The document discusses lessons learned from state efforts to align quality measures across payers through State Innovation Model programs. It provides a strategic framework for developing a common measure set that includes determining an alignment strategy, articulating goals, setting the scope, engaging stakeholders, identifying selection criteria, inventorying measures, evaluating measures, selecting measures, and sustaining alignment. It highlights Washington state's development of a statewide common measure set as an example.
This document summarizes a presentation on developing a framework for monitoring the impact of health reform. It discusses why states should develop such a framework and have Medicaid involved. Key points include using the framework to track progress on goals, define each program's contributions, and avoid duplicative data collection. The presentation provides examples from California and Maryland and outlines steps to develop a framework, including defining scope, choosing measures, identifying data sources, and engaging stakeholders. It emphasizes establishing the framework early to monitor baseline trends and impacts over time.
CMS hosted an Open Door Forum call on November 22, 2013 to allow providers, suppliers, beneficiary advocacy groups, and other interested parties to provide input into the design and implementation of this demonstration. Mandated by the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (P.L. 112-242)”, the purpose of this demonstration is to evaluate the impact of providing payment for items and services needed for the in-home administration of IVIG for the treatment of primary immune deficiency disease (PIDD). The demonstration will provide these benefits for up to 4,000 Medicare beneficiaries for a period of three years.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document discusses potential data sources for collecting baseline data before implementing a public health intervention program. It describes how baseline data is collected before a program begins to later compare outcomes. Sources discussed include birth certificates, CDC databases, state vital records, local health departments, hospitals, Medicaid programs, March of Dimes, and several CDC surveillance systems. The document provides examples of the type of baseline data that could be collected and considerations for selecting a data source.
This document provides an overview of SHAP (State Health Access Program) evaluations and how they can inform implementation of the Affordable Care Act. It discusses how SHAP grantees are conducting evaluations through administrative data, surveys, focus groups and ROI analyses. Grantees will report benchmarks on enrollment, costs, and qualitative measures. The evaluations can provide best practices on outreach, newly insured characteristics, and models for insurance exchanges. Technical assistance is available from SHADAC to help grantees with data, indicators, methods and a data user workshop.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes updates to the Strong Start funding opportunity. Key points include: the application deadline was extended to August 9th, 2012; optional letters of intent are no longer required; applicants can propose testing multiple models but individual sites can only administer one; and applicants must commit to collecting gestational age and birthweight data for the intervention and baseline periods to help with evaluation.
The Governance of Quality: Defining Experiences and Success Factors in Instit...HFG Project
he objective of the activity is to assess and document global experiences in institutional relationships that govern quality health services as well as provide practical and action-oriented guidance to countries on success factors in structuring institutional roles, responsibilities, and relationships. Countries seeking to develop new governance structures or to improve existing structures would have a resource, based on the results of documented country experiences, to successful approaches and lessons learned in structuring institutional roles, responsibilities, and relationships to enable, foster, and ensure ongoing quality.
Using EQROs to Improve the Quality of Preventive and Developmental Servicesnashp
This document discusses using external quality review organizations (EQROs) to improve the quality of preventive and developmental services for children in Medicaid managed care plans. It finds that while states are required to assess quality, most current EQRO reports provide only basic data without interpretation. The document provides guidance to states on developing quality strategies and contracts with EQROs that specifically focus on preventive and developmental services for children, such as measuring developmental screening rates and referral outcomes. States can better utilize EQROs and federal regulations to improve children's healthcare quality by undertaking strategic planning with stakeholder input.
This document summarizes a presentation on developing a framework for monitoring the impact of health reform. It discusses why states should develop such a framework and have Medicaid involved. Key points include using the framework to track progress on goals, define each program's contributions, and avoid duplicative data collection. The presentation provides examples from California and Maryland and outlines steps to develop a framework, including defining scope, choosing measures, identifying data sources, and engaging stakeholders. It emphasizes establishing the framework early to monitor baseline trends and impacts over time.
CMS hosted an Open Door Forum call on November 22, 2013 to allow providers, suppliers, beneficiary advocacy groups, and other interested parties to provide input into the design and implementation of this demonstration. Mandated by the “Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (P.L. 112-242)”, the purpose of this demonstration is to evaluate the impact of providing payment for items and services needed for the in-home administration of IVIG for the treatment of primary immune deficiency disease (PIDD). The demonstration will provide these benefits for up to 4,000 Medicare beneficiaries for a period of three years.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document discusses potential data sources for collecting baseline data before implementing a public health intervention program. It describes how baseline data is collected before a program begins to later compare outcomes. Sources discussed include birth certificates, CDC databases, state vital records, local health departments, hospitals, Medicaid programs, March of Dimes, and several CDC surveillance systems. The document provides examples of the type of baseline data that could be collected and considerations for selecting a data source.
