Maine SIM Evaluation Subcommittee April 2015 April 22, 2015

lewin.com | 1 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackResearch CollaborativeRisk Identification & DiscussionNext StepsPublic Comment

lewin.com | 2 Welcome, Introductions, and Goals for Today’s Meeting Provide a status update on SIM Self-Evaluation provider, key stakeholder, and consumer interview implementation Follow up on Core Metrics and Targets for Evaluation Plan Preliminary discussion of Research Collaborative and vision Risk Identification Update from most recent Steering Committee

lewin.com | 3 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackResearch CollaborativeRisk Identification & DiscussionNext StepsPublic Comment

lewin.com | 4 Meeting Minutes Please see meeting minute handouts for March 25 th Suggested edits from Committee members? Additional questions or clarifications? Motion to approve as written or amended

lewin.com | 5 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackResearch CollaborativeRisk Identification & DiscussionNext StepsPublic Comment

lewin.com | 6 SIM Self-Evaluation: Qualitative Interviews Status Update Providers Crescendo has begun provider outreach process. Timeline for provider interviews Status update; available early findings will be presented at the next subcommittee meeting Key Stakeholders Crescendo has begun contacting key stakeholders. Timeline for key stakeholder interviews (sample increased from 15 to 25 stakeholders) Status update; available early findings will be presented at the next subcommittee meeting Consumers Consumer outreach started this week ( ) after the letters were distributed and the NEIRB approval was received for the interview tool. Status update & available early findings will be presented at the next subcommittee meeting

lewin.com | 7 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackResearch CollaborativeNext StepsPublic CommentRisk Identification & Discussion

lewin.com | 8 Maine SIM Core Metrics – Vetting the Data Results Lewin is collaborating with the Office of MaineCare Services and the Office of Continuous Quality Improvement to review and validate the methodologies used to calculate core metrics. Key steps (following shows steps for MECare data; same steps to be applied to Commercial and Medicare subsequently): –Lewin uses claims data to generate measures for ~2/3 of the ME Core Metrics. (Remaining measures are not claims-based) –Compare summary results to reports issued by MECare –Identify any significant differences and compare Lewin and MECare measurement criteria –As needed, explore further with MECare to clearly understand reasons –Finalize each measure by either 1) aligning the criteria; or 2) providing an explanation for any variation Commercial and Medicare data –Commercial: MHDO will release updated commercial files 4/27/15 –Medicare: Obtaining Medicare data still in progress

lewin.com | 9 Maine SIM Core Metrics – Setting Benchmarks and Targets Once measures are vetted, identify appropriate benchmarks: –“Benchmarks” are usually defined as how the top 90 th percentile performs. Example: For the top 10% of providers, XX% of their patients received the correct procedure. –Benchmarks are guideposts to what the system can aspire to. –For overall ME SIM performance, we identify national benchmarks, such as NCQA, CMS, NQF. If a relevant national example isn’t available, we won’t display a national benchmark. –For HHs and BHHs, we calculate the 90% benchmark based on the ME Care data and the providers participating in those programs using the “Achievable Benchmarks of Care” (ABC) Methodology. This is the 90% measure that is statistically adjusted Stakeholders can then use the benchmarks to help select “Targets” Targets are achievable goals that promote accountability and can be readily monitored

lewin.com | 10 Maine SIM Core Metrics

lewin.com | 11 Evaluation Plan next steps Additional feedback from Committee members to overall documented approach for self-evaluation? Final written feedback needs to be submitted to committee chairs no later than Next steps –Incorporate any additional edits & convert to ‘Final’ version’ –Affirmation that Evaluation Plan is “living” document & will be amended based on identified rapid cycle improvement opportunities

lewin.com | 12 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackRisk Identification & DiscussionNext StepsResearch CollaborativePublic Comment

lewin.com | 13 Maine SIM Research Collaborative Goal: To establish an ongoing research and evaluation collaborative to build upon the evaluative research occurring under the SIM grant. –The collaborative will: Facilitate ongoing research studies Test innovative health care delivery and reform approaches Implement targeted quality improvement initiatives Develop focused strategies for translating research OCQI and SIM leadership will support the development of this infrastructure and a collaborative of health care researchers. This aims to enhance instate research expertise and launch further innovation while continuing to translate the results of Maine SIM across the health care system.

lewin.com | 14 Maine SIM Research Collaborative To implement the collaborative, Lewin and the state will: 1)Convene local experts to define key research areas of interest 2)Engage local and regional research and academic institutions to where there are shared priorities 3)In partnership with participating institutions, develop a 10-year plan outlining initiatives and potential funding sources 4)Implement the plan This will include engagement of experts and institutions within and outside of Maine to leverage the immense innovative resources of the region. Long-term planning will include exploration of resources to maintain the collaborative and its work long after SIM is complete.

lewin.com | 15 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackResearch CollaborativeNext StepsPublic CommentRisk Identification & Discussion

lewin.com | 16 Risk Identification and Discussion Have subcommittee members identified any risks, either as part of the evaluation or across SIM generally, that need to be discussed and further considered? Discussion Follow-Up & Next Steps

lewin.com | 17 Today’s Agenda Welcome and IntroductionsReview & Approve the March 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsEvaluation Plan: Core Metrics/Targets & Committee FeedbackResearch CollaborativeRisk Identification & DiscussionPublic CommentNext Steps

lewin.com | 18 Next Steps Next Meeting –May 27th, 2015, 3-5 pm Conference room A 35 Anthony Avenue, Augusta Future Discussion Topics –Sustainable Research Collaborative –Status Update of the Self-Evaluation Provider, Stakeholder, & Consumer interview process & early findings when available –Presentation of preliminary data analysis –Follow up on today’s identified risks as necessary

lewin.com | 19 Today’s Agenda Welcome and IntroductionsReview & Approve the February 25th Meeting MinutesStatus Update: Provider, Key Stakeholder, & Consumer InterviewsSIM Project Risk Identification ProcessEvaluation PlanRisk Identification & DiscussionNext StepsPublic Comment