6 days ago - 3) Why is the University of Colorado issuing a SIM Practice RFA? ... health care services by clinicians who
Frequently Asked Questions (FAQs) for State Innovation Model (SIM) Cohort 3 Request for Application (RFA) FQAs Posted with RFA Release 11/15/2017 1) When will the Colorado State Innovation Model (SIM) Cohort 3 application be available? a. The SIM Cohort 3 application will be open from November 15, 2017 – January 10, 2018 (11:59 PM MST). 2) What is the SIM Practice Request for Application (RFA) and what are the submission requirements? a. This RFA is a solicitation notice for primary care practices in Colorado to submit an application to be considered for inclusion in the third cohort of the SIM initiative. The RFA Packet describes SIM, benefits and expectations of participation, required and preferred practice qualifications, and the review process and instructions for completing and submitting the application. Interested applicants should reference the RFA Packet that outlines practice eligibility. If an applicant fails to submit all of the required documents as outlined within the RFA Packet or does not meet the requirements for SIM, the practice site will be considered ineligible. 3) Why is the University of Colorado issuing a SIM Practice RFA? a. There is an interagency agreement between the SIM office and the University of Colorado (the University), which provides staff and expertise to convene and facilitate practice transformation services that are an integral part of SIM. The University will oversee the process of collecting the primary care practice responses to the RFA and convene a multi-stakeholder Practice Application Review Committee that will conduct a comprehensive, thorough, complete and impartial review of each practice application received. Recommendations will then be made to the SIM office, which will make the final decision on which practices are included in the third cohort to receive practice transformation support anticipated to begin June 2018. 4) Who should I contact with questions about the SIM Practice RFA? a. For questions related to the application and the SIM RFA please contact University staff:
[email protected] 5) What are the minimum requirements a practice must meet in order to be eligible to participate in SIM? a. To be eligible and fully considered for inclusion in SIM, a practice site must meet the following criteria: Applying practice sites must be physically located in Colorado. Individual practice sites must complete and submit the application in its entirety before close of business on the posted deadline date. Healthcare systems/multi-site organizations or other sponsoring organizations interested in participating in SIM Cohort 3 should encourage their practice sites to apply and can assist practice sites in preparing their applications. o Some sections within the application MUST be completed by the practice site; in particular, questions in narrative sections should be completed by a lead clinician or another key leader from the practice site. An individualized narrative that gives the reviewers a sense of the practice site culture and commitment to integrated care greatly increases the likelihood of a practice site being offered the opportunity to participate in Cohort 3. o It is critical to submit an application that addresses all questions as applicable and has been thoroughly reviewed in order to ensure consideration for participation in Cohort 3. Practice sites must currently use an EHR. As defined by the Institute of Medicine (IOM), care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing the large majority of personal health care needs (such as preventative counseling, screening, early intervention, management of acute problems as well as coordination of care). In addition to this the primary care provider is tasked with not only developing a sustained partnership with patients but practicing in the context of family and community as well.
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An eligible primary care practice site must be capable of providing a majority of its patients’ comprehensive primary, preventive, chronic, and acute care. “Non-traditional” practice sites that provide a full range of primary care services and otherwise meet the requirements can be considered for participation. Non-traditional practice sites could include school-based clinics, local public health clinics, practice sites providing primary care services to specified groups of patients (such as women’s health clinics), and others. Applicants that are not clearly traditional primary care practice sites but representatives believe the sites provide primary care services will be considered on a case-by-case basis. On the application, “non-traditional” practice sites will be asked to address how the practice meets the IOM definition of primary care. Prior to review or acceptance, these practice sites might be required to provide additional information (such as billing information), to substantiate that they provide comprehensive primary care services. If practice eligibility remains unclear after review of a practice site’s completed application, participation recommendations will be made by the Practice Application Review Committee that is convened by the University of Colorado. Final decisions will be made by the SIM office.
