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COLORADO STATE INNOVATION MODEL (SIM)
COHORT 2 INTRODUCTORY WEBINAR
WEBINAR OBJECTIVES
▪ Overview of Colorado SIM
▪ SIM Cohort 2 Timeline
▪ SIM Achievement Based Funding
▪ SIM Practice Transformation Support
▪ SIM Practice Participation Expectations
▪ SIM Practice Tools & Reporting
▪ Next Steps
▪ Questions & Answers
2
Integrate.
Innovate.
Transform.
OVERVIEW OF COLORADO SIM
BACKGROUND, GOALS & TIMELINES
3
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
SIM GOALS
5
SIM APPROACH
Public
Health
Behavior
al Health
Providers
Consumers
Practice
Transformation
Payment
ReformPopulation
HealthHIT
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.
5
▪ Integration of physical and behavioral health care in 400 practices over the four year grant period
▪ Implementation, assessment and technical requirements for practices to move toward integrated care and new payment model implementation
▪ Toolkits – including a comprehensive Implementation Guide, Collaborative Learning Sessions, Disseminating Best Practices, Technical Support, etc.
▪ Develop inventory of all practices and behavioral health providers in Colorado and what services are being provided
SIM INITIATIVE TIMELINE
6
Ramp-up, including practice
assessment tool & IT infrastructure Additional 156 practices participating
2015 2016 2017 2018
Initial 100 practices on-boarded / 92 sustained engagement
2019
▪ 226 total qualified practices submitted applications for Cohort 2
▪ 156 practices participating in Cohort 2
▪ 92 practices participating in Cohort 1 (ending March 2018)
▪ Currently 248 total practices participating in SIM!
▪ Expected addition of final 150 for Cohort 3
SIM COHORT PRACTICE MAKEUP
SIM
CO
HO
RT
2P
RA
CT
ICE
LO
CA
TIO
NS
8
9
▪ Almost 90% 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
COHORT 1 FEEDBACK FROM PARTICIPATING PRACTICES
KEY IMPROVEMENTS BASED ON FEEDBACK
10
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 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
11
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 1 Milestones $1,000 $1,000 NA NA
Achievement of Building Block 4 Milestones $2,000 $2,000 $1,000 $1,000
Achievement of Building Blocks 7 Milestones $2,000 $2,000 $1,000 $1,000
Achievement of Building Blocks 8, 9, or 10 Milestones
(choose 2 for corresponding year)
NA NA $3,000 $3,000
Quarterly Reporting of Required CQMs $1,000 $1,000 $1,000 $1,000
Completion and Review of All SIM Assessments $500 $500 $500 $500
Total: $13,000 $13,000
Practice Achievement Based Payments – Practices in SIM Only:
▪ Up to $13,000 TOTAL (over 2 year project period)
▪ $1000 - Completion and Review of all SIM Assessments
▪ $500 (x2 years)
▪ $2000 - Quarterly Reporting of Required Clinical Quality Measures
▪ $1000 - per year (x2 years) if a practice submits CQMs quarterly
▪ Achievement of Building Block Milestones for corresponding year:
▪ $1000 Building Block 1 Milestones per year (x2 years = $2000)
▪ $2000 Building Block 4 Milestones per year (x2 years = $4000)
▪ $2000 Building Block 7 Milestones per year (x2 years = $4000)
ACHIEVEMENT FUNDING FOR SIM ONLY PRACTICES
Practice Achievement Based Payments Practices in SIM and CPC+:
Up to $13,000 TOTAL (over 2 year project period)
▪ $1000 - Completion and Review of all SIM Assessments
▪ $500 (x2 years)
▪ $2000 - Quarterly Reporting of Required Clinical Quality Measures
▪ $1000 - per year (x2 years) if a practice submits CQMs quarterly
▪ Achievement of Building Block Milestones for corresponding year:
▪ $1000 Building Block 4 Milestones per year (x2 years = $2000)
▪ $1000 Building Block 7 Milestones per year (x2 years = $2000)
▪ $3000 Building Blocks 8,9, or 10 Milestones (choose two of these Building Blocks)
(x2 years = $6000)
13
ACHIEVEMENT FUNDING FOR SIM & CPC+ PRACTICES
SIM PAYMENT SUPPORTS
14
While each payer is using its own payment model to support SIM’s transformation goals, the payment model(s) that payers will apply to SIM participating practice sites include the following basic elements:
1. Fee-for-service payments
2. Payments that include behavioral health integration through one of the following mechanisms:
a) Upfront paymentsb) Population-based payments (e.g., per-member-per-month)c) Care coordination payments
3. Shared savings opportunities OR incentive payments based on performance and/or outcomes linked to quality
Small Grant Funding:
Request for Proposal (RFP) opening Nov 15th
Email with information about Oct 18th webinar sent to all Cohort 2 practice key contacts
$3.125 million in SIM budget originally
$3 million generously added by The Colorado Health Foundation
Total $6.125 million across all three cohorts through 2019
Up to $40,000 in Small Grants
15
PRACTICE TRANSFORMATION FUND
COLORADO SIM
PRACTICE TRANSFORMATION
WHAT IS PRACTICE TRANSFORMATION?
