Advisory Board Materials Packet

Monday, August 3rd 1:00 pm – 3:00 pm Colorado Department of Public Health and Environment 4300 E Cherry Creek South Drive Denver, CO 80246 Sabin/Cleere Conference Room Building A

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Contents Agenda ....................................................................................................... 3 July Minutes ............................................................................................... 4-8 Selection of Vice-Chair .................................................................................... 9 Colorado Health Extension System...................................................................... 10 Proposal .................................................................................................. 11 Visual Overview ......................................................................................... 12 SIM Organizational Chart ................................................................................. 13

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Meeting Agenda SIM Advisory Board 8/3/15 | 1:00 - 3:00 pm | CDPHE Chair

Vatsala Pathy

Facilitator

Bill Fulton

Note taker

Matthew Welchert

Timekeeper

Connor Holzkamp

Agenda Items Topic

Time

Approval of Previous Minutes

5 minutes

Advisory Board Expansion

5 minutes

Presentation by Romaine Pacheco, Boards and Commissions ACTION ITEMS Selection of Vice Chair

10 minutes

Public Comment

5 minutes

ACTION: Board members to select a Vice Chair by majority vote. Colorado Health Extension Service

20 minutes

Presentation by Perry Dickinson, MD, University of Colorado Denver, and Gabriel Kaplan, CDPHE Public Comment

5 minutes

ACTION: Board members to recommend whether or not to move forward with the presented proposal. INFORMATIONAL UPDATES ON SIM WORK Value-Based Purchasing

20 minutes

Presentation by Kyle Brown, Governor’s Office Population Health Collaboratives RFP

20 minutes

Presentation by Liz Whitley, Ph.D., RN, CDPHE Health Information Technology

20 minutes

Presentation by Kate Kiefert, Governor’s Office Public Comment on SIM Updates

The Project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the US Department of Health and Human Serv ices, Centers for Medicare and Medicaid Serv ices.

10 minutes

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Meeting Minutes July Advisory Board Meeting 7/6/15 | 1:00-3:00 pm | CDPHE Type of meeting

SIM Advisory Board

Members in Attendance Reggie Bicha, Susan

Facilitator

Vatsala Pathy

Note taker

Matthew Welchert

Timekeeper

Connor Holzkamp

Birch, Patrick Gordon, Glenn Madrid, Lilly Marks, Vatsala Pathy, Jeannie Ritter, Marguerite Salazar, Larry Wolk.

Discussion Items: Boards and Commissions: 

Romaine Pacheco, Director of Boards and Commissions, addressed the board to discuss the following points: o The Board was called by function of an Executive Order, and any subsequent changes to the specifics outlined within, such as composition, will require a compelling argument for creating an amendment. o The Governor specified within the Executive Order that Vatsala Pathy serves as the Governor’s representative on the Board.  As such her appointment as Chair will not be changed by the Governor’s office in any amendatory action.  The by-laws allow for a Vice-Chair to manage some of the Chair’s responsibilities as needed. o The Board’s role is purely advisory and will have no authority to create new policy. Rather, recommendations may be brought from the Board to the Governor.  There was some confusion and disagreement regarding the nature of the advice the Board could present. For instance, could the Board’s advice hold up a program of the SIM Grant, or could it only ask for more time for consideration?

By-Laws Finalization: 

The Board discussed the last sentence of Section 6B, which stated that members would have to excuse themselves from the room in cases of potential conflict of interest. The Board agreed such a measure was not necessary to avoid conflictual issues.

Board Composition: 

There was discussion concerning what the makeup of the Board should look like should it be expanded. Director Birch called for representation of a large carrier and health equity perspective in addition to consumer advocacy. Lilly Marks remarked that health systems

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.

