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Maine SIM Evaluation Subcommittee December 2015 December 2, 2015.

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Presentation on theme: "Maine SIM Evaluation Subcommittee December 2015 December 2, 2015."— Presentation transcript:

1 Maine SIM Evaluation Subcommittee December 2015 December 2, 2015

2 lewin.com | 1 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareCommercial Target Setting Process UpdatesConsumer Interviews: Updates for Round 2Time for Public CommentNext Steps

3 lewin.com | 2 Welcome, Introductions, and Goals for Today’s Meeting Review findings from the evaluation and continue discussion of prioritizing topics for Rapid Cycle Improvement Review SIM Core Metrics Findings for MaineCare Update on Commercial Target Setting Process Consider updates to the consumer interview tool for Round 2

4 lewin.com | 3 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareCommercial Target Setting Process UpdatesConsumer Interviews: Updates for Round 2Time for Public CommentNext Steps

5 lewin.com | 4 Meeting Minutes Please see meeting minute handouts for October 28th. Suggested edits from Committee members? Additional questions or clarifications? Motion to approve as written or amended

6 lewin.com | 5 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareCommercial Target Setting Process UpdatesConsumer Interviews: Updates for Round 2Time for Public CommentNext Steps

7 lewin.com | 6 Principles for Rapid Cycle Improvement (RCI) discussions “The facts are friendly”: Treat evaluation findings as opportunities to make improvements. Stay future-focused. Question, Question, Question –Evaluation findings ideally prompt more questions than they answer. –A “positive” evaluation outcome is one that prompts thoughtful discussion about the findings and leads to constructive action steps. The “answer is in the room”: engaging people closest to implementation benefits RCI: –Stakeholders have “front line” knowledge about the intervention. –Stakeholder involvement to define the opportunities / challenges and develop action steps typically leads to greater ownership of the solution. –Next steps are Action or Solution oriented – It is not just about a good discussion.

8 lewin.com | 7 Structured Process for RCI discussions 1.OCQI and Lewin identify the most important and the most actionable findings. 2.Share the list of prioritized issues with supporting data with the Evaluation Subcommittee and the Steering Committee for input and modification. a.Governance structure establishes timeline for RCI breakout discussions; b.Governance identifies key stakeholders to be engaged in discussion as needed. 3.Develop targeted improvement recommendations/action plans based on findings. 4.Bring RCI recommendations back to SIM Leadership for review and implementation decisions.

9 lewin.com | 8 Preliminary list of important & actionable findings MaineCare Stage A Health Home quality & utilization findings Patient Engagement opportunities Multiple data portals / data sources Multiple entities providing Care Coordination activities- not enough or too much of a good thing? MaineCare Stage B Behavioral Health Homes - preliminary outcome data-opportunities

10 lewin.com | 9 Next steps for discussion of preliminary actionable findings Prioritization of preliminary list of important & actionable topics Modifications to RCI domains &/or discussion questions needed? Recommendations for stakeholders to be engaged in discussions? Recommendations for specific action plans for each topic? FYI re. break-out sessions at annual meeting (patient engagement, multiple data portals /sources, care coordination)

11 lewin.com | 10 Important & Actionable Findings - MaineCare Stage A Health Homes DomainDescriptionDiscussion Questions MaineCare Stage A HH findings – Robust estimated cost avoidance  Significant decreases in non-emergent ED utilization in the stage A population  Significantly lower fragmentation of care in the stage A population as compared to control  Significantly poorer access to primary care for children ages 7-11 in the stage A population as compared to the control  Inpatient medical/surgical cost avoidance estimates show control group had an increase in septicemia, complications of medical care, and injury related admits, while stage A group did not have a similar increase  Are the shifts consistent with SIM / stakeholder and provider expectations? Are there any surprises?  Should there be any practice changes based savings/shifts?  Should there be any SIM policy changes?

