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Accountable Communities and Stakeholder Engagement in Maine's SIM Evaluation Subcommittee

This document provides meeting minutes and summaries for the Maine SIM Evaluation Subcommittee discussing accountable communities and stakeholder engagement in healthcare initiatives. Topics include provider and stakeholder research, decision-making processes, staff roles, training, and the importance of health home models. Stakeholder focus groups highlight challenges with governance and steering committee responsibilities.

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Accountable Communities and Stakeholder Engagement in Maine's SIM Evaluation Subcommittee

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  1. Maine SIM Evaluation Subcommittee November 2016 November 2, 2016

  2. Today’s Agenda

  3. Today’s Agenda

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

  5. Today’s Agenda

  6. Provider and Stakeholder Research • Accountable Communities Questionnaire • Stakeholder Focus Groups • Health Home/Behavioral Health Home Provider Survey

  7. Accountable Communities Questionnaire • Targeted to four participating Accountable Communities (ACs): • Eastern Maine Healthcare Systems • MaineGeneral Health • MaineHealth • Penobscot Community Health Care • 31 closed and open-ended questions developed collaboratively by MaineCare, The Lewin Group, and Market Decisions Research (MDR) • Emailed invitation with survey attached as MS Word document, reminder calls

  8. Four very different Accountable Communities efforts defy generalization • Populations Targeted A wide variety of targeting approaches was used. Two ACs targeted populations with specific chronic conditions (Diabetes, Asthma, etc.), one AC targeted populations by demographic characteristics (children, disabled, etc.), and two targeted high utilization or users of high cost services. • Intervention Components These differed with the intervention and the targets. Common elements include care teams, revising care protocols, and improved proactivity to manage care.

  9. Accountable Communities Questionnaire • Decision Making on Interventions and Populations Each of the ACs used broad constituencies to select interventions and target populations. Behavioral staff and medical staff appear to be part of all decision making. • Rationale for Intervention Selection Two of the ACs mentioned that their choice was data driven, one was consistent with ongoing Health Home Initiatives, and another was driven by the personal interest of one champion. • Recruiting Practices ACs used existing structures to recruit and inform participating practices; this included PCMH monthly meetings, a Physician Hospital Organization, and two existing ACOs.

  10. Accountable Communities Questionnaire • Central Versus Practice Level Responsibilities The emphasis at ACs was on practice level implementation with central leadership and data support. • Staff Roles and Level of Commitment A wide variety of staff are involved, too many to characterize. Two ACs indicated that staff was very supportive and two said somewhat supportive. • Training Two ACs relied on training that had been conducted previously and was not specific to their initiatives. One AC, recognizing the need for training, added a specific “performance improvement coach.” Another AC noted the need for more training but had not taken action.

  11. Accountable Communities Questionnaire • Importance of Health Home (HH) Program to AC Interventions Two ACs indicated that HHs were very important to the AC Intervention and two indicated that it was somewhat important. All ACs agreed that the implementation of the interventions would not be successful without HHs. HHs provided a base of experience, cross disciplinary teamwork, and familiarity with data on at-risk patients.

  12. Accountable Communities Questionnaire Summary • “Target Populations” defined differently in each AC • Broad participation in planning –clinicians worked with management • Interventions implemented at the practice level • Supportive practice level staff • Health Home model important to success

  13. Stakeholder Focus Groups • Two focus groups • SIM Steering Committee Members • Subcommittee Members • Contacts were identified and provided by Maine SIM Leadership, MDR recruited by e-mail and phone • Discussion guide developed collaboratively with Maine SIM Leadership • Moderated by Curtis Mildner of MDR • 8 participated in the Steering Committee focus group at a Maine General meeting room • 7 participated in the Subcommittee focus group at an Augusta restaurant meeting room

  14. Stakeholder Focus Groups Governance • Focus group participants report little opportunity for committees to steerinitiatives: • SIM initiatives set before committees formed • Impossible for committees to keep ahead of work • SIM Leadership Team reserved important decisions for itself • Natural obstacles reported by focus group participants: • Committee members represented the interests of their organizations, not necessarily the common good • Some committee members were also contractors to SIM

  15. Stakeholder Focus Groups Steering Committee Responsibilities • Participants noted a disconnect with stated mission to steer the project. Actual work largely limited to: • Reviewing presentations on the work • Discussing and making comments on the work • Strategic Objective Review Team (SORT) process was an exception, in that participants reported they had an important role in identifying and discussing issues and making a recommendation that was acted on.

  16. Stakeholder Focus Groups Subcommittee Responsibilities • Participants reported their role as only advisory • Participants felt closer to action, better able to influence work by leveraging expertise, discussion and the power of good ideas.

  17. Stakeholder Focus Groups Reasons Cited for Ongoing Committee Participation • To assure their organization is represented • Not to miss an opportunity to influence • Peer to peer relationships developed over course of project • Opportunity to discuss and share views Through the SIM governance structure, something important was created: Groups of engaged stakeholders who want to contribute to health care improvement.

