SIM COHORT 2 RFA INFORMATIONAL WEBINAR

FEBRUARY 22 7:30 AM – 8:30 AM

Presenters: Nicole King, MA - SIM Implementation Program Manager Allyson Gottsman - CU Colorado Health Extension System (CHES) Program ManagerKyle Knierim, MD - CU Associate Director of Practice Transformation Heather Stocker, MA - CU Project Manager

WEBINAR OBJECTIVES

▪ Overview & Significance of Colorado SIM

▪ SIM Cohort 2 Timeline

▪ SIM Alignment with CPC+

▪ SIM Practice Participation Qualifications

▪ SIM Practice Transformation Support Services

▪ SIM Practice Participation Benefits

▪ SIM Practice Participation Expectations

▪ SIM Practice Request for Application (RFA) Process

▪ Questions & Answers

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Integrate.Innovate.

Transform.

VISION – To create a coordinated, accountable system of care that will provide Coloradans access to integrated primary care and behavioral health in the setting of the patient’s medical home.

GOAL - Improve the health of Coloradans by providing access to integrated physical & behavioral health care services in coordinated systems, with value-based payment structures, for 80% of Colorado residents by 2019.

GOAL & VISION

▪ SIM: State Innovation Model

▪ SIM is an initiative funded by the Centers for Medicare & Medicaid Services (CMS)

▪ Colorado was awarded a $2 million planning grant and $65 million implementation grant to strengthen Colorado’s Triple AIM strategy

▪ Encourages states to develop and test models for transforming health care payment and delivery systems

▪ Colorado received the 4th largest award and is the only SIM state focused on the integration of primary care and behavioral health

WHAT IS COLORADO SIM?

COLORADO SIM: WHY IT MATTERS

84%

> 50%

80%

50%

67%

Of the time, the 14 most common physical complaints have no identifiable organic cause

Of referrals from primary care to an outpatient behavioral health clinic do not make the 1st appointment

Of people with a behavioral health disorder will visit primary care at least once a year

Of behavioral health disorders are treated in primary care

Of people with a behavioral health disorder do not get behavioral health treatment

SIM APPROACH

Public Health

Behavioral HealthProviders

Consumers

Practice Transformation

Payment Reform

Population Health

HIT

80% of Coloradans have Access to Integrated Care

Support for practices as they

accept new payment models

and integrate behavioral and physical health

care.

Engaging communities in

prevention, education, and

improving access to integrated

care.

Development and implementation of value-based

payment models that incentive integration and improve quality

of care.

Secure and efficient use of

technology across health and non-health sectors in order to advance integration and

improving health.

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▪ Integration of physical and behavioral health care in 400 practices over the three year implementation period

▪ Practices to move toward integrated care and alternative payment models benefiting from:

- Toolkits, Collaborative Learning Sessions, Dissemination of Best Practices, Practice Facilitation and Clinical Health Information Technology Advisors (CHITAs)

- Data Collection: Clinical Quality Measures and claims data to track improvements in cost and quality

SIM INITIATIVE OVERVIEW

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Ramp-up and planningAdditional 150 practices on-boarded

2015 2016 2017 2018Initial 100 practices on-boarded

Additional 150 practices on-boarded

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▪ 87% of survey respondents stated that they would recommend participation in SIM to a colleague and/or other practice

▪ Responses to an open-ended item regarding advantages and value that SIM offered practices were as follows:▪ Networking▪ Increased focus on integrated behavioral health▪ Optimized use of EHR▪ Structured goal setting ▪ Grants and funding access

SIM PARTICIPATIONRECOMMENDED BY COHORT 1!

