Project Processes and Operational Planning a Data collection and reporting

Based on the strong collaborative relationship referenced in section 12, the commissioners of Health and Human Services will work closely with the Multipayer Consultation Group to explore the establishment of performance standards for participating entities (ACO and ACH). Starting from the foundation of the core measure sets in the Statewide Quality Reporting and Measurement System (SQRMS) and the HCDS program, as described above, we will also explore the development of a core measure set for ACOs and other providers under total cost of care models, and provide annual reports to the public on performance of providers relative to established targets and metrics, in a consumer-friendly online format.

For ACOs participating in the Medicaid HCDS demonstration, the core quality and patient experience measure set is based on the already established data collection mechanism under the SQRMS program. The goal of the program is not to require any separate or

unnecessary data collection for ACOs, but to leverage the existing statewide program for existing measures and development of new measures. In addition, DHS will calculate HEDIS measures using Medicaid fee-for-service and managed care encounter claims to monitor ACO performance

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on measures that are important to the overall Medicaid program (e.g. well child visits, immunizations, screenings, etc.) and for possible inclusion in the model.

b. Provider payment systems

The HCDS payment models are based on ACO performance against a risk-adjusted total cost of care target for all qualifying Medicaid participants (which includes Medicaid enrollees under the state plan and through the state’s 1115 waiver) attributed to the ACO for the

performance period. The total cost of care target will be calculated using risk-adjusted Medicaid fee-for-service claims and encounter claims submitted by managed care organizations (MCOs) under contract with the State. ACO financial incentives under the HCDS demonstration related to reducing total costs will be contingent on performance on quality and patient experience outcomes. All shared savings and shared loss payments under the models will be calculated and disbursed annually via a reconciliation payment. Providers will continue to receive the current Medicaid fee-for-service or MCO contracted payment during the performance period.

c. Model enrollment or assignment processes:

The state will rely on the current HCDS demonstration attribution process, similar to the Medicare Shared Savings methodology. Participants will be attributed to one ACO at a time at the beginning and end of each annual performance period using retrospective claims data. All of the attributed participants’ care as provided in the total cost of care definition will be attributed to the ACO regardless of whether the ACO delivered the services. Patients will maintain free choice of providers under the Model to ensure access to needed and appropriate care during the testing period.

A preliminary population will be determined at the beginning of the performance period and shared with the ACO prospectively based on health home, primary care, and specialty

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provider visits. The attributed population will be re-calculated at the end of the performance period for the purposes of the financial settlement. Attribution will be done using a hierarchical process that incents active outreach and retention of patients by the ACO under the following HCDS attribution methodology described in detail in the State Health Care Innovation Plan.

The state plans to continue monitoring and testing its attribution methodology during the testing period and maintains flexibility in the process to make mid-course adjustment consistent with the goals of the demonstration.

d. Contracting and administrative processes

Relying on the same process used in the Medicaid HCDS demonstration project, the state will competitively procure additional contracts. The HCDS contract is between the provider organization or, if applicable, a newly formed legal entity of multiple provider organizations (and other partners such as counties), such as a 501(c)(3), and the state for their attributed patient population including both fee-for-service and managed care enrollees. The state will include the HCDS participation separately in its Medicaid MCO contracts. The state will calculate shared savings and shared risk payments and quality benchmarking and execute the attribution

methodology for all ACOs participating in HCDS and all Medicaid populations included in the demonstration. DHS is responsible for oversight and monitoring of ACO compliance with HCDS contracts. DHS and MDH will work with the Multi-payer Consultation Group on the development and alignment of ACO contract requirements.

The Department of Health will contract separately with organizations that will serve as the fiscal agent for each Accountable Community for Health, with contracts covering community participation, support for leadership functions, and technical assistance. MDH will be

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e. Continuous improvement analysis and performance optimization process In order to assist providers participating in the Minnesota Accountable Health Model to achieve improvements in the quality and efficiency of their care, DHS will begin Phase One by employing the provider data feedback system implemented for the ACOs participating in the HCDS demonstration. DHS will provide data populated by a monthly set of risk adjustment output (Johns Hopkins Adjusted Clinical Groups [ACG®]), including both fee-for-service and MCO encounter claims data, to providers via provider web portal. Data will be as timely as possible given standard claims lag. Key variables available to delivery systems will include population-level data (such as the total cost of care and rates of inpatient and emergency department utilization) and participant-level data (such as medical and pharmacy utilization histories, predictive risk information, and indices of care coordination).

DHS will seek to enhance reporting and performance feedback in Phase One of the Model by releasing an RFP for a data analytics vendor to provide customized reporting, technical and assistance and training to ACOs that can provide claims-based data and reports that meets their needs and specific targets for improvement. The state will seek to include other payers in the data analytics contract, such as the State Employee Group Insurance Program (SEGIP) and commercial payers, to provide ACOs with a standardized single source for all data feedback. The contract will also build the infrastructure to accept clinical data from the electronic health records (EHR) of participating ACOs to provide more timely and actionable data that allows ACOs to act more rapidly to improve care management and coordination early in the care cycle.

The state, in collaboration with other payers, will establish standards for quality and efficiency measurement and improvement and require the ACOs to ensure the submission of data at the payer and provider level. Using multiple new and existing mechanisms, the state will

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collect relevant data across all Minnesota ACOs and ensure that they maintain high value care and demonstrate improvement in any areas of weakness. The state will support the Minnesota ACOs and ACHs with continuous performance improvement by providing assistance with data analytics and identifying opportunities for improvement through the use of standardized data reports, multi-year focused quality improvement initiatives and learning collaboratives.

f. Other processes needed to complete delivery system reform Necessary processes are included in the descriptions above. g. Project management and governance structure

The Department of Human Services (DHS) is responsible for the oversight and

administration of ACOs under the HCDS demonstration. Working collaboratively with the Department of Health (MDH), DHS will convene regular implementation and oversight meetings to ensure the smooth launch of the Minnesota Accountable Health Model in January and to monitor practice transformation to identify issues as early as possible and make necessary program adjustments. The statewide Model Testing community advisory committee and the Multi-Payer Alignment Group will be established during the first six months of funding, and will meet at least quarterly to advise the Departments on priorities, strategies, marketing, and

consumer engagement. An overall project manager will coordinate efforts between the two agencies, with involvement from relevant financial management and contracts staff as

appropriate. Each agency will also have project managers on staff, to coordinate efforts within each agency related to hiring, contracting, grants management, communications, outreach, and federal reporting requirements.

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Implementation and testing of the Model will be resourced through a combination of state staff and contracts with local and national experts and organizations. The Medicaid ACO contracts will be managed under the existing administrative structure, with additional staff to support expansion. MDH and DHS will release a series of requests for proposals to assist in developing the tools and resources needed for the payment and care delivery transformation outlined in this proposal. As described in the Project Plan and Timeline, these RFPs will occur in three phases and will focus on data analytics, secure data exchange/infrastructure, ACO measurement, ACO provider transformation and support for Community Care Teams to become Accountable

Communities for Health, and expansion of Accountable Communities for Health. State staff will provide oversight and management of RFPs, grants and contracts. State staff will also provide technical assistance, analytical support, and consultation to Model participants