Meeting Minutes Practice Transformation 07/27/2014 | 1:00-3:00 | HCPF 225 E. 17th Ave.11A Type of meeting
Practice Transformation
Facilitator
Perry Dickinson, Mindy Klowden
Note taker
Matthew Welchert
Timekeeper
n/a
Members in Attendance: Greg Reicks, Mindy Klowden, Perry Dickinson, Anita Rich, Polly Anderson, Pam Jones, Lynnette Hampton, Claudia Zundel, Lori Stephenson, Kimberly Walter, Karen FrederickGallegos, Margaret Huffman, Jo Ann Doherty, Nicole Deaner, David Brody, Members Absent:
Discussion Items: Item 1: Proposed mix of practice types for first cohort: Previous Discussions and Ongoing Deliberation: o The Categories and mix of practice types has been discussed in prior iterations of the practice transformation workgroup, by the university’s design team and by subgroups on pediatrics and behavioral health. The proposed recommendations from these earlier efforts has culminated in the document Draft Qualifications and Preferences for Cohort 1 SIM Practices 7/21/15 which is available on the workgroup’s basecamp or by request of the SIM Office. The proposed mix of practice types has been an ongoing discussion and as such the efforts of this group will serve as a part of the ongoing evolution of this topic. Conclusions drawn from this discussion will be the recommendations of this practice transformation workgroup as to what the cohort will look like. Such conclusions shall be introduced into the Draft document: These recommendations are broad and thematic, not specific or seeking to set specific selections or quotas for the cohort. These recommendations will be presented to other workgroups like Payers as well as to the SIM Office to be considered when cohort selection begins. What kind of practice groups do we need or want to see in the first cohort? o Current debate exists around the requirements and minimum qualifications for the first cohort:
The Project described was supported by Funding Opportunity Number CMS -1G1-14-001 from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Meeting Minutes There remains debate within the Steering Committee about whether to focus on advanced practices which may more readily take on and succeed at accomplishing the many challenges of the first cohort or, Whether to select for a mix of capability and integration level to better illustrate progress and provide lessons learned for future cohorts and practices. Overall: The group saw the pros and cons of both possibilities and marked this as an area which other workgroups, particularly evaluation, might be able to assist. Practice Categories: (p.3 of the Draft Qualifications and Preferences Document) o The practice categories listed in the document are not mutually exclusive. Many different practices could fit within a number of the currently proposed categories: such as being a school-based practice within a rural area. Both categories exist for the practice to fit within. o What kind of mix of practices ought to be included in the categories: Provide for the entire mix of possible practices? If the general list of specialty types, listed in the document, were to include pediatrics that would be an acceptable level of inclusion. The group needs to ensure there is enough inclusion to allow for an integrated HMO. The question becomes more a matter of who would we be excluding. o The group needs to determine what it thinks is needed at a minimum for the cohort to be successful, rather than think of what could be included or excluded generally. Practice type, patient reach, provider numbers, payer mix, location along the integration continuum, ages served, and geographic and demographic markers are all factors for consideration when determining practice categories for the first cohort. Practice Size and Patient Scope are two areas which would separate similar types of practices and produce more specific milestones and expectations. o There is a balance which must be struck between practices with enough size and patient reach to provide an effect, and with smaller practices, particularly ones in underserved communities, that do not provide a large patient size but are nonetheless critical to include. In particular practice size combined with geographic and demographic markers are integral as they are good predictors of a practice’s integration potential and effect.
The Project described was supported by Funding Opportunity Number CMS -1G1-14-001 from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Meeting Minutes Item 2: Practice Milestones: Kyle Knierim, Assistant Professor at the University of Colorado Department of Family Medicine, presented to the group the set of practice milestones the University proposes to present to practices involved in the first cohort as per a deliverable to the SIM Office. o The building blocks were originally constructed around the milestones used in CPC with additional content but was changed when TCPi introduced phases as a milestone component. Phases allowed for practices at differing levels of capability or integration to utilize the same set of milestones but yet have those milestones be more tailored to their practice. o The current milestones represent a long process and incorporate these considerations but currently have been altered to account for the Building Blocks concept which is gaining traction with payers and practices as a useful tool. The Building Blocks clearly illustrate the order and priority of certain milestones for practices and as a result provides a more useful roadmap and a better structure than CPC. The Building Blocks work with the phases to produce more flexibility than other types of milestones and thus provides more utility to practices. Questions: o Do these building blocks make sense and do the activities seem to align with what practices need to be completing to work with SIM? Should Behavioral health building blocks be separated? SIM requires the integration of primary and behavioral health and so this is reflected in the building blocks. A practice and a transformation coach can determine where they fall on the milestones and what they need to accomplish. Do we need to show practices or tell them where they are at? For example, not everyone empanels their patients to the degree that is necessary to meet other milestones. o Empanelment is a necessity, and so yes a major milestone will be demonstrating that empanelment is happening to the proper degree. But more specifically, the milestones may be changed to better reflect progress made in this area an others. Rather than empanelment, for instance, being a yes/no benchmark, it could introduce phases as well with the first phase being a move towards empanelment and the second being a 90% patient empanelment. o Practices need to be able to illustrate where they are in the milestones and what are their limitations and capabilities.
