Meeting Minutes Steering Committee 11/18/2015 | 1:00-3:00 PM| 4300 South Cherry Creek Dr. Rm. A5A Type of meeting
Steering Committee
Facilitator
Teri Clough
Note taker
Matthew Welchert
Timekeeper
Teri Clough
Members in Attendance: Mark Gritz, Perry Dickinson, John Douglas, Ben Miller, Paul Staley, Brian Turner, Mark Lassaux, Steve Melek, Lynnette Hampton, Camille Harding, David Keller, Liz Whitley, Vatsala Pathy, Michael Talamantes On Phone: Judy Zerzan, Joe Sammen, Mindy Klowden, Kyle Brown Ex Officio: Tara Smith, Ellen Kauffman, Rachel Short, Teri Clough, Matthew Welchert, Michele Coleman, Cambria Brown, Barbara Martin, Sydney Oelerich, Nicole King, Jean Lamont
Housekeeping:
New calendar invites sent out- please decline old invitations (from
[email protected]) and accept new invitations (from
[email protected]). December 2nd meeting- Room and building change. o Will now be held in 225 16th Ave in Rm. 9AB. Invitations for 2016 meeting will be sent out soon. o 1st Monday and the 3rd Thursday of each month from 1-3 PM.
Report out on Workforce Summit- presented by Ben Miller
Purpose of conference was to establish criteria for behavioral health to work in primary care. Got everything they needed- very big accomplishment. Facilitators were impressed with Colorado. Came out with 8 competencies distilled down from many. o They will be publicly available for comment soon. Brian Turner commented that is was a great event and he was impressed with the group’s ability to come together. He walked away feeling good about things. Sydney Oelerich: The preparation work before the conference made it a very productive day. Team collected data pre- conference and plans to collect post data as well. Completed an IRB for this collection. Next steps for gaining consensus will be to put information out in a document to disseminate. o Want to make sure we are at the right tables so organizations can use these for their competencies. o Many will use them to build off of for training programs. Constantly changing and will need to be revisited, but we now have baseline.
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 There was a quick discussion regarding communication concerns. Some committee members stated that they are not getting SIM emails. The SIM office is aware of this issue and is in the process of resolving it.
Presentation of SIM Operations Plan HIT presented by Jean Lamont
Milestones, broke out the anticipated highpoints. Jean highlighted important dates o 2016 February, SIM All-Stars will be identified. Plan to offer them additional resources to keep their progress going. March, Office of E-Health innovation will be in place. End of April, Telehealth/HIT will have a number of sites underway with broadband expansion. o 2017 Aggregation of clinical and behavioral health data. (Building out the central data hub) Central Data Warehouse Hub was included in original SIM proposal. Planned to be a robust reporting and analytical tool. By end of 2017, have data warehouse hub operational. o 2018 Telehealth strategy will be implemented. Deeper understanding of needed improvements for building of data warehouse. Will All-Stars case studies to share best practices April, we will have integrated high quality data. o 2019 All programs will be online and running. Risks and Mitigations: o Master Patient Index: attributes patients with providers and payers. Mitigation: Use the new E-Health Office to convene the various parties and provide necessary leadership. o Infrastructure Design Mitigation: working on getting independent consultant to evaluate design and determine feasibility. Because we applied with this, it is obligatory in the agreement with CMMI. o Data Quality We are aware of it as a potential risk. Questions: o Difference between broadband solutions vs. internet solutions. Is that limiting us?
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 At the time of proposal, we chose broadband. If we found compelling reasons to change strategy, then address those with CMMI. o Why was the initial reporting for practices date different than what we originally determined? May 31st was offered by Steering Committee but the SIM office ultimately chose a June date because of cost and testing. May is not a part of a standard quarter, so it would be an additional cost to feed data apart from the standard. o How do you pick all-stars? Is that part of the feedback loop? SIM All-stars will be chosen based on their progress and innovation. They will be leaders in demonstrating SIM HIT projects. There was a suggestion to Jean to amend a phrase regarding SIM ending in 2019 o Suggested to frame as the ending of the interagency agreement, but not the end of the idea. Request for clarification regarding consultants for telehealth o Jean explained that SIM has done work to find an indie consultant. Now, looking to work they have done with other states. We haven’t found one with our exact model. o To validate whether infrastructure will work or no, we have been able to find consultants who are willing to help us. To what degree is SIM offering funding and resources to expand broadband access? If they are not offering anything, to what degree do we have to put forth more broadband? Since expanding broadband may mean other things, is CMMI going to hold us accountable to broadband if we do not have the fund? CMMI will hold us accountable to telehealth and access to services. Vatsala will speak with Kyle offline about this.