This document provides an overview of SHAP (State Health Access Program) evaluations and how they can inform implementation of the Affordable Care Act. It discusses how SHAP grantees are conducting evaluations through administrative data, surveys, focus groups and ROI analyses. Grantees will report benchmarks on enrollment, costs, and qualitative measures. The evaluations can provide best practices on outreach, newly insured characteristics, and models for insurance exchanges. Technical assistance is available from SHADAC to help grantees with data, indicators, methods and a data user workshop.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document summarizes updates to the Strong Start funding opportunity. Key points include: the application deadline was extended to August 9th, 2012; optional letters of intent are no longer required; applicants can propose testing multiple models but individual sites can only administer one; and applicants must commit to collecting gestational age and birthweight data for the intervention and baseline periods to help with evaluation.
The Governance of Quality: Defining Experiences and Success Factors in Instit...HFG Project
he objective of the activity is to assess and document global experiences in institutional relationships that govern quality health services as well as provide practical and action-oriented guidance to countries on success factors in structuring institutional roles, responsibilities, and relationships. Countries seeking to develop new governance structures or to improve existing structures would have a resource, based on the results of documented country experiences, to successful approaches and lessons learned in structuring institutional roles, responsibilities, and relationships to enable, foster, and ensure ongoing quality.
Using EQROs to Improve the Quality of Preventive and Developmental Servicesnashp
This document discusses using external quality review organizations (EQROs) to improve the quality of preventive and developmental services for children in Medicaid managed care plans. It finds that while states are required to assess quality, most current EQRO reports provide only basic data without interpretation. The document provides guidance to states on developing quality strategies and contracts with EQROs that specifically focus on preventive and developmental services for children, such as measuring developmental screening rates and referral outcomes. States can better utilize EQROs and federal regulations to improve children's healthcare quality by undertaking strategic planning with stakeholder input.
An Examination of the Strong Start Initiative Group Prenatal Care (GPC) Model...Brandon Lock
The document examines the Strong Start initiative, which funds enhanced prenatal care models including group prenatal care (GPC). After two years:
- Enrollment in GPC increased but was lower than expected, with challenges including eligibility restrictions and program implementation.
- Early results showed lower C-section rates and high participant satisfaction compared to national averages, though selection bias remains a concern.
- Costs of pregnancy in the US are increasing overall but vary significantly based on factors like delivery method, complications, and state. GPC aims to improve outcomes while controlling costs.
Myanmar Strategic Purchasing 5: Continuous Learning and Problem SolvingHFG Project
This is the fifth in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot aims to start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and incentivize providers to deliver an essential package of primary care services.
CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) in late 2013 entitled the “Evolution of ACO Initiatives at CMS.” These are the first of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Highlights from ExL Pharma’s 2nd Annual Patient Assistance ProgramsExL Pharma
The document summarizes key topics from ExLPharma's annual patient assistance programs conference, including implications of US health care reform proposals. Proposed reforms around expanding Medicaid eligibility, establishing health insurance exchanges, and closing the Medicare Part D "donut hole" could impact existing industry patient assistance programs by reducing the uninsured population and affecting cost-sharing responsibilities. Manufacturers may need to modify programs, increase support services to help patients navigate new coverage options, and coordinate more with public health programs and exchange navigators. The growing underinsured population also presents ongoing challenges requiring innovative program characteristics and operational improvements.
The Accountable Health Communities Model team hosted a webinar to provide an overview of the new funding opportunity and application requirements for Track 1 on Wednesday, September 14, 2016 from 2:00p.m. – 3:00p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted an introduction webinar about the Oncology Care Model (OCM) on Thursday, February 19, 2015 from 12:00pm – 1:00pm EST. The webinar focused on introducing core concepts of OCM and application instructions. Advance registration was not required.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses changes in substance abuse prevention services and funding. Prevention providers will need to demonstrate their ability to use data and evidence-based programs, produce positive community outcomes, and build long-term sustainability. Funding sources now require use of the Strategic Prevention Framework approach. Providers will need to show their programs are effective, that they have community support, and that their organizations are well-run to remain competitive for future funding.
This document summarizes a webinar about a Centers for Medicare and Medicaid Services initiative called Strong Start that has two strategies: reducing early elective deliveries and delivering enhanced prenatal care. It provides information on funding opportunities for applicants to test models of enhanced prenatal care for Medicaid beneficiaries, including three approaches: Centering/group care, care at birth centers, or care at maternity homes. Key details are provided on eligibility, required number of beneficiaries, total funding, budget requirements, and next steps.
The document summarizes a study that hosted focus groups with state birth defect surveillance programs to learn about their practices. Two focus groups were conducted via WebEx due to time constraints, covering topics like data collection, surveillance, quality assurance, outreach, and hospital reporting. The focus groups provided an opportunity for states to learn from each other's practices. Key discussion points included the need for updated legislation, improved communication between states, and a lack of standardization in hospital reporting. The majority of states that were invited did not participate in the focus groups.
The Primary Care First Model Options team hosted a payment webinar on Wednesday, July 24, 2019 from 12:00 p.m. - 1:00 p.m. EDT. Topics discussed included how eligible practices can participate in the SIP payment model option of Primary Care First, eligibility requirements, quality measures, and payment.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Accountable Health Communities Model team hosted a webinar to provide an overview of the new funding opportunity and application requirements for Track 1 on Wednesday, September 14, 2016 from 2:00p.m. – 3:00p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
An Insider's Guide to Working with CMS - Shari LingCancerSupportComm
This document summarizes a presentation given by Shari Ling, Deputy Chief Medical Officer at CMS, to the Cancer Policy Institute at the Cancer Support Community. Some key points:
- CMS is focused on developing more patient-centered quality measures that assess outcomes important to patients and caregivers. They welcome input from patient advocacy groups.