KEY IMPROVEMENTS

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Cohort 1 Practice Feedback Changes As A Result of Feedback

Reporting burden Streamlined set of Clinical Quality Measures

Difficulties implementing SIM at individual practice sites instead of across healthcare systems/multi-site organizations

All practices within a healthcare system/multi-site organization now encouraged to apply

Confusion regarding support from payers Inclusion of clarifying language with links to the payer MOU, addendum, and payment model summaries in RFA

$5,000 insufficient and practices relayed the $40,000 grant applications were difficult

Achievement-based payments of up to $13,000 available with $40,000 grant funds exclusively provided by The Colorado Health Foundation

Insufficient HIT support Inclusion of HIE support, more clearly defined information regarding broadband expansion

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FINANCIAL SUPPORT –SIM PAYMENT TO PRACTICES (FOR COHORT 2)

Activity SIM Only Practice Sites SIM/CPC+ Practice Sites

Year 1 Year 2 Year 1 Year 2

Achievement of Building Block 4 Milestones $2,000 $2,000 $1,000 $1,000

Achievement of Building Block 7 Milestones $2,000 $2,000 $1,000 $1,000

Achievement of Building Blocks 8,9, or 10 Milestones (choose one)

NA NA $2,000 $2,000

Participation in twice-yearly Collaborative Learning Sessions

$1,000 $1,000 $1,000 $1,000

Quarterly reporting of required measures $1,000 $1,000 $1,000 $1,000

Participation in the assessments and evaluation activities

$500 $500 $500 $500

Total: $13,000 $13,000

Small Grant Funding:

All practice sites can apply

Competitive grants of up to $40,000 to assist in meeting SIM milestones and achieving goals outlined in their Practice Improvement Plans

Provided by a generous grant from The Colorado Health Foundation

Applicants selected through a competitive process, based on: Overall quality of the application Ability of proposed project to help practice achieve practice transformation

milestones Practice need

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FINANCIAL SUPPORT –SIM PAYMENT TO PRACTICES (FOR COHORT 2)

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PAYER MOU

Enhanced Financial Support

Data Sharing

Aligning Quality

Measures

Common Approach to

Accountability

• Colorado Medicaid• Anthem Blue Cross Blue Shield• Cigna• Colorado Choice Health Plans• Kaiser Permanente• Rocky Mountain Health Plans• UnitedHealthcare

Payer MOU Available Online At:

https://drive.google.com/file/d/0BxUiTIOwSbPUWHlHT0RzLTgwcXc/view

SUPPORT FROM PAYERS

FINANCIAL SUPPORT -PAYER COMPENSATION

Payments from Health Plans:

▪ Fee-for-service payments

▪ Payments that include behavioral health integration through one of the following mechanisms: ▪ Upfront payments ▪ Population-based payments (e.g., PMPM) ▪ Care coordination payments ▪ Payment for additional codes

▪ Shared savings opportunities OR incentive payments based on performance and/or outcomes linked to quality

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SUPPORT FROM PAYERS

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MedicaidColorado ChoiceUnited

Medicaid

UnitedAnthemCignaRMHP

Practice A

Practice B

Practice C

• Each practice site may be supported by a different group of payers.

• Practice sites will be notified in writing of which payers have agreed to support them.

• Practices in existing APMs and value-based payment initiatives, including CPC+, may not receive additional value-based payments for their participation in SIM.

SUPPORT FROM PAYERS

▪ SIM Practice Request for Application OPENED: February 15, 2017

▪ SIM Informational Webinars being held between: February 22 – March 2

▪ SIM Practice Application CLOSES: March 31, 2017

▪ SIM Practice Participants NOTIFIED: June/July 2017

▪ Second Cohort STARTS: September 1, 2017 / ENDS: July 31, 2019

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SIM COHORT 2 TIMELINE

Feb 2017

Mar2017

July2017

July2019

SIM PARTICIPATION QUALIFICATIONS

To be eligible for participation in SIM Cohort 2:

1. Practice sites must be physically located in Colorado.

2. Individual practice sites* must complete and submit the application in its entirety online before 11:59 pm MST on March 31, 2017.

3. Practice sites must currently use an EHR.

4. Practice sites must meet the IOM definition of primary care.

* Healthcare systems/multi-site organizations should encourage individual practice sites to apply and can assist practice sites in preparing applications. Though some sections must be completed by the practice site; in particular, the Narrative and Attestation sections.

