Meeting Minutes Steering Committee 10/14/2015 | 1:00-3:00pm | 4300 South Cherry Creek Dr. Rm. A2A Type of meeting
Steering Committee
Facilitator
Teri Clough
Note taker
Matthew Welchart
Members in Attendance: Mark Gritz, Perry Dickinson, John Douglas, Paul Staley, Mindy Klowden, Brian Turner, David Keller, Steve Melek, Michael Talamantes, Jenifer Jessup, Camille Harding On Phone: Ben Miller, Mark Lassaux. Lynnette Hampton Ex Officio:, Tara Smith, Nicole King, Jean Lamont, Sydney Oelerich, Teri Clough, Matthew Welchart
Introductions & Housekeeping:
Evaluation Update presented via phone by Ellen Kaufmann
Quick update on needed feedback from workgroups on evaluation research questions o Are we on the right track? o Are we going to be evaluating what you are actually working on? o Have we correctly identified ways to capture this? Each workgroup member should have been sent an email containing a quick survey to rate top questions most applicable to their workgroups. With this email, they should have also been sent a link to a master document containing all research questions o Please ask workgroup members to look at both documents and provide their feedback o Feedback due back October 23rd o Please add this to any workgroup meeting agendas if meeting before the 23rd
Workgroup Report Outs
Payers Workgroup Report Out presented by Paul Staley
Had their first meeting in September. They meet again this Monday, October 19th At first meeting they: o Covered the basics (COI forms, SIM vision, meeting schedules etc.) o Discussed inter-relationships and how the Steering Committee fits in with that
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 Received an update from Samantha, an OHSU consultant who is helping with the SIM Multi-Payer Collaborative (6 members of Payers workgroup are a part of Collaborative) Spoke about the work that the collaborative has undergone over past four years- How do they leverage this work through a SIM lens? Discussed issues with trust- why Multi-Payer Collaborative meetings are closed to public Mentioned Collaborative’s three goals: 1) comprehensive payment reform 2) data/rise health tool 3) SIM- looking at consistency and sustainability o “Rise health” tool- sophisticated data collection system. o Sustainability = Desire to create an infrastructure that is sustainable postgrant Payment structure o Steve from Milliman presented about origination of SIM grant, writing/pieces of grant and the dollars (ROI) of integration He will speak again at second meeting- October 19th- to talk about historical perspective of the SIM grant o Presented Cost and Utilization metrics to group and asked for feedback No input = acknowledgment Lynnette- SIM office received confirmation that the CQM have been approved by the Payers Member of the Steering Committee asked how do we (SIM) answer questions practices have about the value in joining SIM? o Refer them to the Multi Payer Collaborative FAQ Multi-Payer Collaborative MOU will help clarify their commitment o Expected to be released in December o
Action Item: Rename and repost Collaborative FAQ so members can easily reference it on Basecamp site
Concern in the Steering Committee about confusion regarding charge and role of each workgroup/Steering Committee regarding payment reform. o Some members came into SIM feeling like they would have a say in the value-based payment models that SIM will develop and test. Is that the case? OR will the payer workgroup serve as a “conduit” to SIM and Multi-Payer Collaborative? How does SIM office envision this? The Payers workgroup has requested further clarification on the purpose of the their role in payment reform
Action Item: Vatsala will listen to recording of meeting about questions between payers workgroup and multi-payer collaborative and speak about them at next meeting- November 4th
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
Ben Miller: from earlier discussions with Payers years ago, they made it clear that specific recommendation on payment methodology could not be brought forward, but they would be open to hearing what doesn’t work. Ideas from a workgroup’s perspective tells them what could work and helps bring payers to agreement and alignment Mindy has asked that, before we ask workgroups to go back and make these recommendations, that we go back to payers and make sure they are receptive to ideas/suggestions about things that have not worked/ gauge their reception to input Mark L has asked that we consider approaches that have been state-approved/procured and are already in use, instead of trying to jump on board of the “next-best-thing”
