SIM PTO TRAINING FEBRUARY 27, 2019 9:00 AM Call Instructions: Please • Mute your phone, microphone, and speakers on your computer/device • Turn off the zoom video feature • Enter your name/organization in the chat box feature for attendance • Submit questions via the chat box feature Questions will be answered following the presentation • Time to ask questions via audio will be offered for those on the phone • 1
FEBRUARY 27, 2019 COLORADO SIM PTO TRAINING Presenters: Marjie Harbrecht, MD REVIEW BB8, BB9 & BB10 Stephanie Kirchner, MSPH, RD REVIEW COST/UTILIZATION KEY DRIVER DIAGRAM Kelly Pearson, RN, MSN Lauren Shviraga
TRAINING OBJECTIVES ▪ Invoicing in SPLIT ▪ Review BB8, BB9, BB10 – moving toward behavioral health integration. ▪ Review Cost/Utilization Driver Diagram ▪ Upcoming Events and Due Dates for Assessments 3
INVOICING IN SPLIT LAUREN SHVIRAGA SPLIT PROJECT COORDINATOR & SIM RESEARCH ASSISTANT 4
INITIATIVE ASSESSMENTS & DUE DATES Task/Assessment Name Assessment Timeframe Final Assessments – Part 1 March 1 st – March 31 st Integrated Practice Assessment Tool (IPAT) Health Information Technology Assessment (HIT) Clinician & Staff Experience Survey (CSES) Updates to SIM CQM Reporting for Q4 – 2018 Updated Data Due March 15th (Opportunity for practices to update CQM data for Payer Reports, if issues were encountered during the Q4-2018 reporting period) April 1 st – April 30 th SIM CQM Reporting for Q1 - 2019 Final Assessments – Part 2 April 1 st – May 15 th Medical Home Practice Monitor (Monitor) Milestone Attestation Checklist (MAC) SIM Practice Closeout Questions (Closeout) Report Monthly thru May/June 2019 PF & CHITA Monthly Field Notes (Submit within one week of the last day of the month – (Last Monthly Field Note due June 8, 2019) Last field note will document work completed after May 15 th ) Final Practice Site Progress Report April 1 st – May 15 th ( Previously known as ‘Final Field Note’ and to be completed by PFs & CHITAs) 5
CQM REPORTING FOR Q4 – 2018 o Practice sites that were unable to submit CQMs due to a vendor or other issue were required to complete the CQM reporting survey in SPLIT by January 31 st o In the survey select ‘Unable to Report this Quarter’ response for CQMs usually reported o In the survey select ‘EHR vendor issue’ on the last page and supply details related to the issue(s) and include a date when the practice site anticipates being able to report Q4 – 2018 CQMs o Practice sites that are unable to report CQM due to a vendor issue will be able to update reported the CQM values used in SIM Payer Reports until March 15 th o Reminder – failing to submit CQMs or failing to indicate that they are unable to by January 31 st , may prevent a practice site from receiving payment 6
PTO INVOICING PROCESS Practice Transformation Organizations (PTOs) are responsible for submitting invoices to the Practice Innovation Program team upon completion of all SIM reporting activities/assessments for all practice sites assigned to the PTO. Required deliverables can be referenced in the appropriate PF or CHITA Statement of Work (SOW). To assist PTOs in tracking the completion of deliverables a ‘PTO Deliverable Completion Reports’ will be posted in SPLIT on a biweekly schedule March 29 th to June 10 th . Listed are important due dates, additional submission instructions, and PTO invoices/payments details: • All SIM work and activities related to PTO deliverables must be completed no later than June 8, 2019. • To receive payment for completed work PTO invoices must be submitted no later than June 30, 2019. • Completion reports will be generated and posted in SPLIT on Fridays biweekly starting March 29, 2019. • The final completion reports for work completed will be generated and posted in SPLIT on June 10, 2019. • PTO invoices will be created and submitted by the PTO, and are not generated by or available in SPLIT. • PTO invoices should be submitted by email to Natalie.Buys@ucdenver.edu. • Payments are typically processed and issued within 30 days of submission. 7
PTO COMPLETION REPORTS Completion reports will summarize the following activities by practice site for PTOs: • Practice Site Assessments • CQM Reporting • Monthly Field Notes • Deliverable Completion 8
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QUESTIONS? Contact the Support Team http://bit.ly/PracticeInnovationSupport 10
REMAINING BUILDING BLOCKS & MILESTONES PHASE 4: FEB 1 – JUNE 30, 2019 COHORTS 2 & 3 ▪ BB8 – Prompt access to care, including BH ▪ BB9 – Care coordination for primary care/BH ▪ BB10 – Fully integrated BH/whole person care 11
