Meeting Minutes August Advisory Board Meeting 8/3/15 | 1:00-3:00 pm | CDPHE Sabin-Cleere Room Type of meeting

SIM Advisory Board

Members in Attendance Susan Birch, Patrick

Chair

Vatsala Pathy

Note taker

Matthew Welchert

Gordon, Glenn Madrid, Lilly Marks, Vatsala Pathy, Jeannie Ritter, Marguerite Salazar

Timekeeper

Connor Holzkamp

Discussion Items: Item 1: Advisory Board Expansion 

Romaine Pacheco, Director of the Governor’s Office of Boards and Commissions, provided an update on the expansion of the Advisory Board: o The Executive Order, which created the Advisory Board, is in the process of being amended to include the addition of four new members. The amendment will not occur until later in August, with approval of new members to take place in September.  New members will be selected through a new application process and the Office of Boards and Commissions will accept recommendations for the four open positions.  The Executive Order must be revised before the application process can begin.  The four new positions will be selected based on a new set of criteria:  Two of the positions will be selected based on a candidate’s consumer representation credentials.  One of the positions will be filled by a representative of a major statewide health system.  One of the positions will be filled by a representative of a major payer.  Geographic and racial diversity will be major considerations in the selection process.

Item 2: Vice-Chair 

Sue Birch nominated Patrick Gordon to serve as the Vice-Chair of the Advisory Board. The motion was seconded by Marguerite Salazar. o Patrick Gordon suggested that the Advisory Board refrain from selecting a ViceChair until after it had expanded its membership, so that new members could be considered in the process.

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes 

Sue Birch expressed the immediate need to fill the Vice-Chair position and suggested that Patrick Gordon serve as an interim Vice-Chair until the Board fully expands. At that time, the entire Board, including new members, will vote on a permanent Vice-Chair.  This option was accepted and passed by the Advisory Board as an amendment to the original motion.

Item 3: Colorado Health Extension System 

Perry Dickinson, Professor at University of Colorado School of Medicine, Family Medicine, and Gabriel Kaplan, Health Promotion and Chronic Disease Prevention Branch Chief at the Colorado Department of Public Health and Environment, presented proposed next steps related to SIM’s Health Extension work. o Perry Dickinson presented on the history of the Colorado Health Extension System (CHES), outlining how the collaborative’s previous experience makes it uniquely qualified to manage health extension efforts. o Perry Dickinson explained that CHES has already been funded by other agencies, such as AHRQ, to oversee health extension efforts. He proposed that by funding CHES, SIM has the opportunity to align with and augment existing efforts. o Gabriel Kaplan discussed how funding CHES would be the best possible plan of action when considering sustainability, local effectiveness, and alignment of established and future efforts.  Marguerite Salazar expressed concerns regarding disparities she perceived between the proposal and conversations that occurred at previous Advisory Board meetings:  At the July Advisory Board meeting, the Board recommended that “Health Extension Agents” be renamed “Regional Health Innovation Liaisons” (RHILs). However, the new proposal referred to the positions as “Regional Health Connectors” (RHCs). o Perry Dickinson and Gabriel Kaplan responded that while the Board did recommend the title of “RHIL”, the SIM Office and project leaders proposed the title “Regional Health Connectors” in order to better reflect the role of this workforce and to avoid an unwieldy name. However, the Advisory Board’s continued desire to use RHIL will be taken into consideration.  Marguerite Salazar expressed concern that the role of this workforce was not made clear within the proposal as presented. o Vatsala Pathy suggested that Board members reference the job description that was included in the July Board packet. Gabriel Kaplan explained that the role of this workforce would be to assist with collaboration and learning between

