1. SIM High Level Framework and Overview Thursday, July 11, 2013 1

2. SIM High Level Components 1.Test reform - Bringing to the next level 100% adoption by MaineCare (great level of specificity on MaineCare SIM goals) Anticipate > adoption by newer, more immature test models Optional/not mandatory for more mature test models (e.g. – Systems Medicare ACOs) 2.State of Maine as “convener” driving reform alignment and actions across Payers and the State Identify common, shared reform goals/objectives acknowledging test models may vary in approach Share what’s working/what’s not working to drive towards best practices 3.Public reporting of results and identifying trends impacting healthcare 2

3. n SIM Governance Structure 3

4. SIM GOALS Int. BH/PH PCP Utilization Surgery Infection ED Costs Costs per Life Transparency Workgroup Lead: HealthInfoNet Admissions, Discharges, Trans ED Notifications PH Record Statewide HIE State: Lead Convener - Public Reporting --Share best practices --What’s working, what’s not? SERVICE DELIVERY REFORM Workgroup Lead: Quality Counts PCMH & HH Learning Collaborative ACO Learning Collaborative Support Leadership Development (RFP) Behavioral Health Collaborative (RFP) MAINE CDC Patient Engagement Diabetes Prevention 5 Sites Pilot w/ Community Health Workers PAYMENT REFORM Workgroup Lead: MHMC Data Analytics VBP Development & Learning Health Care Cost Workgroup Development of Behavioral HCC Workgroup Public Reporting Payer Populations MaineCare Medicare Commercial Self-Insured Employers 4

5. MAINE CDC Patient Engagement Diabetes Prevention 5 Sites Pilot w/ Community Health Workers SIM GOALS Int. BH/PH PCP Utilization Surgery Infection ED Costs Costs per Life TRANSPARENCY Chair: HealthInfoNet Admissions, Discharges, Trans ED Notifications PH Record Statewide HIE Public Reporting (MHMC) SERVICE DELIVERY REFORM Chair: Quality Counts PCMH & HH Learning Collaborative Leadership Development (RFP) Behavioral Health Collaborative (RFP) PAYMENT REFORM Chair: MHMC Data Analytics Public Reporting ACO Learning Collaborative Support VBP Development & Learning Health Care Cost Workgroup Development of Behavioral HCC Workgroup Public Reporting Payer Populations MaineCare Medicare Commercial Self Insured Employers Model Choice of SIM Grant Deliverables MaineCare: All In! 5

6. MAINE CDC Patient Engagement Diabetes Prevention 5 Sites Pilot w/ Community Health Workers SIM GOALS Int. BH/PH PCP Utilization Surgery Infection ED Costs Costs per Life TRANSPARENCY Chair: HealthInfoNet Admissions, Discharges, Trans ED Notifications PH Record Statewide HIE SERVICE DELIVERY REFORM Lead: Quality Counts PCMH & HH Learning Collaborative Leadership Development (RFP) Behavioral Health Collaborative (RFP) PAYMENT REFORM Chair: MHMC Data Analytics ACO Learning Collaborative Support VBP Development & Learning Health Care Cost Workgroup Development of Behavioral HCC Workgroup Public Reporting Payer Populations MaineCare Medicare Commercial Self-Insured Employers Model Choice of SIM Grant Deliverables Emerging/Immature Models: Anticipate Significant usage of SIM deliverables 6

7. MAINE CDC Patient Engagement Diabetes Prevention 5 Sites Pilot w/ Community Health Workers SIM GOALS Int. BH/PH PCP Utilization Surgery Infection ED Costs Costs per Life TRANSPARENCY Chair: HealthInfoNet Admissions, Discharges, Trans ED Notifications PH Record Statewide HIE SERVICE DELIVERY REFORM Chair: Quality Counts PCMH & HH Learning Collaborative Leadership Development (RFP) Behavioral Health Collaborative (RFP) Public Reporting Payer Populations MaineCare Medicare Commercial Self-Insured Employers PAYMENT REFORM Chair: MHMC Data Analytics ACO Learning Collaborative Support VBP Development & Learning Health Care Cost Workgroup Development of Behavioral HCC Workgroup Model Choice of SIM Grant Deliverables Mature Models: Usage of SIM as appropriate/desired 7

8. Enhancements to Test Models Position the State to assess the impact to healthcare delivery and cost by enabling test models to move to the next level through: Enhanced care delivery capabilities Greater access to high-value care information Enhanced care delivery participant (provider and patient) training / support Introduction of targeted incentives 8

9. SIM’s Enhancements to Test Models 9 Consumers Payers & Purchasers EE Portal Shared Decision- Making (SDM) tool Public Reporting Patient Satisfaction Plan Design (deductibles) While Providers & Consumers are the more direct recipients of Grant deliverables, all Stakeholders are reform beneficiaries Improved database Improved reporting tools PMPM Lower Annual Cost Enhanced Capabilities Data/Information Workforce/Patient Support Targeted Incentives Real-time ED alerts Practice reports Providers Common Quality Measures Cost of Care HIE expansion (including BH) Collaborative learning’s Leadership training Primary Care & BH integration Payment Reform Public Reporting

10. Build foundation to next level and evaluate model impacts Assess Test(s) Impact Reform to “next level” Foundational in-flight reform efforts Results/Public Reporting Adjustments

11. n Operational Plan Development and Review: Timeline and Process June 10 – 28 Operational Plan Development June 28: Deadline for Content Submission July 10: Steering Committee receives high level draft July 24: Steering Committee Approval for Submission Aug 1: Submission of SIM Operational Plan to CMMI Oct 1: Deadline for CMMI approval to move into implementation phase 11