process, the initiative is well underway and has achieved a number of accomplishments (p. 8)
  • The plan for improving population health will utilize and build upon the DPH’s recent State Health Assessment, State Health Improvement Plan (Healthy Connecticut 2020) and the state Chronic Disease Prevention Plan. This revised plan will be completed during Years 1 and 2 of the Test Grant. (p. 48)
  • DPH will also seek capable vendors that have prior experience developing the state’s Healthy Connecticut 2020 State Health Improvement Plan. In this way the contractor will have knowledge of Connecticut’s structure and environment, experience working with sectors and partners involved in initial planning, and demonstrated skills in community engagement, facilitation of diverse groups discussing complex issues, and statewide health improvement planning. (p. 73)

Delaware

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State's SIM website

  • Delaware will conduct a needs assessment, finalize details for Healthy Neighborhoods’ structure and process, build DPH resources to support communities and local data collection, and select pilots. (p. 6)
  • A review of health needs identified by hospital community health assessments, the Division of Public Health’s (DPH) State Health Improvement Plan, and comparisons against national averages and goals set by the CDC shows that Delaware’s most pressing health needs include: rising obesity, in particular for children (14.2% vs. 13.7% nationally); tobacco use; diabetes (9.6% prevalence; 7.6% pre-diabetes); cardiovascular disease; behavioral health (9th highest death rate from overdoses in U.S.); and dental care. (p. 1)
  • Healthy Neighborhoods: Neighborhoods will agree on an initial plan for health improvement, including overall goals, 1-2 priority interventions, and existing assets. (p. 3)
  • Delaware has a series of federal programs, including funding for the DHIN and CDC funding for public health initiatives (e.g., assessment and planning for DPH’s State Health Improvement Plan). (p. 39)

Idaho

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State's SIM website

  • Communities will participate in community needs assessments and will work with the Regional Collaboratives (RCs) to align specific performance metrics for the PCMHs in their region with identified areas of need. (p. 21)
  • Model Transformation and Patient Experience of Care Measures includes Regional Health Needs Assessments: % of PCMHs who receive results of community health needs assessments to guide development of quality initiatives within their practice. (p. 28)
  • Division management has been meeting since June of 2014 to design the Idaho Health Assessment (IHA) which will inform the Idaho Health Improvement Plan (IHIP), Idaho’s plan for improving population health. The IHIP will integrate population health with the healthcare delivery system. Between November 2013 and April 2014, the Division of Public Health developed a set of Leading Health Indicators for Idaho. The indicators provide a framework for describing the health of all Idahoans and provide direction for the IHIP. The workgroup has an aggressive timeline, targeting completion of the assessment in December 2014, and completion of the IHIP in May 2015. (p. 2)
  • The foundation of the IHIP will be a thorough statewide health assessment with the following timeline (see p. 2-3).

Iowa

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State's SIM website

  • During the SIM Initiative, IDPH will draw together an expert panel to expand upon the state-wide Heath Improvement Plan to improve population health, and use that to guide SIM activities. Specific initiatives have already been identified (Table 1), along with major efforts to train ACOs in the tools, processes, re-sources, and culture of public health. IDPH, with assistance from the Iowa Health Collaborative (IHC) will implement these initiatives and monitor their outcomes. (p. 3)
  • One important responsibility of Iowa’s local public health agencies (LPHAs) is coordinating the development of community health needs assessments and health improvement plans for their local jurisdictions. While IDPH requires these be developed every five years, adjustments to this schedule are being made to enable LPHAs to coordinate more effectively with local hospital partners, allowing achievement of their IRS requirements to conduct these same local planning efforts on a three-year basis. (p. 17-18)
  • The model test proposed in Iowa uses these newly formed Community Care Teams to address social determinants of health by sharing community needs assessment data, and sharing data gathered from the HRA Assess My Health. (p. 49)