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Meeting Minutes and insurance companies, while integral to the success of the project, should not necessarily be seated on the Board due to their market competition nature. Patrick Gordon supported the expansion and thought lived-experience is critical from the consumer perspective. Health Extension Agents: 





Gabriel Kaplan, CDPHE, spoke regarding the decisions and choices made in the proposal submitted to the Advisory Board regarding the Health Extension Agent (HEA): o The key work will be happening on the ground, so a main concern is making sure that the most funds possible go towards that effort. o The program will provide 20 full time employees combined with other grants, AHRQ and TCPi, creating similar positions.  How do you distribute these agents; for instance regionally or by organization?  Need for independent third party organization which can administer as a fiscal agent these different funding streams.  It was determined that that State, University, nor SIM Office would be suitable for the sustainability of this program.  Contracting the third party represents a better option as it avoids the hefty and lengthy legal requirements to create a new organization while providing the minimal administrative oversight required to get the money to the HEA to move towards the communities.  This kind of organization would allow for long-term sustainability.  Contracting a third party would also mean no new body, infrastructure, or staff would have to be created or hired.  The third party would contract with the best vehicles with which to embed the HEA. Additional questions remained regarding the HEA proposal: o Though there needs to be more detail provided on the budgetary requirements visà-vis implementation of this fiscal agent. o Need for more detail concerning the organizations which might then be contracted by the fiscal agent. o Some question remained as to how the fiscal agent would be decided, whether through an RFP process or some other means. o The Board at large had concern regarding the proposed creation of a large additional advisory board to oversee the HEA program. The program would not seek to create new specialists or community health workers. Rather their goal will be to connect with practices and providers to the tools and resources available to them and assist with navigating transformation in a way which adapts to the needs of the specific community.

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.

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Meeting Minutes



o The focus will be on health outcomes, but may be related to a variety of areas such as HIT, new payment models, or enlisting community health workers or other agents. The decision to have one third party acting as fiscal agent, as stated in the general outline, was accepted by the Board with the caveat that ongoing details regarding any future decisions be presented to the Board for further deliberation.

Public Comment: 



Regarding Advisory Board Makeup: o Elisabeth Arenales, Health Program Director, Colorado Center on Law and Policy: CCLP sent a letter with 27 signatories asking for expanded representation on the Board. There is a significant difference being on a workgroup and being on the Advisory Board directly advising the Governor. While there is wide representation on workgroups, that representation does not extend to the Board. It is of critical importance to have someone with a broad consumer needs perspective on the Board. In order to encompass a variety of voices within a limited number of representatives, it would be helpful to pick a person from an organization that represents many organizations in a collaborative manner. o Deb Judy, Policy Director, Colorado Consumer Health Initiative: Consumer voice, intellectual developmental disabilities, and health equity are important areas that are not represented on the current Board. o Michael Lott-Manier: There is a need for greater consumer representation on the Board. The real need here is to be more transformative. The Board has the great opportunity to be an advocate for behavioral and mental healthcare as an aspect of whole-person health. The Board would benefit from an individual with lived experience in accessing mental health care. Health Extension Agents: o Lynnette Hampton, SIM Operations Manager, spoke to clarify the design of the proposal. Namely, the group from CDPHE and the University of Colorado were trying to provide options to the Board. The key decision hinged on the need for a third party agency outside of the SIM Office to act as the administrative entity. o Deb Judy, CCHI: Instead of a specific comment, Deb Judy spoke to the need for there to be details of the program available to the public for her to be at all able to weigh in on the discussion. Additionally, she requested that the slides for the meeting be made available before Board meetings. o Steve Poole, CU: Wanted to know what non-profits were under consideration for the role of third-party fiscal agents and whether not RCCOs were included. The Chair spoke to how RCCOs might make for suitable vehicles to host the Health Extension Agents but not as the administrative agency to manage them.

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.

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Meeting Minutes

Voted Items:    





The By-Laws were passed with unanimous vote with the inclusion of the amendment to section 6B (see above). Simple Majority Rule was unanimously voted upon for the Board’s voting procedure. The Board unanimously voted against the use of proxy voting and unanimously voted for the ability to vote via conference call. The Board unanimously voted: o To advise the Governor’s Office to increase the size of the Board by up to four members. o To recommend the total number of members remain odd. o To recommend there be a strong consumer voice represented within the increased number. o To defer to the Governor’s Office the selection of new members. o To defer to the Governor’s Office the nature of the constituent and stakeholder perspectives to be included in the increased membership. The Board unanimously voted to support the general outline for the Health Extension Agent as presented by CDPHE and the University of Colorado, with the additional stipulation that further information be presented on all future decisions regarding the Health Extension Agents. The Board unanimously voted to rename the Health Extension Agent the Regional Health Integration Liaison (RHIL).