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes

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practices, to connect practices to regional and state resources, and to provide technical assistance to practices. o Perry Dickinson and Gabriel Kaplan proposed next steps for health extension efforts in Colorado:  As a collaboration of many organizations, CHES will provide a cooperative leadership and management committee to guide the work of extension efforts throughout the state.  CHES Governance: A steering committee of involved groups and a smaller management committee made up of representatives of key actors, including the SIM Office, CU, and CDPHE, will guide the collaborative’s work. o Additional members may be added as needed.  CHES will select an experienced and capable agency to act as its fiscal sponsor.  Funding from many different sources may be funneled and managed through the one fiscal sponsor. Doing so will encourage alignment of efforts and sustainability beyond the term of the SIM grant.  Gabriel Kaplan and Perry Dickinson outlined that the proposed approach was beneficial because it:  Builds on Colorado’s existing experiences and expertise.  Is adaptable and capable of incorporating new efforts that fill existing gaps.  Provides an efficient distribution of funds.  Convenes partners to provide guidance on overall statewide extension efforts. o Lilly Marks requested clarification regarding the relationship between CHES and CU, as presented in the proposal, including what fiduciary responsibilities CU would play in this process.  She suggested that if the CU is involved in this process, there needs to be clarification regarding CU’s authority, agency, and responsibilities.  It was clarified that CHES would be moved out of the University to function under the aegis of the new fiscal agent. . The fiscal agent chosen would handle the legal and fiduciary responsibilities as it “does business as” CHES. Conclusion: The Board approved of the overall spirit of the proposal as presented in the Advisory Board packet. However, the Advisory Board made several recommendations regarding amendments to the proposal, outlined in the “Voted Items” section below.

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes Item 3: Presentation on Value Based Purchasing 

Kyle Brown, Senior Health Policy Advisor with the Governor’s Office, presented an update on Value Based Purchasing (VBP) o Governor’s office committed to moving VBP forward, and to aligning/integrating the goals and ideals of SIM into a state-wide strategy  Over the summer, a Dukakis fellow conducted a deeper study of VBP to examine current landscape in Colorado; interviewed a number of key stakeholders. o Executive Summary/Key Recommendations:  Articulate a unified public message regarding VBP across Governor’s Office, HCPF, CDPHE, SIM, and federal partners;  Clarify the role of HIT partners in the context of VBP, potentially through a new office created within the Governor’s Office; utilize SIM, Medicaid to influence and set reporting standards  Recommend or require alignment of quality metrics across carriers, to reduce provider burden  Develop funding models that allow providers to make system investments o Board Suggestions/Input on Recommendations:  Marguerite Salazar noted that only about 30% of Medicare payments are currently using VPB methodology, but looking forward to additional carriers adopting; some carriers have contacted the DOI about implementing, and how to include VBP as part of their provider contracts.  Sue Birch explained that Colorado Medicaid currently pays managed Fee For Service, incentive payments, and in some areas a global capitation demonstration (1281); also has a bundled payment project under development  Medicaid is evolving away from volume-based payments, towards value, efficiency  Private payers aligned with Medicaid years ago under federal grant to push towards value-based payments; under CPCI, some private payers have aligned with Medicare  State (Medicaid and private insurers) are already moving in direction of VBP, but at different maturation rates; first need to stabilize floor (education regarding what a Patient-Centered Medical Home is); next step is SIM transformation, help people understand the importance of integrated care, then expand to social determinants of care; VPB will support this evolution.  Glen Madrid highlighted the importance of aligning metrics across payers; very important for physician practices, who have difficulty negotiating the sometimes significant differences between payer reporting requirements

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes 

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Also noted that funding is critical for practice transformation, and was of great value to CPCI practice; without up-front financial assistance, very difficult to make transition to new care delivery models Patrick Gordon noted that it was important to focus on the relationship between Value Based Purchasing and Value Based Payment.  Separate but related concepts that function best when aligned.  Ultimate goal is to provide better value to the purchaser/tax-payer and better experience for the patient; that outcome is most likely to happen when purchaser, payer, provider, and support from patient are all in alignment. o Measurement alignment is important o With respect to comprehensive primary care, requires a multi-payer process; no one payer, even government, could do this on its own o Need policies that foster multi-payer alignment, in terms of investments made in provider types:  Within government programs regarding measurements.  Policy work around how healthcare is purchased – whether government purchasing healthcare in Medicaid or for state employees, providing direction in the state Exchange, or how employers could come together to promote alignment. Lilly Marks suggested broadening the definition of VBP beyond a true capitated model.  Moving all payment models (100%) is hard and unlikely or even necessary.  Still able to embed value based purchasing concepts into any payment models. o In one model, talking about shifting financial risk to provider o Also should have utilization and performance risk – add value to system and don’t have to be linked to only one payment model.

