Message from the CEO and Board Chair

Reflecting on Altarum’s endeavors and successes this past year, we are struck by our people’s drive to solve the biggest health challenges facing our country. From identifying ways to get accessible health care information to vulnerable populations to helping physicians successfully transition to payment models that reward quality and efficiency, Altarum is not only making a difference in the communities we work with, but also promoting higher value health care for all.

In 2016, Altarum strengthened its capabilities by combining with the Health Care Incentives Improvement Institute (HCI3). As Altarum’s new Center for Payment Innovation, the HCI3 team helps position Altarum at the forefront of our country’s move toward higher value care through evidence-based incentive programs and a fair and powerful model for payment reform.

But our work goes beyond sustainable health care spending and value. Altarum is working to counter the effects of social determinants of health by helping communities build strong coalitions of support services.

We are using technology to reduce the burden of dental disease for children in Michigan. And we are supporting life-improving clinical trials. No matter what problem we are looking to solve, we are driven by a mission that transcends our desire to research, our desire to innovate, and our desire to implement. We want to bring real, long-lasting solutions to the communities we serve.

We are inspired by all of our colleagues across Altarum and its subsidiaries, Palladian Partners and KAI Research, Inc. You are transforming the landscape of health and health care. We also are extremely grateful to our clients, funders, and partners. Without your support we would not be able to achieve our vision. Together, we will continue to create a better, more sustainable future, for all Americans.

Linc Smith
President and Chief Executive Officer

Rosemary Gibson
Board Chair

Identifying Ways to Get Health Care Information to Vulnerable Consumers

The Right Place, Right Time project investigated strategies vulnerable consumers—including those who are lower-income, Medicaid beneficiaries, the uninsured, caregivers, and Spanish speakers—use when searching for health care information and how they make decisions regarding when and where to seek treatment. The goal of this project was to identify ways to get accessible health care information to consumers where they need it when they need it.

Altarum conducted interviews and focus groups with 65 consumers and a nationally representative mail and web survey of 4,068 consumers. This is what the team learned:

• Consumers are most dissatisfied with the lack of information about health care costs.
• Caregivers have a sophisticated approach to using online health resources—but are highly stressed and have trouble finding the support they need for themselves.

• For Spanish speakers, friends and family are as important a resource for health information as any medical website.
• Low income consumers in poor health are far more likely to feel disrespected by providers—and when that happens, they are twice as likely not to take their medications.
• Many consumers are unaware comparisons are available for procedure cost and quality, and do not search for this information, but indicate they would find these comparisons highly useful.

These findings present opportunities to better serve the needs of consumers, particularly those who are vulnerable.

For more information, visit http://altarum.org/RightPlaceRightTime

Enabling Clinicians to Develop and Implement Quality Improvement Strategies

As part of the Great Lakes Practice Transformation Network (GLPTN), Altarum staff are leading efforts in Michigan and Ohio to support providers in developing and implementing comprehensive quality improvement strategies. This support will strengthen the quality of patient care, foster patient engagement, and promote wiser spending of health care dollars. Altarum’s dedicated quality improvement advisors are helping clinicians navigate quality reporting requirements, supporting quality improvement efforts, and helping practices participate in value-based payment initiatives.

In 2015, in preparation for the Centers for Medicare & Medicaid Services’ (CMS) Quality Payment Program (QPP), CMS awarded $46M to the GLPTN with the goal of saving $800M by providing technical assistance to approximately 15,000 eligible clinicians in Michigan, Ohio, Indiana, Illinois, Kentucky, and portions of Virginia, and West Virginia. As one of the largest PTNs in the country, GLPTN has emerged as an early success story frequently highlighted at CMS-sponsored webinars and conferences.

Altarum’s work under the GLPTN program and as a former Office of the National Coordinator for Health Information Technology-funded Regional Extension Center positioned us to be the lead applicant on a 2016 proposal to support small and rural provider participation in CMS’s Quality Payment Program. Altarum led a team of 10 highly qualified technical assistance organizations across seven states, successfully securing funding for the Quality Payment Program Resource Center for the Midwest. The QPP Resource Center will begin delivering critical technical assistance services via a robust web portal, Altarum-developed forecasting software, and virtual consulting supports in mid-2017.

For more information, please visit http://www.qppresourcecenter.com or http://altarum.org/HITA.

