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Colorado SIM Program Charter

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Revision History Date

Nature of Change

By

7/24/15

Original Draft

Jean Lamont

7/30/2015

Governance and Workgroup updates

Nicole King

8/4/15

CMS Disclaimer updated

Jean Lamont

8/11/15

Policy Workgroup modification

Tara Smith

9/10/15

Final uploaded to SharePoint site

Jean Lamont

10/11/15

Policy Workgroup modification

Tara Smith

11/12/2015

HIT Modification

Jean Lamont

2/22/16

Periodic progress updates

Jean Lamont

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Table of Contents Revision History ..........................................................................................................................................................2 Overview.....................................................................................................................................................................5 Program Vision ...........................................................................................................................................................5 Program Governance and Organizational Structure ..................................................................................................5 Figure 1: SIM Governance Model ...........................................................................................................................6 Centers for Medicare and Medicaid Innovation (CMMI) .......................................................................................6 SIM Office ...............................................................................................................................................................6 SIM Advisory Board ................................................................................................................................................7 Steering Committee................................................................................................................................................7 Workgroups ............................................................................................................................................................8 Sub-Workgroups .....................................................................................................................................................8 Public Input .............................................................................................................................................................8 Workgroup Objectives ................................................................................................................................................8 Consumer Engagement ..........................................................................................................................................8 Evaluation ...............................................................................................................................................................9 Health Information Technology .............................................................................................................................9 Payers .................................................................................................................................................................. 10 Policy ................................................................................................................................................................... 10 Population Health ................................................................................................................................................ 11 Practice Transformation ...................................................................................................................................... 11 Workforce ............................................................................................................................................................ 11 Common Expectations of all Workgroups ........................................................................................................... 12 Summary Program Description ............................................................................................................................... 12 Anticipated Measures of Success ............................................................................................................................ 12 Assumptions and Constraints .................................................................................................................................. 13 High level Risks ........................................................................................................................................................ 13 Summary Milestones ............................................................................................................................................... 14 Summary Budget ..................................................................................................................................................... 16

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

4 Stakeholders ............................................................................................................................................................ 16 Human Resources .................................................................................................................................................... 16 Sponsoring Authority............................................................................................................................................... 16

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Overview The purpose of this Charter document is to provide an overview of the SIM governance and organizational structure for the initiative, as well as to outline high-level objectives for each of SIM’s eight stakeholder engagement workgroups.

Program Vision Vision: To be the catalyst for collaborative culture change that will drive healthcare transformation for all citizens of Colorado. This will create a coordinated, accountable system of healthcare to improve the health of Coloradoans in measureable ways. Goal: To improve the health of Coloradans by providing access to integrated physical and behavioral healthcare services in coordinated systems, with value-based payment structures, for 80% of Colorado residents by 2019. All SIM efforts are in support of the Triple Aim: improving the patient experience, improving population health, and lowering per capita costs.

Program Governance and Organizational Structure Figure 1, below represents the governance model for the SIM Program.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Figure 1: SIM Governance Model Centers for Medicare and Medicaid Innovation (CMMI) CMMI is part of the Centers for Medicare and Medicaid Services (CMS), which funds the Colorado SIM Initiative. The SIM Office is accountable to CMMI for all deliverables. CMMI provides technical assistance to the SIM Office and monitors and evaluates progress toward grant-specified objectives and goals.

SIM Office The SIM Office was created by executive order of Governor John Hickenlooper. Vatsala Pathy was appointed by the Governor as director of the Colorado SIM Office. Roles and responsibilities of the SIM Office include, but are not limited to:   

Coordinating with (CMS), Office of the National Coordinator, and the Colorado Governor’s Office to ensure all deliverables are met. Establishing standards for the SIM Initiative. Executing and monitoring contracts with vendors.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Reporting on progress toward SIM goals and objectives. Ensuring that all legal, regulatory, and administrative requirements are met. Hiring or contracting staff, as needed, to fulfil the work outlined above.

The SIM Office staff will provide direction and support in order to make the Workgroups, Steering Committee, and Advisory Board successful in their goals and objectives for the benefit of all associated with this Program. The SIM Office proposed and adopted the following structure in order to best engage stakeholders, create input avenues for constituent groups who will implement the objectives of the Program, and sustain a collaborative environment for this Program and the future. The SIM Office is the sponsoring authority for the SIM Initiative.

SIM Advisory Board As written in the by-laws, the SIM Advisory Board “provides advice, oversight, and guidance over the management of SIM grant funds. The Board’s oversight function includes oversight of the strategic direction of building the Colorado healthcare framework, ensures sustainability of the framework, and reviews and analyzes results achieved in payment reform and integration of care. The Board provides recommendations to the SIM Office about how to better integrate behavioral and physical health in Colorado.” Nine Advisory Board members have thus far been appointed by the Governor’s Office of Boards and Commissions.