Michigan

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State's SIM website

  • The Blueprint proposes that Community Health Innovation Regions organize partners based on the collective impact model. They will leverage community benefit and public health accreditation requirements to conduct collaborative community health needs assessments that will identify key health concerns, illuminate root causes of poor health outcomes, and set strategic priorities. (p. 4)
  • Some communities in Michigan have already developed sustainable funding mechanisms to support the backbone organization for a Community Health Innovation Region, such as support from local business and payers, hospital community benefit funding, public funding, and philanthropy, including the United Way. (p. 9)
  • A Population Health Advisory Board will be created to formalize this partnership, and provide guidance to the development and implementation of the Population Health Improvement Plan. (p. 5)
  • Population health improvement is a key objective of Michigan’s Model Test Proposal. Key health targets will be monitored and reported annually on public dashboards. The overarching strategy to address population health is to establish Community Health Innovation Regions, which will be accountable to improve population health Strategies will draw on existing plans, updated based on collaboration with the Centers for Disease Control and Prevention and local experience. The resulting strategies will be included in a Population Health Improvement Plan, and disseminated extensively. (p. 5)

New York

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State's SIM website

  • Sustainability will be assured through ongoing support of key population health interventions by DSRIP, delivery system transformation, payer support of proven effective services (tobacco cessation) and potential hospital investments in community benefits as required by the Affordable Care Act. (p. 3)

Ohio

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State's SIM website

  • The state is working to align community health needs assessment and population health planning. Currently, Ohio’s 124 local public health districts and multiple hospital systems are performing Community Health Assessments and Community Health Needs Assessments with varying levels of coordination. During the SIM test, the state will pursue better coordination of these plans, with the goals of identifying clear population health priorities across regions, facilitating stronger relationships among public health districts and health care delivery systems (e.g., PCMH), and explicitly tying hospital community benefit requirements to addressing regional population health priorities. (p. 7)

Rhode Island

State's SIM website
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  • In addition to regulatory authority, DOH also leverages existing policies and practices to drive healthcare facilities and professionals towards a Value-Based Care Paradigm. An example is adding conditions to the licenses of health care facilities to improve public health outcomes. This authority has most recently been used in the Certificate of Need process with several hospital acquisitions and the introduction of Minute Clinics. Conditions include setting clear expectations for the community assessment plans that IRS requires from non-profit hospitals through their 990H and conducting a joint public hearing process for health facilities. This is currently underway for hospitals. (p. 12)

Tennessee

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State's SIM website

  • The DOH will share population health and county level Community Health Assessments data with the universities to inform their approaches to draft regional goals and objectives and gather public input on population health priority topics (obesity, diabetes, tobacco, child health, and perinatal health). (p. 13)
  • Aligning Certificate of Need (CON) Criteria with Payment Reform: Tennessee is required by law to have a state health plan updated annually and approved by the Governor which covers the topics of population health, access to health care, economic efficiency, health care quality, and health care workforce. 7 Pursuant to the State Health Plan, Tennessee regulates the establishment and modification of health care institutions, facilities and services through CON. Certificate of Need applications are reviewed by an independent appointed board based on whether the proposed project is consistent with the State Health Plan, as required by the Tennessee Health Services and Planning Act. Therefore, changes to the State Health Plan as a result of the SIM design grant will align CON criteria with payment and delivery system reform. (p. 15)

Washington

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State's SIM website

  • Washington will invest in a Practice Transformation Support Hub to capitalize on consultant and community expertise in clinical practice transformation. During the Hub Startup phase the Hub will practice needs assessment. (p. 47)
  • Certificate of need. Requirements have been suspended for fiscal year 2015 for hospitals that change the use of their licensed beds to provide psychiatric services to alleviate significant access issues. (p. 25)


Design States


Arizona
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State's SIM website

  • Arizona is using multiple regulatory authorities to facilitate delivery system reform. Overall, Arizona has few regulatory restrictions impeding reform efforts. It has a very competitive commercial insurance market as well as limited certificate of need (CON) requirements, extending CONs only to ambulance services to ensure service delivery in rural areas. (p. 13)
  • Arizona is now using the results of the Assessment to develop the State Health Improvement Plan (SHIP), a state-wide plan to improve population health, which provides a 5-year strategy for partners to work together toward a healthier Arizona. ADHS is assembling a Steering Committee and workgroups, including representatives from the legislature, the Arizona Health Care Cost Containment System (AHCCCS), business community, academia, healthcare, small business, public health, human services, non-profit and faith-based organizations to formulate the draft plan by December 31, 2014.2 The State Health Assessment (see footnote 1) documents the numerous opportunities for CDC collaboration on these efforts. (p. 2)