6) How does SIM define a practice? a. For the purposes of SIM a practice is defined as a physical location. Some practices have one tax identification number (TIN) with multiple locations. For purposes of SIM, a practice with one TIN and five locations would be considered five practices. In this example, each practice would be required to submit a separate application. 7) Are “non-traditional” primary care practices eligible to participate in SIM? a. ‘Non-traditional’ practices that provide a full range of primary care services and otherwise meet the requirements can be considered. This could include school-based clinics, local public health clinics, practices providing primary care services to specified groups of patients (such as women’s health clinics), and others. Applicant practices that are not clearly traditional primary care practices but representatives believe they provide primary care services will be considered on a case-by-case basis and might be required to provide additional information (such as billing information) to substantiate the fact that comprehensive primary care services are provided. Decisions on eligibility in such cases will be made by a committee convened by the University and the SIM office. 8) How will practices be selected? a. A multi-stakeholder application review committee will conduct a comprehensive, thorough, complete and impartial review of each practice application received. Recommendations will then be made to the SIM office, which will make the final decision on which practices are included in the third Cohort to receive practice transformation support beginning in July 2018. 9) What funding support is available to practices that participate in SIM Cohort 3? a. Each practice participating in SIM Cohort 3 is eligible to receive ‘achievement-based payments’ of up to $6,500. Practices will invoice annually based on the SIM Cohort 3 Practice Achievement Based Payments as outlined on pages 13 & 14 in the SIM Cohort 3 RFA. b. Additionally, small grant funds of up to $40,000 will be available during the one-year time frame for Cohort 3 practices. The small grants are funded by the Colorado Health Foundation and managed by the SIM office. To learn more about SIM small grants please visit: www.colorado.gov/healthinnovation/sim-small-grantsopportunity. 10) What are the primary benefits to participating practices beyond financial compensation? a. There are numerous non-financial benefits to participating practices, including: Business services support Tools and consulting to help practices prepare and adapt to new payment models Practice facilitators (PFs) who help implement ongoing change and quality improvement processes Clinical Health Information Technology Advisors (CHITAs) to help assess and improve data quality, support practice data capacity, identify HIT resources, assist with workflow for data collection,
reporting, validation and analysis and support to use that data to guide improvement priorities Regional health connectors (RHCs) located in the community, who connect practices and clinicians to resources on multiple levels among the various components of the health and healthcare delivery system Participation in collaborative learning sessions with your peers from other practices working on similar issues in an “all teach/all learn environment” and from national experts/speakers Performance Improvement, Part IV of board recertification requirements: o Family medicine o Pediatrics o Internal medicine Maintenance of Certification (MOC) and Continuing Medical Education (CME) credits available: o Performance improvement activities in practices o Participation at collaborative learning sessions o Participation in e-Learning modules Potential to reduce the total cost of care, reduction of inappropriate use of medical services and a costsavings in big-ticket items like emergency room visits and hospitalization, which help practices participating in value-based payment models Improvement in patient and provider satisfaction by reducing access barriers, improving communication and enabling providers to have better connection to resources to help patients with behavioral health issues. 11) If my practice previously applied to participate in SIM Cohort 1 or 2, do I still have to fill out a new application for SIM Cohort 3? a. Yes, all practices that applied to participate in SIM Cohort 1 or 2 will need to complete new application for SIM Cohort 3. 12) How many practices do you anticipate participating in SIM Cohort 3? a. We hope to accept up to 150 additional practices for participation in SIM Cohort 3. 13) Can I apply if I am part of a healthcare system or multi-site organization? a. Yes, practices that are part of a healthcare system or multi-site organization are eligible and encouraged to apply for SIM Cohort 3. 14) What are the requirements for SIM Cohort 3 practices? a. Practice Site Leadership commitment b. Identifying a cross-functional quality improvement team to implement improvements based on the SIM Building Blocks c. Completing a set of practice assessments to identify key areas for improvement d. Collecting, reporting, and reviewing SIM Clinical Quality Measures (CQMs) on a quarterly basis e. Attending two Collaborative Learning Sessions f. Participating in SIM evaluation activities g. Achieving selected SIM milestones 15) If a practice has multiple sites and one of their practices is already participating in Cohort 1 or 2 but the other isn’t, can the site not participating in Cohort 1 or 2 apply for Cohort 3? a. Yes, the practice site that isn’t ready participating in SIM Cohort 1 or 2 can certainly apply and is encouraged to do so for SIM Cohort 3. 16) Are clinics already enrolled in CPC+ eligible for the full possible payment of $6,500? a. CPC+ practices that also participate in SIM are eligible to receive the $6,500 if they meet the deliverables outlined on pages 13-14 in the RFA Packet. The RFA Packet can be viewed or downloaded here:
http://resourcehub.practiceinnovationco.org/wp-content/uploads/2017/11/SIM-Cohort-3-RFA-Packet.pdf 17) I started the application for SIM Cohort 3 and am trying to get back into it to finish, but I can’t seem to get back into my application. a. Please contact us directly for support at
[email protected]. 18) Does our practice have to have a certified EHR? a. Practices must have an EHR, but it is not required to be certified to participate in SIM.
