Meeting Minutes Evaluation 09/16/2015 | 12:00-2:00 pm | CDPHE 4300 Cherry Creek Drive South, Denver, CO, Room A2A Type of meeting
Evaluation
Facilitator
Mark Gritz, Steve Melek
Note taker
Linda Sample
Members in Attendance: Mark Gritz, Steve Melek, Ana English, Doug Muir, Deb Parsons, Deborah Foote, Michael Rice, Jennifer Greenfield, Jordana Ash, Lisa Clements, Ryan Biehle Guest: Emily Haller Ex Officio: Ellen Kaufmann, Lynette Hampton, Tara Smith, Nicole King, Alison Laevey, Rachel Short
Discussion Items: Item 1: Conflict of Interest Forms – Ellen Kaufmann
There are a few members who still need to complete COI forms. Ellen Kaufmann will send out a reminder to those individuals. A blank COI form is available on Basecamp. Completed COI forms are due by 9/23/15.
Item 2: SIM Program Charter – Ellen Kaufmann
Reference webinar slides. Reviewed overarching goal of Colorado SIM (vision, goal). Evaluation workgroup charter and objectives were reviewed. The workgroup and Lynette approved on behalf of SIM office the additional two objectives proposed. Tasks for Evaluation workgroup for the next 3 months: o Develop high-level evaluation plan through 1/31/19 and submit to Lynnette Hampton by 11/1/15. o The key areas that workgroup will focus on are 1.) Research questions; 2.) Logic model; 3.) Methods, data collection, data analysis; 4.) Using evaluation findings. The primary focus will be on #1 and #2. o The Evaluation workgroup is also charged with identifying evaluation measures that track progress toward SIM’s overarching goal. o Complete SIM operations plan is due to CMMI on 12/1/15, however, the SIM office will be submitting draft materials to CMMI in advance of this which is why workgroup plans are due to Lynette by 11/1/15. The reason this plan is so important is because if CMMI doesn’t approved this plan initially and there is back and forth discussion, it could delay the release of round 2 funding which could delay 2/1/16 go live target and funding for next 3 years. o The plan for each workgroup meeting over the next 4 meetings will be to focus on each of the sections of the evaluation plan and also sets of measures. Goal is to focus on both
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
deliverables for evaluation plan and some set of measures. Research questions are the primary driver of these measures. Evaluation RFP went out on 9/15/15. It’s up on the procurement and SIM websites. There is an email address set-up for questions and inquiries from potential bidders. Questions and intent to bid are due on 10/9/15 and proposals are due 11/10/15. The goal is to have a vendor by February, 2016. o Conflict of interest: Lynnette indicated that a vendor cannot be an evaluator and bid for any other work. The evaluation contractor cannot evaluate the work its organization is implementing for another SIM component. o An organization can bid as a Colorado state evaluator and national evaluator, however, there will have to be administrative firewalls and separation of duties. o There was a national evaluator for round 1 chosen, however, a vendor has not been chosen for round 2 to date; this is expected to occur in about 2 ½ weeks.
Item 3: Cost Utilization Measures – Steve Melek, Mark Gritz and Ellen Kaufmann
Presentation of Milliman’s work (see webinar slides). o Steve Melek presented how SIM received $65M. The original assumed amount was $86,928,565. o Cost savings and ROI: Estimated year 3 savings: $126,587,853; ROI-gross: 1.46; Restated ROI: 1.95. Estimated 4 year savings: $211,609,607; ROI-gross: 2.43; Restated ROI: 3.26 o For the proposal, the following data was captured: Detailed commercial and Medicare data, and not as detailed Medicaid data (missing diagnoses codes in claims). Therefore, Milliman took a 4 quadrant approach for commercial and Medicare data and looked at specific cohorts and condition groups. Data reflects every individual evaluated for a calendar year. Claims were broken into major service categories which will allow further evaluation. o Biggest savings are projected to come from commercial patients with chronic medical conditions (~30% of savings in model year 3). Commercial data does include self-funded data. Second largest savings is in the Medicare population with chronic medical conditions. Medicare population also includes Medicare Advantage. o A formal letter has gone out from Payer workgroup to Medicare asking for their participation. o Projected savings are very modest or conservative compared to what has been achieved across the nation. The reason PMPM savings goes down over time is because we are ramping up savings initially and then ramping up resources spent over time in later years. One other factor included in differences in savings has to do with population trends. o It is projected that most savings PCP practices should see will come from a decrease in inpatient and ER visit service categories. Report on cost utilization measures: 1.) Potential Measures for Practice Level Reporting and 2.) Potential Measures for Evaluation. The information included are proposed measures, descriptions and stewards/notes.