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Requirements for Practices Interested in Participating:

PRACTICE TRANSFORMATION IS A PROCESS

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The main concepts of practice transformation: implementation of continuous QI engaged leadership empanelment developing continuous and team-based

relationships with patients evidence-based care patient-centered interactions enhanced access care coordination

… that results in observable and measureable changes to practice behavior

SIM PRACTICE TRANSFORMATION BUILDING BLOCKS

Based on Bodenheimer’s “The 10 Building Blocks of High Performing Primary Care" framework

The building blocks are made up of milestones that have been aligned with alternative payment models intended to strengthen delivery of comprehensive primary care by moving toward greater integration of behavioral health services

Outlined in the: ‘Colorado SIM Framework and Milestones’

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Reflect SIM’s target focus on behavioral health integration and population health

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SIM PRACTICE TRANSFORMATION BUILDING BLOCKS

Found in the RFA Packet Attachment A and on the University’s Practice Innovation website in the Resource Hub:

http://resourcehub.practiceinnovationco.org/initiative-information/sim/

▪ Practice Transformation Support Services

▪ Financial Support

▪ Recognition

▪ Health Information Technology

▪ Data

▪ Connection to Community Resources

▪ Business Support

▪ Patient Outcomes

▪ Provider Satisfaction20

SIM PARTICIPATION BENEFITS

Outlined on page 5 in the RFA Packet

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PRACTICE TRANSFORMATION SUPPORT SERVICES

▪ Support implementation of ongoing change and quality improvement process through Quality Improvement Teams

▪ Contribute to the development and updating of a SIM Practice Improvement Plan (PIP)

▪ Facilitate Quality Improvement Team activities to focus on PIP objectives

▪ Identify and help resolve challenges in achieving objectives

▪ Facilitate the development of sustainable quality improvement skills, techniques and processes

▪ Coordinate and facilitate practice site access to additional resources

Practice Facilitators:

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▪ Assist in the development and updating of a SIM Data Quality Plan (DQA), including assessment and identification of current HIT resources

▪ Support the enhancement of practice capacity to implement data-driven quality improvement

▪ Assist with the development and implementation of practice workflow for data collection, reporting, validation and analysis

▪ Facilitate data-driven quality improvement priorities

▪ Link practice sites with technical assistance available through various SIM and non-SIM HIT resources

PRACTICE TRANSFORMATION SUPPORT SERVICES

Clinical Health Information Technology Advisors (CHITAs):

▪ In-person health information technology support provided by a CHITA

▪ Support connecting to a health information exchange (HIE) to share data and coordinate care

▪ Subsidies for nonprofit practice sites to install or upgrade broadband, a key step toward developing the infrastructure necessary to provide telehealth services

▪ Access to aggregated claims data that allows cost and utilization data to be tracked across providers and payers to improve population health management

▪ Access to aggregated clinical quality data to compare practice site level data to the SIM cohort and inform quality improvement efforts

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HEALTH INFORMATION TECHNOLOGY& DATA

▪ Access to a Regional Health Connector (RHC), a local person dedicated to connecting practice sites to resources that can improve patient outcomes

▪ Facilitate the connection of practice site to local public health and other community resources

▪ Establish ongoing supportive relationships with practice sites that can be sustained beyond the two years of active practice transformation support

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Public Health

CONNECTION TO COMMUNITY RESOURCES

Regional Health Connectors (RHCs):

▪ Access to data benchmarking to help practice sites assess business processes

▪ Training program to develop skills in budgeting and administrative processes to support value-based payments

▪ Recognition through a certificate of recognition signed by the Governor’s Office

▪ Continuing Medical Education (CME) credits▪ Performance Improvement activities in the practices▪ Participation at Collaborative Learning Sessions▪ Participation in e-Learning modules

▪ Part IV Maintenance of Certification (MOC) toward Board Recertification▪ Family Medicine▪ Pediatrics▪ Internal Medicine

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RECOGNITION, BUSINESS SUPPORT, CME & MOC

▪ Having access to behavioral health services is expected to reduce the total cost of care

▪ Some studies indicate integrated care leads to a reduction of inappropriate use of medical services and cost-savings in big-ticket items, such as ED visits and hospitalizations

▪ Integrated behavioral health services may improve patient and provider satisfaction by: ▪ reducing access barriers▪ improving communication▪ enabling providers to influence comorbidities between physical and behavioral

health issues

(References listed at end of the RFA Packet)

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PATIENT OUTCOMES & PROVIDER SATISFACTION

