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SIM PRACTICE PARTICIPATION & RFA INFORMATION WEBINAR
SEPTEMBER 23RD 2015 12:15PM-1:15PM
Presenters:Kyle Knierim, MD Assistant Professor Instructor, Practice Transformation ResearchAllyson Gottsman, CU Transformation ManagerLynnette Hampton, Colorado SIM Manager of Operations
WEBINAR OBJECTIVES
▪ Overview & Significance of Colorado SIM
▪ SIM Practice Transformation
▪ SIM Practice Transformation Project Timelines (Cohort 1)
▪ SIM Practice Participation Qualifications
▪ SIM Practice Participation Benefits
▪ SIM Practice Participation Expectations
▪ SIM Practice Request for Application (RFA) Process
▪ Questions & Answers
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“Health is a state of complete physical, mental
and social well-being,and not merely the absence
of disease or infirmity.”
World Health Organization
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…Integration is our call to action…
▪ SIM: State Innovation Model
▪ SIM is an initiative of the Center for Medicare & Medicaid Innovation (CMMI)
▪ 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?
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 AND VISION
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
▪ 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, Learning Collaboratives, Dissemination of Best Practices, Practice Facilitation and Clinical HIT Advisors (CHITAs)
- Data Collection: Clinical Quality Measures and claims data to track improvements in cost and quality
SIM PRACTICE TRANSFORMATION
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2015 2016 2017 2018
SIM PRACTICE TRANSFORMATION
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CURRENT 2015 ACTIVITIES: Planning and Preparation
- Work group meetings occurring- Materials and resources being developed
Select Practice Transformation Organizations (PTOs) and Practices- PTO selection being finalized by SIM Office- Practice RFA Open
Additional 150 practices on-boarded
2015 2016 2017 2018
Initial 100 practices on-boarded
Additional 150 practices on-boarded
▪ SIM Practice Application OPENED: September 15, 2015
▪ SIM Informational Webinars: ▪ Wednesday September 23rd 12:15 pm – 1:15 pm
▪ Wednesday October 7th 7:00 am – 8:00 am
▪ Thursday October 22nd 12:15 pm – 1:15 pm
▪ SIM Practice Application CLOSES: October 26, 2015
▪ SIM Practice Participants NOTIFIED BY: December 25, 2015
▪ SIM Project STARTS: February 1, 2016
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SIM PRACTICE TRANSFORMATION-PROJECT TIMELINES
July 2015 Aug-Sept Oct-Jan Feb
2016
SIM PARTICIPATION QUALIFICATIONS
▪ Colorado primary care practice
▪ Leadership commitment to move toward behavioral health integration
▪ Electronic health record (EHR) in place
▪ Experience with practice transformation, including team based care, quality improvement, population management and using data for improvement
▪ Sufficient financial knowledge to be able to adapt to new payment models
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▪ Better for patients: decreases in client depression levels, improvement in quality of life, decreased stress and lower rates of hospitalization
▪ Expected to reduce the total cost of care; can lead to a reduction of inappropriate use of medical services and a cost-savings in big-ticket items like emergency room visits and hospitalization~ A benefit to practices when participating in value-based payment models
▪ Improvement in patient and provider satisfaction by reducing access barriers, improving communication and enabling providers to look at how physical and behavioral health issues interplay and impact overall health
▪ Helps patients adhere to medical regimens like diet and smoking cessation when behavioral health specialists are available in the primary care setting
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SIM PARTICIPATION BENEFITS-BENEFITS OF INTEGRATION
Grant-funded Consultation:
▪ Extensive support to implement models of care that address the changing role in care delivery, behavioral health integration and emerging frameworks for alternative payment models for primary care
▪ Support through PTO delivery of Practice Facilitation/Coaching, Clinical Health Information Technology Advisors and Regional Health Connectors
▪ Business services support provided by Medical Group Management Association ▪ Tools and consulting to help practices prepare and adapt to new payment
models
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SIM PARTICIPATION BENEFITS-PRACTICE TRANSFORMATION & BUSINESS SERVICES SUPPORT
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PRACTICE TRANSFORMATION SUPPORT
▪ Implement ongoing change and quality improvement processes working with improvement teams
▪ Focus on changes involving practice redesign and specific clinical improvements:
