Meeting Minutes Payment Reform Workgroup 04/13/2016 | 9:00 – 11:00 MT | CDPHE Type of Meeting: Chairs:
Workgroup Meeting Judy Zerzan, Paul Staley
SIM Representative:
Nicole King, Vatsala Pathy
Note Taker:
Matthew Welchert
Members in Attendance:
Tracy Fennern, Jay Brooke, Carol Plock, Adela Flores-Brennan, Dave Downs, Kelly Henry, Whitney Connor, Harriet Hall, Steve Melek, Julie Turcheck, Patrick Gordon,
Ex Officio:
Ellen Kaufmann, Barbara Martin, Scott Wasserman.
Action Items and Decisions:
Provide any additional comments to the SIM attribution methodology on Basecamp.
Discussion Summary:
SIM Office Updates: o The first practice transformation cohort has been finalized. A good diversity of practices, geographic representation, wide spread of participating health systems, an abundance of pediatric and family practices, mixture of Medicaid coverage, and 32 CPC practices. Multi-Payer Collaborative Meeting Update: o MPC met 2 weeks ago and discussed need for alignment of communication and completion of contacting practices to clear up confusion and ensure a connection between practices and payers. A list of practices payers will be supporting will be completed by 4/30; 30 days later the SIM Office will have connected with each practice site regarding who will be their payer support and primary contact. Further connections will be established with the Practice Transformation Workgroup in order to encourage ongoing discussion and focus. 1
The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agenc ies.
Meeting Minutes
The MPC will take up the timeframe as an opportunity to work on the messaging and prepare communication for practices Payers in SIM will use a national framework for measuring level of alternative payment which allows us to define alternative payment in the state. This portion is part of ongoing discussion; SIM will attend a national Learning Action Network meeting this month to discuss the framework further. CPC+ Announcement: o A brand new announcement; more information and understanding will come in time, but initial reaction is very positive. CPC+ will be a kind of narrative continuation of the work laid forth in CPC and currently being done with SIM. It expands the number of states and practices which will be involved. Presents a new opportunity to involve Medicare participation. An application process will be required, first by the MPC then by the practices. However, former CPC practices and SIM states will be given a preference in the application process. There will be a lot of opportunity for alignment between SIM and CPC+, they will have to be viewed as integrated elements; e.g. a practice in SIM will be successful in SIM and will not need to drop out for CPC+. Will provide added resources to practices which may help reinforce what we need to accomplish with SIM while SIM can help practices be successful with CPC+. Alignment will be key; the MPC does not seem them as different entities and does not want to treat them as such. o There will be 2 tracks of payment in CPC+, and the second track is explicitly focused on complex populations with mental health aspects. We will have to see how well that links with behavioral health integration; but an area wherein alignment may be facilitated and SIM-CPC+ can be leveraged together. Standard Attribution Methodology for SIM Reporting and Evaluation: o 3M serves as the APCD data manager, however, CIVHC has developed its own standard attribution methodology which provides a stable testing platform. Recommended lookback period will start from 12 then 15 and finally 24 months. CIVHC has 4 models currently that it is testing. Currently, the model using NPPES as a source for provider taxonomy codes produced the highest percentage attributed.
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The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agenc ies.
Meeting Minutes
The method will need to be tested with SIM cohort to make sure the taxonomy codes are represented correctly, as there could be potential issue with specialist codes. OB/GYN will be included as well. o Recommendations to the Attribution Methodology: No specialists will be included. FQHCs will be included. Clinical specialists involved in prescription would be included. Presentation on Risk Adjustment by Ksenia Whittal and Steve Melek of Milliman: o Slides covering the presentation are on the basecamp and the recording is publicly available on the website. o Questions and Comments: Is there any way to incorporate socio-economic impacts on a rick adjustment rating? In theory, yes. Different coefficients could be calibrated in the scores given but the issue is finding reliable data that is useable for such a measure. Should such data become available, even in a smaller scale such as with the cohort then that could become possible.
Referrals to the Practice Transformation Workgroup: o N/A
Public Comments: n/a
Next Meeting:
5/31/2016 -- 9:00–11:00 AM – HCPF 303 E. 17 th Ave. 11B
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The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agenc ies.
