Maine SIM Evaluation Subcommittee June 2015

June 24, 2015

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Today’s Agenda

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Welcome, Introductions, and Goals for Today’s Meeting

• Provide a status update on SIM Self-Evaluation provider, key stakeholder, and consumer interviews

• Provide input to Crescendo and Market Decisions regarding format and what to include in reports

• Review risks previously identified and identify any additional risks that require discussion

• Review goal setting process for Core Measures

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Today’s Agenda

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Meeting Minutes

Please see meeting minute handouts for May 27th

•Suggested edits from Committee members?

•Additional questions or clarifications?

•Motion to approve as written or amended

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Today’s Agenda

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SIM Self-Evaluation: Provider/Stakeholder interview update

Maine SIM Provider / Key Informant Interviews Update as of June 18, 2015

Provider interviewsCalls made: 379Interviews scheduled: 103Interviews completed**: 100Declined to participate: 1Voice mails left: 199Messages (live) left: 39Spoke with target: 27Calls - no message left: 29Other call responses: 0

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SIM Self-Evaluation: Provider/Stakeholder interview update

Maine SIM Provider / Key Informant Interviews Update as of June 18, 2015

*Types of Completed InterviewsMedicaid Health Homes including PCMHs 59Behavioral Health Homes 18Community Care Teams 7Key Informants 16Interviews completed: 101Cumulative Progress Medicaid Health Homes including PCMHs (57 total goal) 105%Behavioral Health Homes (20 total goal) 90%Community Care Teams (7 total goal) 100%Key Informants (16 total goal) 113%Interviews completed: 103%

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SIM Self-Evaluation: Provider/Stakeholder interview update

•Committee to Provide input to Crescendo regarding final report format

and other desired information

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Today’s Agenda

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SIM Self-Evaluation: Consumer interview /survey update

Consumer Interview Outreach and Completion Data as of 6.16.2015

HH-Adult

HH-Adult

ControlHH-Child HH-Child

ControlBHH - Adult

BHH-Adult

Control

BHH - Child

BHH-Child

ControlTotal

Sample Records 1700 550 1400 600 878 400 99 51 5678

No Phone Number 444 181 593 221 154 98 24 18 1733Invalid Phone Number 395 135 241 111 264 99 21 5 1271

Refusals 45 7 13 5 29 10 1 1 111Completes 332 81 248 110 216 85 37 13 1122Total Final Disposition 1216 404 1095 447 663 292 83 37 4237

Remaining Sample 484 146 305 153 215 108 16 14 1441

Outreach Attempts 3813 3215 3543 377 10948

Mailing Sample 839 316 834 332 418 197 45 23 3004Returned as Undeliverable 34 44 25 0 103

Returned Complete 69 12 36 17 47 23 1 2 207

Total Completed Surveys 401 93 284 127 263 108 38 15 1329

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SIM Self-Evaluation: Consumer interview /survey update

•Committee to Provide input to Market Decisions regarding final report

format and other desired information

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Today’s Agenda

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Risk Identification and Discussion

• Risks previously identified– Delays in access to Medicare data

– Potential delays in timely access to Medicare data due to time lags in release of data

– Potential delays in timely access to Commercial data due to time lags in release of data

– Lack of access to clinical data for evaluation analysis purposes

• Any new risks from the committee?

• Discussion

• Follow-Up & Next Steps

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Today’s Agenda

SIM Maine Leadership TeamMessage to SIM Steering Committee

June 24, 2015

Development of Targets for SIM Core Evaluation Measures

SIM Maine Leadership Team Guidance to the SIM Steering Committee

The SIM Maine Leadership Team has directed the SIM Steering Committee to finalize SIM core evaluation measure targets across all payor

populations

These evaluation targets will be set for, and reported on, only at the highest payor levels

MaineCareMedicare

Commercial

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SIM Evaluation Measure Targets

• The State Innovations Model cooperative agreement is a test intended to evaluate the impact of those transformative changes implemented to accomplish the Triple AIM ( improved outcomes, lower cost & improve patient experience).

• The State of Maine is required, in the SIM Test, to determine the impact and efficacy of these implemented innovations

• Targets aligned to these evaluation measures help to align focus on specific outcomes

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Definitions

• Measure- a numeric description of the project’s work and the results of that work

• Benchmark- measure that serves as a guide post or standard to guide target/goal setting

• Target/Goal- endpoint that you are trying to achieve

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The SIM Triple Aim Goals

As determined at the outset of SIM in Maine, the SIM Triple Aim goals are as follows:

The total cost of care per member per month in Maine will fall to the national averageMaine will improve the health of its population in at least four categories of disease prevalence (ie diabetes, mental health, obesity, etc)Maine will improve targeted practice patient experience scores by 2% from baseline for practices that participated in the 2012 surveyMaine will increase from 50% to 66% the number of practices reporting on patient experience of care

The SIM core evaluation measure targets are intended to contribute to these SIM Triple Aim goals

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What are the SIM Core Evaluation Measure Categories?

Emergency Department Utilization

Readmissions Imaging Fragmented Care Cost of Care Mental Health Patient Experience and

Engagement Pediatric/Adolescent Care Obesity Diabetes

MaineCare Medicare Commercial

6*SIM Core Measure set developed and approved through SIM Governance in May 2014

Why SIM Core Evaluation Measure Targets?

Targets are necessary to increase focus and drive transformation

“If you don’t know where you are going….any road will get you there” Cheshire Cat, Alice in Wonderland

•Sharpened focus creates more direct ability to evaluate SIM interventions and determine the overall trends throughout the State for all payer populations•Targets promote “laser beam focus” of all payers on critical and mutually agreed upon measures•Greater alignment of measures reduces administrative burden and change fatigue for providers

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Intended Use

Payment Amount

SIM core evaluation measures and associated targets are not intended to be used to determine payment

amounts

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SIM Core Evaluation Measures

SIM Core Evaluation Measures – A small subset of what already exists

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*SIM Core Measure set developed and approved through SIM Governance in May 2014

End Product View

Measure Category Measure MaineCare Commercial MedicareTarget Target Target

Ed UtilizationNon-Emergent

ED Use112 TBD TBD

ReadmissionsAll-Cause

Readmissions12% TBD TBD

ImagingImaging for Low

Back Pain87% TBD TBD

Cost of CareTotal Cost of

CareTBD TBD TBD

Fragmented Care% of members

with fragmented care

26.50% TBD TBD

Ped/Adol Care Well Child Visits TBD TBD TBD

Ped/Adol CareChildren 7-11 w/

PCPsTBD TBD TBD

Ped/Adol CareDev Screenings

in first 3 yrsTBD TBD TBD

Mental HealthFollow-up after Hospitalization

for MITBD TBD TBD

Pt Experience CAHPS TBD TBD TBDObesity Adult BMI TBD TBD TBD

ObesityWeight

assessment and BMI class.

TBD TBD TBD

ObesityAdults meeting

physical act guidelines

TBD TBD TBD

DiabetesDiabetic Care

HbA1cTBD TBD TBD

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Timeframe for SIM Core Evaluation Measure Target Development

The Maine Leadership Team is charging the SIM Steering Committee with the development of

SIM core evaluation measure targets by the end of SIM Year 2

September 30, 2015

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Today’s Agenda

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Today’s Agenda

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Next Steps

• Next Meeting– July 22, 2015, 3-5 pm

Conference room A

35 Anthony Avenue, Augusta

• Future Discussion Topics – Sustainable Research Collaborative

– Provider, Stakeholder, & Consumer interview early findings

– Presentation of preliminary data analysis

– Follow up on identified risks as necessary