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Consumer Advocate Engagement in Connecticut’s State Innovation Model (SIM) Quality Council Elizabeth M. S. Krause, ScM Vice President of Policy and Communications.

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Presentation on theme: "Consumer Advocate Engagement in Connecticut’s State Innovation Model (SIM) Quality Council Elizabeth M. S. Krause, ScM Vice President of Policy and Communications."— Presentation transcript:

1 Consumer Advocate Engagement in Connecticut’s State Innovation Model (SIM) Quality Council Elizabeth M. S. Krause, ScM Vice President of Policy and Communications Connecticut Health Foundation Families USA Health Action 2015


3 Connecticut 3.5 million residents 70 miles x 110 miles 169 Towns “Land of steady habits” “Two Connecticuts” State Facilitated Marketplace Uninsured rate: Pre ACA 8% Post Round One 4% Post Round Two Goal: 2-3%


5 5

6 6 Connecticut SIM Award: $45 million / four years

7 Connecticut SIM Vision Establish a whole-person-centered healthcare system that improves population health and eliminates health inequities; ensures superior access, quality, and care experience; empowers individuals to actively participate in their healthcare; and improves affordability by reducing healthcare costs

8 Connecticut SIM Statewide Initiatives Population health planning Payment reform: Alignment with Medicare Shared Savings Program Value-based Insurance Design Health Information Technology Targeted Initiati ves Medicaid Quality Improvement & Shared Savings Program Primary Care Transformation  Advanced Medical Home Glide Path  Community and Clinical Integration Program

9 What will the State Innovation Model Mean for You? 9

10 CT SIM Workgroups Quality Develop core measure set for primary, specialty, and hospital care Develop multipayer scorecard Practice Transformation Develop NCQA- based “Advanced Medical Home” standards and glidepath Equity and Access Develop methods to measure access, patient selection, and underservice Health Information Technology Establish priorities and investments, ensure interoperability 10

11 CT SIM Work Group Composition 11

12 CT SIM Quality Council

13 Quality Measure Alignment 100+ measures across CT’s payers Aspiration: Simplify performance measurement by establishing an all-payer measure set: –Improve efficiency, reduce complexity –Improve focus, support quality improvement Make care experience matter Measure and reward health equity gains

14 Measure Comparison 33 Medicare Accountable Care Organization measures (2012 – 2014) New Medicare ACO measures proposed and accepted for 2015 All measures currently in use by Connecticut’s largest commercial payers – claims based All measures currently in use by Connecticut Medicaid for the Person Centered Medical Home Program More than 100 measures under review Pre-decisional – for discussion only

15 Sample Measure Set Format Pre-decisional – for discussion only

16 SIM Quality Counsel Guiding Principles 1.Align with Medicare Shared Savings Program Accountable Care Organization measure set 2.Recommend additional measures that address the most significant health needs of CT residents, the needs of non- Medicare populations, and areas of special emphasis such as behavioral health and health equity. 3.Wherever possible, draw from established measures such as NQF, NCQA, PQRS, etc.

17 Guiding Principles 4.Balance comprehensiveness and breadth with the need to prioritize and focus. 5.Promote measures and methods with the aim of maximizing impact, accuracy, validity, fairness and data integrity. 6.Promote credibility and transparency in order to maximize patient, employer, payer, and provider engagement. 7.Assess the impact of race, ethnicity, language, economic status, and other important demographic and cultural characteristics important to health equity.

18 Guiding Principles 8.Recommend measures that are accessible with minimal burden to the clinical mission; should draw upon established data acquisition and analysis systems; should be both efficient and practicable with respect to what is required of payers, providers, and consumers; and should make use of improvements in data access and quality as technology evolves and become more refined and varied over time. 9.Maximize the use of outcome over process measures. 10.Use measurement to promote the concept of the Rapidly Learning Health System.

19 Additional Consumer Principles SIM Consumer Advocates Have Prioritized: –Measures of patient access that demonstrate superior access –Measures of patient experience that demonstrate superior care experience and active participation –Measures of patient outcomes that demonstrate whole person centered health care, improved community health and elimination of health inequities –Measures that reflect all the patient populations (by age, conditions) prioritized in the SIM plan 19

20 CT SIM Quality Council Health Equity Design Group (HEDG)

21 SIM Quality Council Health Equity Design Group (HEDG) - Context CT SIM stated goal to alleviate and eventually eliminate health disparities. The Quality Council formed a HEDG to make recommendations for leveraging SIM’s multi- payer quality scorecard and various quality improvement initiatives to advance health equity 21

22 Health Equity Design Group - Context Over the past decade, health equity has become an established national and state concern. Fundamental infrastructure to bolster an equitable delivery system is needed and knowledge of how to implement solutions at practical levels lags behind intentions. The door is open for innovation that will be only be reached with persistence and incremental steps over the duration of SIM. 22

23 HEDG Members Ignatius Bau, JD, Health Policy Consultant Aileen Broderick, Director, Clinical Quality Commercial and Exchanges, Anthem Blue Cross Blue Shield Dora Hughes, MD, MPH, Senior Policy Advisor, Sidley Austin Elizabeth Krause, ScM, VP, Policy and Communications, Connecticut Health Foundation, HEDG Lead Kathleen Lavorgna, MD, Surgeon, Connecticut State Medical Society Theanvy Kuoch, MA, Executive Director, Khmer Health Advocates, SIM Consumer Advisory Board Member Wayne Rawlins, MD, MBA, VP and National Medical Director for Racial and Ethnic Equality Issues, Aetna 23

24 HEDG - Direction Draft recommendations aim to leverage and align with national requirements to improve the collection of provider race, ethnicity, language, gender identity, sexual orientation and other demographic data collection (e.g., Meaningful Use Stage 2, NCQA, Office of Minority Health). Although the field moves in the right direction, we are in the meantime challenged by a lack of granularity sufficient to capture CT sub populations that experience inequities (e.g., Southeast Asian populations). 24

25 HEDG - Direction Draft recommendations support a progression from data collection at the practice level, to reporting, to pay for performance over several years. A goal for CT would be to get to the point where virtually all SIM quality measures can be analyzed to identify and address inequities. In spite of a multiyear sight line to the goal, for some measures related to prioritized SIM areas for better health with known inequities (e.g., diabetes, asthma), it is anticipated that there will be near term opportunities to improve quality. 25

26 Leveling the Playing Field For Consumer Advocates to Engage in State QI Initiatives Spread the word to ensure consumer stakeholders are aware of opportunities to participate Provide background education Support consumers in learning together, as well as with providers and payers Embed consumer values and priorities in guiding principles Ensure consumers have speed dial access to their own subject matter and technical experts who understand their POV Do not expect consumers to function as technical experts Equip consumers to be ambassadors 26

27 Acknowledgements Mark Schaefer, PhD, CT SIM Director Ignatius Bau, JD, Health Policy Consultant Members of the CT SIM Quality Council 27

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