Meeting Minutes Evaluation 09/30/2015| 09:30-11:30AM | HCPF 303 E. 17TH Ave., Denver, CO 80203, Room 11D Type of meeting

Evaluation

Co-chairs

Mark Gritz, Steve Melek

SIM Office Liaison

Ellen Kaufmann

Members in Attendance: Mark Gritz, Steve Melek, Doug Muir, Michael Rice, Jordana Ash, Liz Bayliss, Lisa Clements, Brad Sjostrom, Mark Johnson Guest: Kristin Paulson, Lloyd Guthrie, Alison Laevey, Emily Haller, Don Sutton Ex Officio: Ellen Kaufmann, Tara Smith, Lynnette Hampton

Discussion Items: SIM Office Update  CDPHE/Denver Foundation Joint RFA closes  Oct 19th LPHA RFA released  Oct 26th Practice Cohort 1 RFA closed  Nov 9th–13th SIM Roadshow  Nov 10th Evaluator RFP closes  Nov 17th Workforce Summit Evaluation Questions Update  Sent survey to other workgroups to solicit feedback on high-level evaluation questions for the Operational Plan, due to CMS on December 1 o Feedback requested by Friday, October 23 o Ellen will post full survey results to Basecamp and present summary at next meeting CIVHC Presentation – Proxy measures in APCD  Kristin Paulson and Llyod Guthrie from CIVHC presented potential proxy measures for the 18 clinical quality measures and cost and utilization measures  These proxy measures can be pulled from the APCD and be reported to CMS in addition to the clinical quality measures reported by practices participating in the practice transformation cohort (will supplement, not replace clinical quality measures reported by practices)  CIVHC is utilizing these proxies to calculate baseline by the end of this pre-implementation year (by Jan 31, 2016)  What sub-groups will we be able to examine utilizing APCD data? o Geography (county, 3-digit zip, region), age group, gender o Race/ethnicity is unreliable, income is not available  Self-insured will start submitting claims next year (January), will be available in warehouse around June Clinical Quality Measures Anxiety

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 

Drop anxiety Rx fill for secondary adherence? o Need list of common anxiety meds o CO clinical guidance on anxiety o Limit to those that have anxiety Dx

Substance Use Disorder  Only illicit drug use is barred by CFR Part 2  What about tobacco and alcohol? o Tough to get via claims o SBIRT screening claims? Hypertension  % of HTN patients with 2 or more Rx o Does this mean they have it controlled or they are trying to control? o Many need 2 Rx to control  Blood pressure would be ideal  Specific ICD for controlled hypertension? Tobacco  Included in Substance Use Disorder composite measure; removing as standalone measure  Other data sources: o CO Quit Line o BRFSS (every 1-2 years) o Is increasing or decreasing utilization better? Obesity  Drop incidence and prevalence of Type II diabetes  Nutritional counseling covered by very few plans o Limit to those who have DX – how many have received billable counseling Breast Cancer Screening  Can deliver per specs Colorectal Screening  Can deliver per specs Asthma  Split peds and adults, Dx by age group  Drop initial Rx fill o Refills more reliable and informative Influenza Immunization  Will not integrate data from CDPHE into APCD, will use in addition to APCD data o Number of immunizations given  Tricky, many free programs Comprehensive Diabetes Care  Can create composite

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 

% receiving all 3; % receiving 2 of 3 (and also report all 3 separately)

Diabetic Blood Pressure Management  % of diabetics with HTC Rx fill o Concern about precision – limit to those with HTN Dx? o Look at regular refills, for maintenance Diabetic LDL Management  Tabling, pending guidance from CMS  Still capture in baseline, may need to report on it later  Lipid or LDL? o Will ask Jonathan Mathieu o Look at both LDL and full lipid panel Ischemic Vascular Disease (IVD)  Tabling, pending guidance from CMS  Still capture in baseline, may need to report on it later Screening for Future Fall Risk  In primary care settings, not hospitals  Liz Bayliss will send algorithm for osteoporatic fractures, including age breakdown  No standard fall risk screen (Minnesota has one that can be coded)  For operational plan – we don’t have a standard screen for baseline purposes o Can work towards – policy? o Get out of practices via eCQM Depression  Filled o o o

Rx for depression meds Sometimes prescribed for anxiety, smoking cessation, etc Limit to those with depression Rx ID list of drugs primarily used for depression, no cross-over  Reach out to Ben Miller, Depression Treatment Center

Post Partum Depression Screening  “Pregnancy related depression”  Screen within 6 months of delivery  Children’s well-child visits o 6 weeks o Coded under mom o Recently – can screen mom under child’s code Developmental Screening Cost and Utilization Measures Total Cost of Care  Robert Wood Johnson Foundation study on total cost of care  Align with CPCi  Work with federal CMMI evaluator

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 

Health Partners endorsed NQF for TCC measure, already built in APCD, includes risk adjustment

Inpatient Admissions  Can deliver per specs Psychiatric Admissions  Need to dig into behavioral health data (this is first request to use it)  BHO (Medicaid) and commercial data  Milliman looking at this Inpatient Readmissions  Need guidance from CMS – more than 1 methodology, prefer NQF  Look at 90 days as well Inpatient Psychiatric Readmissions  Look at 12-17, 18+, 65+  Risk adjustment will be challenging (30/90 days, length of stay) Emergency Department Visits  Count all – stratify if possible  Keep observation separate (ED vistis doesn’t normally include observation -> admit) Psychiatric Emergency Department Visits  Count all (all ED, all psych ED) Follow-up after Hospitalization for Mental Illness  Follow-up with behavioral health provider? Out-of-Pocket Expenses  For overall PMPM (vs. by condition or procedure)  Population breakdown: Medicaid, Medicare, commercial  Report annually CAHPS  Report annually  Need to know which CAHPS questions o Consumer engagement has recommended (based on Medicaid tool) Consumer Engagement Update  Four consumer priorities  Recommended CAHPS questions  Recommended evaluation considerations  Slides posted to Basecamp Risk Mitigation  Risk: getting all of the necessary data to track progress toward goals

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 Mitigation strategies: Will need to take multiple “looks” at the same questions (i.e. eCQM and claims proxies); multiple data sources; examine a sub-set of practices; key informant interviews (qualitative methods) Risk: attributing impact to SIM efforts o Mitigation strategies: framing as SIM “contributed to” versus “caused;” look at differences between practices participating in both SIM and CPCi versus just SIM; sensitivity analysis; difference in differences; interrupted time series; “preponderance of evidence;” longitudinal association Risk: Insufficient time to measure impact (see change in outcomes) o Mitigation strategies: measuring intermediate outcomes; rapid-cycle feedback; examine impact on individual providers and consumers; analysis at county level; sub-analyses of high-performing practices o Don’t expect radical shifts in 80% of the population in just 3 years o If investing in preventative care, utilization will go up in short term o

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Public Comment: None

Action Items: Topic

Responsible Party

Deadline

Input from CMS on utilizing NQF vs. CMS methodology (readmissions)

Ellen

10/28/15

Align with CPCi total cost of care methodology

Ellen

10/28/15

Post survey feedback on evaluation questions to Basecamp

Ellen

10/28/15

Solicit input from other workgroups on high-level evaluation questions

Ellen Kaufmann

10/23/15

Continue drafting high-level evaluation plan to inform operations plan for CMS.

Ellen Kaufmann, Co-chairs, Workgroup members

11/1/15

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.