- CMS aims to align quality measures across different healthcare settings to reduce reporting burden and focus measurement on the issues that matter most to patients.
- CMS is responsible for administering Medicare, Medicaid, and other large healthcare programs, and uses quality measurement to incentivize higher quality, more coordinated care, and payment reform efforts like value-based purchasing.
Poster95: Monitoring and evaluation: setting the stage for improved impactCIAT
The document discusses monitoring and evaluation approaches used by the Improved Beans for the Developing World Partnership (PABRA) research program. It outlines how PABRA applied participatory monitoring and evaluation to improve accountability, track outcomes and impacts, and support decision-making. Key partners were involved in designing and implementing monitoring and evaluation plans and tools. Evaluation findings were reviewed with partners to inform recommendations and options for program improvements.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document outlines an agenda and proposed next steps for the Information Exchange Workgroup. Key points include:
- Establishing two task forces focused on provider directories and public health transactions.
- Developing work plans and timelines for each task force to assess current issues, identify barriers, and make recommendations.
- Prioritizing initial areas like laboratory results, electronic prescribing, and patient summary exchange in relation to Meaningful Use.
- Coordinating activities with the HIT Policy Committee and ensuring alignment with other national health IT initiatives.
The workgroup aims to address specific challenges to information exchange and make policy recommendations to facilitate interoperability goals.
The Medicare Advantage Value-Based Insurance Design Model team presented a webinar discussing the CY2020 application cycle on Friday, January 25 from 4:00 p.m. to 5:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
An Examination of the Strong Start Initiative Group Prenatal Care (GPC) Model...Brandon Lock
The document examines the Strong Start initiative, which funds enhanced prenatal care models including group prenatal care (GPC). After two years:
- Enrollment in GPC increased but was lower than expected, with challenges including eligibility restrictions and program implementation.
- Early results showed lower C-section rates and high participant satisfaction compared to national averages, though selection bias remains a concern.
- Costs of pregnancy in the US are increasing overall but vary significantly based on factors like delivery method, complications, and state. GPC aims to improve outcomes while controlling costs.
Myanmar Strategic Purchasing 5: Continuous Learning and Problem SolvingHFG Project
This is the fifth in a series of briefs examining practical considerations in the design and implementation of a strategic purchasing pilot project among private general practitioners (GPs) in Myanmar. This pilot aims to start developing the important functions of, and provide valuable lessons around, contracting of health providers and purchasing that will contribute to the broader health financing agenda. More specifically, it is introducing a blended payment system that mixes capitation payments and performance-based incentives to reduce households’ out-of-pocket spending and incentivize providers to deliver an essential package of primary care services.
CMMI, in partnership with Million Hearts® at the Centers for Disease Control and Prevention (CDC), will sponsor a webinar entitled Value-Based Insurance Design, Opportunities to Improve Medication Adherence for Cardiovascular Disease Prevention on October 21, 2021 from 3:00-4:00 PM ET. The webinar will present evidence-based high impact strategies for MAOs to improve care and outcomes for beneficiaries with cardiovascular disease (CVD), including underserved populations.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
The CMS Innovation Center hosted a webinar on Tuesday, June 10, 2014 from 12:00pm - 1:00pm EDT that focused on all components of the Round Two Model Test Award opportunity. The webinar also highlighted the requirements for submitting an application as well as considerations regarding the application review process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation released a Request for Information (RFI) in late 2013 entitled the “Evolution of ACO Initiatives at CMS.” These are the first of two batches of responses received by the Center for Medicare and Medicaid Innovation to the RFI.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Highlights from ExL Pharma’s 2nd Annual Patient Assistance ProgramsExL Pharma
The document summarizes key topics from ExLPharma's annual patient assistance programs conference, including implications of US health care reform proposals. Proposed reforms around expanding Medicaid eligibility, establishing health insurance exchanges, and closing the Medicare Part D "donut hole" could impact existing industry patient assistance programs by reducing the uninsured population and affecting cost-sharing responsibilities. Manufacturers may need to modify programs, increase support services to help patients navigate new coverage options, and coordinate more with public health programs and exchange navigators. The growing underinsured population also presents ongoing challenges requiring innovative program characteristics and operational improvements.
The Accountable Health Communities Model team hosted a webinar to provide an overview of the new funding opportunity and application requirements for Track 1 on Wednesday, September 14, 2016 from 2:00p.m. – 3:00p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted an introduction webinar about the Oncology Care Model (OCM) on Thursday, February 19, 2015 from 12:00pm – 1:00pm EST. The webinar focused on introducing core concepts of OCM and application instructions. Advance registration was not required.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document discusses changes in substance abuse prevention services and funding. Prevention providers will need to demonstrate their ability to use data and evidence-based programs, produce positive community outcomes, and build long-term sustainability. Funding sources now require use of the Strategic Prevention Framework approach. Providers will need to show their programs are effective, that they have community support, and that their organizations are well-run to remain competitive for future funding.
