sim high level framework and overview thursday, july 11, 2013 1
TRANSCRIPT
SIM High Level Framework and Overview
Thursday, July 11, 2013
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SIM High Level Components
1. Test reform - Bringing to the next level • 100% adoption by MaineCare (great level of specificity on MaineCare SIM
goals)• Anticipate > adoption by newer, more immature test models• Optional/not mandatory for more mature test models (e.g. – Systems
Medicare ACOs)
2. State of Maine as “convener” driving reform alignment and actions across Payers and the State
• Identify common, shared reform goals/objectives acknowledging test models may vary in approach
• Share what’s working/what’s not working to drive towards best practices
3. Public reporting of results and identifying trends impacting healthcare
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SIM Governance Structure
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SIM GOALS •Int. BH/PH•PCP Utilization•Surgery Infection•ED Costs•Costs per Life
Transparency WorkgroupLead: HealthInfoNet•Admissions, Discharges, Trans•ED Notifications•PH Record•Statewide HIE
State: Lead Convener - Public Reporting --Share best practices--What’s working, what’s not?
SERVICE DELIVERY REFORM Workgroup Lead: Quality Counts•PCMH & HH Learning Collaborative •ACO Learning Collaborative Support•Leadership Development (RFP)•Behavioral Health Collaborative (RFP)
MAINE CDC•Patient Engagement•Diabetes Prevention•5 Sites Pilot w/ Community Health Workers
PAYMENT REFORM WorkgroupLead: MHMC•Data Analytics•VBP Development & Learning•Health Care Cost Workgroup•Development of Behavioral HCC Workgroup
Public Reporting
Payer Populations
MaineCareMedicare
CommercialSelf-Insured Employers
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MAINE CDC•Patient Engagement•Diabetes Prevention•5 Sites Pilot w/ Community Health Workers
SIM GOALS •Int. BH/PH•PCP Utilization•Surgery Infection•ED Costs•Costs per Life
SERVICE DELIVERY REFORM Chair: Quality Counts•PCMH & HH Learning Collaborative •Leadership Development (RFP)•Behavioral Health Collaborative (RFP)
Public Reporting
Payer Populations
MaineCareMedicare
CommercialSelf Insured Employers
Model Choice of SIM Grant Deliverables
MaineCare: All In!
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MAINE CDC•Patient Engagement•Diabetes Prevention•5 Sites Pilot w/ Community Health Workers
SIM GOALS •Int. BH/PH•PCP Utilization•Surgery Infection•ED Costs•Costs per Life
TRANSPARENCYChair: HealthInfoNet•Admissions, Discharges, Trans•ED Notifications•PH Record•Statewide HIE
SERVICE DELIVERY REFORM Lead: Quality Counts•PCMH & HH Learning Collaborative •Leadership Development (RFP)•Behavioral Health Collaborative (RFP)
PAYMENT REFORMChair: MHMC•Data Analytics•ACO Learning Collaborative Support•VBP Development & Learning•Health Care Cost Workgroup•Development of Behavioral HCC Workgroup
Public Reporting
Payer PopulationsMaineCareMedicare
CommercialSelf-Insured Employers
Model Choice of SIM Grant Deliverables
Emerging/Immature Models:Anticipate Significant usage of SIM
deliverables
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MAINE CDC•Patient Engagement•Diabetes Prevention•5 Sites Pilot w/ Community Health Workers
SIM GOALS •Int. BH/PH•PCP Utilization•Surgery Infection•ED Costs•Costs per Life
TRANSPARENCYChair: HealthInfoNet•Admissions, Discharges, Trans•ED Notifications•PH Record•Statewide HIE
SERVICE DELIVERY REFORM Chair: Quality Counts•PCMH & HH Learning Collaborative •Leadership Development (RFP)•Behavioral Health Collaborative (RFP)
Public Reporting
Payer Populations
MaineCareMedicare
CommercialSelf-Insured Employers
PAYMENT REFORMChair: MHMC•Data Analytics•ACO Learning Collaborative Support•VBP Development & Learning•Health Care Cost Workgroup•Development of Behavioral HCC Workgroup
Model Choice of SIM Grant Deliverables
Mature Models: Usage ofSIM as appropriate/desired
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Enhancements to Test Models
Position the State to assess the impact to healthcare delivery and cost by enabling test models to move to the next level through:
•Enhanced care delivery capabilities
•Greater access to high-value care information
•Enhanced care delivery participant (provider and patient) training / support
•Introduction of targeted incentives
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SIM’s Enhancements to Test Models
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Consumers
Payers & Purchasers
• EE Portal• Shared Decision-Making (SDM)
tool
• Public Reporting• Patient Satisfaction
• Plan Design (deductibles)
While Providers & Consumers are the more direct recipients of Grant deliverables, all Stakeholders are reform beneficiaries
Improved databaseImproved reporting tools
• PMPM• Lower Annual Cost
Enhanced CapabilitiesEnhanced Capabilities Data/InformationData/Information Workforce/Patient SupportWorkforce/Patient Support Targeted IncentivesTargeted Incentives
• Real-time ED alerts• Practice reportsProviders
• Common Quality Measures• Cost of Care• HIE expansion (including BH)
• Collaborative learning’s• Leadership training• Primary Care & BH integration
• Payment Reform• Public Reporting
Build foundation to next level and
evaluate model impacts
Results/Public
Reporting
Adj
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Operational Plan Development and
Review:
Timeline and Process
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