12 lewin.com | 11 Important & Actionable findings – Patient Engagement DomainDescriptionDiscussion Questions Patient engagement  Consumer engagement findings suggest providers are sharing information with patients; but more opportunities exist to engage patients in their health care decision making.  How do we improve bi- directional patient engagement between providers and patients?  How do PCPs view this perception?  Should it be addressed? If so, how? Via Learning Collaboratives? Other?

13 lewin.com | 12 Important & Actionable findings- Multiple portals/data sources DomainDescriptionDiscussion Questions Multiple Portals/ data sources Use of data provided through portals and practice reports is common to many initiatives within and outside of SIM. Key findings: 27 of 69 or 39% of providers interviewed reported that the numerous portals, and other related tasks (e.g., attestation related to Health Home members) are burdensome and create confusion. Practice reports are generally seen as valuable. However, 16 of 25 (64%) stating that the utility of the reports is limited because the data is not current.  How significant an issue for improving care?  How do portal owners (HIN, MEHMC, Muskie, etc.) see this issue?  Should it be addressed? If so, how? (e.g., combining portals? single portal entry?)  Are there additional provider educational opportunities for portal use?

14 lewin.com | 13 Important & Actionable findings - Care Coordination DomainDescriptionDiscussion Questions Multiple entities providing care coordination in patient care team Current entities providing some type of “care coordination” activities include: MaineCare Stage A HH’s, MaineCare Stage B HH’s, CCT’s, CHW’s, and others. Survey respondents stated that there is a wide variation in how CCTs operate, which they viewed positively to some extent, (suggests responsiveness and flexibility in the provision of services e.g. some CCT’s make home visits). However, there were also suggestions that more standardization would be beneficial.  Where are gaps/overlap in care coordination? Are there efficiencies to be achieved?  What’s the cost/benefit of the CCT’s?  What’s the best practice design of the CCT’s to produce the best outcomes?

15 lewin.com | 14 Important & Actionable Findings - MaineCare Stage B Behavioral Health Homes DomainDescriptionDiscussion Questions MaineCare Behavioral Health Home – preliminary outcome data- opportunities.  Further cost analysis is needed to fully understand the changes that are occurring in the data  Significantly higher fragmentation of care in the Stage B population as compared to control  What targeted studies or additional revisions to evaluation plan are needed?  What targeted activities would most enhance integration of physical and behavioral health?  How should success be measured?

16 lewin.com | 15 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareCommercial Target Setting Process UpdatesConsumer Interviews: Updates for Round 2Time for Public CommentNext Steps

17 lewin.com | 16 SIM Core Metrics Findings - MaineCare Current analysis is based on data from: –2012 Q3 – 2013 Q2 –2013 Q3 – 2014 Q2 –2014 Q3 – 2015 Q2 Dashboard Review in Tableau

18 lewin.com | 17 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementMaine SIM Dashboard – MaineCare & Commercial Data UpdatesCommercial Target Setting Process UpdatesConsumer Interviews: Updates for Round 2Time for Public CommentNext Steps

19 lewin.com | 18 Updates on Commercial Target Setting Process Meeting held to review targets for 4 metrics in November: –Non-emergent Emergency Department Use –Readmissions –Imaging Studies for Low Back Pain –Diabetic Care These targets will be reviewed internally and responses are expected from the Maine Commercial Plan team on December 4 th. Further meetings will be scheduled for December and early 2016 to continue this process.

20 lewin.com | 19 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareConsumer Interviews: Updates for Round 2Preview of EvaluationTime for Public CommentNext Steps

21 lewin.com | 20 Consumer Interviews – Methodology Recommendations Problem: Low statistical power –Due to wide margins of error it was difficult to determine if differences existed among sub-populations within the evaluation including comparisons to the control group and differences by demographics in the intervention groups. Proposed Solution: Increased sampling sizes for all intervention groups –By increasing the number of completed surveys performed in each intervention area margins of error can be reduced across all demographic groups, allowing for more precise measurements. –More precise measurements allow statements of difference to be made with greater confidence and potential areas of action to be identified.