This document summarizes a webinar about a Centers for Medicare and Medicaid Services initiative called Strong Start that has two strategies: reducing early elective deliveries and delivering enhanced prenatal care. It provides information on funding opportunities for applicants to test models of enhanced prenatal care for Medicaid beneficiaries, including three approaches: Centering/group care, care at birth centers, or care at maternity homes. Key details are provided on eligibility, required number of beneficiaries, total funding, budget requirements, and next steps.
The document summarizes a study that hosted focus groups with state birth defect surveillance programs to learn about their practices. Two focus groups were conducted via WebEx due to time constraints, covering topics like data collection, surveillance, quality assurance, outreach, and hospital reporting. The focus groups provided an opportunity for states to learn from each other's practices. Key discussion points included the need for updated legislation, improved communication between states, and a lack of standardization in hospital reporting. The majority of states that were invited did not participate in the focus groups.
The Primary Care First Model Options team hosted a payment webinar on Wednesday, July 24, 2019 from 12:00 p.m. - 1:00 p.m. EDT. Topics discussed included how eligible practices can participate in the SIP payment model option of Primary Care First, eligibility requirements, quality measures, and payment.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Accountable Health Communities Model team hosted a webinar to provide an overview of the new funding opportunity and application requirements for Track 1 on Wednesday, September 14, 2016 from 2:00p.m. – 3:00p.m. EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
An Insider's Guide to Working with CMS - Shari LingCancerSupportComm
This document summarizes a presentation given by Shari Ling, Deputy Chief Medical Officer at CMS, to the Cancer Policy Institute at the Cancer Support Community. Some key points:
- CMS is focused on developing more patient-centered quality measures that assess outcomes important to patients and caregivers. They welcome input from patient advocacy groups.
- CMS aims to align quality measures across different healthcare settings to reduce reporting burden and focus measurement on the issues that matter most to patients.
- CMS is responsible for administering Medicare, Medicaid, and other large healthcare programs, and uses quality measurement to incentivize higher quality, more coordinated care, and payment reform efforts like value-based purchasing.
Poster95: Monitoring and evaluation: setting the stage for improved impactCIAT
The document discusses monitoring and evaluation approaches used by the Improved Beans for the Developing World Partnership (PABRA) research program. It outlines how PABRA applied participatory monitoring and evaluation to improve accountability, track outcomes and impacts, and support decision-making. Key partners were involved in designing and implementing monitoring and evaluation plans and tools. Evaluation findings were reviewed with partners to inform recommendations and options for program improvements.
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The document outlines an agenda and proposed next steps for the Information Exchange Workgroup. Key points include:
- Establishing two task forces focused on provider directories and public health transactions.
- Developing work plans and timelines for each task force to assess current issues, identify barriers, and make recommendations.
- Prioritizing initial areas like laboratory results, electronic prescribing, and patient summary exchange in relation to Meaningful Use.
- Coordinating activities with the HIT Policy Committee and ensuring alignment with other national health IT initiatives.
The workgroup aims to address specific challenges to information exchange and make policy recommendations to facilitate interoperability goals.
The Medicare Advantage Value-Based Insurance Design Model team presented a webinar discussing the CY2020 application cycle on Friday, January 25 from 4:00 p.m. to 5:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Value-Based Insurance Design (VBID) Model team hosted a webinar on January 28, 2021 from 4:00-5:00 PM EST. During this webinar, presenters provided a brief review of the recently released Calendar Year (CY) 2022 Requests for Applications (RFAs) for the VBID Model and the Hospice Benefit Component. This session also offered attendees an opportunity to ask follow-up questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Poster, advancements in care coordination mn simsoder145
The document summarizes findings from an evaluation of Minnesota's State Innovation Model (SIM) Initiative. It finds that Minnesota's SIM investments increased organizations' capacity for coordinated care in several ways:
1) It strengthened relationships and knowledge sharing between organizations.
2) It improved some care coordination processes like assessing social needs and accessing data.
3) It expanded access to health information exchange capabilities needed to coordinate care across settings.
The Medicare Advantage Value-Based Insurance Design Model and Part D Payment Modernization Model teams provided a deep dive webinar of the two models on Thursday, February 28 from 3:00 p.m. to 4:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This document discusses value-based purchasing and pay-for-performance programs implemented by the Centers for Medicare and Medicaid Services (CMS). It provides an overview of key CMS value-based programs for hospitals, home health agencies, skilled nursing facilities, end-stage renal disease facilities, and physicians. The goals are to improve quality of care, patient outcomes, and reduce healthcare costs through linking provider payments to performance and quality measures. The document describes the measures, payment adjustments, and potential incentives/penalties associated with each program.
A 360° view of value-based healthcare: how to position your facility for successSourceMed
The shift from volume to value-based healthcare is underway and many outpatient providers are already participating. How are you preparing for this transition?