19) Can you please clarify the specific CQMs SIM/CPC+ practices have to report? a. These are outlined in the “SIM Clinical Quality Measure (CQM) Reporting Requirements” included in the RFA and located here: http://resourcehub.practiceinnovationco.org/wp-content/uploads/2017/11/SIMCohort-3-Clinical-Quality-Measures-Reporting-Summary.pdf. 20) How effective is hiring a behavioral health specialist versus hiring someone to help with care management of mental illnesses? How would care management for mental illnesses work? What has Cohort 2 found to be the biggest difference between the two? a. Determining these needs is often site-specific. Practice Facilitators and Learning Networks can assist with developing strategies that are best for your site and its needs. If you have questions regarding strategizing, please email
[email protected] and we can connect you with the right people and/or resources that can help you in making these decisions and talking through what others have found to be effective and the differences. Please read the SIM practice transformation article series for tips on how SIM practices are using behavioral health providers: https://www.colorado.gov/healthinnovation/ptseries3. 21) How do we apply for the small grants from the Colorado Health Foundation and when will the application be released? a. The opportunity to apply for SIM small grants funded by the Colorado Health Foundation is anticipated to occur shortly after Cohort 3 practices kick-off work in June 2018. The application will be short and straightforward, and will ask practices to explain how the funds will be used to catalyze achievement of the transformation goals your practice identified. To learn more about SIM small grants please visit: www.colorado.gov/healthinnovation/sim-small-grants-opportunity. 22) Are practices committed to SIM if they submit an application? a. Practices are not committed to SIM participation if they apply. Once a practice is accepted, the practice will have the opportunity to make the final decision. 23) How do practices know which payers will support them? a. When practice sites are accepted to SIM, they will receive offer letters identifying which payers will support them. This support takes several forms as outlined in the payment support section of the RFA. 24) Do practices participating in SIM get to choose their PTOs? a. Practices will have the opportunity to select their PTOs upon acceptance into SIM. 25) We have one of our 13 clinics that consistently has Saturday clinic hours. Providers throughout the region rotate through Saturday clinic, even though their home base is a separate clinic. When we submitted an application for this clinic, do we need to include all Saturday providers? This clinic is basically for acute walk-in visits, not for continuity care. a. Please include all providers and their NPIs who work at all clinics, even if it is on a rotating schedule. The reason is that we use this data for cost and utilization data from the All-Payer Claims Database (APCD), which relies on accurate attribution of the right patients to the right providers so it is important that we have documentation of each provider who is caring for patients at any given site. 26) Are the RFA webinars available for viewing? Or, are the slides available? a. The webinar recordings and slide presentations are available in the Resource Hub on the Practice Innovation Program Colorado website. http://www.practiceinnovationco.org. 27) If a practice is part of a larger organization and has multiple sites practicing under the same Tax ID, does the practice need to complete multiple applications? And will each site receive support through SIM? a. Each practice site is required to submit a separate application and each site will receive support and be eligible for all SIM benefits on an individual basis. 28) We are reviewing the RFA document and see that our primary insurance carrier (Aetna) is not one of the participating insurance carriers. What impact would this have on our participation in SIM if we were selected to participate?