Steering Committee The Steering Committee is made up of the chairs and co-chairs of each workgroup and is moderated by the SIM Operations Manager. The Steering Committee is charged with:    

Reconciling issues and timeline dependencies brought forth by the SIM Office or workgroups. Establishing quality metrics for the SIM Initiative. Developing mitigation strategies for identified risks. Ensuring that information is communicated across workgroups.

The SIM Steering Committee may refer issues to the SIM Advisory Board for further guidance and recommendations.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Workgroups Eight Workgroups have been established with co-chairs providing leadership as subject matter experts in their field. A SIM Office staff member will provide support to each Workgroup. Workgroups consist of approximately 17 members, who were selected in a competitive application process by the SIM Office based on their subject-matter expertise. To achieve the objectives of all Workgroups, interaction and coordination of efforts is expected across the various Workgroups. Please see the “Workgroup Objectives” section below for a list of all workgroups and their attendant roles and objectives.

Sub-Workgroups Sub-workgroups may be formed on an ad hoc basis to address specific topics that require more intensive work or in-depth expertise than is normally handled in an existing workgroup. Subworkgroups may include members of multiple workgroups as well as subject matter experts, consumer representatives, or other appropriate participants who do not formally sit on a particular workgroup.

Public Input Public input plays a critical role in guiding the development of SIM’s strategy and approach. All Advisory Board, Steering Committee, and Workgroup meetings are open to members of the public, both in person and by web-based conference call. Each meeting includes a designated period for public comment. A recording of each meeting, along with its agenda, minutes, and any related documents are publicly posted on the Colorado SIM Website at: www.colorado.gov/pacific/healthinnovation/meetings-10. Members of the public may submit comments to the SIM Office via the website at https://www.colorado.gov/healthinnovation/contact-us-73.

Workgroup Objectives Consumer Engagement The Consumer Engagement Workgroup will ensure that the needs and perspectives of consumers inform all aspects of SIM’s work. Specific objectives are to:

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

9 1. Consult and advise other workgroups, the SIM Advisory Board, and the SIM Office on consumer engagement related issues, 2. Take on periodic ad hoc assignments related to consumer engagement, as assigned by the SIM Office, 3. Make recommendations about how integration of physical and behavioral health could improve the consumer experience, and 4. Ensure that consumers are part of the SIM process and that their interests and needs are met.

Evaluation The Evaluation Workgroup will provide recommendations regarding how to effectively measure and evaluate the outcomes of the SIM Initiative. Specific objectives are to: 1. Finalize an external evaluation plan that assesses the effectiveness of SIM interventions outlined in the SIM proposal to CMMI, and 2. Create a quantifiable set of metrics that measures processes and outcomes on both the individual and population level.

Health Information Technology The Health Information Technology Workgroup will provide recommendations and requirements so that those charged with implementing health-related Information Technology solutions, tools, and systems can complete work in support of the SIM objectives. It is anticipated that most if not all Workgroups will have technical needs, and may need the advisory expertise of this Workgroup. Specific objectives are: 1. Develop a Quality Measurement Reporting Tool, 2. Expand telehealth capabilities throughout the state, including broadband expansion, an implementation strategy including technical assistance for providers, and the establishment of resources for providers, patients, and supporting organizations, 3. Acquire and Aggregate clinical and behavioral health data, 4. Integrate claims data, resulting in the analytical capability to evaluate electronic Clinical Quality Measures, and deliver value based payment models, 5. Create the integrated data infrastructure with robust data quality standards, including clinical, behavioral health data, and claims data, to support population health, and 6. Create reports and the capability to disseminate data to other sources or data stores.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Payers Comprised of representative from multiple public and private payers, the Payers Workgroup will provide recommendations on designing an alternative payment model that supports integration of behavioral health and clinical care. Specific objectives are to: 1. Develop a definition of key terminology related to payment models, 2. Collaborate with other workgroups to define a set of common measures related to payment reform, 3. Clarify how SIM will define and measure its goal of providing 80 percent of Colorado residents with access to healthcare services in coordinated systems, with value-based payment structures, and identify key steps toward achieving this goal, and 4. Recommend minimum criteria for participation in practice transformation cohorts.