Raising Awareness about Health Disparities through Communication and Outreach

The National Institute on Minority Health and Health Disparities (NIMHD) is working to raise awareness about the prevalence and impact of health disparities so that all populations can have an equal opportunity to live long, healthy, and productive lives. Palladian Partners is helping the Institute to achieve this vision by delivering communications planning, strategy, and content development across many channels, and health education and public outreach to underserved populations.

Through leveraging partnerships, Palladian has enabled NIMHD to successfully reach target audiences. For example, by teaming with Omega Psi Phi Fraternity, Inc. to promote the Brother, You’re on My Mind initiative, NIMHD has greater reach and influence to raise awareness of the mental health challenges associated with depression and stress that affect African American men and their families. Results of this partnership include a feature in Essence Magazine, 1,363 downloads of the Brother, You’re on My Mind educational toolkit from June–December 2016, and a Twitter chat yielding more than 25,000 impressions.

In addition to the unique approach to addressing African American men and mental health, Palladian is increasing awareness of minority health and health disparities by planning promotional activities for the Precision Medicine Initiative (PMI), Minority Health Month, and Fuel Up to Play 60, an initiative by the NFL and GENYOUth to increase physical activity among Latino youth.

For more information, please visit http://palladianpartners.com/our-work/case-studies/minority-health-disparities

Designing, Implementing, and Measuring a Maternity Care Bundled Payment Program in Texas

Altarum’s Center for Payment Innovation collaborated with Community Health Choice, a nonprofit Medicaid HMO in southeastern Texas, to design, implement, and measure a maternity-care bundled-payment pilot program. This program takes an innovative approach to paying for and evaluating Medicaid births: it unifies pregnancy, delivery, and newborn care into one episode with one budget, instead of treating them as separate experiences.

Budgeting all three segments of care together encourages coordination among providers, and rewards clinicians for delivering care in one segment, for example prenatal care, that yields savings and produces strong outcomes in another segment.

Raising quality and lowering costs for births are important goals for any state, as Medicaid pays for about half of all U.S. births. Harm to mother and child from unwarranted C-sections, premature births, and other causes of low birth weight have long-term consequences for these patients and society.

Important lessons learned from the case study include:

• Comprehensive maternity-episode budgets should include all phases of the care: pregnancy, delivery, and neonatal.
• A bundled-payment budget methodology can provide a clear financial incentive to reduce unwarranted C-sections.
• Even a few high-need, high-cost infants can greatly affect a provider’s actual costs and potential for shared savings in a bundled-payment model.
• A comprehensive maternity-care bundled-payment program relies on linkage between maternal and newborn IDs at all stages of care.

Altarum’s work in Texas has informed both a Health Care Payment Learning & Action Network whitepaper and the New York State Value-Based Payment Roadmap on maternity bundles. It shows that a collection of quality data, tied to a bundled payment methodology, addresses important structural issues related to maternity care, and leads to improved outcomes, and healthier babies.

For more information, please visit http://altarum.org/research-centers/center-for-payment-innovation

Improving the Quality of Clinical Research and Patient Safety

As the contractor to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Division of Extramural Research Activities, KAI supports the investigators in the operationalization and implementation of their research proposals. Specific activities include but are not limited to:

• Providing scientific infrastructure including implementation of Data and Safety Monitoring Boards (DSMBs);
• Developing data base applications which characterize clinical research portfolios in terms of population, study design, intervention, and potential risk;
• Creating training programs for investigators that encompass good clinical practice (GCP) and NIH-wide and Institute-specific clinical research guidelines;
• Methodological and statistical consultation;
• Creating Web sites and systems to support clinical studies; and
• Conducting study process and monitoring visits.

For the past 20 years, KAI has supported the NIAMS’s research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases through overall support of their extramural clinical research program.

KAI supports more than 50 ongoing clinical trials annually, plus additional clinical research studies extramurally funded by the NIAMS. In this role, KAI delivers daily services to the principal investigators who are conducting these studies, the data and safety monitoring boards who are overseeing the research, and the NIAMS staff who have a responsibility to manage their portfolio of studies.

KAI is leveraging our existing clinical studies web-based system to create a dashboard that may be utilized by the NIAMS program staff to oversee these studies. This feature will allow NIAMS program directors to assess the ‘health’ of their studies in real time and to make decisions regarding whether project milestones are being achieved and their impact on funding, timeline, and the outcomes of the research.