Item 4: Presentation on Population Health Efforts: 

Dr. Elizabeth Whitley, Director of the Prevention Services Division at CDPHE and Monica Buhlig, Director of Basic Human Needs at The Denver Foundation, presented on the possibility of releasing a joint request for applications between CDPHE and the Denver Foundation’s Colorado Health Access Fund.

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes o The SIM Interagency Agreement with CDPHE authorizes the distribution of $2.2 million to fund collaboratives to improve behavioral and population health in their communities. o CHAF has a similar opportunity to fund collaboratives that advance behavioral health at the community level. o In order to align efforts, the two organizations propose releasing a joint request for applications, as doing so could minimize confusion caused by parallel processes, more efficiently leverage funds, and provide a model for collaboration across agencies. o The presenters also outlined potential challenges of partnership, including potential dilution of the CHAF and/or SIM “brands,” difficulties with aligning timing, and perceived loss of agency control.  The two organizations plan to keep the Advisory Board abreast of issues as they arise Item 5: Health Information Technology Update Presentation: 

Kate Kiefert, HIT Coordinator, Governor’s Office, updated the Board on the status of work related to Health Information Technology (HIT). o Overview of Current Situation: As Colorado advances a comprehensive, personcentered health care delivery system, secure and efficient use of technology across health and non-health sectors is vital to achieving integration and improving health. A coordinated, health IT governance structure is needed to align health programs, unify technology investments, and advance data integration across state agencies and private health partners. o Future plans include:  Creation of a central HIT governance entity.  Establishment of an advisory committee that will include public and private partners.  Development of criteria for qualified technical organizations.  Alignment with other health governance models. o The HIT stakeholder workgroup will provide recommendations and implement technical solutions in support of SIM objectives. Specific activities are listed in the workgroup’s charter.  Sub-workgroups will be created as needed to address specific topics that require a greater depth of consideration. o Allocation of funds and governance structure are the next major topics to be addressed by the workgroup. o Long-Term Vision: To implement technological changes in support of SIM goals, integrate solutions, components, and systems into the Colorado HIT infrastructure, and create a sustainable, cost-effective, and robust infrastructure to meet Colorado’s future healthcare needs.

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes

Public Comment: There was no public comment given at this meeting.

Voted Items:  

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Approval of July Minutes: The minutes were unanimously approved by the Board. Selection of a Vice Chair: o Sue Birch motioned to nominate Patrick Gordon as Vice-Chair. The motion was seconded by Marguerite Salazar. o The motion was amended so that Patrick Gordon will serve as interim Vice-Chair until the Board fills its four vacant positions, at which point the Board will vote on a permanent Vice-Chair. o The amended motion passed unanimously. Colorado Health Extension Service/Regional Health Connectors: o The Board agreed to the following broad principles related to the Health Extension work, with the understanding that details of the work are in development. While next steps do not need to be brought back to the Advisory Board for approval, continued reporting on progress is expected. The agreed-upon principles include:  CHES uniquely possesses the knowledge, experience, and collaborative structure necessary to manage Health Extension efforts ;  CHES will be overseen by a steering committee and a management committee as described in the presentation, but with possible revisions to account for the proper relationship with CU;  CHES will select a fiscal agent with adequate capacity to take on fiduciary responsibility for the project;  The description of the project needs to be carefully and clearly articulated;  The approach to this work will build on existing community assets and efforts, rather than duplicate them.  The University of Colorado and HCPF will meet to further outline how to best implement the proposal and next steps in this work.

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.

Meeting Minutes

Action Items:

Topic

Responsible Party

Deadline

CU, HCPF, and other key leaders will meet offline to determine next steps regarding the Colorado Health Extension System proposal.

Sue Birch, Lilly Marks

9/3/2015

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. The content provided are solely the view of the author and do not represent the views of HHS or its agencies.