This presentation will explore the move to value-based care, and share ways for your facility to adapt what it is doing today to thrive under collaborative service delivery models, including: revenue cycle management, data analytics, patient engagement and system interoperability.
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MALCOLM BALDRIGE QUALITY AWARD- ST. DAVID’S HEALTHCAREColin John
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The Foundations of Success in Population Health ManagementHealth Catalyst
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1. Supporting Payment and Delivery System
Reform through Multipayer Quality
Measure Alignment:
Lessons from State Innovation Models
June 24, 2019
You will be connected to broadcast audio through your computer.
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Problems: Call ReadyTalk’s help line: (800) 843-9166 or ask for help using the
chat feature
Slides can be found at: https://www.shadac.org/publications/supporting-payment-
and-delivery-system-reform-through-multipayer-quality-measure
2. About SHADAC
• SHADAC is a multidisciplinary health policy research center with a
focus on state policy. Affiliated with the University of Minnesota,
School of Public Health, SHADAC faculty and staff are nationally
recognized experts on collecting and applying health policy data to
inform policy decisions, with expertise in both federal and state survey
data sources. Learn more at shadac.org.
• SHADAC also provides technical assistance to states that received
State Innovation Model — or “SIM” — awards from the Center for
Medicare & Medicaid Services to accelerate health care
transformation as part of a team led by NORC at the University of
Chicago that serves as the SIM Resource Support Contractor.
SHADAC and other technical assistance partners support states and
the Center for Medicare & Medicaid Innovation (CMMI) in designing
and testing multi-payer health system transformation approaches.
6/21/2019 2
3. Speakers
6/21/2019 3
CMMI
• Allison Pompey, DrPH
Director, Division of State Innovation Models
• Jennifer Lloyd, PhD
Evaluation Lead, SIM Round 1
• Greg Boyer, PhD
Evaluation Lead, SIM Round 2
SHADAC
• Colin Planalp, MPA
Senior Research Fellow, SHADAC
Washington
• Bonnie Wennerstrom
Healthier Washington Connector, Washington Health Care Authority
• Laura Pennington
Practice Transformation Manager, Washington Health Care Authority
• J.D. Fischer
Manager, Value-Based Purchasing, Washington Health Care Authority
4. Webinar Agenda
4
• Overview of State Innovation Models (SIM)
• Multipayer Quality Measure Alignment
o A strategic framework drawn from SIM States’ experiences
o State highlight: Washington Statewide Common Measure Set
o Measure alignment lessons from SIM evaluations
• Question and Answer Session
o Please submit questions via the chat feature
5. Overview of State Innovation Models
6/21/2019 5
Allison Pompey, DrPH
Director, Division of State Innovation Models (SIM)
Center for Medicare & Medicaid Innovation (CMMI)
6. Multipayer Quality Measure Alignment:
A Framework Drawn from SIM Experiences
Colin Planalp, MPA
Senior Research Fellow
SHADAC
6/21/2019 6
7. Developing a Common Measure Set
• Determining an alignment strategy
• Articulating a rationale
• Setting an alignment scope
• Engaging a workgroup
• Identifying measure selection criteria
• Inventorying and evaluating measures
• Selecting measures
• Sustaining alignment
6/21/2019 7
8. Determining an Alignment Strategy
Voluntary vs. Mandatory Alignment
Voluntary strategy
• Commercial payers encouraged, but not required, to align
with a common measure set
Mandatory strategy
• Commercial payers are required to align with a common
measure set
6/21/2019 8
9. Determining an Alignment Strategy
Mandatory strategy
• Leveraging statutory or
regulatory authority to
mandate commercial payers
align with a common measure
set
• Employing negative or positive
mandates on commercial
payers’ use of quality
measures
6/21/2019 9
10. Determining an Alignment Strategy
Voluntary strategy
• Building buy-in through
stakeholder engagement
• Using state purchasing authority to
“jump start” a common measure
set (e.g., adopt in Medicaid, public
employee benefits, etc.)
6/21/2019 10
11. Determining an Alignment Strategy
Minnesota
• Statutory negative mandate
• Prohibits commercial insurers from
requiring providers to report on
measures excluded from the
common measure set
6/21/2019 11
Source: https://www.revisor.mn.gov/statutes/2008/cite/62U.02
12. Determining an Alignment Strategy
Rhode Island
• Regulatory positive mandate
• Requires commercial payers to use
measures from common measure set
in any value-based payment
arrangements
6/21/2019 12
Source: http://www.ohic.ri.gov/documents/2016-OHIC-Regulation-2-amendments-2016-
12-12-Effective-2017-1-1.pdf
13. Articulating a Rationale
Setting goals for quality measure alignment
• What do stakeholders seek to accomplish by aligning quality
measures? Examples:
o Reducing provider burden
o Furthering shift to value-based payment
o Promoting quality transparency to consumers
Making the case to stakeholders
• When and how to set alignment rationale, as a tool for
engaging stakeholders? Options:
o Before stakeholder process —
to persuade stakeholders to join the effort (i.e., “sales pitch”)
o During the stakeholder process —
to ensure goals reflect stakeholder priorities (i.e., develop buy-in)
6/21/2019 13
14. Articulating a Rationale
Minnesota
• Authorizing statute set goals:
o Contain provider burden
o Promote quality transparency
6/21/2019 14
Source: https://www.revisor.mn.gov/statutes/2008/cite/62U.02
15. Articulating a Rationale
Connecticut
• Stakeholder workgroup set guiding
principle that common measure set
should:
o “assess the impact of race, ethnicity,
language, economic status, and other
important demographic and cultural
characteristics important to health equity”
6/21/2019 15
Source:
http://www.healthreform.ct.gov/ohri/lib/ohri/work_groups/quality/report/qc_report_11102016_fi
nal.pdf
16. Setting an Alignment Scope
What payers and programs could be covered?
