Measuring success, proving value: A SIM journey

By Heather Grimshaw

Practice transformation requires staff time, resources and a commitment to redesigning processes to ensure the delivery of patient-centered, team-based, integrated healthcare. The Colorado State Innovation Model (SIM) team appreciates the work you do and continues to seek ways to highlight SIM practices with state executives, health plans and patients. As we approach the two-year mark for cohort-1 practices that end their formal participation in SIM March 31, the team continues to gather and share stories of success.

“It’s been very valuable,” Cindy Mattingly, RN, BSN, manager of practice transformation for Rocky Mountain Health Plans, said about SIM practice implementation during the Jan. 18 Multi-Stakeholder Symposium (MSS). “It’s really exciting to see how all of this has grown and the value that you get by participating,” she added.

Mattingly joined representatives from SIM cohorts 1 and 2 practices, health plans that support SIM and practice transformation organizations (PTOs) at the MSS, which is designed to foster respectful discussion about practice transformation work and alternative payment models (APMs) that support it. This was the first MSS for cohort-2 practices and highlighted the need for more frequent discussions between practices and payers about how practices are evaluated, what payment support looks like and ways to develop closer partnerships.

Attendee surveys for MSS events from January 2017 through January 2018 show that 76% of attendees picked good or excellent to describe their experience.

“Being able to put names to faces in a setting like the SIM Multi-Stakeholder Symposiums really deepens the commitment to seize this opportunity to work together toward the quadruple aim,” said Beth King, quality coordinator, Associates in Family Medicine, a Fort Collins-based cohort-1 and cohort-2 practice representative. 

One of the common themes discussed in all four MSS events to date is the need for practices to hone their ability to collect, report and use data effectively to show their unique value and to negotiate more effectively with health plans.

In addition to payment, Neha Patel, manager of community transformation with Anthem, talked about the need for practices to track cost savings associated with practice transformation efforts and identify ways those savings might fund future efforts. 

“Part of the work you’re doing with data collection, reporting and analysis is to help you change workflows,” said Patel. “You always have to take that information and apply it… How do we help you improve quality and reduce costs, because that reduction in cost is going to help fund future transformation.”

Patrick Gordon, vice president, Rocky Mountain Health Plans, noted some of the challenges associated with data reporting and emphasized the need to create a mutually-beneficial solution. “We still live on different data planets and it’s important that we find a bridge across. Data from the practice lives in practice electronic health record, and the measures, methodologies are different. It’s not about reducing risk or adding value they’re about closing gaps. The real opportunity is to find a way to integrate the data and work with an aligned view where we’re looking at the clinical and administrative data in the same way, same place and both agree that it’s valuable. There are fledgling efforts to do that. We just need to be honest. We live on different data planets and need to find different ways to communicate with each other.”

Meeting in the middle
The agenda for the January MSS was split into two parts to welcome cohort 2 practice representatives to the symposium and include an overview of SIM, details about the Multi-Payer Collaborative and goals for the MSS. The second part of the agenda included cohort-1 practices and continued the discussion that was started last September about the ways in which payers, practices and PTOs can help each other with successful practice transformation. There was a decrease in positive ratings for the January event, and requests for more direct conversation with payers, which was offered in 2017 and will be considered for future agendas.

During the morning session for cohort-2 practices, health plan representatives talked about their roles and responsibilities as well as resources and supports during a panel discussion. Later in the day health plan representatives joined three cohort-1 practice representatives on a panel to address questions compiled during the September 2017 MSS. The SIM team will publish the questions posed by MSS participants as well as feedback from payers, practices and PTOs in the next provider newsletter.

Panel members fielded several questions and met with frustration from audience members, who expected more direct answers from health plan representatives regarding payment support and a demonstration of how they act as true partners in practice transformation. The SIM team encourages all SIM practice representatives to reach out to payer representatives listed in SIM materials regarding payment support with practice-specific questions. Please email the SIM team if you don’t have this resource, and we will resend your payer contact information. 

SIM is committed to helping practices develop closer relationships with payer representatives, and a comment made during the panel discussion illustrates that progress has being made. “We were really frustrated when we started with SIM but some of that frustration has been mitigated as we recognize that payers are on the same page,” said Carol Schlageck, managing associate, Primary Care Partners, Inc., Grand Junction. 

Mark your calendars for the next MSS, which will be held in Grand Junction April 26. Both cohort-1 and cohort-2 practices are welcome and encouraged to attend, and stay tuned for more information about questions and answers from MSS participants in the next SIM provider newsletter.