Meeting Minutes Practice Transformation 08/13/2015 | 2:00-4:00 | HCPF 225 E. 17th Ave.12A Type of meeting

Practice Transformation

Facilitator

Perry Dickinson, Mindy Klowden

Note taker

Matthew Welchert

Timekeeper

n/a

Members in Attendance: Nicole Deaner, David Brody, Susan Mathieu, Anita Rich, Claudia Zundel, Phone: Pam Jones, Karen Frederick-Gallegos, Jen Conrad. Guests: Alicia Caldwell, Alison Laevey, Heather Stocker, Debbie Hinkons, Emily Haller, Ellen Kaufmann.

Discussion Items: Item 1: Update from the SIM Office:  Quality Measures are under further review at the Steering Committee and once they conclude their ultimate recommendation on the matter a number of practice transformation document, such as the practice qualifications and milestones, will be adjusted to reflect the Steering Committee recommendations. o Cost and utilization measures will be covered by the Steering Committee shortly.  The Recommended Practice Milestones and Qualifications from the University will be presented to SIM Director, Vatsala Pathy, and the payers workgroup and multipayers collaborative to gather further feedback. Item 2: Practice Communications:  How shall the SIM Office communicate with practices, what needs to be communicated, and what is the proposed value-proposition which will be presented to practices?  Gathering primary care doctors and mental health providers together to determine what they are looking for from SIM, what their expectations are, and what barriers they perceive as the most challenging. This will be a worthwhile endeavor to best determine what are messaging should be and if it is effective. o The SIM Office communications staff will work on this project and should use the professional societies within the state to get the names of the individuals who ought to be included in the test groups.  Practices can be scared of change, there is a lot of understandable uncertainty and concern. SIM will need to address those fears and demonstrate to practices the sustainable element of SIM and how joining SIM will prepare them for the future. o Fear may be mitigated if SIM can express how it will help overcome hurdles and break down barriers while helping practices to achieve necessary change.

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

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o Practice transformation may be daunting, keep the messaging simple and to a few concrete points that practices can understand and focus themselves towards. An important reason practices should join the SIM cohorts is because SIM will help them adjust to a value-based payment environment and be successful and competitive in that environment. o The adjustment towards value-based payment models for practices is ultimately a tremendous advantage. This plays into the value-proposition aspect. o Clarity around what SIM is referring to when talking about matters like becoming value-oriented and not just from a consistency of definition perspective but also as a matter of how that translates into reimbursement. When thinking about communications to practices a variety of practice types will need to be considered, but an emphasis will need to be placed on practices who are the most hesitant to make these changes. o Cohort 2 and 3 will be made up of more practices who are not as keen for transformation, for varieties of reasons, and so we need to be cognizant of a possible need to recruit these practices or at least mitigate any apprehension which may have arisen due to problems faced by the first cohort. o We need to consider what success looks like across the range of practices; small practices will have different goals than larger ones. Overall, all practices in the cohort will move towards the triple aim but the how will vary and we should speak to that. The SIM Office should be clear with practices about where savings will be coming from. o Steve Melek, actuary from Milliman and Evaluation Chair, can work on talking points regarding where the savings for practices may be expected to come from. Policy and regulations are often seen as a barrier as well, such as HIPPA or parity reimbursement, and these issues will need to be addressed. o Policy Workgroup can provide some recommendations on these matters. A message box should be created with a number of high-level key talking points which can then be broken down into more specifics to be tailored towards the audience. o The SIM Office communications staff will begin working on the message box after pre-testing messaging with primary care doctors and mental health providers. The questions around ‘how do I pay for it’ and other financial questions are going to be some of the first things asked by practices and will be a main driving concern. o Talking about other values presented by SIM are difficult to draw out because the financial element first requires attention; it is a prerequisite to any additional messaging. Overall, we need to keep the messaging small, such as three major items. How best to continue? o Should this conversation be continued as a subgroup or will it remain within practice transformation 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.

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There is value in bringing multiple workgroups in on this discussion and perhaps working with the SIM Office communications staff in more detail. Should subgroup come together and involve payers, we need to be very clear about what the ‘ask’ is and what solutions we are hoping to see. After engaging here at the workgroup and subgroup level then recommendations may be brought up to Vatsala Pathy and the multi-payer collaborative.

Item 3: Practice Qualifications-Brought to Payers:  The SIM Office will ultimately select the 100 practices based on the recommendations provided by the workgroups, University, and payers. o A practice will have to apply to join the cohort. o Payers will provide a list of names of practices they have chosen and will be providing support but that will not affect the 100 within the cohort.  The Payers list is an effort of incorporating and involving the Payers and will be a part of alignment of efforts.  Much of the work will be around moving people towards the center and aligning efforts.

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Communications with practices should be brief, consistent, and varied enough Before any other further messaging may be successfully crafted, the financial aspects and considerations need to be determined. A message box of high-level talking points needs to be established. Practice communication will be an ongoing topic, incorporating many different groups, and will likely continue as a subgroup.

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

Determine from CMMI how round 1 SIM states have addressed practice communication and recruitment

Deadline

SIM Office

9/8/2015

Policy Workgroup Chair will present at the next practice transformation workgroup regarding bi-directional integration.

Brian Turner

9/1/2015

Milliman will present to the workgroup regarding further details around where cost-savings measures will be coming from.

Steve Melek, SIM Office

9/1/2015

SIM Office

9/15/2015

SIM Office, Payers Workgroup

9/15/2015

The questions regarding the involvement of the payers in the first practice cohort will be brought to Vatsala Pathy to share with the mulit-payer collaborative. Questions brought forth from the practice transformation workgroup will be presented to the payer’s workgroup; specifically around the financial elements of integration and how that may be best communicated.

SIM Communications team will pre-test possible practice comSIM Office, Alicia munications and messaging with primary care physicians and be- Cladwell, Alison havioral health providers. They will work on building a message Laevey box and nuanced messaging based on practice audience.

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.

9/8/2015