Maine SIM Evaluation Subcommittee April 2015

1. Maine SIM Evaluation Subcommittee April 2015 April 22, 2015

2. Today’s Agenda

3. 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

4. Today’s Agenda

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

6. Today’s Agenda

7. 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 (4.20.2015) 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

8. Today’s Agenda

9. 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

10. Maine SIM Core Metrics – Setting Benchmarks and Targets • Once measures are vetted, identify appropriate benchmarks: • “Benchmarks” are usually defined as how the top 90th 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

11. Maine SIM Core Metrics

12. 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 4.30.2015 • 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

13. Today’s Agenda

14. 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.

15. Maine SIM Research Collaborative • To implement the collaborative, Lewin and the state will: • Convene local experts to define key research areas of interest • Engage local and regional research and academic institutions to where there are shared priorities • In partnership with participating institutions, develop a 10-year plan outlining initiatives and potential funding sources • 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.

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17. 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

18. Today’s Agenda

19. 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

20. Today’s Agenda