Alaska Healthcare Transformation Project announces new reform report

The Alaska Healthcare Transformation Project, in partnership with NORC at the University of Chicago, recently announced a draft of a new report outlining potential health care reforms and initiatives for the state of Alaska.

The Alaska Healthcare Transformation Project is a collaboration of stakeholders across the health care spectrum working to reform Alaska’s health care system. The primary goals of the project are to increase the percentage of Alaskans with a usual source of primary care, to reduce the overall, per capita health care cost growth rate, and to align all payers toward value-based alternative payment models.

 

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The transformation project also identifies five priority building blocks for health care reform:

  1. Increase primary care utilization and fully integrate behavioral health services
  2. Coordinate patient care to shift to patient-centered, whole-person care and align payment incentives
  3. Implement payment reform and integrate value-based payments and benefit design
  4. Increase the data analytics capacity of the state
  5. Identify and coordinate resources around addressing social determinants of health

As part of its collaboration with the transformation project, NORC, a non-partisan research institution, is charged with developing four different research reports to advise the project on reform options.

The recently announced draft report is a national scan that evaluates innovations and programs in seven states (Arkansas, Colorado, Maryland, New Mexico, North Carolina, Oregon, and Washington) that have similar characteristics to Alaska.

While the report notes that no two states are alike, “The successes, experiences, challenges, and outcomes of other states’ initiatives provide lessons and approaches that Alaska can tailor to meet the needs of its population.”

The report evaluates the health care reform projects as they relate to the transformation project’s five priority building blocks. Top-level findings and lessons learned from the seven case-studies include:

 

1. Increase primary care utilization:

There is already a “foundation for primary care transformation” in Alaska, including efforts like the Alaska Primary Care Association’s Alaska Patient Centered Medical Home (PCMH) Initiative. However, the national scan states that Alaska could leverage the PCMH initiative to expand primary care transformation to all primary care practices in the state.

Options for Alaska to consider based off the case-study states include offering incentives to providers who deliver advanced primary care services to patients and utilizing the PCMH model to offer care management and preventative care.


2. Coordinate patient care:

The report identifies physical and behavioral health integration as a “promising approach” to improve care coordination. While Alaska is already working on methods to coordinate care and to provide a continuum of services for its Medicaid enrollees, the NORC report recommends considering ways “to expand or broaden them.”

Specific examples of integration initiatives in other states include Arkansas’s Behavioral Health Transformation Program for its Medicaid enrollees and Colorado’s Regional Accountable Entities (RAEs), both of which manage medical and behavioral health services for enrollees.  

The report also identifies the use of care coordinators as a potential method to help manage care for high-risk patients.

 

3. Implement payment reform:

The report offered several considerations related to implementing payment reform, including initiating multipayer reform to help reduce the growth of health care costs.

“Alaska’s health care system is fragmented into multiple systems and a decentralized structure, with a complex landscape of payers…. One of the key goals of the Alaska Healthcare Transformation Project is alignment of all payers—both public and private—toward VBP innovation,” the report states.

Other findings include pairing global budgets with care transformation, integrating payment reform into a non-managed care environment, incorporating flexibility into VBP approaches, establishing alternative individual coverage options, and focusing reform on state employee health care.

 

4. Increase data analytics capacity:

Alaska lags behind other states when it comes to data collection, sharing, and analytics. The report identifies investments in data capacity and analytics infrastructure as being critical to the state’s transformation efforts.

“Alaska’s HIE system, healtheConnect, offers services to facilitate the exchange of health information across providers. However, the state and system lack the data or analytic capacity to help guide policy around data analytics and data infrastructure. The state, payers, providers need to access and analyze different types of data to target resources, share data, when needed, and be able to track cost and quality,” the national scan reads.

 

5. Address social determinants of health:

Alaska faces several unique challenges when it comes to addressing social determinants of health. The state’s rural and frontier landscape make it difficult for all residents to have access to affordable health care. The state also faces high rates of chronic homelessness and poverty,  along with significant transportation and communication challenges.

The national scan points to several examples of innovation related to the social determinants of health. For example, New Mexico’s MCOs can offer value-added services such as transportation and infant care. In North Carolina, the Healthy Opportunities Pilot will test interventions targeting food security, housing stability, and transportation access.

The report recommends that Alaska consider measured approaches to SDOH through its Medicaid program and through community-based organizations.

“Nationally, SDOH conversations are happening not just at the state level but also among health providers, community based organizations, insurers through AHCs and other means. AK can leverage these discussions and form partnerships and collaborations,” reads the report.

 

Other considerations:

Other considerations and opportunities recommended in the report include using an incremental approach to transformation, focusing on coordination with tribal health organizations to ensure adequate coverage for American Indian/Alaska Native populations, utilizing regionalized structures and plans, and maximizing the availability of federal dollars.

The next report expected from the NORC team is a review of health care spending in the state and a roadmap of proposed short- and long-term steps for reform.

 

For more information, or to be placed on the distribution list for updates from the Alaska Healthcare Transformation Project, contact Sandra Heffern directly at sandra.heffern@effectivehealthdesign.com.