17
The main concepts of practice
transformation include:
implementation of continuous quality
improvement
engaged leadership
empanelment
developing continuous and team-based
healing relationships with patients
evidence-based care
patient-centered interactions
enhanced access
care coordination
Practice transformation is a process
that results in observable and
measureable changes to practice
behavior
▪ A team of primary care and behavioral health clinicians, working together with patients and families, providing patient-centered care for a defined population
▪ May address mental health and substance abuse conditions, health behaviors, life stressors and crises, stress-related physical symptoms
WHAT IS BEHAVIORAL HEALTH INTEGRATION?
18
CONTINUUM OF PHYSICAL & BEHAVIORAL HEALTH CARE INTEGRATION
19
Coord
inate
d Behavioral and
physical health
clinicians practice
separately within
their respective
systems. Information
regarding mutual
patients may be
exchanged as needed
and collaboration is
limited outside of the
initial referral.
Co-l
ocate
d Behavioral and
physical health
clinicians deliver care
in the same practice.
Co-location is more of
a description of where
services are provided
rather than a specific
service. Patient care
is often still siloed to
each clinician’s area
of expertise.
Inte
gra
ted Behavioral and
physical health
clinicians work
together to design and
implement a patient
care plan. Tightly
integrated on-site
teamwork with a
unified care plan.
Often connotes close
organizational
integration as well.
▪ Practice Transformation Organizations (PTOs)
▪ Organizations approved to provide practice facilitation (PF) and/or clinical health information technology advisor (CHITA) services for large scale practice transformation programs
▪ PTOs were selected based on:
▪ working relationships with Colorado primary care practices and
▪ experience and/or expertise in content areas required for primary care practice transformation
▪ PTOs who will work together to provide practice transformation support to primary care and potentially to specialty practices to improve health and healthcare in Colorado
WHAT IS A PTO?
20
▪ Implements an ongoing change and quality improvement process –improvement teams
▪ Specifically implements the changes involved in practice transformation and (for SIM in particular) behavioral integration
▪ Implements sound quality improvement techniques
▪ Keeps the team on task
▪ Identifies and solves problems
▪ Links to transformation resources
▪ Assists practices with baseline and ongoing assessments, development of practice improvement plan
PRACTICE FACILITATOR (PF) ROLE
21
▪ Supports practice data capacity
▪ Assists practices with assessment of data capacity, development of a data quality improvement plan
▪ Assists with developing and managing workflow for data collection, reporting, and analysis
▪ Links practices with other technical assistance resources as needed and available
CLINICAL HEALTH INFORMATION TECHNOLOGY ADVISOR (CHITA) ROLE
22
▪ Local person who functions as a connector in the community
▪ Builds ongoing supportive relationships with practices:
▪ Engages with practice leaders
▪ Assesses practice needs and then links with resources
▪ Stays in touch with the practice to assess progress and move to next steps
▪ Helps practice in developing a population health plan, tied to the needs of its patient population and the local community health improvement plan
▪ Connects practices with public health agencies and community resources (including behavioral health resources)
▪ Collaborates with community partners to:
▪ Identify and assist with community health priorities
▪ Address social determinants of health
REGIONAL HEALTH CONNECTOR (RHC) ROLE
23