  18. Stakeholder Focus Groups SORT Process • Seen as effective effort by Steering Committee • Engaged committee in identifying and discussing issues • Committee made recommendations that were acted on • Seen as mysterious by Subcommittees • Lack of transparency in choice of decision makers • Lack of transparency for process to make decisions • Unclear how Subcommittee input was considered, if at all

  19. Stakeholder Focus Groups Most Important Results/Accomplishments Cited • Support for and progress of Behavioral Health Homes • Improved data availability, including the Health Information Network (HIN) • Support provided by the Learning Collaborative • The committees themselves Stakeholders, with many different interests, were successfully brought together to focus on health care reform.

  20. Stakeholder Focus Groups Summary • Committees considered to be a success • Networking was appreciated • Liked discussion and debate of issues • Believed that their expertise is helpful to government • Willing to continue participation • If given a meaningful role

  21. HH/BHH Provider Survey • Online survey • Questionnaire developed collaboratively by Market Decisions Research, The Lewin Group, and members of the SIM Evaluation Committee • Closed end and open-ended questions • Contact file of 272 active names and e-mail addresses provided by SIM Leadership • Participants invited by e-mail with embedded link to online survey • Multiple e-mail reminders • 150 fully or partially complete surveys: 107 fully complete, 2 mostly complete, 41 only first several questions completed. 109 surveys used in analysis and reporting • Long survey, 30+ minutes to complete, 1500 open-ended comments provided by respondents

  22. HH/BHH Provider Survey Important Notes • Data is perceptual, responses represent what respondents believe • Open-ended responses are “top of mind” • Data is directional, represents respondents not necessarily all in sample or all in HHs or BHHs

  23. HH/BHH Provider Survey Survey Respondents

  24. HH/BHH Provider Survey

  25. HH/BHH Provider Survey • Most frequently mentioned changes at Health Homes to improve physical health • 33% Increased care coordination/care management • 23% More preventive care (screenings/immunizations) or better follow-ups/referrals • 18% Added new managers/staff • 13% Assessed individual barriers or gaps in patient care • 12% Implemented new care management software or model

  26. HH/BHH Provider Survey • Most frequently mentioned patient engagement actions at Health Homes • 35% Shared decision-making/increased care coordination/collaboration • 28% Implemented a Patient Advisory Board • 22% Developed patient satisfaction surveys/ question of the month • 15% Increased communication/peer engagement/meetings

  27. HH/BHH Provider Survey • Most frequently mentioned efforts to improve Behavioral Health coordination at Health Homes • 42% Use behavioral health clinician or LCSW • 27% Implemented behavioral health integration/co-location • 23% Increased care coordination • 13% Increased communication/collaboration with community providers • Most frequently mentioned efforts to improve Physical Health coordination at Health Homes • 52% Increased care and quality management • 29% Using or added care coordinator • 17% Increased communication/collaboration with community providers

  28. HH/BHH Provider Survey • Most frequently mentioned efforts to improve Diabetes care at Health Homes • 96% Regular HbA1c testing • 93% Blood pressure (BP) management • 91% Regular eye exam • 88% Increased care coordination/education of patients with diabetes who have frequent ED/inpatient admissions • 88% Referral to diabetes educator • 84% Weight management (diet/nutrition counseling) • 72% Neuropathy screening • 71% Lifestyle coaching (activity/exercise) • 35% Monitoring use of anti-psychotic medications and impact on physical health for patients with diabetes

  29. HH/BHH Provider Survey • Most effective/ineffective Diabetes care according to Health Homes • 25% Effective: Increased care coordination/engagement • 20% Not effective: Lack of engagement/compliance from patients • 16% Effective: Increased education/on-site Certified Diabetes Educator • 16% Not effective: Issues with eye exams/hard to get patient in for eye exams

  30. HH/BHH Provider Survey

  31. HH/BHH Provider Survey • Most frequently mentioned changes at Behavioral Health Homes to Improve Behavioral Health • 32% Developed wellness groups/peer supports • 27% Use of Health Information Exchange/portal • 27% increased care coordination/team-based approach • 23% BHH integration • 18% Implemented new care management software or model • 18% Increased availability

  32. HH/BHH Provider Survey • Most frequently mentioned patient engagement actions at Behavioral Health Homes • 42% Increased communication/peer engagement/meetings • 25% Hired new managers/peer support staff • 21% Shared decision-making/ Increased care coordination/collaboration • 21% Increased client education

  33. HH/BHH Provider Survey • Most frequently mentioned efforts to improve physical health coordination at Behavioral Health Homes • 40% Increased communication/collaboration between practices • 24% Increased care coordination • 20% Using or added care coordinator • 16% Use of Health Information Exchange/EHR • 12% Integrated healthcare • Most frequently mentioned efforts to improve behavioral health coordination at Behavioral Health Homes • 53% Increased collaboration/Team based approach • 26% Increased care coordination • 16% Use of Health Information Exchange • 11% Using or added care coordinator/RN