a. Your primary insurance carrier should not affect your participation with SIM. If selected, your practice should still receive all of the same benefits (from SIM as outlined in the RFA) and might be selected by one of the seven payers that does support the initiative. 29) There is an application question that asks us to identify "Percentage of patients in the following payer categories for this Practice Site.” Would Medicare Advantage Plans fall under "Medicare" or "Commercial or Private Insurance”? a. For the purposes of this application, Medicare Advantage plans would fall under the Medicare category. 30) If we participate in SIM would we be required to ‘push’ data to the Health Information Exchange or would there be any flexibility on this issue? a. SIM participation does not require you to push any data to the Health Information Exchange. 31) Does the exemption of CPC+/SIM practices from attending the Collaborative Learning Sessions apply to practices in both SIM Cohorts? a. The exemption of CPC+/SIM practices from attending the Collaborative Learning Sessions applies to practices in both Cohorts. It is expected that these practices meet the CPC+ Learning Community requirements and the SIM Collaborative Learning Sessions are optional but practices are encouraged to attend to gain valuable skills and network with their peers. 32) Are the Regional Health Connectors different than the RHCs that work for the Mile High Health Alliance? a. The Regional Health Connector (RHC) aligned with Mile High Health Alliance is one of the 21 RHCs in the community working with SIM. The RHCs working with SIM also work with other programs. 33) How often will the Practice Coaches/Practice Facilitators be visiting the practice? a. Practice Facilitators on average, meet with the practices twice per month. Most of these meetings will be in person, but some meetings will be virtual via phone or email if it suits the practice. These are averages, so meetings will vary throughout the course of the program depending on needs of the practice. 34) Will the Clinical Health Information Technology Advisors (CHITAs) make visits to the practices to help us with data extraction? a. CHITAs, on average, meet with the practice once a month. These are averages, so meetings will vary throughout the course of the program depending on needs of the practice. 35) Is there room for practices that need to completely transform in the project? a. We encourage practices at all levels along the transformation spectrum to apply. Some SIM practices are just taking their first steps in the practice transformation process and has been a great resource for them, in addition to more advanced practices. 36) Which measures are also included in Quality Payment Plan? a. Quality Payment Plan measures are demarcated in the RFA Packet. You will see that some of our Clinical Quality Measures align perfectly with QPP. 37) We are a Pediatric practice within a multi-specialty practice. Our Corporate name, linked to our Federal Tax Identification Number is different than the name we do business under. Which name do we use? a. If your practice uses multiple names, you are given an opportunity inside the SIM Cohort 3 application to list several practice site names, this includes your Preferred Practice Name, Legal Practice Name, and Doing Business As (DBA). 38) Which part of the financial landscape is a CPC+ practice not eligible for? a. Payers may consider CPC+ payments to count for SIM participation as well. For this reason, CPC+ practices may not receive additional payments from payers. 39) For applicants with multiple clinic sites and providers who provide care in more than one clinic, how do the NPI numbers work? What happens when providers leave or enter during the program period? a. In the ‘Practice Site Provider Roster’ section of the SIM Cohort 3 Application, all providers (regardless if they work across multiple sites) and their associated National Provider Identifiers (NPIs) should be listed. If providers work across multiple practice sites and those practice sites are applying for SIM Cohort 3, the
provider names and NPIs should be listed in each application. Practices will be asked to update their Provider Roster and NPIs annually. It is expected that this updated information will reflect the providers working with the practice during that time. 40) Where are the Collaborative Learning Sessions located? a. In order to best serve practices across the state, Collaborative Learning Sessions will be held in two locations; one in the Denver Metro area and one on the Western Slope. Practices can choose which location is most convenient for them during these bi-annual CLS events. Typically, one Collaborative Learning Session will be held in the fall/winter and one will be held in the summer. 41) How much time should a behavioral health provider give to each practice? a. There is no direct expectation that you provide patients with access to a behavioral health professional in your setting; this is not practical for some practices. SIM achievement-based payments and small grant funds may be used to support a behavioral health professional and you can deploy them within your practice however you see fit. If you choose, you can work with your Practice Facilitator to see what is best for your practice. 42) What is the role for the SIM Practice Site Contact as identified in the SIM Application? a. The SIM Practice Site Contact is the person at the practice we will reach out to first regarding any SIMrelated communications. We ask for a person who can be the “go-to” at the practice site for SIM-related communication. 43) If only one provider strictly sees pediatric patients within a clinic, should we still list the site as adult to cover the majority of the providers? Will listing the site as a Family Practice suffice? a. If only one provider sees pediatric patients it would be best to list the site as a Family Practice. You will be able to distinguish between the providers in the Taxonomy Code column in the Practice Site Roster. 44) We are applying for multiple practice sites. One question in the application asks for “Practice Site Group National Provider Identifier (NPI).” Is this referring to our corporate NPI or each individual site’s NPI? a. The Practice Site Group NPI is referring to each individual site’s NPI. 45) We are working on Cohort 3 applications and are wondering if in “number of practice site providers with NPIs” we should include PRN providers? a. If you have the NPIs for your PRN providers please include them in the total count of providers with NPIs but if the NPIs are not known it is not a barrier to completing the application. 46) I have a recommendation letter I would like to include as part of the Cohort 3 application. Is there a way that I can attach it in the application platform? a. Attachments can be uploaded in the SIM Cohort 3 application platform, but it is suggested to also detail your work and what would make you a good candidate for SIM participation in the Narrative sections. 47) Is there a way to print out the whole application (with answers in it) prior to submitting it? a. There is not a way to print out the application prior to submitting it. However, upon submission you will have the opportunity to download a PDF containing all of the questions and answers.
