Meeting Minutes Payment Reform Workgroup 04/13/2016 | 9:00 – 11:00 MT | CDPHE Type of Meeting: Chairs:

Workgroup Meeting Judy Zerzan, Paul Staley

SIM Representative:

Nicole King, Vatsala Pathy

Note Taker:

Matthew Welchert

Members in Attendance:

Tracy Fennern, Jay Brooke, Carol Plock, Adela Flores-Brennan, Dave Downs, Kelly Henry, Whitney Connor, Harriet Hall, Steve Melek, Julie Turcheck, Patrick Gordon,

Ex Officio:

Ellen Kaufmann, Barbara Martin, Scott Wasserman.

Action Items and Decisions: 

Provide any additional comments to the SIM attribution methodology on Basecamp.

Discussion Summary: 

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SIM Office Updates: o The first practice transformation cohort has been finalized.  A good diversity of practices, geographic representation, wide spread of participating health systems, an abundance of pediatric and family practices, mixture of Medicaid coverage, and 32 CPC practices. Multi-Payer Collaborative Meeting Update: o MPC met 2 weeks ago and discussed need for alignment of communication and completion of contacting practices to clear up confusion and ensure a connection between practices and payers.  A list of practices payers will be supporting will be completed by 4/30; 30 days later the SIM Office will have connected with each practice site regarding who will be their payer support and primary contact.  Further connections will be established with the Practice Transformation Workgroup in order to encourage ongoing discussion and focus. 1

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agenc ies.

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The MPC will take up the timeframe as an opportunity to work on the messaging and prepare communication for practices  Payers in SIM will use a national framework for measuring level of alternative payment which allows us to define alternative payment in the state. This portion is part of ongoing discussion; SIM will attend a national Learning Action Network meeting this month to discuss the framework further. CPC+ Announcement: o A brand new announcement; more information and understanding will come in time, but initial reaction is very positive.  CPC+ will be a kind of narrative continuation of the work laid forth in CPC and currently being done with SIM.  It expands the number of states and practices which will be involved.  Presents a new opportunity to involve Medicare participation.  An application process will be required, first by the MPC then by the practices. However, former CPC practices and SIM states will be given a preference in the application process.  There will be a lot of opportunity for alignment between SIM and CPC+, they will have to be viewed as integrated elements; e.g. a practice in SIM will be successful in SIM and will not need to drop out for CPC+.  Will provide added resources to practices which may help reinforce what we need to accomplish with SIM while SIM can help practices be successful with CPC+. Alignment will be key; the MPC does not seem them as different entities and does not want to treat them as such. o There will be 2 tracks of payment in CPC+, and the second track is explicitly focused on complex populations with mental health aspects. We will have to see how well that links with behavioral health integration; but an area wherein alignment may be facilitated and SIM-CPC+ can be leveraged together.  Standard Attribution Methodology for SIM Reporting and Evaluation: o 3M serves as the APCD data manager, however, CIVHC has developed its own standard attribution methodology which provides a stable testing platform.  Recommended lookback period will start from 12 then 15 and finally 24 months.  CIVHC has 4 models currently that it is testing. Currently, the model using NPPES as a source for provider taxonomy codes produced the highest percentage attributed.

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The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agenc ies.

Meeting Minutes 

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The method will need to be tested with SIM cohort to make sure the taxonomy codes are represented correctly, as there could be potential issue with specialist codes.  OB/GYN will be included as well. o Recommendations to the Attribution Methodology:  No specialists will be included.  FQHCs will be included.  Clinical specialists involved in prescription would be included. Presentation on Risk Adjustment by Ksenia Whittal and Steve Melek of Milliman: o Slides covering the presentation are on the basecamp and the recording is publicly available on the website. o Questions and Comments:  Is there any way to incorporate socio-economic impacts on a rick adjustment rating?  In theory, yes. Different coefficients could be calibrated in the scores given but the issue is finding reliable data that is useable for such a measure. Should such data become available, even in a smaller scale such as with the cohort then that could become possible.

Referrals to the Practice Transformation Workgroup: o N/A

Public Comments: n/a

Next Meeting:

5/31/2016 -- 9:00–11:00 AM – HCPF 303 E. 17 th Ave. 11B

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The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agenc ies.