Meeting Minutes Practice Transformation 07/15/2014 | 1:00-3:00 | HCPF 225 E. 16th 9a/b Type of meeting

Practice Transformation

Facilitator

Perry Dickinson, Mindy Klowden

Note taker

Matthew Welchert

Timekeeper

n/a

Members in Attendance: Greg Reicks, Bern Heath, Mindy Klowden, Perry Dickinson, Mike Fisher, Anita Rich, Polly Anderson, Pam Jones, Lynnette Hampton, Claudia Zundel, Amanda Brooks, Lori Stephenson, Lesley Brooks, Kimberly Walter, Jennifer Conrad,

Discussion Items: Item 1: Definition of Primary Care: Polly and Susan provided further information on the subject:  Colorado Indigent Care Program (CICP) definition: One area in statute in which primary care is defined: “The basic, entry-level health care provided by health care practitioners or non -physician health care practitioners that is generally provided in an outpatient setting. ‘Comprehensive primary care’, at a minimum, includes providing or arranging for the provision of the following services on a year -round basis: Primary health care; maternity care, including prenatal care; preventive, developmental, and diagnostic services for infants and children; adult preventive services, diagnostic laboratory and radiology services; emergency care for minor trauma; pharmaceutical services; and coordination and follow-up for hospital care. ” 25.5-3-203 (1) C.R.S

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o The definition does not have the inclusion of integration of behavioral health, but it is a broader definition than just focusing on medical practices and can include specialty care as well.  Lack of behavioral health defined is not an issue so it can include practices at the end of the integration continuum without behavioral health already integrated. o What does “arranges for” mean? Likely in this definition it is referring to meaningful referral relationships acknowledging the limitations of smaller remote practices. Accountable Care Collaborative organization regarding PCMP’s Definition: Note: This is the definition of a primary care medical provider within the ACC and so not necessarily as broad based. If used as a definition it could include additions. o 1.1.3.3 Emphasis on primary care including a practice which provides a majority of a patient’s primary care. o 1.1.3.4: Ways to illustrate a practice is a primary care facility. Such items may serve a use for defining practices:  Certified by HCPF as a medical home and children’s provider through Medicaid and CHIP+

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 FQHC and Rural Health Clinic: They provide a mandated list of services clearly within primary care.  Focus on primary care, general practice, internal medicine, pediatrics, geriatrics, obstetrics, gynecology, allowing for specialization but within realm of the primary care home.  Enhanced Primacy Care Medical Provider Standard and Payment Definition: How a PCMP already within ACC could apply for additional dollars. o Not a relevant definition as it lists more the bar which practices should aspire to reach and not the base by which they must qualify.  Better to focus the definition on the services the practice provides the consumer and not towards their specialty. Item 2: Draft Eligibility, Requirements and Preferences for Cohort 1  Eligibility: o How to determine this for practices?  Give baseline requirements which if the practice falls above the minimum threshold they would be applicable to the cohort.  List of practice types which fall within the set primary care definition which could then be an easy check-box for practices to complete and an area for the practice to define themselves.  The harder to define practices could then appeal and be considered on a case-by-case basis as needed.  Leadership and Practice Engagement: o Leadership should be interested in integration but that integration can fall along the continuum. o Would need to include an administrative leader as well as clinical leader in the practice and this should function at the highest level of leadership. o An RFQ could be issued to clear up the specifics of the practice’s leadership involvement.  Payment Structure and Fiscal Preferences and Requirements: o Rather than written fiscal commitments, have practices illustrate current commitments and plans or processes for seeking further support. They need to demonstrate thinking on this issue. o Need for messaging from the SIM Office around the fiscal elements and the resources provided and not provided by SIM.  Technology Requirements: o The preferred section does set the bar high, but there are means of helping practices to reach this mid-level bar by a later cohort. o However, the technical aspect is rigorous and may appear daunting to practices and eliminate some who should otherwise apply. 

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 3: Role of Payers in Practice Selection:  A number of payers have been involved with CPCi to work with 73 practices towards testing different payment models and SIM wants to continue this pioneering work o Payers will thus be involved in some capacity in the Practice Transformation Cohort  Payment reform is a major goal and a requirement for the success of practice integration and so payers are needed onboard. o Payers will select a number of practices they wish to see involved in the cohort and they shall provide specific funding for the cohort. o There might be a tiered setup to differentiate practices working with the payers in the cohort.  The qualifications and criteria will be relayed to the payers so they know what the specifics of the cohort will be.  There will be a diversity of practices involved in the cohort and payers will only be making recommendations for the cohort. Final decision shall be with the SIM Office who will act as an independent third party.  The final details and specifics are still being deliberated and much is still liable to change.

Conclusions: 

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For Practice Application Process: Operate under the CPCI 1.1.3.3 with the definition of primary care provided with some example primary care practices which could be checked off by applicants and applicants would self-define their practice. Should the practice not necessarily meet the 1.1.3.3 requirement or fall within the check box examples they could attest to being a primary care provider, appeal, and be accepted pending appeal. Need to provide practices with more information about what they are signing up to join, have answers to likely questions, and more details about reporting requirements etc. Edits to the Draft Eligibility, Requirement and Preferences for Cohort 1 Practices: o Strike first sentence of Eligibility section, item d): “Only practice sites with a majority of primary care clinicians will be eligible.” As it may exclude practices without the clinical care staff but are otherwise providing primary care and ought to be included. o Avoid calling out specific specialties within the definition to avoid leaving out possible specialties which might otherwise comply. o Practice Transformation Section: Required: Move item b to item d as a combined item.

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 

In Required Section: reword Item c) and d) but keep in language to ensure practices have experience with data and quality improvement process. i.e. section c) should read “willingness to establish quality improvement teams”.

o Technology Section: Requirements need to be softened and the language made more accessible, to reflect “willingness”.  EMR, Meaningful use criteria, QI measures, quarterly reports are still requirements.

Action Items: Topic

Responsible Party

Deadline

Need to receive a report from the Steering Committee on quality measures.

SIM Office, Chairs

Committee deliberations are prerequisite

Mark the changes and edits to the “Draft Eligibility, Requirement and Preferences for Cohort 1 Practices” document and post to Basecamp for members to review and sign-off on.

Perry Dickinson

8/13/2015

SIM Office

8/31/2015

Further messaging for practices seeking to join the cohorts around SIM, the overall goals, and the resources available. Determine if a need exists for a subgroup around messaging.

Review the General Requirements for Practices for final discussion at Practice Transnext meeting formation Workgroup

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.

8/13/2015