SIM PTO TRAINING SEPTEMBER 26, 2018 9:00 AM Call Instructions: - PowerPoint PPT Presentation

SIM PTO TRAINING SEPTEMBER 26, 2018 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

SEPTEMBER 26, 2018 COLORADO SIM PTO TRAINING: Presenters: COHORT 2 – BB1, BB2, BB4, BB5 Marjie Harbrecht, MD COHORT 3 – BB1, BB2, BB4, BB5 Andrew Bienstock, MHA Stephanie Kirchner, MSPH, RD Kelly Pearson, RN, MSN

TRAINING OBJECTIVES ▪ Review MAC Requirements ▪ Cohort 3 – Year 1 - (Reviewed in August) ▪ BB1, BB2, BB4, BB5 ▪ Cohort 2 – Year 2 ▪ BB1, BB2, BB4, BB5 ▪ Review Preliminary Results – Andrew Bienstock ▪ CQM and Other Results To Date ▪ Extended CHITA Services ▪ Upcoming Events and Due Dates 3

MILESTONE REQUIREMENTS “Good standing” is defined as the following for each project year: ▪ Practice Sites participating in SIM-Only : ▪ Project Year 1 (Cohort 3): Practice sites must achieve Year 1 milestones within BBs: 1, 2, 3, 4, and 7. ▪ Project Year 2 (Cohort 2): Practice sites must achieve Year 2 milestones within BBs: 1, 2, 3, 4, 7, and any two additional building blocks. ▪ Practice Sites participating in SIM and CPC+: ▪ Project Year 1 (Cohort 3) : Practice sites must achieve Year 1 milestones within BBs: 1, 2, 3, 4, 7, 8, 9, and 10. ▪ Project Year 2 (Cohort 2) : Practice sites must achieve Year 2 milestones within BBs: 1, 2, 3, 4, 7, 8, 9, and 10. NOTE : Though not required for good standing, Cohort 3 practices should be scored on Year 2 BBs/Milestones on the MAC.

USE MAC TO GUIDE ONGOING PRACTICE WORK

NOW THROUGH OCTOBER 31, 2018 COHORT 3 – YEAR 1 COHORT 2 – YEAR 2 ▪ BB1 – Engaged Leadership ▪ BB1 – Engaged Leadership ▪ BB2 – Using data to drive change ▪ BB2 – Using data to drive change ▪ BB4 – Team-based care ▪ BB4 – Team-based care ▪ BB5 – Partnership with patients ▪ BB5 – Partnership with patients 6

PHASED APPROACH TIMELINE – COHORT 3 – YEAR 1 7

PHASED APPROACH TIMELINE – COHORT 2 - YEAR 2 8

SIM OPERATIONAL ALGORITHM – COHORT 3 & 2 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 Year 2: Risk stratify at least 75% of EXPAND and MAINTAIN EFFORTS 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 BUILD COLLABORATIVE BB8 - ACCESS TO BH CARE BB6 - CLOSELY MANAGE at INTEGRATED AGREEMENTS WITH Year 2: Bi-directional data sharing least 75% of HIGH RISK BEHAVIORAL HEALTH CARE PATIENTS BB9 - CARE COORDINATION TO REDUCE (EITHER ONSITE OR OFFSITE) COSTS AND IMPROVE CARE 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

SUSTAIN EXPAND BUILD 10

COHORT 3 MILESTONES BUILDING INFRASTRUCTURE BB1 - BB2 - BB4 - BB5 REVIEWED YEAR 1 MILESTONES IN AUGUST (ANY QUESTIONS??) 11

COHORT 2 MILESTONES YEAR 2 – EXPANDING INFRASTRUCTURE BB1 - BB2 - BB4 – BB5 12

COHORT 2 – YEAR 2 BB1.YR 2 - ENGAGED LEADERSHIP 1. Leadership allocates appropriate resources to complete QI work 2.Design plans to evaluate effects of value-based payments (Review VISION for any adjustments needed) 13

COHORT 2 – YEAR 2 BB2.Y2 - USE DATA TO DRIVE CHANGE 1. Review CQM data 2. Develop process for providing performance feedback to providers (CQMs/cost) 3. Conduct regular QI activities based on CQMs (Continue to submit CQM’s quarterly – next DUE Oct 31 st )

