1. Maine SIM Evaluation Subcommittee April meeting 2016 March 30, 2016

2. lewin.com | 1 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

3. lewin.com | 2 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

4. lewin.com | 3 Meeting Minutes Please see meeting minute handouts for March 2. Suggested edits from Committee members? Additional questions or clarifications? Motion to approve as written or amended

5. lewin.com | 4 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

6. lewin.com | 5 Consumer Survey 2016 – Summary of Proposed Changes The 2016 survey adds questions to guide quality improvement –New questions follow-up 2015 questions to provide more detail on the reasons for responses –Follow–up questions are open-ended, expressed in the consumer’s own words. Responses will be the “voice of the consumer” –New questions address topics identified in SIM Annual Meeting Sample revisions for 2016- 1500 total targeted completed interviews: 500 MaineCare AC patients 500 Stage A Health Home patients 500 Behavioral Health Home patients See updated tools for final discussion

7. lewin.com | 6 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

8. lewin.com | 7 Provider Research 2016 - Changes from 2015 Effort (review & updates) Rather than one instrument, tailored questions for Behavioral Health Homes MaineCare Stage A Health Homes MaineCare Accountable Communities SIM Stakeholders Use of quantitative questions to replace open-ended questions where possible Use of interviewers & possible online surveys to reach appropriate & knowledgeable respondents in MaineCare Stage A Health Homes, Behavioral Health Homes, & MaineCare Accountable Communities Use of focus groups instead of interviews to collect data from SIM stakeholders

9. lewin.com | 8 2016 Provider and Stakeholder Interviews- Next steps Keeping the 2016 SIM focus in mind, a preliminary list of questions has been developed for groups to be interviewed. Discussion today aims to –Review first draft of interview/survey tools for MaineCare Accountable Communities & Health Homes/Behavioral Health Homes; –Identify any gaps or refinements for the questions based on subcommittee member experience and knowledge of SIM; –Inform the refinement of the final tools that will be brought back to the committee at the May 2016 meeting.  Note that the Stakeholder focus group moderator guide is still in development & will be presented for final review at the May 2016 meeting

10. lewin.com | 9 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

11. lewin.com | 10 SIM Dashboard & Target setting updates Maine Care Dashboard- review of updated data Medicare data & next steps for target setting process Status update on Commercial Target setting process

12. lewin.com | 11 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

13. lewin.com | 12 Rapid Cycle Improvement (RCI) Principles “The facts are friendly”. The process should emphasize how the evaluation findings can be used, not to find fault, but to strengthen overall efforts. The evaluation should prompt as many questions as it answers. Recognize that the “answer is in the room”. Effectively engaging people closest to implementation has two benefits: a) they are the ones on the “front line” who are knowledgeable about the intervention; and b) engaging them in solving the problem will lead to greater ownership of the solution.

14. lewin.com | 13 Rapid Cycle Improvement Process There are hundreds of discrete findings, it is important to narrow the field to enable a productive, focused discussion. Share the focused list with the Evaluation Subcommittee and the Steering Committee for input and modifications. Identify key parties who have a deep understanding of each key topic area and convene a meeting to discuss the finding, deepen our understanding of what is going on “under the hood”, and move to constructive next steps. Bring the recommendations from these discussions back to Maine Leadership for further discussion and, where appropriate, action

15. lewin.com | 14 How do we strengthen patient engagement by providers? CategoryTheme Table Number % of Theme feedback 1471013 Barriers to patient engagement FFS as well as prescribed structure constrains time for patient visits - Examples: Lack of time to have more open discussions; ineffective domestic violence screening xxxxx 100% Ineffective communication between patient and provider, including power dynamics, poor provider listening, and insufficient empowerment of consumers to share xxx x 80% Patients not empowered to engage, ask questions, and develop trusting relationships with providers. xxx x 80% Wide variation across providers in level of engagement of patients x x 40% Reactive care occurs during most patient-provider interactions rather than proactive patient engagement throughout care process x 20% Ineffective communication/information sharing between care providers; fragmentation of information due to system barriers x 20% Current methods for patient engagement Choosing Wisely tool xxxxx 100% Patient advisory groups (should be expanded) xx 40% Community Health Advocates, rural volunteers x 20% PCMH model has started to make patient involvement a priority x 20% Seaport FP - example of physicia led retired men's group x 20% Suggestions for improved patient engagement Broader use of Choosing Wisely and Shared Decision Making models xxxxx 100% Customize doctor visits/care approaches to patient needs, including creating more welcome space to ask questions and increased provider sensitivity and efforts to build trusting relationships; create follow-up, questioning mechanism xxxxx 100% Incentivize patient engagement through payment reform. May include: Survey patients - Use experience of care survey results to evaluate (and pay) providers and staff based in part on their ability to engage patients; Other productivity standards (Patient activation measures via Duke University) xxxxx 100% Greater role for patient engagement across care team, not just physicians. This may also include care workers outside of office and greater use of community groups and rural resources to reach patients. xxxx 80% Educate patients about insurance, medical terminology to make care more accessible xxxx 80% Delivery reform to better coordinate information between providers; For example, use new technologies/communication methods like GPS for medicine reminders, to avoid risky places xxxx 80% Provider and staff training to support workflow change and better communications xxx x 80% Set expectations and incentives for patients to manage own care x xx 60%