• Payers: Public payers (e.g., Medicaid, state employee
plans, etc.), commercial payers
• Programs: Value-based payment programs (e.g.,
PCMHs, ACOs, etc.), transparency programs (e.g., public
quality reports or websites)
What levers may be employed?
• Contracting levers (e.g., Medicaid managed care
contracts)
• Regulatory levers (e.g., regulatory requirements for
commercial plans)
6/21/2019 16
17. Setting an Alignment Scope
Washington
• Use of common measure set
in required in state purchasing
of health care (e.g., Medicaid,
employee health benefits)
6/21/2019 17
Sources:
http://lawfilesext.leg.wa.gov/biennium/2013-14/Pdf/Bills/Session%20Laws/House/2572-S2.SL.pdf
https://www.hca.wa.gov/assets/Washington-State-Common-Measure-Set-2018.pdf
18. Engaging a Stakeholder Workgroup
Roles of a stakeholder workgroup
• Solicit input from relevant constituencies
• Identify and establish shared priorities
• Cultivate stakeholder buy-in for effort
Select stakeholders and convening
entity
• Convening entity (state agency vs.
trusted non-state entity)
• Stakeholder workgroup members
Measure set authority
• What entity holds authority over the
measure set?
o Workgroup
o State agency
6/21/2019 18
Common workgroup
members
Commercial payers
Public payers
(e.g., Medicaid, public employee
benefits)
State agencies
(e.g., insurance department, health
department)
Health care providers
(e.g., hospitals, physicians)
Consumers
(e.g., individuals, advocacy orgs.)
Others
(e.g., labor unions, private employers,
quality measurement experts)
19. Engaging a Stakeholder Workgroup
6/21/2019 19
State
Workgroup
convener
Measure set
authority
Connecticut
State agency Workgroup
Massachusetts
State agency State agency
Minnesota
Third party State agency
Rhode Island
State agency State agency
Washington
Third party Workgroup
20. Engaging a Stakeholder Workgroup
State Agency Conveners
• Connecticut: Office of Health
Strategy, State Innovation Model
office
• Massachusetts: Department of
Public Health and Center for Health
Information and Analysis
• Rhode Island: Office of the Health
Insurance Commissioner
6/21/2019 20
21. Engaging a Stakeholder Workgroup
Third-party conveners
• Minnesota: Minnesota
Community Measurement
(not-for-profit quality
measurement organization)
• Washington: Washington
Health Alliance
(not-for-profit operator of
voluntary APCD)
6/21/2019 21
22. Identifying Measure Selection Criteria
Purpose of measure
selection criteria
• Allows a systematic
evaluation of available
quality measures
• Prevents arbitrary
decisions that could
undermine stakeholder
confidence
6/21/2019 22
Common selection criteria
Opportunity for improvement
(e.g., gap between actual and optimal
performance, performance variation across
providers)
Proven/consensus measures
(e.g., preference for National Quality Forum-
endorsed measures, evidence-based
measures that are reliable and valid,
availability of benchmarks)
Containing burden
(e.g., practicality/feasibility of data collection,
prioritization of claims vs. self-reported data)
Measure type
(e.g., preference for outcome over process
measures)
23. Inventory and Evaluation of Measures
Develop an inventory of measures under consideration
• Measures currently used by payers in the state
• Other measures for consideration (e.g., opioid measures)
6/21/2019 23
Measure Payer 1 Payer 2 Payer 3 Alignment score
Diabetes
Hemoglobin A1c
(HbA1c) testing X 1
Hemoglobin A1c
(HbA1c) control
(<8.0%)
X X 2
Hemoglobin A1c
(HbA1c) poor control
(>9.0%)
X 1
Preventive screenings
Colorectal cancer
screening X X X 3
Assessing existing alignment
24. Inventory and Evaluation of Measures
6/21/2019 24
Measure NQF endorsed
Room for
improvement
Outcome over
process
Diabetes
Hemoglobin A1c
(HbA1c) testing X
Hemoglobin A1c
(HbA1c) control
(<8.0%)
X X X
Hemoglobin A1c
(HbA1c) poor control
(>9.0%)
X X X
Preventive screenings
Colorectal cancer
screening X X
Evaluate measures according to selection criteria
• Score measures according to how well they meet selection criteria
Evaluating candidate measures
25. Selecting Measures
Weighting selection criteria
• Should certain criteria be weighted more heavily than others when
selecting measures?
