Maine SIM Evaluation Subcommittee June 2015 June 24, 2015

lewin.com | 1 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 2 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

lewin.com | 3 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 4 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

lewin.com | 5 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 6 SIM Self-Evaluation: Provider/Stakeholder interview update Maine SIM Provider / Key Informant Interviews Update as of June 18, 2015 Provider interviews Calls made:379 Interviews scheduled:103 Interviews completed**:100 Declined to participate:1 Voice mails left:199 Messages (live) left:39 Spoke with target:27 Calls - no message left:29 Other call responses:0

lewin.com | 7 SIM Self-Evaluation: Provider/Stakeholder interview update Maine SIM Provider / Key Informant Interviews Update as of June 18, 2015 *Types of Completed Interviews Medicaid Health Homes including PCMHs59 Behavioral Health Homes18 Community Care Teams7 Key Informants16 Interviews completed:101 Cumulative 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%

lewin.com | 8 SIM Self-Evaluation: Provider/Stakeholder interview update Committee to Provide input to Crescendo regarding final report format and other desired information

lewin.com | 9 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 10 SIM Self-Evaluation: Consumer interview /survey update Consumer Interview Outreach and Completion Data as of HH- Adult HH-Adult Control HH- Child HH-Child Control BHH - Adult BHH-Adult Control BHH - Child BHH-Child Control Total Sample Records No Phone Number % Invalid Phone Number % Refusals % Completes % Total Final Disposition % Remaining Sample % Outreach Attempts Consumer Interview Outreach and Completion Data as of HH-Adult HH-Adult Control HH-Child HH-Child Control BHH - Adult BHH- Adult Control BHH - Child BHH- Child Control Total Sample Records No Phone Number Invalid Phone Number Refusals Completes Total Final Disposition Remaining Sample Outreach Attempts Mailing Sample Returned as Undeliverable Returned Complete Total Completed Surveys

lewin.com | 11 SIM Self-Evaluation: Consumer interview /survey update Committee to Provide input to Market Decisions regarding final report format and other desired information

lewin.com | 12 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 13 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

lewin.com | 14 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

SIM Maine Leadership Team Message 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 MaineCare Medicare Commercial 2

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 3

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 4

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 average Maine 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 survey Maine 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 5

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 7

Intended Use Payment Amount SIM core evaluation measures and associated targets are not intended to be used to determine payment amounts 8

SIM Core Evaluation Measures SIM Core Evaluation Measures – A small subset of what already exists Universe of Quality Measures (~ 300) Core Measure Set developed by ACI Subcommittee (~30 ) SIM Core Evaluative Measures (~12) 9 *SIM Core Measure set developed and approved through SIM Governance in May 2014

End Product View 10

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,

lewin.com | 26 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 27 Today’s Agenda Welcome and IntroductionsReview & Approve the May 27 th Meeting MinutesStatus Update: Provider, Key Stakeholder InterviewsStatus Update: Consumer InterviewsRisk Identification and DiscussionGoal Setting for Core MeasuresTime for Public CommentNext Steps

lewin.com | 28 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