PARTICIPATION BENEFITS –BEHAVIORAL HEALTH INTEGRATION

▪ Integrated behavioral healthcare produces significant positive results, including:▪ decreased patient depression levels▪ improved quality of life▪ decreased stress, and ▪ lower rates of hospitalization

▪ Practice Transformation support tailored to each practice’s unique needs and priorities via a model that is aligned with the CPC+ Behavioral Health Integration Menu of Options: ▪ Option 1 - Care Management for Mental Illness▪ Option 2 - Primary Care Behaviorist Model

▪ More information can be found:▪ Linked with RFA Packet (page 13) or On the CMS webpage:

https://innovation.cms.gov/Files/x/cpcplus-bhinteg-options.pdf27

CPC+ ALIGNMENT

▪ CPC+ also funded by CMS through Centers for Medicare and Medicaid Innovation (CMMI)▪ Initiative aimed at, strengthening primary care and helping practices shift from

volume-based to value-based payment systems

▪ SIM Collaborating with CMS to align SIM with CPC+▪ Complementary initiatives offering unique benefits to practice sites interested in

integrating behavioral health and primary care

▪ Support focusing on behavioral health integration, business support, and health information technology assistance

▪ Practice sites that participate in both initiatives will receive support through the SIM Practice Transformation Program that will build on the support provided by CPC+

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SHARED EXPECTATIONS (across both SIM-Only & SIM/CPC+ practices)

1) Identify a cross-functional Quality Improvement Team to implement improvements based on the SIM Practice Transformation Building Blocks.▪ Quality Improvement Team, generally includes:

- Provider Champion - Clinical Support Staff - Front Desk Staff - Office Manager AND (if applicable) - Care Manager - Behavioral Health Professional

2) Complete a set of practice assessments to identify key areas of focus for improvement.

3) Participate in SIM evaluation activities.

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SIM PRACTICE PARTICIPATION –SHARED EXPECTATIONS

SHARED EXPECTATIONS (across both SIM-Only & SIM/CPC+ practices)

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SIM PRACTICE PARTICIPATION –PRACTICE ASSESSMENTS

EXPECTATIONS OF SIM-ONLY PARTICIPATING PRACTICES

4) Required to attend the SIM Collaborative Learning Sessions.

5) Collect, report, and review SIM Clinical Quality Measures on a quarterly basis (outlined in RFA Packet Attachment B).

6) Complete a foundational subset of building blocks through achievement of key milestones (outlined in RFA Packet Attachment A as well as in Section II).

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SIM PRACTICE PARTICIPATION –SIM-ONLY EXPECTATIONS

EXPECTATIONS OF SIM/CPC+ PARTICIPATING PRACTICES

4) Encouraged to attend the SIM Collaborative Learning Sessions, but not required to do so.

5) Collect, report, and review only those SIM Clinical Quality Measures that align with CPC+ requirements on a quarterly basis (outlined in RFA Packet Attachment B).

6) Complete an advanced subset of building blocks through achievement of key milestones (outlined in RFA Packet Attachment A as well as in Section II).

** Practice sites that participate in both CPC+ and SIM will be expected to adhere to all expectations of CPC+

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SIM PRACTICE PARTICIPATION –SIM/CPC+ EXPECTATIONS

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Adult Clinical Quality Measures (CQMs)

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Pediatric Clinical Quality Measures (CQMs)

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CPC+ Clinical Quality Measures (CQMs)

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CLAIMS-BASED MEASURES

Cost of Care and Utilization• Total Cost of Care• Out of Pocket Expenditures for Consumers• Admissions• Psychiatric Admissions• Readmissions• Psychiatric Readmissions• Emergency Department (ED) Rate• Psychiatric ED Rate• Follow-up after Hospitalization for Mental

Illness

Access to Care• Prevention Quality Chronic Composite• Prevention Quality Acute Composite• Pediatric Quality Overall Composite• Prevention Quality Overall Composite

SIM PRACTICE REVIEW & SELECTION PROCESS

▪ A comprehensive and impartial evaluation by a selection committee

▪ Practices ranked based on meeting required characteristics and application responses

▪ Applicants will be grouped and ranked and the information shared with the SIM Office

▪ Applicant practices will be placed in one of the following categories:▪ Strongly Recommend▪ Recommend▪ Consider with some concerns▪ Do not recommend at this time