The Project described was supported by Funding Opportunity Number CMS -1G1-14-001 from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Meeting Minutes But such demonstration must not be intensive, it needs to be easy enough to complete. There are no milestones presented which a practice could not readily prove. Can we assume that if a practice is certified as a certain type of practice that it already meets certain milestones? Not likely, as we would need more than a certification as it only illustrates so much and could be misleading. How might these milestones link up with the efforts that payers are already doing? Do the milestones illustrate what it would take to do integrated care and what support would practices need to have? Is that reflected well enough in these milestones?
Item 3: Update from the SIM Office: Payers are also working on the Building Blocks piece and their recommendations for the cohort; no new specifics yet to report. The practice transformation workgroup should consider including a Tribal Nation Clinic in the first cohort. The SIM Office is preparing the Advisory Board for the final discussion of the Health Extension portion. There was a question regarding the highest priorities and priority order for the SIM Office in terms of long and short view goals. o The answer was tabled for further discussion at a later date.
Conclusions:
The workgroup concluded that practice types for the cohort: o Will be inclusive enough to allow for the practice types needed to create a successful and instructive cohort. o And will provide a general mix of practices to yield the best possible lessons learned. o The workgroup concluded that Chair, Perry Dickinson, would craft language which would include these goals and the overall points discussed by the group and present the recommendations as a deliverable to the SIM Office. Discussion surrounding the details of selection can be refined later and so this topic was tabled for a later date. The workgroup concluded practice milestones: o A sufficient consensus around the concept of the building blocks milestones.
The Project described was supported by Funding Opportunity Number CMS -1G1-14-001 from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Meeting Minutes
o Understanding that the milestones are a part of living and evolving document which may change in the future to better represent any of the concerns presented in the discussion. o The workgroup asked for a building block on educating the practice to ensure they understand the models and the basic concepts of behavioral health, its problems, and the aspects of integration. o Empanelment ought to be its own building block. o There is a need for more specifics in the building blocks around team base care, care conferencing, between visit outreach, and redesigning delivery. It is muted in this version and should be cross-walked with CPC and TCPi to gain further specifics. o Should be linked to the payers workgroup to gain more specifics from that perspective: Take the characteristics and make linkages with the milestones to the “what’s in it for me” value assessment. Subgroup on Practice Communication: o The workgroup agreed that a subgroup ought to be formed and that this suggestions should be brought to the Steering Committee for consideration and possible involvement of other workgroups. o The subgroup should discuss value propositions. o Practice Transformation members will begin work on communication offline and on the Basecamp site. Further discussion will be tabled for a future date.
Action Items: Topic
Responsible Party
Provide revisions and notes made from the meeting discussion concerning the makeup of the practice cohort to the workgroup for further comment and final revision. Workgroup members will provide feedback by Friday, July 31.
Perry, Workgroup
Send revisions, comments, suggestions for the practice milestones to Workgroup, Kyle Kyle Knierim. Milestones will be revised according to these comments Knierim. and based on the group’s discussion. Consider possible work and functions of the practice communication subgroup and be prepared to provide it recommendations. Begin work on the Basecamp thread. Present subgroup on practice communication to the Steering Committee
Deadline 7/31/2015
07/31/2015
Workgroup Member
08/06/2015
Perry, Mindy
08/06/2015
The Project described was supported by Funding Opportunity Number CMS -1G1-14-001 from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Meeting Minutes Topic
Responsible Party
Present to the workgroup the SIM Office’s priorities and goals for the Lynnette Hampfirst cohort and overall for the practice transformation process. ton
The Project described was supported by Funding Opportunity Number CMS -1G1-14-001 from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services.
Deadline 08/13/2015
