State Innovation Model Evaluation Results

1. State Innovation Model Evaluation Results The Lewin GroupFirst Annual Evaluation Report Results December 8, 2015

2. Agenda

3. Introduction • Maine engaged Lewin in July 2014 to support the Maine self-evaluation of its State Innovation Model (SIM). • The December 2015 annual report displays data collected by Lewin for activities occurring 2013 – Sept. 2015. • Full report is available on Maine SIM website • Lewin employed a mixed methods evaluation approach to assess implementation, cost effectiveness, and impact of SIM initiatives: • Qualitative data collection – surveys and interviews • Quantitative data – claims and related datasets

4. Data Sources & Analysis Exhibit 1. Data Sources for Maine SIM Evaluation

5. Findings: MaineCare Stage A Health Homes • Quality Findings • MaineCare Stage A Health Homes differed significantly from the similarly matched control group on three core metrics. The trends from pre (CY 2012) to post (CY 2013) evaluation period are: • Exhibit 2. Summary of Significantly Different Core Metrics Performance

6. Findings: MaineCare Stage A Health Homes • Consumer Interview Findings(1) • Perceptions of provider communications are positive. See the next slide for further details on this score. • Consumers scored how well providers actually engage patients as partners in their health care lower, as illustrated in Exhibit 3. • Exhibit 3. Low Scoring Items Under Patient Engagement (1) See the full Lewin report for details of the methodology used to determine these scores.

7. Findings: MaineCare Stage A Health Homes Consumer Interview Findings: Summary of Composite Measures

8. Findings: MaineCare Stage A Health Homes • Service Utilization and Expenditure Findings • Pre-intervention period: CY 2012; Post-period: CY 2013 • Reduced expenditures per member per month (PMPM) in relation to the control group, including total, medical, and behavioral health costs. • Exhibit 4. MaineCareStage A Health Homes – PMPM Cost Avoidance by Category *Average PMPM in the stage A Health Home group was $615 in the post period *Average PMPM in the stage A Health Home control group was $690 in the post period [2] Hospital-based outpatient clinics that provide services, such as urgent care, preventive medicine, dialysis, cardiology. [3] Diagnostic evaluation, psychotherapy, drug services, and prescription management in an office setting.

9. Findings: MaineCare Stage A Health Homes • Service Utilization and Expenditure Findings (continued) • Cost avoidance generated by lower inpatient medical/surgical costs: • 17.9% reduction in overall PMPM is notable, pointing to positive impact of interventions designed to strengthen primary care. • Higher inpatient medical/surgical expenditures in the control group were attributed to: • Injury-related admissions (8.2%) • Septicemia (7.8%) • Complications of medical care (3.4%). • Exhibit 5. Changes in Utilization Associated with Decrease in Cost

10. Findings: MaineCare Stage B Behavioral Health Homes • Quality Findings • Pre-intervention period: April 2013 – March 2014 • Post-intervention period: April 2014 – March 2015 • Preliminary findings suggest a notable cost avoidance in the MaineCare Stage B Behavioral Health Homes intervention group.  Further analysis is needed to fully understand the changes that are occurring in the data. • MaineCare Stage B Behavioral Health Homes differed significantly from the similarly matched control group on one core metric. • Exhibit 6. Summary of Significantly Different Core Metric Performance

11. Findings: MaineCare Stage B Behavioral Health Homes • Consumer Interview Findings • Consumers in the intervention and control groups report being very satisfied with the care they are receiving(4): • Exhibit 7. Summary of High Domain Scores • Scores were lower for functioning and outcomes for both groups, including improvements in their behavioral health condition (Intervention: 84%/Control: 86%). (4) See the full Lewin report for details of the methodology used to determine these scores.

12. Findings: MaineCare Stage B Behavioral Health Homes Consumer Interview Findings: Summary of Domain Scores

13. Findings: Data Infrastructure • 28 of 54 (52%) behavioral health providers say HealthInfoNet’s support for adoption of EHR technologies is key to coordinating with other providers and gaining access to information needed to deliver effective care • Some participating providers have experienced barriers with developing bidirectional connections with the HIE. • The practice reports under SIM are generally seen as valuable, but utility is diminished because data is not current. • 27 of 69 (39%) of providers interviewed reported that multiple portals and other related tasks (e.g., attestation related to Health Home members) are burdensome and create confusion.

14. Findings: Workforce Development • Key provider and stakeholder findings: • A majority of providers and stakeholders indicate that Learning Collaboratives have delivered opportunities for best practices development and peer learning for participants. • Providers would benefit from inclusion of more advanced topics and sessions with a stronger focus on learning from peers. • 5 participating providers view Community Health Worker (CHW) pilots favorably. Providers are working with the CHWs to establish: • Greater cultural sensitivity • Continuity with community-based resources in their practices

15. Findings: Workforce Development • There are many concurrent efforts underway in Maine to improve care coordination, including the Community Care Teams (CCTs) • 29 of 50 (58%) of providers that commented on CCTs, were favorable about the overall ability of CCTs to positively impact patient care and/or integrate with MaineCare Health Homes. • Respondents stated that there is a wide variation in how CCTs operate: • Some pointed to CCTs’ responsiveness and flexibility (e.g. some CCT’s make home visits, while some do not). • However, some suggested that more standardization would be beneficial.

16. Conclusion & Next Steps Key Highlights • MaineCare Stage A Health Home models showing robust claims-based cost reductions relative to controls • Stage A Health Homes are making significant progress in reducing non-emergent ED use and fragmentation of care. • Consumer engagement findings suggest providers are sharing information with patients; but more opportunities exist to engage patients in their health care decision making. • Findings related to the impact of centralizing data, workforce development, and development of new payment models are inconclusiveand could be targeted for future evaluation efforts. Rapid Cycle Improvement Discussions – used to dig deeper into key findings from the evaluation to improve upon SIM in the 3rd year of grant.