Measurement priorities and goals
• Does the state have certain measurement priorities (e.g., diabetes,
substance use disorder) or goals (e.g., reducing disparities, promoting
transparency) that should be considered in measure selection?
Measure sub-sets
• Measure sets are commonly organized into different sub-sets
Measure set stewardship authority
• What entity has ultimate authority over the measure set?
25
26. Selecting Measures
Measurement priorities and goals
• Rhode Island: Adopted measure of
appropriate opioid prescribing in
response to priority of opioid crisis
• Connecticut: Investigating ways to
quantify disparities in quality
measures to goal of improving health
equity
6/21/2019 26
27. Selecting Measures
Measure Sub-sets
• Massachusetts: Sub-sets for different
provider types — Physician
Group/Practice, Hospital, Post-Acute
• Rhode Island: Sub-sets of “core”
measures for mandatory use and
“menu” measures for optional use
• Connecticut: Sub-sets of “core”
measures for payment, “reporting” for
public reporting only, and
“development” for future consideration
6/21/2019 27
28. Selecting Measures
Measure Set Authority
• Rhode Island: Office of the Health
Insurance Commissioner, with
workgroup recommendations
• Connecticut: Quality Council
stakeholder group
• Minnesota: Department of Health,
with workgroup recommendations
6/21/2019 28
29. Sustaining Common Measure Sets
Preventing measure sets from becoming stale
• Without regular updates, common measure sets can lose
effectiveness for multiple reasons:
o Providers may “top out” in performance improvement
o Evidence changes, supporting measures themselves or
the practices they promote
o Feasibility of measures may change (e.g., allowing a shift from claims-
based to clinical quality measures)
o Quality priorities may evolve over time
• States commonly revise measure sets with an annual process,
addressing:
o Retirement of measures and adoption of new measures
o Re-evaluation of measurement priorities
6/21/2019 29
30. Sustaining Common Measure Sets
Preventing measure sets from becoming stale
6/21/2019 30
Washington
• Added new measures of appropriate
opioid painkiller prescribing align with
new quality priorities
31. Washington
Statewide Common Measure Set
31
Bonnie Wennerstrom, MSW, MPH
Healthier Washington Connector, former SIM Project Director
Washington State Health Care Authority
Laura Pennington
Practice Transformation Manager
Washington State Health Care Authority
J.D. Fischer, MPH
Value-based Payment Manager
Washington State Health Care Authority
33. • Accountable Communities of Health
• Paying for value
• Performance measures
• Practice transformation support hub
• Shared decision making
• Integrated physical and behavioral health
• Analytics, interoperability, and measurement
• A plan for improving population health
• Health workforce innovation
Many different strategies, with
many public and private partners
35. Washington State Common Measure
Set on Health Care Quality and Cost
35 https://www.hca.wa.gov/about-hca/healthier-washington/performance-measures
36. Why a Common Measure Set?
• Legislative mandate
• To standardize the way we measure
performance
• Promote voluntary alignment of measures
• Publicly share results on an annual basis
through APCD
6/21/2019 36
37. Additional Purposes of the Measure
Set: Making the Data Actionable
• Leverage role as largest purchaser of healthcare in state
o Use measures in contracts to drive payment and deliver system reform
• A path to performance-based payment arrangements
o “North star” for how we select incentive-based measures
• Ensure equal access to high-quality health care
o Identification of opportunities to improve value of health care provided
through delivery systems
37
38. Development of Common Measure Set
Successes
• Stakeholder driven process
oGovernor-appointed Performance Measures Coordinating
Committee
• Convening partner – state accountable for measure set
• Standard set of measure selection criteria
• Multi-workgroup approach, depending on topic
• Full transparency is very important!
oAllowing for public input at all times, as well as a formal
public comment period
6/21/2019 38
39. Development of Common Measure Set
Challenges
• Keeping the total number of measures reasonable
• Practicing providers were not actively engaged in
conversation
• Lack of understanding of purpose of measures
• Ongoing engagement/defining scope for PMCC
6/21/2019 39
40. Lessons Learned
• Establish a clear goal and purpose statement from the
beginning that is relevant to all potential end users
• Build in a strong communication and outreach strategy
• Find potential “critics” and engage them regularly
• Engage practicing providers in the discussion from the
beginning
• Communicate, communicate, communicate!
6/21/2019 40
41. Sustaining the Common Measure Set
• Plan for ongoing evolution of common measure set
• Work with commercial payers to ensure voluntary
alignment, particularly with the VBP measures
• How do we continue to ensure we are using the right
measures to drive quality?
oQuality Measurement & Monitoring Improvement (QMMI)
6/21/2019 41
45. PEBB SEBB
HCA’s VBP Guiding Principles:
1) Continually strive for the quadruple aim of lower costs, better outcomes, and better consumer
and provider experience;
2) Reward the delivery of person and family-centered, high value care;
3) Reward improved performance of HCA's Medicaid, PEBB, and SEBB health plans and their
contracted health systems;
4) Align payment and delivery reform approaches with other purchasers and payers, where
feasible, for greatest impact and to simplify implementation for providers;
5) Drive standardization and care transformation based on evidence; and
6) Increase the long-term financial sustainability of state health programs.
