Maine SIM Evaluation Subcommittee February 2016 February 3, 2016

lewin.com | 1 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 2 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 3 Meeting Minutes Please see meeting minute handouts for January 6th. Suggested edits from Committee members? Additional questions or clarifications? Motion to approve as written or amended

lewin.com | 4 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 5 SIM Year 3 – Update from SORT/MLT Process Update from Jay Yoe and Randy Chenard

lewin.com | 6 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 7 Clinical Data Risk Update Update given by Jim Leonard

lewin.com | 8 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 9 Consumer Survey 2016 – Summary of Proposed Changes The 2015 evaluation survey identified areas of challenge and strength The 2016 survey will add questions to guide quality improvement –New questions will follow-up 2015 questions to provide more detail on the reasons for responses –Follow–up questions will be open-ended, expressed in the consumer’s own words. Responses will be the “voice of the consumer” New questions will address topics identified in SIM Annual Meeting

lewin.com | 10 Consumer Survey 2016 – Summary of Proposed Changes Topic Areas for Follow-up Questions: Communications and Patient Engagement Coordination of Care Expectations and Outcomes Topic Areas for New Questions Patient Involvement Emergency Department Use Barriers to Care

lewin.com | 11 Consumer Survey 2016 Proposed Follow-up Questions Communications and Patient Engagement Earlier, you indicated problems or concerns in communicating with your/your child’s provider or how much your/your child’s provider asked for your input into managing your/your child’s care. What problems did you experience? Did you mention your problems or concerns to your provider or support staff? Did your/your child’s provider or anyone in his or her office work to resolve any problems or concerns? What do you think could be done to improve communication between you and your/your child’s provider and improve how involved you feel in managing your/your child’s own health?

lewin.com | 12 Consumer Survey 2016 Proposed Follow-up Questions Coordination of Care Earlier, you indicated that you experienced problems or concerns with coordinating your/your child’s care with other providers including (include list of issues). What were these problems? Did you mention your problems or concerns to your provider or support staff? Did your/your child’s provider or his or her office work to resolve any problems or concerns? What do you think could be done to improve the coordination of your/your child’s care between this provider and others from which you/your child receive care or services?

lewin.com | 13 Consumer Survey 2016 Proposed Follow-up Questions Expectations and Outcomes Now, I’d like to ask about how this care has helped you/your child. When you/your child first saw this provider, what change in your/your child’s condition did you expect? Please describe your/your child’s experiences seeing this provider. Did you receive the care you expected and did it work as well as you thought it would? Did you mention any problems or concerns to your provider or support staff? Did your/your child’s provider or his or her office work to resolve any problems or concerns?

lewin.com | 14 Consumer Survey 2016 Proposed Follow-up Questions Ask of All What about your experience with this provider was positive? And finally we would like to get your feedback about your provider and your patient experience. What else do you think can be done to improve your/your child’s experience as a patient?

lewin.com | 15 Consumer Survey 2016 Proposed New Questions Patient Involvement Currently this question is included in the child survey. We would propose including in the adult version of the survey: Thinking about the last 6 months, how often did this provider ask you for your ideas about managing your health?

lewin.com | 16 Consumer Survey 2016 Proposed New Questions Emergency Department Use During the past 12 months did you/your child seek medical care in a hospital emergency room for any reason? I'm going to read you a list of reasons why some people go to the emergency room. Please tell me if any of these were important reasons for you/your child’s last visit to a hospital emergency room. –10 You/Your child was so ill that they needed immediate medical attention –11 You/Your child had an injury that needed immediate medical attention –12 You/Your child were unable to get an appointment at a doctor's office as soon as needed –13 You/Your child needed care after normal hours at the doctor's office or clinic –14 The family owed money to the doctor's office or clinic –15 It was more convenient to go to the hospital emergency room –16 The doctor's office or clinic told you/your child to go to the emergency room –17 A specialist was not available –18 You/Your child were unable to get an appointment with a mental health provider –95 Some other reason? (SPECIFY)

lewin.com | 17 Consumer Survey 2016 Proposed New Questions Barriers to Care During the past 12 months, was there any time when you/your child needed any of the following but didn't get it because they could not afford it: –Medical care from a doctor or surgery? –Mental health care or counseling? –Dental care including checkups? –A diagnostic test such as a CAT scan, MRI, lab work, or x-ray that was recommended by a doctor or other care provider? –Prescription medicines? Have you/your child ever delayed or not gotten PHYSICAL OR MENTAL health care because you could not find a doctor or other health care provider or a health care provider was not available at the time they needed care (what type of care)? Has you/your child ever delayed or not gotten care because they could not find or did not know a doctor or other health care provider who accepts MaineCare (Follow Up: what type of care did you not receive)?

lewin.com | 18 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 19 Provider Research Changes from 2015 Effort Rather than one instrument, tailored questions for Behavioral Health Homes Accountable Communities Community Care Teams MaineCare Health Homes SIM Stakeholders Use of quantitative questions to replace open-ended questions where possible Use of focus groups instead of interviews to collect data from Behavioral Health Homes, Accountable Communities, Community Care Teams and SIM stakeholders Use of interviewers to reach appropriate & knowledgeable respondents in MaineCare Health Homes

lewin.com | 20 Provider Research Focus Groups Discussion questions tailored for each provider group with evaluation committee support Groups held in conjunction with planned work group meetings, AC’s brought together for focus groups minute sessions facilitated by professional moderator Structured discussion, but flexible to respond to participant priorities Discussion transcribed, quantitative responses reported in tables, full analytical report with respondent comments and quantification

lewin.com | 21 Provider Research Interviews Questions tailored for MaineCare Health Homes with evaluation committee support Survey programmed into Computer Aided Telephone Interviewing (CATI) software Interviews by experienced executive interviewers Most appropriate or knowledgeable respondent interviewed (more than 1 per Home) Data reported in tables with full analysis

lewin.com | 22 Provider Research Summary Segment Actual 2015Proposed 2016 No. in Sample In-depth Interviews Completed* Data Collection Target Participation SIM Stakeholders25182 Focus Groups12-16 Behavioral Health Homes24182 Focus Groups12-16 MaineCare Accountable Communities (ACs) 4?1 Focus Groups4-8 Community Care Teams (CCT)872 Focus Groups12-16 MaineCare Health Homes (Not included in AC and CCT above) In-depth, Tele-interviews Total

lewin.com | 23 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 24 Rapid Cycle Improvement – Next Steps Update from Jay Yoe

lewin.com | 25 How do we strengthen patient engagement by providers?

lewin.com | 26 How can data sources be streamlined and simplified to better support this function?

lewin.com | 27 The Role of Care Coordination….do we need more or too much of a good thing?

lewin.com | 28 Today’s Agenda Welcome and IntroductionsReview & Approve the January 6 th Meeting MinutesSIM Year 3 – Update from SORT/MLT ProcessConsumer Interview Tools Review – Final DiscussionProvider/Stakeholder Interview Tools – Updated ApproachRapid Cycle Improvement: Feedback from Annual MeetingClinical Data Risk UpdateTime for Public CommentNext Steps

lewin.com | 29 Next Steps Next Meeting – March 2, 2016, 2-4 pm Pine Tree Room 2 Anthony Avenue, Augusta Future Discussion Topics –Continue Rapid Cycle Improvement Discussions –Review/revision Provider, Stakeholder research tools –Target setting progress for Commercial & Medicare- progress update –Updated Maine SIM dashboard review –Follow up on clinical data risk and other identified risks as necessary