Policy The Policy Workgroup will assess the legislative, regulatory, and administrative context in which SIM operates. This includes reviewing and analyzing statutes, regulations, rules, policies and procedures, at the federal, state and local level, and identifying strategies for advancing policy actions that will drive the achievement of SIM goals and objectives. Specific Workgroup objectives are to: 1. Identify policy barriers that may impede the progress of various SIM initiatives, and make recommendations regarding how these challenges can be overcome; 2. Stay informed of any current or proposed changes to state or federal law that may impact SIM initiatives, and report the opportunities or risks presented by such changes to the SIM Office, SIM Workgroups that may be impacted, and the Steering Committee and Advisory Board as needed; pro-actively identify opportunities to influence and shape the direction of policy actions and priorities at the state and federal level; 3. Monitor other State and Federal reform initiatives to ensure that SIM policy approaches are in alignment with other health care innovation efforts; engage with the public and private institutions and organizations involved in such activities, to inform current programs and propose new ideas for future initiatives; 4. Make recommendations on new policies that should be implemented to support the advancement of SIM goals; and 5. Develop an overarching policy framework that: a) facilitates future collaboration and alignment around state health policies and initiatives, b) fosters and supports innovative, evidence-based, person-centered methods of delivering and paying for health care services; and c) provides a sustainable pathway for achieving SIM’s short- and long-term objectives around providing access to integrated physical and behavioral health in primary care settings, applying value-based payment structures, improving population health, and expanding health information technology efforts.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Population Health This Population Health Workgroup will work to ensure that SIM Interventions improve health outcomes at the community and population level. Specific objectives are to: 1. Define “population health” and associated terms as they relate to the SIM Initiative, 2. Ensure that SIM strategies and approaches address the social determinants of health, 3. Work with the evaluation workgroup and Steering Committee to align population based metrics with indicators of success at the individual level, 4. Recommend strategies to reduce stigma regarding behavioral health at both the individual and population levels in the State of Colorado, 5. When requested, provide guidance on the best manner to achieve deliverables outlined in the Interagency Agreement between the SIM Office and the Colorado Department of Public Health and Environment, and 6. Provide recommendations regarding the inclusion of public and community health initiatives in the work of Regional Health Connectors.

Practice Transformation The Practice Transformation Workgroup will develop strategies to improve and integrate healthcare across approximately 400 practices chosen to participate in transformation efforts throughout Colorado. Specific objectives are to: 1. Collaborate with Health Information Technology, Population Health, Payers and Evaluation workgroups to determine minimum criteria for participation in practice transformation cohorts, 2. Ensure that practices chosen for participation represent a variety of affiliation models (independently owned vs. system affiliated) and reflect the diversity of the geographies and populations they serve, 3. Make recommendations regarding the definition of practice transformation and what specific interventions transformation efforts will include, and 4. Recommend a set of practices for each transformation cohort.

Workforce The Workforce Workgroup will assess and plan for the development and standardization of the workforce needed to effectively deliver integrated care. Specific objective are to: 1. Make recommendations regarding minimum qualifications, credentialing, training, and job descriptions for new positions within the workforce (e.g. Regional Health Connectors), 2. Offer guidance on the best manner of delivering training to existing providers in order to promote successful integration of behavioral and physical health, and

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

12 3. Propose strategies that create standardization in the way that existing, but largely unregulated positions (e.g. Community Health Workers), interact with health care integration efforts throughout Colorado.

Common Expectations of all Workgroups All Workgroups are tasked with: 1. the identification of risks and possible mitigation strategies and referring those to the Steering Committee in a timely manner, 2. researching, discussing and making recommendations for the objectives within their scope, 3. collaborating with other Workgroups when objectives overlap, 4. informing the Steering Committee on at least a monthly basis regarding their recommendations, 5. referring to the Steering committee those issues or recommendations that overlap Workgroups, so that dependencies can be identified and issues resolved and 6. having been selected to serve in a Workgroup, active participation is expected and, therefore, attending at least 75% of the scheduled meetings is respectfully requested.

Summary Program Description SIM (State Innovation Model) is an initiative of the Center for Medicare and Medicaid Innovation (CMMI). Colorado was awarded a $2 million planning grant and a $65 million grant for model design and testing assistance, to develop and test models for transforming healthcare delivery and payment systems.

Anticipated Measures of Success By December 2016, a Master Patient Index will be implemented providing the ability to securely and accurately identify individual patients, to support accurate data aggregations from disparate sources of healthcare data and robust quality analytical data to support payment reform models. By June 2017, a Provider Directory for Colorado, including clinical and behavioral health providers and what services they provide, will be available to accept provider information updates. By April 2018, a robust healthcare data repository will be implemented. This repository will capture and store the integrated clinical, behavioral, and claims data with the capability to disseminate data to other sources and produce reports reflective of integrated data.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

13 By June 2018, 400 practices will have under gone initial practice assessment regarding the capability to capture appropriate quality measures for their practice, received a baseline report about their performance and at least one additional quarterly report reflecting their progress. By September 2018, at least 4 grants will be awarded to communities to increase awareness of integrated healthcare. Recipient communities will have exhibited collaboration and evidence-based best practices, as noted in their grant applications. By January 2019, 80% of the state’s population, will have access to integrated clinical and behavioral coordinated health care services with value-based payment systems or alternatives to fee for service models.