▪ Milestones, based on 10 Building Blocks framework, Comprehensive Primary Care initiative change package, and approaches to behavioral integration
▪ Developed by SIM Practice Transformation Workgroup
▪ Refined further for pediatric and Mental Health Center use by task groups
▪ Implementation Guide – detailed information about how to implement each milestone, framed by Building Blocks
▪ Now Online: http://www.practiceinnovationco.org/sim/simimplementationguide/
▪ Toolkit – additional online resources
SIM CHANGE PACKAGE
24
25
BUILDING BLOCKS OF HIGH
PERFORMING PRIMARY CARE
▪ Comprehensive Tool to help in your practice transformation efforts
http://www.practiceinnovationco.org/sim/simimplementationguide/
▪ Located on University’s Practice Innovation Program Coloradowebsite
SIM IMPLEMENTATION GUIDE
26
▪ Form a SIM Implementation/Quality Improvement (QI) Team
▪ Can also be existing QI Team targeting SIM
▪ Meet with Practice Facilitators
▪ Meet with Clinical Health Information Technology Advisors (CHITAs)
▪ Meet with Regional Health Connectors (as available)
▪ Complete the practice assessments and other evaluation activities
▪ Submit Clinical Quality Measures (CQMs)
▪ Quarterly to SIM
▪ Participate in SIM Collaborative Learning Sessions (CLS)
PRACTICE EXPECTATIONS: COHORT 2
27
COLORADO SIM
PRACTICE TOOLS & REPORTING
SIM COHORT 2 ASSESSMENTS & REPORTING SCHEDULE
29
Assessment Name/Tool Assessment
Purpose
Responsible
for
Filling Out
Responsible
for
Submitting
Frequency
of
Reporting
Expected
Time to
Complete
Field Note(includes free text and check
box fields)
Documentation of number of meetings/encounters and
specific areas of focus as aligned with SIM Framework &
Milestones (aka Practice Transformation Building Blocks)
Practice
Facilitator &
CHITA
Practice Facilitator &
CHITA
Monthly 10 minutes
Medical Home Practice
Monitor
Practice self-assessment of level of implementation of core
aspects of advanced primary care
Practice Team
(led by Practice
Facilitator)
Practice Champion Baseline &
Annually
60 minutes
Integrated Practice
Assessment Tool (IPAT)
Assesses current methods BHI along levels of coordination,
co-location and integration
Practice Team
(led by Practice
Facilitator)
Practice Champion Baseline &
Annually
10 minutes
Clinician and Staff
Experience Survey
Individual provider and staff survey that assesses: 1) Clinician
and Staff Experience and 2) Burnout
All Members of
Practice
Each Practice Member Baseline &
Annually
15 minutes
SIM Milestone
Attestation Checklist (previously Milestone Activity
Inventory)
Assesses practice's current implementation of SIM milestone
activities and progress. Additionally, will provide mechanism
for Practice Facilitator attestation.
Practice Team
(led by Practice
Facilitator)
Practice Team
Submits Draft
Practice Facilitator
Submits Final
Baseline & Every 6
Months
(updateable
anytime)
60 minutes
HIT Assessments Assesses practice's current state of data quality, validity of
CQM reports and implementation of SIM’s other HIT priorities.
Practice Team (led
by CHITA)
CHITA Baseline & Every 6
Months
60 minutes
Clinical Quality
Measures (CQMs)
Track patient and process outcomes achieved by practices Practice Champion
(led by CHITA)
Practice Champion Every Calendar
Quarter
Variable
▪ Assessments completed by the Practice Site with PTOs
▪ IPAT – Baseline and annually
▪ Practice Monitor – Baseline and annually
▪ HIT Assessment – Baseline and annually
▪ Milestone Attestation Checklist– Baseline and every 6 months
▪ Complete individually:
▪ Clinician and Staff Experience Survey – Baseline and annually
▪ Field Notes – Populated by PFs and CHITAs
▪ Completed monthly documenting PTO work with Practice Sites
PRACTICE ASSESSMENTS
30
SIM ASSESSMENT LANDING PAGE
1) Select a practice site
from the
dropdown and the
assessment
to be completed.
