Project Plan for Performance Reporting, Continuous Improvement and Evaluation Support

During Phase One (January-June 2013), Minnesota will assemble a state evaluation team consisting of staff from the departments of Human Services and Health. Minnesota’s State Health Access Data Assistance Center (SHADAC) at the University of Minnesota is a local evaluator uniquely positioned for this project and may assist in overall evaluation design and coordination.

By the beginning of Phase Two, the state will contract with external in-state vendor(s) to support the Innovation Center evaluation across all model-testing states and to support an in-state evaluation of our model. A collaborative approach, including stakeholder input, will facilitate efficient sharing of rapid-cycle evaluation findings during model implementation and testing and ensure state monitoring and evaluation capacity beyond the three-year grant period.

The emphasis will be to capture and measure the innovation changes, to do continuous improvement monitoring during the contract, to develop and enhance state agency performance monitoring systems and capacity, and to sustain measurement and evaluation beyond the three- year grant period.

Innovation Center Evaluation Support

Minnesota is dedicated to supporting all three components of the Innovation Center

evaluation, including the evaluation design and data collection stage, rapid cycle evaluations, and overall impact evaluation of state innovation models. To ensure the success of the Innovation Center evaluation, our evaluation team will:

 Participate in meetings or conference calls with the Innovation Center and contractor to provide information about Minnesota’s model and available and new data sources, and work with the Innovation Center to provide the needed information.

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 Analyze claims and other data and produce reports on a timely basis to facilitate study of the effectiveness of our model on key outcomes (i.e., quality of and access to care, health care utilization and costs, and health outcomes) for Medicaid, Medicare, and CHIP beneficiaries.  Conduct primary data collection in support of the federal evaluation efforts.

Data Collection

In supporting the Innovation Center evaluation, we will rely on existing data to the greatest possible extent. However, we will also identify data gaps critical to the evalu-ation of

Minnesota’s model and corresponding new sources of data, and facilitate its collection. The data collected and prepared for the Innovation Center evaluation will also be used for the in-state evaluation wherever possible. Possible domains for analy-sis include: quality of care, care coordination, provider/practice experience, patient/

enrollee experience, access to care, health care utilization and costs, cost savings,

community/population health, unintended consequences, barriers and approaches to overcoming barriers, key drivers of success, state policy and program changes made.

Possible measures include: avoidable emergency department utilization, rate of

hospitalizations, hospital readmissions, balance in primary care/specialty/hospital use, utilization for chronic conditions, reduction in chronic condition exacerbations, chronic disease

management, referrals, providers and patient communication, financial incentives to achieve goals, model impact on practices and outcomes, patient satisfaction with quality and care coordination, patient engagement in health care and health, coordination across providers, usual source of care, health disparities, PMPM utilization and costs, preventive care utilization, patient selection, access to care, health care costs, provider/practice burden and support,

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services and partnerships, behavioral and mental health services resources and transfer communication.

Possible data sources include: Statewide Quality Measurement and Reporting System, provider peer grouping, hospital discharge data, CMS Adult Quality Measures, provider surveys and/or provider interviews, practice site visits and/or focus groups with practice staff, surveys and/or focus groups of beneficiaries and families/caregivers, provider reports from Health Care Delivery System demonstrations, data collected from ACOs that serve the commercial market, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results,

administrative claims data, population surveys, including the Minnesota Health Access Survey (MNHA) and the Behavioral Risk Factor Survey (BRFSS), and interviews with state

administrators

Data Management and Privacy

Minnesota places an extraordinarily high priority on data privacy, security, and efficiency in data management. All evaluation team staff and contractor(s) involved in data extraction, collection, and analysis will be trained in data security and be required to sign data privacy agreements as necessary. Wherever possible, data files will be de-identified and limited to the variables being analyzed. Data will be stored and shared securely. All data collection, storage, exchange will be governed by the state’s data practices statutes, applicable state IT security practices, and, as appropriate, Institutional Review Board requirements.

In-State Evaluation

The goals of our Minnesota evaluation will be to build on the CMMI evaluation by conducting a more in-depth investigation of selected key components of our model. For example, a key area of interest to Minnesota and one possible focus of our in-state evaluation

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pertains to the variation and innovation in approaches providers take responding to the payment incentives to address health care quality, costs, and patient well-being. Another key focus is the integration of providers/practices with non-health care community services, such as mental health, social services, long-term care, schools, etc. A critical part of this analysis will be understanding effective models in preparation for scale up and coordinating alignment of performance measurement activities in the existing multi-payer environment.