Stakeholder Engagement & Practice Transformation presented by Nicole King
Stakeholder Engagement o Engagement Strategies: Workgroup Strategies: Post finalized charters to website. Public meeting and comment: want to engage the public as much as we can. How are we handling these comments? Will make sure we are transparent. Medical Home Community Forum: SIM will leverage that group to discuss topics geared towards providers and stakeholders. Outreach Tour: Provided general orientation. Feedback from the Committee: leverage this tour in the future to develop longer convening in these communities to see how best we may align communities with SIM. Annual SIM conferences.
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 Consumer Engagement work: Development of strategies Consumer Priorities identified by consumer engagement workgroup: Broken into categories- evaluation workgroup asked what consumer engagement wanted to have measured. o Question/feedback: Stakeholder engagement spoken too broadly and kind of conflated with consumer engagement. Need to be clear about them and their differences Practice Transformation o Reviewed strategy to explain practice transformation to the public and how it moves towards triple aim. o This section of the operations plan was a useful exercise in determining key dependencies with other workgroups. o
Population Health presented by Cambria Brown and Michele Coleman
Approach: CDC will review the plan in addition to CMS. o CDC provided guidance on how to structure these things. o Utilized information from existing structures and plans to help inform the SIM plan. o Engaged workgroups o Organized content along CDC Level of Care framework.
Traditional clinical approaches
Community wide approaches.
Innovative patient centered care and funding models, clinical community linkages
Outline (CDC Language): Leveraging existing policies and plans, prioritize where we want to focus, section A is about that.
A1: leveraging the other existing plans.
B1: Michelle: o Discussed state plans happening on the ground. o Non-SIM activity sources: broken down to 3 levels of CDC (listed above)
B2: Identify and update SIM-specific work:
C/D: Behavioral health/Pop Health roadmap o Drilled down into behavioral health components that they will track. o SIM identified pop health goals were broken down with metrics along the three CDC levels.
A2: Resources to determine areas of high burdens of cost. o Burden of behavioral health issues: cost of current cost of care
B3: Identify other opportunities to consider for SIM, moving forward o Coordinate efforts, launch funds together and look to specific populations.
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
Seen as a platform for tracking future movement.
Question: o Does CDC and CMS have an interagency agreement? Why are they both reviewing this plan? CDC will review population health portion. The whole plan goes to larger consulting groups. o Are these already etched in stone? No, this is a draft of the plan. Roadmap specific to SIM is based on what we are funding but additional feedback is welcome. o Is the Operations Plan posted somewhere for Committee members to review?
Presented here today to give everyone a sense of what is going into operations plan.
The final plan will be posted for public review
Policy sections presented by Tara Smith
Described the layout of the plan o There were some specific templates: it may seem awkward, but we are working around template’s wording.
How SIM will coordinate public and private efforts; Alignment with Government; Internal SIM processes and procedure. o Referenced State of Health plan. In terms of coordination, we are trying to take advantage of those partnerships out there, both private and public. Leveraging regulatory authority: What they are most asking about regulatory policy and how we are relating with other state agencies? o Certificate of needs statues Colorado does not have one. Try to use the community of needs assessments Education programs and training o Policy priorities: Master chart outline of what the policy workgroup has identified as categories of issues. A document we can make available to you for further review. Alignment with initiatives: o CMMI gave us a laundry list o Federal and state Fraud and abuse protections: o Answer at this time: we are going to monitor this but do not see anything at this time. o Will rely on the structures that exist. o As the models become more complex, we will monitor.