Action Items: Topic

Responsible Party

Deadline

The Board requires further specifics be presented on the subject of the Health Extension Agent, with particular focus on the nature of the third party fiscal agent.

SIM Office

8/3/2015

Present recommendations and member comments regarding the expansion of the Board to the Governor’s Office for final decision.

SIM Office

8/3/2015

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.

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Meeting Minutes Topic

Responsible Party

Deadline

Present quarterly status report summarizing the efforts undertaken by the workgroups.

SIM Office

9/3/2015

Clarify the nature of the Board’s advice. Is it binding and if so, in what regard? If not, can the board only express its decisions to the Governor?

SIM Office

8/3/2015

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.

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Key Issue: Selection of Vice-Chair Goal: To select a Vice-Chair, by majority vote, at the next Advisory Board meeting. Background: SIM Advisory Board By-laws state: “The Vice-Chair shall be selected by the Board by a nomination process and majority vote. The Vice-Chair shall serve a two-year term. The first election of the Vice-Chair shall be held as soon as practicable after adoption of these by-laws…. The Vice-Chair shall fulfill the duties of the Chair when the Chair is not available and carry out any tasks or duties assigned by the Chair.” By-laws were formally adopted at the last meeting. Action: If you would like to nominate yourself or another Advisory Board member for the position of Vice-Chair, please e-mail a nomination to the following address no later than close of business on Friday, July 31st. Lynnette Hampton SIM Operations Manager [email protected]

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.

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Key Issue: Health Extension System

Action: Read the following overview of a plan jointly proposed by staff at the Colorado Department of Public Health and Environment and the UCD Department of Family Medicine to deploy SIM-Funded Health Extension Agents (now referred to as Regional Health Connectors) throughout Colorado. Come prepared for the next meeting with feedback on the proposal. Goal: To recommend whether or not the SIM Office should proceed with implementing the proposal as presented or with modifications. Note: In order to comply with timetables set forth by CMS, timely decisions regarding the program are required. If you have any questions for which the SIM Office may provide clarification before the meeting, please email: Lynnette Hampton SIM Operations Manager [email protected]

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.