Kentucky
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State's SIM website

  • Kentucky will leverage the Certificate of Need program (located in the Office of Health Policy (OHP) to support systemic innovation. (p. 8)
  • Kentucky’s Model Design Population Health Improvement Plan (PHIP) will build upon the Commonwealth’s Affordable Care Act (ACA) implementation, Governor Beshear’s kyhealthnow initiative, and state population health plans in development. The PHIP will form the foundation of any and all progress the Commonwealth makes with health care reform. (p. 2)

Illinois
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State's SIM website
  • The Innovation and Transformation Resource Center (ITRC) will work with IDPH to support community capacity development to conduct needs assessments, certifications, and monitoring and support of community-based services. (p. 5)
  • In their applications, integrated delivery systems will be evaluated on both their current state of progress toward, and their ability to achieve during the Model Test period: an Integrated care model based on community needs assessment and broad service array. (p. 8)
  • Illinois’ Certificate of Need (CON) process is designed to ensure access to necessary health services. The Health Facilities and Services Review Board is in the process of determining whether alternative care models, which will streamline the CON process in order to ensure timely approvals, denials and appeals can be established, via administrative rule, and/or by legislation. The newly developed rules will address the need for services, facility size, staffing, payer mix, travel time, patient transfer, emergency care, and contractual relationships. (p. 13)
  • The Illinois Department of Public Health (IDPH) appoints a planning team every five years to lead a state health assessment and publish a SHIP. (see p. 2-3 for SHIP process).
  • Each of the 89 local health departments engages in a local IPLAN process, a community health assessment conducted every five years. (p. 3)

Nevada
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State's SIM website

  • DHCFP is committed to designing a state health plan that includes multi-payer payment innovation and measure alignment. (p. 11)

New Hampshire:
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State's SIM website

  • Regional Healthcare Cooperative Extensions (RHCE) population health improvements will be data-driven and initially target tobacco use, obesity, and diabetes, as prescribed, as well as be guided by the New Hampshire State Health Improvement Plan (SHIP), produced by the Division of Public Health Services (DPHS). (p. 7)

New Mexico
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State's SIM website

  • New Mexico’s Current Health Council System: The system is comprised of 33 county-based health councils and five tribal health councils. Many of these health councils were originally established under provisions of the 1992 Maternal and Child Health Plan Act. The New Mexico Department of Health provides training, coordination, technical assistance, and other kinds of support to the health councils. The existing health councils have varying degrees of resources and infrastructure. New Mexico’s community health councils have achieved a number of positive changes in their communities that in turn result in improved community health. (p. 11)

Oklahoma
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State's SIM website

  • The OSIM activities will be aligned with the state’s Healthy People 2020 health improvement plan (OHIP). (p. 16)
  • Health Alert Networks (HANs) operating in Oklahoma expand on the PCMH model by creating community-based, integrated networks intended to increase access to healthcare services, enhance quality and coordination of care, and reduce healthcare costs. (p. 10)

Pennsylvania
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State's SIM website

  • Pharmacists may be placed on Care Management Teams (CMTs) and in high-volume community health centers (p. 10).

West Virginia
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State's SIM website

  • The preliminary goals, objectives, and supported interventions (see pages 6-7) are based on results from population health and health care system needs assessments conducted in 2012 and planning efforts of the Collaborative and other stakeholder groups. (p. 5)
  • The WV Health Care Authority, also a participant in the Collaborative, regulates acute care hospital rates as well as the need for capital expenditures of covered services for health facilities through the rate review and certificate of need (CON) programs. (p. 10)

Wisconsin
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State's SIM website

  • Behavioral health has been examined in Wisconsin through efforts that include nonprofit hospitals’ community health needs assessments (p. 5)
  • The PHIP developed during the SIM design period will support greater alignment in local efforts to improve population health, as well as inform the efforts of the DHS and SVC LC to align clinical and community health improvement strategies to realize the bold vision of the state public health agenda, Healthiest Wisconsin 2020: “Everyone living better, longer.” This vision reflects the state health plan’s twin goals: 1) improve health across the lifespan, and 2) eliminate health disparities and achieve health equity. (p. 2)