The scope of KAI’s work with NIAMS has broad impact. Our efforts to improve the quality of clinical research and patient safety ultimately allow life-altering technologies and interventions to reach the populations that need them, promoting better health for all those affected by arthritis, musculoskeletal, and skin diseases.

For more information, please visit http://www.kai-research.com

Reducing the Burden of Childhood Dental Disease

Altarum’s Health Innovation group is working to reduce the burden of dental disease among children through the Michigan Caries Prevention Program (MCPP). Through a comprehensive approach, the MCPP aims to change provider behaviors, produce enabling technology, and create community connections to promote the sharing of dental resources.

To date, the MCPP has trained over 1,500 medical providers and 2,500 clinical support staff in Michigan, impacting more than 500,000 Medicaid/Children’s Health Insurance Plan (CHIP) beneficiaries. In primary care clinics trained by the MCPP, only 5-10% of children were getting the care they needed. Today, as a result of MCPP, 70–90% of children are receiving care that is instrumental in preventing dental disease.

Our staff also developed a first-of-its-kind dental monitoring system, the Michigan Dental Registry℠ (MiDR℠), which uses innovative technology to document care and foster care coordination between medical and dental providers. With over 1,500 users, MiDR addresses a care coordination and communication gap between medical and dental provider communities.

The team also pioneered a unique social networking solution, SmileConnect℠, which has delivered oral health services and resources to more than 40,000 children across the U.S.—children who would otherwise not have access to care. SmileConnect℠ allows educators and community organizations to easily post requests for oral health resources and services, which are then viewable by those who can directly connect with them to meet the need.

As a result of the MCPP, thousands of Michigan children are now receiving appropriate preventive care. Altarum is in the process of expanding these program components to other states and ensuring the gains made in Michigan are sustained beyond the initial Centers for Medicare & Medicaid Services grant funded period.

For more information, please visit http://www.MITeeth.org or http://altarum.org/HITA

Building a Network of Substance Use Recovery Services

Through the Community and Faith-Based Organization Technical Assistance Project, Altarum’s Behavioral Health Technical Assistance Center team addresses stress, trauma, and other social determinants in an attempt to reduce disparities affecting the health of communities across the country. This community organizing and coalition building framework enables the Altarum team to work with 28 communities to identify disparities, outline community-driven solutions, and empower them through technical assistance and capacity-building resources.

Designed to help community and Tribal coalitions build capacity to support a network of substance use recovery services, the coalitions’ work includes:

• Providing sustained recovery support services
• Addressing the opioid and heroin epidemic
• Incorporating trauma-informed approaches to understanding substance use challenges; and
• Offering faith-based involvement to address drug and alcohol use, including prescription drug use

Altarum’s participatory approach to community and faith-based coalition engagement in technical assistance and capacity building has resulted in the identification of promising, community-driven approaches to addressing community health. The coalitions have partnered with clinical providers; local corporations; legislators; and government, education, military, and Veteran's agencies to improve behavioral health outcomes in their communities—and the reach has been significant. In the past year, the coalitions have trained more than 340 people through 17 Mental Health First Aid Events. Members of the Honolulu coalition came together to provide services to more than 1,100 individuals in need of recovery support services during a gap in funding. And, more than $1,000,000 in funding has been awarded to the coalitions from multiple state, local, and private sources.

These findings present opportunities to better serve the needs of consumers, particularly those who are vulnerable.

For more information, please visit http://altarum.org/behavioralhealth.

Message from The CFO

We strengthened our balance sheet in 2016, placing the organization in a stronger position to advance longer-term strategic goals.

Specifically, revenue reached $82 million, an increase of nearly 8% year over year. This outpaced our growth in expenses, and led to a more than 40% rise in excess revenues over expenses.

In total, our cash flow from operations increased 81% over 2015. This was due not only to increased revenue, but also to our reducing the average collection period from 72 days in 2015 to 58 days in 2016.

The increase in cash flow allowed us to accelerate payments on long-term debt, leading to a 5% reduction in debt to net assets.

This solid financial position enables Altarum to make additional investments in both internally-chartered research and client-supporting operations, giving us an edge in the market and positioning us for challenges and opportunities presented by a health care sector undergoing accelerated change.

Alicia M. Torres
Chief Financial Officer & Senior Vice President, New Ventures