22 lewin.com | 21 Consumer Interviews – Methodology Recommendations Proposed Solution: Increased sampling sizes Potential Drawbacks –Increasing overall sample sizes will increase cost. This could be mitigated by eliminating the control groups from data collection. Sample Size Overall Margin of Error (2015 Design) 375 per intervention group/125 per control group 5.1%/8.7% (Proposed 2016 Design – minimum proposed change) 500 per intervention group 4.4% (Expanded 2016 Design) 800 per intervention group 3.5%

23 lewin.com | 22 Consumer Interviews – Methodology Recommendations Problem: Insufficient control group completed surveys –The current control group sample is not large enough to determine whether meaningful differences exist between the control and intervention groups. Proposed Solution: Expand control group –By increasing the number of completes within the control population, more precise measures could be created and statements could be made with increased confidence. –The control groups could, where available, be increased to a target of 375 completed surveys, but this would increase data collection costs Another option: Eliminate the control group –The control group could be eliminated and differences measured within intervention by trending the results to 2015. –However, one might miss larger trends within MaineCare that are impacting patient experience.

24 lewin.com | 23 Consumer Interviews – Methodology Recommendations Problem: Low mail survey response rates –The mailed survey is the only method by which a large portion of the survey population can be contacted; low response rates could imply concerns about sample representativeness. Proposed Solution: Reverse phone lookups –By using known information within the sample list phone numbers can often be found, modestly improving response at a low cost. Another option: Follow-ups with low response populations –Identify specific groups with low response rates in the data set and target additional efforts toward completing surveys within those groups. Another option: Verify Receipt of Survey –Confirm mailed surveys can be delivered and their receipt verified. It would improve response but would be quite expensive.

25 lewin.com | 24 Consumer Interviews – Survey Instrument Recommendations Proposal: Including follow-up and open ended response questions in key areas of focus for quality improvement –Allows patients to express their concerns and view points in their own words –Potentially find new areas for focus from a patient view point –Allows analysis of specific patient experiences to be compared to provider experiences as expressed in the provider survey Method: Open ended response questions added to key survey areas –Comments would be recorded verbatim. –Comments would then be coded in order to allow quantitative analysis to be preformed. Coding would reveal specific themes and action areas within the broader composites and domains.

26 lewin.com | 25 Consumer Interviews – Survey Instrument Recommendations Areas for Follow Ups –Coordination of Care Include an additional item asking patients their awareness of how their coordination of care is handled. –Patient-Provider Communication Focus on why patients feel their provider is not listening or taking their views about their care into consideration –Satisfaction with Outcomes of Care Focus on what leads to dissatisfaction with outcomes of care and initial expectations Potential Follow Up Questions –What were your experiences? –Did you experience problems?/Did your provider work to resolve any problems? –How could your experience with your provider be improved?

27 lewin.com | 26 Next steps- 2016 consumer interviews Market Decisions will draft proposed 2016 interview tools including specific new/revised questions OCQI / Lewin / Market Decisions will further explore options for revisions to interview/survey methods & associated costs & bring recommendations to SIM leadership/governance structure Evaluation Committee meetings in early 2016 will include review / discussion of revised tools and methods

28 lewin.com | 27 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareTime for Public CommentCommercial Target Setting Process UpdatesConsumer Interviews: Updates for Round 2Next Steps

29 lewin.com | 28 Today’s Agenda Welcome and IntroductionsReview & Approve the October 28 th Meeting MinutesEvaluation Findings & Prioritizing Topics for Rapid Cycle ImprovementSIM Core Metrics Findings - MaineCareConsumer Interviews: Updates for Round 2Commercial Target Setting Process UpdatesTime for Public CommentNext Steps

30 lewin.com | 29 Next Steps Next Meeting – January 6, 2016, 2-4 pm NOTE NEW TIME & LOCATION Pine Tree Room 2 Anthony Avenue, Augusta Future Discussion Topics –Annual Report Debrief –Continue Rapid Cycle Improvement Discussions –Review/revision of Consumer, Provider, Stakeholder interview tools –Target setting progress for Commercial & Medicare- progress update –Follow up on identified risks as necessary


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