Evaluation Design

The in-state evaluation of the Minnesota Accountable Health Model will involve both quantitative and qualitative research approaches as appropriate. The evaluation will include endpoint measures, process measures, and formative elements throughout the project. Key evaluation features will include an initial stakeholder analysis to refine the state evaluation goals and objectives and ongoing communication and dissemination of results to facilitate continuous improvement throughout the contract.

Initial Evaluation Activities

A stakeholder analysis will be held during the first six months of the contract. This will include developing baseline and performance targets on population health, quality of care and affordability, and cost of services. State staff will meet with partners to share the stakeholder analysis findings and to outline the evaluation goals and objectives based on those findings. Existing data sources, the need for additional data collection, and timing needs for evaluation dissemination will be determined along with baseline measures, to finalize an evaluation plan.

Interim Evaluation Activities

This phase will focus on collecting and analyzing data on both process and outcome measures and providing feedback to participants. Regular deliverables and meetings will be

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scheduled with the evaluation team, advisory group, and stakeholders to ensure relevance. Findings will be shared according to an agreed-upon schedule to make adjustments based on the information learned through the evaluation process.

Longer-Term Evaluation Activities

An overall impact evaluation will provide information to evaluate the value of the initiative relative to model goals and how successful the Minnesota model is in transforming the care delivery system in a multi-payer environment. This phase of the evaluation will focus on assessing the extent to which model providers/practices identified best practices for

1 VII. Project Plan and Timeline with milestones

The governance structure for the Minnesota Accountable Health Model Testing project consists of a relatively flat organization that integrates direct community, provider, and payer input. Governor Dayton has authorized the commissioners of the Department of Health (MDH) and the Department of Human Services (DHS) to apply for and administer this project. The commissioners and a special representative from the Governor’s Office serve as the Leadership Team and are jointly responsible for the project’s strategic direction and accountable for project outcomes. The governance structure is represented in the diagram below:

The Model Testing Operations Team is led jointly by assistant commissioners from MDH and DHS, reflecting shared responsibility between the agencies. Project management functions will reside within the Operations Team, including an inter-agency model testing lead, who will provide overall project management direction with project managers in MDH and DHS. The Operations Team will monitor all SIM-funded activities, report to the Leadership Team, and will be accountable for project progress. Specifically, the Operations Team will be responsible for:

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 Monitoring progress toward project milestones and project evaluation; and

 Staffing the Community Advisory Committee and the Multi-Payer Consultation Group. The Community Advisory Council will be selected to ensure a balanced group comprised of representatives from counties, providers, consumer, and community organizations to ensure sustainability of model testing activities and alignment with related efforts in the state. Quarterly meetings will provide guidance to the Leadership Team on the project approach, milestones, and measurements. A Multi-Payer Alignment Consultation Group will be selected to ensure a mix of representation from commercial and public payers to advise the Leadership Team through quarterly meetings so that model testing maximizes opportunities for and addresses barriers to alignment of ACO development across payers.

The timeline below includes the key activities and milestones necessary to implement and test the Minnesota Accountable Health Model:

PHASE ONE: IMPLEMENTATION (JANUARY 2013-JUNE 2013): Phase One activities will ensure testing and evaluation plans are finalized before testing begins, including:

ACO implementation: Fully implement nine Health Care Delivery System demonstrations for Medicaid ACOs with six-month evaluation, including measures from the Statewide Quality Reporting and Measurement System (SQRMS); early in 2013, release Phase Two RFP to expand the number of providers and Medicaid members served by ACOs.

ACO data analytics: Develop RFP and prepare for Medicaid data warehouse and analytics to enable Web-based provider data feedback and reports.

Secure provider data exchange and infrastructure: Develop RFPs for Electronic Health Record adoption and data exchange grants to providers to enable care coordination between health care and other providers; develop RFPs for development of tools for providers to use data

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effectively and securely; and develop and implement a standards-based health information gateway for secure transfer of public health and other data between providers and the state. ACO measurement: Develop common performance measurement strategy for ACOs and plan for development of new measures for model testing.

Project management, advisory group support, project evaluation: Hire MN model testing project management staff; create model policies and templates; establish Community Advisory and Multi-payer Consultation groups; and contract for Model Testing Evaluation Plan. All activities are ongoing through the end of Phase Three.