16. lewin.com | 15 How can data sources be streamlined and simplified to better support this function? CategoryTheme Table Number % of Theme feedback 2581114 Barriers to consistent portal use Lack of consistent data sources/ "portals" and access across providers xxxxx 100% Need for defined provider utility for data xxxx 80% Time/Staff training issues xxx 60% Data system inconsistencies - not interoperable, multiple payer approaches, etc. x x x 60% Opportunities to improve portal utilization Develop standards for information collection and measurement of outcomes xxxxx 100% Provide better provider training and workflow support for data sources / "portal" use xxxxx 100% Analyze overlaps in data sources/"portals" and make effort to integrate into one platform xxxxx 100% Better identify data utility for providers (purpose/potential use) xxxx 80% Incentivize interoperability xx xx 80% Make better use of other team members for data input x xx 60% Incentivize patient ownership of data x x 40% Other ideas / considerations Reduce competition in data collection market; single payor system x xx 60% Integrate other information: behavioral health data; social determinants of health; financial information; other provider data such as CHWs x xx 60%

17. lewin.com | 16 The Role of Care Coordination….do we need more or too much of a good thing? CategoryTheme Table Number % of Theme feedback 369 1212 1515 Evaluation considerations There is a need for more specific measures of effective care coordination, including more clearly defined goals for each care coordination model xx x 60% The SIM evaluation does not collect data specifically measuring the effectiveness of different types of care coordination xx 40% Defining coordination Evaluate more clearly what populations need specific services to ensure coordination model meets service goals (consider geographical differences, disease specific, risks stratification) xxxx 80% Evaluate and define what the goal of each coordination model is, not clear across users xx x 60% Opportunities for improving upon care coordination activities in Maine and avoid duplication Endorse best practices, including consistent standards of assessments; auto-referrals; medication reconciliation, home visits xxxxx 100% Identify who is responsible for care coordination; distinguish roles of care and ensure better accountability for resource allocation xxxxx 100% Improve communication between hospital, care teams to improve effective information sharing and reduce duplication of effort xxxx 80% Create one unified patient record and/or better utilize data resources, consider inclusion of additional data like dental care, behavioral health xxxx 80% Educate consumers, providers and staff to ensure understanding of coordination model goals xxx x 80% Payment reform Develop payment method for care coordination/Incentivize care coordination x xx 60% Explore opportunities to sustain payment from Medicare for care coordination x x 40% Explore payment reform opportunities to identify and intervene for mid-risk individuals and prevent escalation to high risk (eg. global payments) x x 40%

18. lewin.com | 17 Today’s Agenda Welcome and IntroductionsReview & Approve the March 2 Meeting MinutesConsumer Interview Tools– Final ReviewSIM Dashboard Update & Discussion of Next Steps for Target SettingProvider/Stakeholder Research- Review of 2016 Draft ToolsRCI- Stakeholder Feedback from Annual MeetingTime for Public CommentNext Steps

19. lewin.com | 18 Next Steps Next Meeting – May 4, 2016, 2-4 pm Pine Tree Room 2 Anthony Avenue, Augusta Future Discussion Topics –Review/revision final Provider, Stakeholder research tools –Update on Special Studies for the 2016 SIM Evaluation –Rapid Cycle Improvement Discussions –Update on NDPP & CHW research –Follow up on clinical data risk and other identified risks as necessary