Assumptions and Constraints Payers, healthcare providers, and technology solution providers remain collaboratively engaged. Funding sources remain available. All governmental structures remain supportive.

High level Risks Implement significant portions of Health Information Technology infrastructure, so that integrated healthcare and payment reform models are seen as “the norm” before the tenures of the Governor and several key lawmakers come to an end. Effectively quantify savings as a result of SIM-grant work, and apply those monies to fund sustainability efforts for the future. Key personnel remain assigned to the Program.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Summary Milestones Year

Task

Due Date

Status

12/1/14 12/15/14 1/2/15 1/31/15

Complete Complete Complete Complete

5/30/15 6/10/15 6/30/15 6/30/15 8/30/15 11/1/15 11/15/15 11/30/15 12/31/15

Complete Complete Complete Complete Complete Complete Complete Complete Complete

2/1/16 3/1/16 4/30/16 5/30/16 8/1/16 8/30/16 10/1/16 11/1/16 11/30/16 12/15/16

Complete Planned Planned Planned Planned Planned Planned Planned Planned Planned

Pre-Award September 2014 – January 2015 Proposal Development Complete Award granted SIM Office established Budget approved Year One February 2015 – January 2016 Quarterly Progress Report Quality Measurements established Eight Workgroups established Governance Structure established Quarterly Progress Report Technology Plan complete Operational Plan complete Quarterly Progress Report First Cohort of 100 Practices Selected Year Two February 2016 – January 2017 First Cohort of 100 Practices start Quarterly Progress Report Annual Progress Report Quarterly Progress Report Evaluation of First Cohort Quarterly Progress Report Quarterly Population Health reports start Second Cohort of 150 Practices Selected Quarterly Progress Report Clinical and Behavioral Health Database with Master Patient Index completed

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

15 Year Three February 2017 – January 2018 Second Cohort of 150 Practices start Quarterly Progress Report Annual Progress Report Quarterly Progress Report Integrated Provider Directory complete Evaluation of First and Second Cohorts Quarterly Progress Report Third Cohort of 150 Practices Selected Quarterly Progress Report

2/1/17 3/2/17 4/30/17 5/30/17 6/15/17 8/1/17 8/30/17 11/1/17 11/30/17

Planned Planned Planned Planned Planned Planned Planned Planned Planned

2/1/18 3/1/18 4/15/18

Planned Planned Planned

4/30/18 5/30/18 6/30/18 8/30/18 9/15/18

Planned Planned Planned Planned Planned

11/30/18 1/15/19

Planned Planned

3/2/19 4/30/19

Planned Planned

Year Four February 2018 – January 2019 Third Cohort of 150 Practices start Quarterly Progress Report Integrated Repository with Clinical, Behavioral Health and Claims data complete Annual Progress Report Quarterly Progress Report Evaluation of 400 Practices complete Quarterly Progress Report At least four grants awarded to increase awareness of integrated healthcare advantages Quarterly Progress Report Documentation of at least 80% of Coloradoans have access to integrated healthcare

Post Grant Period Quarterly Progress Report Final Report to CMS

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

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Summary Budget The awarded design and testing grant covers the period of February 2015 through January 2019.

Category Administration Practice Transformation Health Extension Agents Population Health Health IT Evaluation Total Implementation Grant:

Amount (in millions) $ 5.10 $ 25.60 $ 5.50 $ 7.80 $ 12.70 $ 8.20 $ 64.90

Stakeholders Stakeholder groups to this Program include, but are not limited to, Colorado citizens, healthcare providers, healthcare payers, Colorado regulatory agencies, the Office of the Governor of Colorado, the Colorado legislature, the Colorado eHealth Office of Innovation, The Centers for Medicare and Medicaid Services, Office of the National Coordinator, SIM-related Subject Matter Experts from various other states, contracted technology providers, and selected academic professionals. For a detailed list of stakeholders, please contact the SIM Office.

Human Resources The SIM Office is responsible to hire or procure appropriate staff to facilitate the success of the Program. Program Managers will be assigned to support the Workgroups, and any committees and boards that come to exist within the period of this Program.

Sponsoring Authority The SIM Office is the sponsoring authority for this Program, under the guidelines of the funding authority (Centers for Medicare and Medicare Services), and the Office of the Governor of the State of Colorado.

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. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.