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Colorado Health Extension System and Regional Health Connector Overview BACKGROUND The ACA and Health Extension: The ACA authorized the Agency for Healthcare Research and Quality (AHRQ) to create a national Primary Care Extension Program. This program deploys community-based Health Extension Agents, to be referred to in Colorado as Regional Health Connectors (RHCs), to help providers “improve the accessibility, quality, and efficiency of primary care systems” and to “collaborate with local health departments… and other community agencies to identify community health priorities and… address the social and primary determinants of health.” Health Extension Expertise in Colorado: A multi-stakeholder collaboration, known as the Colorado Health Extension System (CHES), was convened by the University of Colorado, Department of Family Medicine five years ago with the goal of creating a statewide infrastructure to support and coordinate practice transformation and connect primary care, local public health, and other community organizations for community health improvement initiatives. In 2011, an AHRQ grant supported the CHES collaborative in joining a learning community across 18 states to test the health extension system model. CHES recently received a commitment from AHRQ to fund RHCs. Creation of the Colorado Health Extension System (CHES): To implement extension work, the Department of Family Medicine is in the process of creating the Colorado Health Extension System (CHES) as an independent and autonomous unincorporated nonprofit entity. The group will select a separate, highly-experienced nonprofit agency to serve as its fiscal sponsor. The fiscal sponsor will accept and manage funds from AHRQ and other funding streams on behalf of CHES. CHES will facilitate a variety of practice transformation efforts in addition to the work of the RHCs, whose role will be to further population health and integration objectives. PROPOSAL Proposed SIM Contract with CHES: The SIM award includes $5.5 million to fund the work of RHCs (approximately 20 FTE). The SIM Office proposes to contract with CHES to oversee this work. CHES will:  Issue a request for proposals to which local public health agencies, health alliances, regional care collaborative organizations, area health education centers, or other community-based agencies may apply for funds to hire RHCs.  Provide standardized training and technical assistance to RHCs and the host agencies that manage them.  Create and manage outcomes-based contracts with selected host agencies.  Provide fiscal oversight for grant-specified health extension activities. Rationale for Approach:  Unique Qualifications of CHES: Due to its success in convening partners around extension work in Colorado, an established relationship with AHRQ, contributions to the national Health Extension Toolkit, and participation in the deployment of extension systems in other states like Oklahoma and New Mexico, the CHES team uniquely possesses the knowledge and experience needed to administer an extension system.  Alignment of Efforts: CHES provides a single, central infrastructure for managing and coordinating extension and practice transformation work, whether funded by SIM, AHRQ, TCPI or future funding streams.  Fostering Relationships with Local Communities: As a new entity, CHES will be free to establish relationships with community partners without being tied to the reputation of state agencies or UCD, a key consideration when working with rural communities throughout the state.  Promoting Efficiency: CHES will be able to distribute funds quickly and efficiently.  Sustainability beyond SIM: As a standalone entity with multiple funding streams, CHES will have the best prospects for ensuring Colorado’s continued extension efforts beyond the end of the SIM grant. Inclusion of Public Health: A population health perspective and a close connection to existing public health infrastructure are central to the success of CHES’s strategic and operational efforts. Therefore, the CHES Steering Committee will include representatives from CDPHE and local public health agencies. Additionally, public health representatives will be involved in writing the agreement between the SIM office and CHES, assuring that a balance is struck between public health and practice transformation efforts.

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Overview of the Colorado Health Extension System Colorado Health Extension System (CHES) FISCAL AGENT TBD

CHES is a multi-stakeholder collaboration with the goal of creating a statewide infrastructure to support and coordinate practice transformation and to connect primary care to local public health and community organizations for community health improvement initiatives. CHES staffed by: Perry Dickinson, MD; Allyson Gottsman; Stephanie Kirchner, MSPH; and Kyle Knierim, MD CHES staff assist in administration of collaborative efforts, program development, training and content with input from partners, and financial oversight among other required organizational management responsibilities.

CHES STEERING COMMITTEE Comprised of Community Stakeholders: Public Health, Payer, Practice Transformation Representatives & Other Community Organizations

RFA Process

LOCAL/COMMUNITY COORDINATION

PRACTICE TRANSFORMATION SUPPORT

Regional Health Connector (RHC) Host Organization

Practice Transformation Organizations (PTOs)

(e.g. Local Public Health Agencies, health alliances, AHECs, RCCOs, etc.)

Practice Facilitators

Regional Health Connectors

Community Organizations

Public Health

Clinical Health Technology Advisors (CHITAs)

Primary Care Practices

COMMUNITY The following practice transformation organizations (PTOs) participate in the CHES collaborative: Colorado Associated Community Health Information Enterprise (CACHIE)/Colorado Community Managed Care Network (CCMCN), Colorado Health Neighborhoods (CHN), Centura Health Physician Group (CHPG), ClinicNet, Colleges of Nursing (Denver & Co Springs), Colorado Children’s Health Access Program (CCHAP), Colorado Community Health Network (CCHN), Colorado Rural Health Center (CRHC), Community Care Central Colorado (CCCC), Colorado Regional Health Information Organization (CORHIO), Denver Health, HealthTeamWorks (HTW), High Plains Research Network (HPRN), Independent Physician Network (IPN), John Snow, Inc. (JSI), Quality Health Network (QHN), Rocky Mountain Health Plans (PMHP), Sisters of Charity of Leavenworth (SCL) Health System

Resources

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CMMI

Governor

SIM Office

Advisory Board Steering Committee

SIM Workgroups (8) Consumer Engagement

Evaluation

Health Information Technology

Payers

Policy

Topic Specific Sub-Workgroups

Population Health

Practice Transformation

Workforce

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