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 o
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These measures are a result of the subcommittee on measures that met recently. The recommendations are for the high-level measure only, methodology still needs to be addressed Recommendations around measures for practice level reporting: Include payer and patient (out of pocket) total cost of care (TCOC) rather than solely payer TCOC. Steering Committee made this recommendation as well. Potential measures for evaluation: CAHPS measures should also include other existing surveys. Nicole King to touch base with Camille regarding “client experience of care”. The Consumer Engagement Workgroup will be making recommendations regarding consumer experience measures. All measures are based on claims data with the exception of CAHPS. These measures cover cost, utilization and access to care. Between now and next meeting, Ellen Kaufmann asked workgroup members to be thinking of what other measures should be added and how each description should be defined.
Item 4: Research and Evaluation Questions – Mark Gritz, Steve Melek & Ellen Kaufmann
There are 4 major SIM components: 1.) Practice Transformation; 2.) Payment Reform; 3.) Improving Population Health; 4.) Health Information Technology. There will be a focus broader than just the 104 practices in the first cohort targeted for practice transformation. There will also be an undetermined number of practices included in payment reform. There will also be an additional 300 practices included in SIM via telehealth. It is important to remember that it is this broader set of practices that will generate savings. The evaluation plan structure will include self-monitoring, formative (process), outcome (impact) and rapid cycle components. Research question review and discussion (Reference document titled “Potential research questions for Colorado SIM Evaluation”): o The research questions should initially focus on SIM model components. o Cost of care – Suggestion to add a question around integrated care and EHRs? o Access to care – How do we calculate? How do you define attribution? Where do the Regional Health Connectors fit in with access to care? The RHCs will be working on a broader community basis. Comments were made regarding the need to consider how to capture public health resources. o Care experiences – A suggestion was made to add the following question: Do patients attributed have fewer unmet health needs? o Delivery systems transformations: A question was asked as to whether there should be questions on spill-over effect (with-in and outside of practices). o Population health: Nicole is meeting with the Population Health workgroup to see where there is alignment or any gaps. CDPHE may be able to give the Evaluation workgroup a presentation. A suggestion was made to add a question around impact on overdose. A recommendation was made to look at different models (i.e., “lighter versions”) and whether outcomes vary.
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 Sustainability: This is a very important component to CMS. A comment was made that both qualitative and quantitative data are needed. o SIM Implementation: A comment was made that there are a lot of social determinants being looked at; are these being captured? This needs to be revisited if this is a focus of SIM. This may be able to be teased out in a potential question about different models. Ellen Kaufmann is going to work on integrating additional questions based on today’s discussion. She will create a document and post it on Basecamp for feedback from Evaluation workgroup members. Ellen asked each member to review each question and provide input on how it might be measured. A suggestion was made to create subcommittees to divide up categories and questions. No decision was made at this point regarding whether or not to do this. The deliverables are to have the research questions completed in the next couple of meetings and have the evaluation plan completed by 11/1/15. A suggestion was made to create a high level question for each research bucket to submit to CMS. o
Item 5: Key Dependencies – Ellen Kaufmann
Consumer Engagement workgroup is working on recommended consumer experience measures which will be provided to this workgroup for incorporation into evaluation measures. Policy workgroup will reach out to this group on any potential policy issues that need to be considered around evaluation. Ellen will follow-up with the Population Health workgroup as per today’s meeting.
Public Comment: None
Action Items:
Topic
Responsible Party
Email to members who have not complete COI form.
Ellen Kaufmann
9/23/15
Workgroup members
9/30/15
Think about additional measures to potentially add to cost, utilization and access to care evaluation measures .
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.
Deadline
Meeting Minutes Topic
Responsible Party
Deadline
Incorporate research questions from today’s discussion into the Research Questions for SIM Evaluation document.
Ellen Kaufmann
9/23/15
Review and submit ideas on Basecamp for how each research question (per Ellen’s pending document) could potentially be evaluated.
Workgroup members
9/28/15
Follow-up with Population Health workgroup per today’s discus- Ellen Kaufmann sion.
9/17/15
Continue drafting high-level evaluation plan to inform operations plan for CMS.
11/1/15
Ellen Kaufmann, Co-chairs, Workgroup members
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.