▪ SIM Office will make the final determination of practices for Cohort 2

▪ Practices will be notified between June/July of their status

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SIM PRACTICE APPLICATION PROCESS

On-Line Application

Each practice site must complete its own individual application Healthcare systems/multi-site organizations should encourage their practice sites to

apply and can assist practice sites in preparing their applications Some sections within the application must be completed by the practice site; in

particular, questions in Narrative and Attestation sections

Consider working with various members of your team to complete the application in order to address different sections: - Practice Demographics & Provider Roster - Transformation Experience- Health Information Technology (HIT)- Attestations (requires leadership commitment and fiscal capabilities)

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SIM PRACTICE ONLINE APPLICATIONBEGINNING THE PROCESS

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▪ Links are on both Colorado SIM and University’s Practice Innovation Colorado websites

▪ Actual Application URL address-http://bit.ly/simapplication

▪ Link will take you here

▪ For more detailed information, click on the hyperlink and download the complete RFA Packet

SIM PRACTICE ONLINE APPLICATIONBEGINNING THE PROCESS

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▪ To ‘Start a New Application’ Click the green ‘Next’ Button on the bottom of the page

▪ On the next page, you will be asked to enter your Official Practice Site Name and to answer two ‘qualifying’ questions:

1) Is this practice site a primary care practice in Colorado?

2) Is your practice site using an EHR?

SIM PRACTICE ONLINE APPLICATIONUNIQUE ACCESS CODES

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▪ You will be provided a unique ‘SIM Application Access Code’ which will also be emailed to the address(es) you provided.

▪ Be sure to save this information! It is required in order to re-access your application.

SIM PRACTICE ONLINE APPLICATION -SAVING & RETURNING LATER

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To return to an application already started, go to the application home page and click on the ‘SIM Application Link’ under the Already in Progress area.

You will be required to enter your Practice Name and the Unique Access Code you were originally emailed.

To close your application and return later, click ‘Save & Next’ and close your browser.

Your application will automatically save.

SIM PRACTICE ONLINE APPLICATION -TIPS TO REMEMBER

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In the ‘Practice Site Provider Roster’ section you will be asked to use dropdown menus. Please pick the most appropriate answer based on your knowledge.

Further explanation is provided at the top of this section in the application.

You will be required to provide NPI’s for your providers.

Accuracy of NPIs and Taxonomy Codes are important because cost and utilization data from the All-Payer Claims Database (APCD) is driven by accurate attribution of the right patients to the right providers, which begins with accurate NPIs.

SIM PRACTICE ONLINE APPLICATION -TIPS TO REMEMBER

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There are ‘required’ questions withinthe application that must be completedprior to submission.

However, you can move betweensections (by clicking the Next arrow),but will be notified of any unansweredquestions before you leave a page.

You can ‘Continue Without Answering’and move to another section.

When you reach the final ‘Application Completion Section’ any unanswered questions will be listed.

You are required to go back into each section and answer the required questions prior to submission.

SIM PRACTICE ONLINE APPLICATION -SUBMITTING YOUR APPLICATION

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This section will list any questions you have not answered. It will also tell you which section those questions are in.

You will not be able to submit the application until all required questions are completed.

UNIVERSITY’S PRACTICE INNOVATION COLORADO WEBSITE

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ADDRESS: www.practiceinnovationco.org

QUESTIONS & ANSWERS

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KEY DATES: (previously listed on Project Timeline Slide)

▪ SIM Practice Application OPENS: February 15, 2017

▪ SIM Practice Application CLOSES: March 31, 2017

▪ SIM Practice Participants NOTIFIED BY: June/July 2017

▪ SIM Cohort 2 Initiative BEGINS: September 1, 2017

RFA LINK: https://www.colorado.gov/healthinnovation/cohort2

APPLICATION LINK: http://bit.ly/simapplication

QUESTIONS: (submit to) PracticeTransformation@UCDenver.edu (or call) 303.724.8968

Colorado SIM Office https://www.colorado.gov/healthinnovation

University’s Practice Innovation Program Colorado Website http://www.practiceinnovationco.org

Comprehensive Primary Care Plus – CMS.gov https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus

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IMPORTANT DATES & INFORMATION

THANK YOU!