Workforce
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
Workforce is weaved throughout most sections of the operations plan Goals o Currently in draft phase o Summit goals Convening of healthcare workforce throughout the state. We want to be a leader in the state when it comes to educating, pipelines, and aligning all current efforts. Questions: o What are you really focusing on in the unlicensed workforce? Patient navigators and community health workers. Care coordinators are also not licensed. There are many parts of integration team that are not registered. o Is this existing data or do you envisage new data? Likely to use existing data. Steve Holloway is doing a lot of this already. We do not want to duplicate. Want to be as efficient as possible. Generating policy recommendations when it comes to healthcare innovation across the state… Trying to think of how policy workgroup can prioritize.
Payment Models presented by Judy Zerzan
Multi-payer Collaborative met last Friday o Talked about aligning with CMS Learning Action Network’s levels of alternative payment models. Agreed to use CPC models as core set with flexibility to utilize other models. Payers Workgroup o Spent a bit of time talking about the flow of data in primary care. o Discussions around what co-location and innovation mean. o Operations Plan’s section of payment models will include all discussions with payers to date and the draft MOU Payers Section of the plan will demonstrate what the Payers are committing too. o Ben Miller is happy to offer up the definition frameworks and some of the evidence behind those definitions. Committee members expressed confusion with difference between co-location and integration o There was a decision for practices to use IPAT: Would be helpful to go over that for definitions piece Steering Committee needs to have a conversation about having a tool that Payers use to assess a practice versus what practice transformation and other workgroups are using to measure practices. o This will be discussed at the next meeting
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 Given the importance of language and how groups think of the same things in different ways, we will have to go back to it at intervals. o Knowing how specific these things are, especially as we talk this out, we need to keep ourselves aligned on what we mean. We have to pay really close attention to definitions o What should Committee members be prepared to discuss? Some specific materials we can bring forth to review and refresh on so we can do this work in clearer terms. From the original proposal, workgroup meetings, and making a format for how to have this conversation in a meaningful way. o
Evaluation presented by Ellen Kaufmann
Core Progress metrics, program monitoring, data sharing o Model participation: includes giant table of what we will be tracking, defining numerators/denominators, etc. General overview of model participation (e.g. how many beneficiaries in practices are in the model) o Participation in the population health initiatives o Participation in HIT Real-time updates Provider organizations enabled for telehealth o Payer Participation metrics Payers will provide data on numbers supported but it will be on a de-identified basis. Model performance metrics: cost of care and utilization metrics o Clinical quality measures: CAHPS measure removed Multi-payer Collaborative asked for its removal as a measure of consumer experience. Going to work with state evaluator and practice transformation organizations to come up with a better measure for SIM. o Access to care measures- aligned with our CQMs Program monitoring and reporting via the evaluation plan Taken from evaluator proposals Self-monitoring and process component: Qualitative o Impact and outcome Quantitative measures o Rapid-cycle improvement component Quarterly Payment piece
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 Milliman will help us with this data and reporting ROI o Evaluation questions Will work with state evaluator to refine once they are selected Included feedback from workgroups Data sharing component RCI is federal evaluator Legal data sharing mechanisms need to be in place Outlining the data flows that need to take place CIVHC will work with Milliman, state evaluator, data aggregator to report out on quarterly basis. 76 practices in SIM get access to RISE for claims data Other potential data sources we may choose to leverage Practice transformation facilitation notes HIT vendors and broadband expansions etc. o Risk Mitigation table Getting data, attributing changes to SIM, lack of time to measure outcomesrapid cycle feedback. Component piece: Subject to change based on contract progress. Questions: o Will the health homes be considered for the RISE tool? SIM office still needs to consider that Measures are the same for reporting so may be beneficial for health homes.
Timeline for Operations plan after today…
December 1st the draft is submitted to CMS CMS will likely come back with revisions Once all revisions are made and document is finalized, it will be shared publically o This will most likely be around February/March
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
Deadline
Decline old meeting invites and accept new ones
Committee members
12/2/15
Send out 2016 calendar invitations
Rachel Short
12/2/15
Review definition material to facilitate discussion in Steering Committee about streamlining definitions
Rachel Short
12/2/15
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.