- For SIM this is behavioral health integration
- For EvidenceNOW Southwest (ENSW) this is cardiovascular health
▪ Help practice team stay focused
▪ Identify and solve problems
▪ Support the adoption of sound quality improvement techniques
▪ Coordinate transformation resources
Practice Facilitators:
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▪ Support practice data capacity: - Identify current HIT resources- Assist with workflow for data collection, reporting, validation and analysis - Use that data to guide improvement priorities
▪ Link practices with technical assistance available through various projects
▪ CHITA activities include:- Initial HIT assessment- Data process planning- Meetings w/practice and practice facilitator to review data and next steps- Learning Network
PRACTICE TRANSFORMATION SUPPORTClinical Health Information Technology Advisors (CHITAs):
▪ Deployed across the state- live and work locally, in communities
▪ Connect practices and clinicians to resources on multiple levels
▪ Facilitate linkages among the various components of the health and health care delivery system, including:- primary care practices- the public health system- community organizations- state and regional agencies and- the academic system
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Public Health
PRACTICE TRANSFORMATION SUPPORTRegional Health Connectors (RHCs):
PARTICIPATION BENEFITS- MOC AND CME
Maintenance of Certification (MOC) and Continuing Medical Education (CME):
▪ Performance Improvement, Part IV of Board Recertification requirements: ▪ Family Medicine▪ Pediatrics▪ Internal Medicine
▪ Continuing Medical Education Credits:▪ Performance Improvement activities in the practices▪ Participation at collaborative learning sessions▪ Participation in e-learning modules
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Participation Funding
▪ Up to $5000 TOTAL/practice to help offset some cost of participation
($5000 potential broken down below)
▪ $2000- for two people per practice attend SIM Collaborative Learning Sessions▪ $500/session/2 sessions per year (x2 years)
▪ $2000- for submitting SIM Measures quarterly▪ $1000- per year (x2 years) if a practice submits clinical quality measures
quarterly▪ $1000- for participation in the SIM Evaluation process▪ $500 Baseline Assessment ▪ $500 Final Assessment
Small Grant Funding- Based on Need and Innovation (Details being finalized)
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PARTICIPATION BENEFITS PRACTICE TRANSFORMATION FUND- COHORT 1
PARTICIPATION BENEFITS-PAYER COMPENSATION
Payments from Health Plans:
▪ Colorado payers, public and private, are working together to develop a framework for achieving whole person care through comprehensive practice transformation
▪ Using this framework, payers will expand value-based payments within their networks to practices engaged in transformation activities and meeting specific milestones
▪ It is anticipated practices participating in Colorado SIM, and persisting in advancing through the model, will greatly improve the likelihood of receiving enhanced funding from private and public payers
▪ Participation in SIM does NOT guarantee enhance payments
▪ If selected for participation in Cohort 1, practices may choose not to participatebased on what is known regarding payer compensation and other variables important to the practices
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▪ Work on advancing behavioral health integration using an advanced primary care model
▪ Form a SIM Implementation Team, generally includes:▪ Provider champion, a clinical support staff member, a front desk person,
the office manager, and, if applicable, a care manager and/or behavioral health professional
▪ Submit Clinical Quality Measures (at least quarterly)
▪ Send (at least) two people to two, day-long learning sessions per year, held regionally across the state
▪ Participate in the SIM Evaluation process
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SIM PRACTICE PARTICIPATION EXPECTATIONS
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Measure Condition Citation Data SourceBreast Cancer Screening NQF 0031 ClaimsColorectal Screening NQF 0034 ClaimsDepression Screening NQF 0418 Adolescents & Adults or NQF 1401 Maternal
Depression ScreeningReported by practice
SUD Screening NQF Composite 2597 Reported by practiceFlu NQF 0041 Reported by practiceAsthma NQF 0036 Reported by practiceObesity NQF 0421 Adult or NQF 0024 Children/Adolescents Reported by practiceDepression Screening NQF 0418 Reported by practiceMaternal Depression NQF 1401 Reported by practiceDevelopmental Screening NQF 1448 Reported by practiceAnxiety GAD-7 Reported by practiceHypertension NQF 0018 Partial claims (diagnosis only) +