PHASED APPROACH TIMELINE: COHORT 2 - YEAR 2 12
PHASED APPROACH TIMELINE: COHORT 3 – YEAR 1 13
SIM COHORT 2 MILESTONE OPERATIONAL ALGORITHM (OVERVIEW) BUILD INFRASTRUCTURE BB1 - ENGAGED LEADERSHIP WHERE TO START? Year 1: Establish agreements with payers, set up budget, QI team, champion attends CLS, set vision for behavioral health (BH) integration and pathway PATIENT POPULATION BUILD INFRASTRUCTURE UNDERSTAND THE ("ACTIVE" PATIENT PANEL) BB2 - USE DATA TO DRIVE CHANGE MAKEUP OF YOUR Year 1: Data, care gaps, CQMs, cost drivers POPULATION ------------ BB4 - TEAM-BASED CARE IMPROVE CONTINUITY Year 2: Workflows for three CQMs (at least 1BH) THROUGH BB3 - EMPANEL AT LEAST 75% of EMPANELMENT BB5 - PARTNERSHIP WITH PATIENTS PATIENT POPULATION ------------ Year 1: Establish PFAC SCREEN FOR BH/SUD Year 2: Shared decision-making aids and self-management support ______________ ------------ tools USE DATA TO BB7 - SCREEN UP TO 90% FOR BH/SUD POSITIVE BH/SUD CLOSE GAPS & BB8, BB9 and BB10 - BEHAVIORAL HEALTH ISSUES Connect to BH/Community IMPROVE CARE Year 1: Start building infrastructure to address BH Year 2: Develop collaborative care agreements with BH providers BB6 - RISK STRATIFICATION EXPAND and MAINTAIN EFFORTS Year 2: Risk stratify at least 75% of population STRATEGICALLY MANAGE ALL PATIENTS YOUR POPULATION BY CONTINUE BB1, BB2, BB4, BB5 RISK STRATIFYING TO LOW RISK MEDIUM RISK HIGH RISK DETERMINE WHO NEEDS BB6 - HIGH RISK PATIENTS ADDITIONAL Year 2: Risk stratify, use data to manage ATTENTION/SERVICES care gaps/track outcomes, develop care Prevent Low and Medium Risk patients plans for 75% of high-risk patients from becoming High Risk COORDINATED -------------- PATIENTS WITH BH ISSUES and/or BB8 - ACCESS TO BH CARE BUILD COLLABORATIVE BB6 - CLOSELY MANAGE at INTEGRATED Year 2: Bi-directional data sharing AGREEMENTS WITH least 75% of HIGH RISK BEHAVIORAL HEALTH CARE PATIENTS BB9 - CARE COORDINATION TO REDUCE (EITHER ONSITE OR COSTS AND IMPROVE CARE OFFSITE) TO IMPROVE BB10 - BH REFERRAL PATHWAY WITH COORDINATION AND 24/7 EHR ACCESS; CARE PLANS, MANAGEMENT TRACK BH PATIENT OUTCOMES USE REGIONAL HEALTH CONNECTORS TO ASSIST YOU WHEN POSSIBLE Improve Quality of Care Reduce Costs Improve Experience for Patients & Healthcare Teams
MOVING TOWARD FULL BH INTEGRATION BB8 - BB9 - BB10 COHORT 3 - YEAR 1 COHORT 2 - YEAR 2 15
BUILDING BLOCK 8 - PROVIDE PROMPT ACCESS TO CARE, INCLUDING BH CARE Goal: Practice (at minimum), has established collaborative care management agreements with BH providers in the community and members of the care team can articulate how to use those agreements. Practice has ability to share clinical data based on collaborative care management agreements with BH providers bi-directionally within 7 days.
MAKING CONNECTIONS How the Regional Health Connector workforce can support you February 28, 2017
COHORT 3 BB8.Y1 - PROVIDE PROMPT ACCESS TO CARE, INCLUDING BH 1. Practice representative with 24/7 EHR access 2. Assess referral pathways and after-hours BH support (work with RHCs) 3. Identify data sources and technology needed for bi-directional data sharing 18
COHORT 2 BB8.Y2 - PROVIDE PROMPT ACCESS TO CARE, INCLUDING BH 1. Establish a collaborative agreement with at least one BH health provider 2. Develop plan for bi-directional data sharing with BH health provider 19
BUILDING BLOCK 9 - COMPREHENSIVE CARE COORDINATION FOR PRIMARY CARE/BH Goal : Practice has reduced total cost of care while maintaining or improving quality of care for patients, including those with depression and substance abuse disorders, compared with non-SIM practices. 20
COHORT 3 BB9.Y1 - COMPREHENSIVE CARE COORDINATION FOR PRIMARY CARE/BH 1.Identify total cost of care for panel, and subset of those with BH conditions 2.Identify/implement policy and procedures for timely follow-up for ED visits/hospital admissions 21
COHORT 2 BB9.Y2 - COMPREHENSIVE CARE COORDINATION FOR PRIMARY CARE/BH 1.Contact 50% of patients within 7 days of hospitalization/ED visit, including medication reconciliation 2.Identify cost drivers for patients with BH conditions and incorporate in QI processes 3.Create/report a measurement to assess impact and guide improvement on at least one of the following: • Notification of ED visit in timely fashion • Completed medication reconciliation within 72 hours • Notification of admission and clinical information exchange at time of admission • Information exchange between primary care and specialty care related to referrals 22
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