Action Item: SIM office and Payers co-chairs will go back to payers and ask if they would be receptive to idea/suggestions and gauge their reception to input Action Item: Jenifer Jessup feedback from a broader perspective to the industries broader than those at the SIM table Colorado Association of Health Plans to survey their members HIT Recommendation to Steering Committee
Scope Statement- five objectives: Quality Measurement Tool & Shared Practice Learning and Improvement Tool (SPLIT) o Addresses data quality, 18 CQMs appropriate to practice, key to practice transformation, extracts reporting Data Acquisition & Aggregation o Clinical and behavioral health data, clinical data in support of CQMs data elements and value sets, scalable for future use Analytical Reporting o Addresses data, reporting for multiple users, including cohort practices, national standards Data Integration o Integrates clinical, behavioral health and claims data, analyze and report quality and cost measurement, assessment of completeness of integrative efforts and ability to produce predictive analysis Telehealth o Expand broadband, technology that facilitates CCDs using nationally recognized interoperability standards, create Telehealth Resource Centers “SIM All Stars” o Practice that might become outstanding if more resources, more inputs, more knowledge, and skills were developed- worthy of more attention. Characterized by: Reporting all CQMs Integrate physical, behavioral and telehealth Value-based cost structure Improve quarter after quarter
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
Utilize additional resources and inputs offered o How do we reward them? o Hope is that they will be the best examples to illustrate how we can best reduce costs o Interconnection with practice transformation and HIT – All Stars ranking & Milestones practice transformation is asking them to meet. Theme throughout HIT: short-term and long-term will be different, we need to be able to start measuring as we start putting other tools in place The big SIM tool will be a place where you can aggregate your data in one centralized location to compare amongst practices who otherwise score better: the comparative platform will be the
Upcoming Dates & Year 2 Measures Reporting
most useful. Conversation on this will be tabled until future meeting- this is the basis on the Tech Plan due December 1st, along with Operation plan. October 16th CDPHE/Denver Foundation Joint RFA closes October 19th LPHA RFA released October 26th Practice Cohort 1 RFA closed November 9-13th SIM Roadshow o Nov 9th Colorado Springs and Pueblo o Nov 10th Lamar and Alamosa o Nov 12th Montrose and Grand Junction o Nov 13th Steamboat Springs/Hayden November 10th Evaluator RFP closes November 17th Workforce Summit
Year 2 Measures Reporting Timelines
Committee discussed possibility of dividing measures into “buckets” and dividing cohort on which measures they will be required to report on
Anxiety and Diabetes LDL are both hard so they would be separated o
Decision to table Diabetes LDL until more alignment on the measure
Diabetes blood pressure and hypertension are easy so they would be included in each
IVD will also be tabled until there is more alignment on the measures
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
Consensus reached: Remove IVD & Diabetes LDL until there is more alignment; Tobacco will be removed since it is included in SUD screening composite. Rest of measures (5) will be required for
Risk Mitigation all practices to report on. There will be no buckets Steering Committee Risk Mitigation Activity
In order to have a more solid foundation as we create the Operations plan to fully understand what each workgroup has identified for risk and if there are strategies to mitigate this risk. In this activity, each Committee member was asked to capture risks for each workgroup, separately As a group they will discuss top risks but workgroups should go back and have a discussion amongst themselves at later workgroups meetings to expand on this. Mitigations can also be looked at from a policy perspective- opportunity for policy solutions o Interconnection:Policy will need to align their policy priorities with the risk/mitigation strategies that come out of today’s activity and the workgroup sessions to follow.
Below is a summary of what was captured by each workgroup Workforce:
Top Risk- Inadequate workforce, both as it exists but also in terms of interest in joining the workforce.