POLLING QUESTION RE COST/UTILIZATION 1. How many of your practices are using Stratus to assist with cost/utilization information? a) All of them b) Half or more c) Less than half d) None 2. For your practices using Stratus, in general what feedback are you receiving about it? a) Overall very positive b) Overall positive but they need more training on it c) Overall negative d) They don’t have access to it 3. What other tool(s) beside Stratus are they using for cost/utilization information? (Mark all that apply) a) Medicaid's Statewide Data Analytics Contractor (SDAC) b) Milliman Reports c) QRUR reports from Medicare d) Other (explain) e) They’re not using anything 15

BB2.Y1.4. PRACTICE BEGINS USING A DATA AGGREGATION TOOL PROVIDED BY SIM TO REVIEW COST AND UTILIZATION DATA. ▪ Practice Attestation Anchor: Demonstrate through attestation of use of a tool that provides cost and utilization data, such as Medicaid's Statewide Data Analytics Contractor (SDAC), Stratus, QRUR reports from Medicare, etc. ▪ Practice Facilitator Attestation Methodology: Attest if practice is learning to review and use a utilization aggregation tool. Document in monthly field notes. 16

COHORT 2 - YEAR 2 BB4.Y2 - PROVIDE TEAM-BASED CARE 1. Re-evaluate team relationships using tools from Year 1 2. Develop protocols for shared workflows (for 3 CQMs with at least one BH measure) 3. Review roles/responsibilities for team-based care activities 17

BB4.Y2.1. PRACTICE REEVALUATES TEAM RELATIONSHIP USING TOOL FROM YEAR 1 Action Items : Re-evaluate how practice teams are functioning by reviewing distribution of patient care tasks by role used in Year 1. ▪ Practice Attestation Anchor : Repeat assessment/discussion of team relationships ▪ Practice Facilitator Attestation Methodology : Confirm review of MAC, Medical Home Practice Monitor and Clinician/Staff Experience Survey results, plus other similar tools used, including comparison to baseline results. 18

BB4.Y2.2. PRACTICE DEVELOPS PROTOCOLS FOR SHARED WORKFLOWS FOR 3 QUALITY MEASURES (AT LEAST ONE BH MEASURE) ▪ Action Items : 1. USE STANDING ORDERS a) Screening for developmental, substance use, cancer, depression b) Disease-based testing (i.e., A1C, PHQ-9, monofilament exams) 2. Develop a written protocol 3. Review with providers/staff 4. Train staff on using standing order protocols, including NEW staff 5. Review/update standing orders/protocols regularly and retrain/update with any new information . ▪ Practice Attestation Anchor : Demonstrate protocols/workflows ▪ Practice Facilitator Attestation Methodology : Confirm practice implementation of protocols/workflows. 19

EXAMPLE: DEPRESSION SCREENING ▪ GOAL: How do we increase depression screening in practice to ensure patients with depression get appropriate treatment and care to improve depression symptoms (and consequences of that – missing work, unable to enjoy things, etc) ▪ Standing Order : Every patient screened for depression at least once per year ▪ Written Protocol (workflow) and who does what ▪ What test do you use? ▪ Who will administer it? ▪ What is done if results are positive? ▪ What follow up is recommended? How often? Who ensures patient gets follow up? ▪ For physicians – what therapy or medications are first line, second line, etc? When do we refer? What happens if patient has risks for harming self or others? ▪ When do we get patient back to normal follow up? ▪ Review Standing Order/Protocol/Workflow as needed 20

BB4.Y2.3. PRACTICE REVIEWS ROLES/RESPONSIBILITIES FOR TEAM-BASED CARE ACTIVITIES TO ENSURE ACCOUNTABILITY FOR VARIOUS TASKS ASSIGNED. ▪ Action Items : 1. Build “team culture”, empower staff to take on new roles, act independently, and communicate effectively. Provide protected time for teams to interact/plan activities. 2. Distribute workload throughout team to make optimal use of each member’s training and skill set, with training for new skills if needed. 3. Help patients understand what they can expect from the team- based care model ▪ Practice Attestation Anchor : Document roles/responsibilities for various team-based activities. ▪ Practice Facilitator Attestation Methodology : Confirm implementation 21