2) Select ‘Submit’ to be
directed
to the appropriate
assessment
login page.
SIM ASSESSMENT LOGIN
3) Enter the provided Access Code for
the practice and select:
‘Start Assessment’Access codes are randomly generated, eight
character, alpha-numeric, and unique for
each practice site. Practice Site Key Contacts
and PTO were emailed the codes.
4) Respond to all required assessment
questions prior to submitting the
assessment responses.
It is required to answer all questions in a
section prior to proceeding. Assessments can
be accessed or modified until submitted.
SIM ASSESSMENTREVIEW & SUBMISSION
6) Review all assessment response
and select ‘Submit Assessment’
when it is completed.
7) Download the PDF assessment
response summary after
submitting assessment –
responses are also available by
request from the SPLIT Support
Team after an assessment is
submitted
CQM Reporting Summary located in the Resource Hub on the Practice Innovation website
http://resourcehub.practiceinnovationco.org/initiative-information/sim/sim-clinical-quality-measures/
Included in Practice Participation Agreements (PPAs)
sent to all practices
SIM CQM INFORMATION
34
PRACTICE INNOVATION PROGRAM CO WEBSITE AND RESOURCE HUB
35
Practice Innovation Program Colorado Website: http://www.practiceinnovationco.org/
Find SIM Initiative information and materials
Visit SIM Resource Hub to access documents and recordings:
http://resourcehub.practiceinnovationco.org/initiative-information/sim/
▪ Initial Practice Acceptance Process
▪ Engage Staff and Review Internal Readiness
▪ Initial/Kickoff Meetings with PF and CHITA
▪ Completion of Baseline Assessments
▪ Submission of CQMs
▪ Attendance at Collaborative Learning Session
▪ Submit Small Grants Application – RFA Open 11/15/17 Closes 01/15/18
▪ Enjoy the holidays
▪ Participate Actively, Ask for Support - Integrate, Innovate, Transform!
WHAT TO EXPECT & NEXT STEPS
36
▪ Participate in SIM Introductory Webinar
▪ October 11th 7:45 AM – 8:30 AM MST
▪ October 16th 12:15PM - 1:15PM MST
**Webinars will be recorded and available on the website**
Small Grants Overview and Application Process Oct. 18th – by Colorado SIM Office
Recorded and ‘On Demand’ – additional information sent in an email to practices
Go to Colorado SIM webpage to register https://www.colorado.gov/healthinnovation
▪ Additional Upcoming Webinar Topics
▪ Introduction and Use of SPLIT- Shared Practice Learning & Improvement Tool
▪ Invoicing and others determined based on practice and PTO need and interest
▪
UPCOMING TRAINING & EVENTS
37
▪ Collaborative Learning Sessions – Register Today!
Denver Metro Area
Friday, November 3
9:00 AM - 4:00 PM
Location: Omni Interlocken Hotel - Broomfield, CO 80021
Western Slope
Friday, December 15
Location: Grand Junction, CO
REGISTRATION information for both and links located on University’s Practice Innovation Program Colorado webpage, under ‘Upcoming Events’
http://www.practiceinnovationco.org/
UPCOMING TRAINING & EVENTS
38
CONTACT US
39
Practice Transformation Related SIM Questions
[email protected] 303.724.8968
Allyson Gottsman, CHES Director
[email protected] 303.724.8968
Heather Stocker, SIM Project Manager
[email protected] 303.724.9525
Lauren Shviraga, SPLIT Project Coordinator & Professional Research Assistant
[email protected] 303.724.9085
▪ SPLIT & Technical Assistance: [email protected]
▪ Practice Innovation Colorado Website: http://www.practiceinnovationco.org
▪ Payer & Operational Questions to the Colorado SIM Office: [email protected]
▪ Colorado SIM Website: www.coloradosim.org
▪ Stay updated with SIM: bit.ly/2nntnRf
▪ Data hub : http://bit.ly/2pMtiGQ
RESOURCES
40
▪ SIM Videos: http://bit.ly/2nTKrLe
▪ SIM Podcasts: http://bit.ly/2pK3FWK
For more information about Colorado SIM:
QUESTIONS
41