Lack of behavioral health (BH U/V?) trained providers and trained PCPs Lack of consensus on competencies and behavioral anchors License Issues Standardization of Training programs Not enough people going into psychiatry and primary care Limited bilingual and bicultural care workforce
Evaluation:
Top Risk- Timeline limited to determine true impact (mitigate with interim measures)
Inability to get detailed data sufficient for evaluation items Limitations in attributing impacts to SIM activities Insufficient time to measure true impacts of SIM grant work Lack of practices to participate in SIM Difficult to identify a comparison group and differentiate between additional CMS initiatives Evaluation of who has lack of context
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
Consumer Engagement:
Top Risk- creating a system that people ultimately do not want o Possible mitigation- figuring out way to get out the information of hard and fact data Patient Experience does not improve and the word spreads that SIM does not work. What consumers do not want is what is ultimately created Patient involvement in decision making, at various levels. Metric for discerning consumer engagement versus patient satisfaction and ensuring that patient satisfaction while considering how we are defining success. Need different engagement strategies for patient’s complex needs (especially MH SUD) Resistance to change in general Consumer perspective left out in decision making of model o We can help mitigate this through additional seat on Advisory Board Diversity of health concerns and behavioral health integration
HIT and Data:
Top risk: Can we opt out of building a central data hub that we said we would do in SIM proposal o Lynnette will check with CMS if this is an option
SIM Proposal versus SIM Reality: o Central Data Hub versus disperse network infrastructure. Procurement Process: Timelines and deliverables Interdependencies with other workgroups. Key personnel: State HIT Coordinator position Data Quality Master PT Index 42CFR Part 2 Complexity of data sets when integration partners are involved
Payers, Purchasers, Payment Reform:
Lack of consensus on reforms Clarity of what success looks like? Structure and integration with Multi-Payer Collaborative Data support of agreements Finance for behavioral health infrastructure to start. Consistency of methodologies across payers.
Practice Transformation:
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
No payment or inadequate payment reform Practice won’t participate, be as successful, or be able to sustain achieving metrics or moving milestones. Data reporting tools not ready and no data from QI and transformation Inadequate workforce for behavioral integration meaning practices cannot move to fully integrated models. Limited access to more intensive services which may be a disincentive to identify patients with mental health issues.
Policy:
SIM is so visible and fairly political with many diverse stakeholders. Can SIM truly affect policy change? Can consensus be reached on solutions? Receptivity of decision makers Public payers cannot make payment model reforms Effective prioritization of policy actions Lack of consensus on vision.
Population Health:
Process around timing and its inefficiencies, funding coordinating and service coordination. Confounding factors such as methodological constraints such as poor interventions, insufficient time and ineffective interventions. Concern that outcomes will not be met such as not seeing a reduction in stigma or see an increase in screening.
Next Steps & Conclusions:
Movement towards Interconnectivity- need to build framework that we can continue to add on within connections and contribute to interconnectivity.
Establish process for workgroups working together on interconnectivity activity
November 4th: Interconnectivity activity
November 16th: review of final Operations Plan
December 2nd: Presentation of Communication Plan
December 16th Expected outcomes for practice cohort and MOU
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
Action Items:
Topic
Responsible Party
Rename and repost Collaborative FAQ so members can easMatthew Welchart, Raily reference it on Basecamp site chel Short Vatsala will listen to recording of meeting about questions between payers workgroup and multi-payer collaborative and speak about them at next meeting Ask Payers if they would be receptive to idea/suggestions and gauge their reception to input
Deadline 10/14/2015
Vatsala Pathy
11/4/2015
Vatsala, Paul Staley, Judy Zerzan
11/4/2015
Reach out to Colorado Association of Health Plans to survey their members regarding what they would be receptive to hearing regarding payment reform.
Jenifer Jessup
11/4/2015
Bring HIT Recommendation back to Steering Committee for discussion on Technical plan
SIM Office
11/18/2015
Steering Committee and Workgroup PMs
11/4/2015
Rachel Short, Connor Holzkamp
11/4/2015
Connect with Joe Sammen to make sure Health Alliances know about Roadshow
Connor Holzkamp
11/4/2015
Ensure clear communication about differences between TCPi and SIM. May need to be brought up to Steering Committee for discussion
Connor Holzkamp, Lynnette Hampton
11/4/2015
Make sure we are alignment SIM messaging to address what SIM change really means. Really cater this to those patients that may be resistant to this type of change
Connor Holzkamp
11/4/2015
Have conversation with CMS about the degree of risk if we do not build a central data hub, considering the recommendation of HIT and relationship with RISE
Lynnette Hampton
11/4/2015
Take risk mitigation activity results back to workgroups for deeper discussion Get Steering Committee details of the Roadshow
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.