  34. HH/BHH Provider Survey • Most frequently mentioned efforts to improve Diabetes care at Behavioral Health Homes • 80% Lifestyle coaching (activity/exercise) • 76% Increased care coordination/education of patients with diabetes who have frequent ED/inpatient admissions • 72% Weight management (diet/nutrition counseling) • 52% Regular HbA1c testing • 44% Referral to diabetes educator • 36% Monitoring use of anti-psychotic medications and impact on physical health for patients with diabetes • 28% Blood pressure (BP) management • 12% Regular eye exam • 12% Neuropathy screening

  35. HH/BHH Provider Survey • Most effective/ineffective according to Behavioral Health Homes • 41% Effective: Increased care coordination/engagement • 24% Effective: Increased education/ on-site Certified Diabetes Educator • 12% Effective: Diabetes education groups • 12% Not effective: Lack of engagement/compliance from patients

  36. HH/BHH Provider Survey

  37. HH/BHH Provider Survey Most frequently mentioned outcomes achieved by Health Home Coordinators at Health Homes • 56% Improved care coordination/more preventive care • 30% Better care/health and satisfaction/understanding for patients • 22% Improved follow-ups/referrals/warm hand-offs • 15% Lower ED/hospitalization rates • 11% Better access to community resources • 11% Improved integration of care/medication reconciliation Most frequently mentioned outcomes achieved by Care Coordinators at Behavioral Health Homes • 38% Improved care coordination/more preventive care • 19% Increased collaboration between providers • 13% Improved follow-ups/referrals/warm hand-offs • 13% Lower ED/hospitalization rates • 13% Better care/health and satisfaction/understanding for patient • 13% Improved integration of care/medication reconciliation

  38. HH/BHH Provider Survey

  39. HH/BHH Provider Survey Most frequently mentioned outcomes achieved by Community Care Teams at Health Homes • 30% Better outcomes for patients • 22% Increased access and support • 14% Increased care coordination • 14% Better compliance from patients • 11% Decreased in ED utilization • 8% Increased collaboration/communication Most frequently mentioned outcomes achieved by Community Care Teams at Behavioral Health Homes • 40% Increased collaboration/communication • 20% Increased care coordination

  40. HH/BHH Provider Survey • Anti Psychotic Drug Management Among Health Homes • 32% focused on medication reconciliation and case review • 29% focused on mental health integration/Embedded mental health specialists or LCSW • 26% focused on Increased coordination/collaboration with prescribers/providers • Anti Psychotic Drug Management Among Behavioral Health Homes • 48% focused on medication reconciliation and case review • 38% focused on increased coordination/collaboration with prescribers/providers

  41. HH/BHH Provider Survey • Most frequently mentioned effective and ineffective actions according to Health Homes • 27% Effective: Integration/co-location of care • 27% Not effective: Lack of staff/resources • 18% Effective: Increased care coordination/accessibility • 18% Not effective: Lack of patient compliance and no-shows • 14% Effective: Increased collaboration between prescribers/providers • 14% Not effective: Lack of access to mental health providers • Most frequently mentioned effective and ineffective actions according to Behavioral Health Homes • 41% Effective: Increased care coordination/accessibility • 24% Not effective: Lack of coordination/collaboration • 24% Effective: Increased collaboration between prescribers/providers

  42. HH/BHH Provider Survey

  43. HH/BHH Provider Survey

  44. HH/BHH Provider Survey Most frequently mentioned efforts to integrate behavioral health at Health Homes • 82% Implemented processes to routinely conduct a standard assessment for depression in patients with chronic illness • 78% Co-located a behavioral health services within in the practice • 51% Hired a behavioralist into the practice to assist with chronic condition management Most frequently mentioned barriers to integration of behavioral health at Health Homes • 30% Lack of behavior health providers/services • 24% Lack of support, resources or funding/reimbursement • 22% Lack of staff availability (LCSW, social workers, etc.) • 15% Lack of compliance or cooperation from patients • 13% Lack of coordination/understanding from medical providers

  45. HH/BHH Provider Survey

  46. HH/BHH Provider Survey • Most frequently mentioned efforts to integrate physical health at Behavioral Health Homes • 48% Through increased coordination of care • 26% Through increased collaboration and communication • 22% By providing education • 13% Fully integrated health services • Most frequently mentioned barriers to integration of physical health at Behavioral Health Homes • 42% Lack of communication/collaboration between providers • 33% Lack of understanding/education/knowledge • 29% Lack of staff/resources/availability

  47. HH/BHH Provider Survey Summary Preponderance of providers at Health Homes and Behavioral Health Homes see efforts as effective or very effective Behavioral Health Homes • Improved behavioral health care coordination • Improved physical health coordination, collaboration and hand-offs from BHHs to HHs • Leveraged and coordinated with community services and wellness groups • Increased patient engagement, peer support & support groups Health Homes • Improved physical health care coordination • Improved behavioral health coordination, added behavioral health staff/co-location • Improved diabetic care management • Better psychotropic drug management

  48. HH/BHH Provider Survey: Most Valuable Tools or Supports

  49. Provider and Stakeholder Research Questions?

  50. Today’s Agenda

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