Reported by practiceTobacco NQF 0028 Reported by practiceDiabetes: Comprehensive Care NQF 0059 Partial claims (diagnosis and if hba1c
occurred) + Reported by practiceDiabetes: Blood Pressure Management NQF 0061 Reported by practiceDiabetes: LDL Management & Control NQF 0064 Reported by practicesSafety NQF 0101 Reported by practicesIVD NQF 0075 Reported by practice
SIM MEASURES (Cohort 1)
SIM PRACTICE MILESTONES
▪ Milestones activities line up with CPCI
▪ Additional components were added to reflect Colorado SIMs targeted focus on: ▪ Behavioral Health Integration▪ Community Engagement and
Population Health▪ Inclusion of Pediatric Practices
▪ Full document can be found in the ‘Resources’ section on the Colorado SIM and CU Practice Transformation
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SIM PRACTICE REVIEW & SELECTION PROCESS▪ A comprehensive and impartial evaluation of each practice will occur
▪ Practices will be ranked based on meeting the required and preferred characteristics as well as application responses
▪ Additional characteristics will be reviewed to ensure a balanced mix of practices to provide a diverse cohort that reflects variance in: - Geographic distribution- Practice size- Practice ownership structure- Urban/rural locations, and - Behavioral health integration
▪ Total points will be tabulated and applicants scored, ranked and shared with the SIM Office, who will make the final determination of practices for Cohort 1
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CU PRACTICE TRANSFORMATION WEBSITE
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www.ucdenver.edu/practicetransformation
RFA: a formal document to meet contractual requirements; provides explanation of the program and processes, including measures and potential “questions”
LINK FOUND AT: www.UCDenver.edu/practicetransformation
QUESTIONS: (submit to) [email protected]
(or call) 303.724.8968
KEY DATES: (previously listed on Project Timeline Slide)
▪ SIM Practice Application CLOSES: October 26, 2015
▪ SIM Practice Participants NOTIFIED BY: December 25, 2015
▪ SIM Project STARTS: February 1, 2016
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PRACTICE REQUEST FOR APPLICATION - (RFA)
SIM PRACTICE APPLICATION PROCESS▪ On-Line Application▪ Each individual practice site must complete an application; each site will be
considered on an individual basis (even within systems)▪ Health Systems may NOT complete the application on behalf of practice sites
▪ You may start application, save it and return at another time– though you MUST remember the code
▪ You may want to include a team to complete the process to address different sections: ▪ Practice Demographics ▪ Transformation Experience▪ HIT ▪ Attestations (leadership commitment and fiscal capabilities)
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SIM PRACTICE ONLINE APPLICATION-BEGINNING THE PROCESS
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▪ Link on both SIM Colorado and CU Practice Transformation websites
▪ Actual Application URL address-https://redcap.ucdenver.edu/surveys/?s=DFMRXMAMER
Required information and questions related to qualifications for practice participation
SIM PRACTICE ONLINE APPLICATION-BEHAVIORAL HEALTH INTEGRATION QUESTIONS
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Check Box and Narrative Questions
SIM PRACTICE ONLINE APPLICATION-ATTESTATION QUESTIONS
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Application can be completed by various staff AT the practice level
Attestation to come from leadership at the practice level
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SIM PRACTICE APPLICATION PROCESS- FAQS
SIM PRACTICE ONLINE APPLICATION-SAVING & RETURNING LATER
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ADDITIONAL RESOURCES▪ WEBSITES:
▪ Colorado SIM- www.coloradosim.org▪ CU Practice Transformation- www.ucdenver.edu/practicetransformation▪ CMS State Innovation Models Initiative- http://innovation.cms.gov/initiatives/state-innovations/▪ EvidenceNow National Website
http://www.ahrq.gov/professionals/systems/primary-care/evidencenow.html▪ Transforming Clinical Practices Initiative (TCPI)
http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/▪ Comprehensive Primary Care (CPC) Initiative
http://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/
▪ MATERIALS/DOCUMENTS:▪ Many pertinent materials and documents can be found in the ‘Resources’ section on both the
Colorado SIM and CU Practice Transformation websites ▪ NEW “Catalog of Transformation Offerings” (also found on CU Practice Transformation website)
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Colorado’s primary careadvancementopportunities…
What’s in it for you?
Learn more about the advancement
opportunities available to your practice
today!
Catalog of Transformation Offerings