2016:
20% VBP
2021:
90% VBP
MEDICAID
Value-based purchasing roadmap
45
2016
actual: 30%
VBP
2017:
30% VBP
2017
actual: 43%
VBP
2018:
50% VBP
2019:
75% VBP
2020:
85% VBP
46. VBP Accountability
• MCO contracts – 1.5% withhold (Medicaid)
• Regence TPA contract – VBP PG (Public/School
Employees)
• SEBB fully-insured plans – VBP PG (Public/School
Employees)
• MTP – VBP incentives (Medicaid)
• Alternative Payment Methodology 4 for FQHCs (Medicaid)
• Rural Multi-payer Model – global budget for CAHs and rural
health systems (One-HCA)
• Annual health plan & provider surveys (One-HCA)
46
47. The Road Ahead
• Incentivizing primary care
• Clinical integration of physical and behavioral health care
• Accountability for total cost of care
• Addressing social determinants of health and substance use
disorder
• Patient engagement and empowerment
• WA-All Payer Claims Database - Pricing data
• MCO Quality Focus Measures
47
48. Multipayer Quality Measure Alignment:
Lessons from SIM Evaluations
6/21/2019 48
Jennifer Lloyd, PhD, MS, MA
SIM Round 1 Evaluation Lead
Research and Rapid-Cycle Evaluation Group,
Center for Medicare & Medicaid Innovation
Greg Boyer, PhD, MHA
SIM Round 2 Evaluation Lead
Research and Rapid-Cycle Evaluation Group,
Center for Medicare & Medicaid Innovation
49. SIM Round 1
6/21/2019 49
• Vermont was the most successful in creating quality
measure alignment across Medicare, Medicaid, and
commercial payers.
• However, of the 4 states that created Medicaid ACO models,
pre-existing Medicare and commercial ACO penetration
within those states heavily influenced the Medicaid ACO
design, including which quality measures were selected.
• There are a number of barriers states encountered that may
be the most useful to discuss for lessons learned.
50. SIM Round 1
6/21/2019 50
• All states invested SIM resources in quality measurement
and reporting, a large portion of which were used to support
new payment models in which financial incentives were tied
to quality.
o Providers viewed the increased use of quality metrics as useful in
principle, but overly burdensome as implemented.
o Recognizing the added burden, all states changed their alignment
strategy.
o Making health care cost and quality transparent to the public continued
in states that initiated public reporting prior to the SIM Initiative (ME,
MN, OR) and began in other states during the SIM Initiative (MA).
o Although some incentivized quality metrics demonstrated improvement
as new models were implemented, this improvement was far from
universal.
51. Other Considerations
6/21/2019 51
• How does this fit with MACRA quality reporting requirements
tied to payment for MIPS/AAPMs (Medicare alignment), the
Medicare Shared Savings Program, and other CMMI models
(CPC+)?
• What about the Medicaid Scorecard can be harnessed to
see the overlapping common metric areas across states (as
most commercial payers have business not just in one
state)?
• Beyond stakeholder engagement, what did states harness
(health IT infrastructure or state data analytic investments
statewide/within models) to bring about better alignment?
52. SIM Round 2
6/21/2019 52
Early Struggles:
• Multiple sources of states including multiple sources of
EHRs and a lack of standardization across MCOs
• Diverse populations not necessarily represented in all
measures sets.
o For example, a measure set tailored for a commercial population may
be inappropriate to use for a Medicaid population.
• Early concerns also centered around alignment with already-
existing systems and their integration with newer measure
sets
53. SIM Round 2
6/21/2019 53
More Recently:
• At least some states took advantage of their roles as payers
(Medicaid) and focused their energies first on aligning
measures within Medicaid before engaging other payers
• Additionally, some states leveraged flexible solutions around
reporting requirements or allowed partial alignment for
payers to retain some of their own measures.
o This flexibility included aligning with existing Medicare models.
• Still other states moved away from state-defined measures
and adopted nationally recognized versions seen as critical
for payer buy-in
54. SIM Round 2
6/21/2019 54
Most recently:
• States focused on establishing common measure sets and
common definitions of measures.
• States have focused on overcoming barriers regarding noted
concerns about actionable feedback including:
o Provision of practice facilitators and clinical IT advisors
o Soliciting specific provider feedback
o Combining feedback reports across multiple payers into single reports.
55. Questions for Speakers?
6/21/2019 55
CMMI
• Allison Pompey, DrPH
Director, Division of State Innovation Models
• Jennifer Lloyd, PhD
Evaluation Lead, SIM Round 1
• Greg Boyer, PhD
Evaluation Lead, SIM Round 2
SHADAC
• Colin Planalp, MPA
Senior Research Fellow, SHADAC
Washington
• Bonnie Wennerstrom
Healthier Washington Connector, Washington Health Care Authority
• Laura Pennington
Practice Transformation Manager, Washington Health Care Authority
• J.D. Fischer
Manager, Value-Based Purchasing, Washington Health Care Authority
56. Contact Information
6/21/2019
Direct inquires to Colin Planalp, cplanalp@umn.edu
or shadac@umn.edu
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