State Health System Innovation Plan (SHSIP)

State Health System Innovation Plan: Final Draft

State Health System Innovation Plan: Executive Summary

State Health System Innovation Plan - Appendices

SHSIP Components and Information

Summary: The State Health System Innovation Plan (SHSIP) puts forth a new healthcare model to move Oklahoma into value-based purchasing of healthcare. It is the final deliverable of the State Innovation Model (SIM) grant and is scheduled to be submitted to the Centers for Medicare and Medicaid Services (CMS) on March 31, 2016. The SHSIP is being posted for a 30 day public comment period

Note: The period for comment has now closed.

State Health System Innovation Plan (SHSIP) Sections:

A. Introduction

This section of the SHSIP will be updated at a future date.

B. Description of the State Health Care Environment

This section details the proposed Oklahoma Model: Regional Care Organizations (RCOs), multi-payer quality metrics, episodes of care.

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

• Additional maps and listings of health of current health care provider organizations in the state have been added in Appendix A & B (SHSIP Appendices, Pg. 3-47)

C. Report on Stakeholder Engagement and Process Deliberations

This section details stakeholder engagement activities and analysis and interpretation of key findings collected data.

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

• Clarification has been added about the submission of the Oklahoma SHSIP. The SHSIP will be submitted by the Oklahoma Deputy Secretary of Health and Human Services, with guidance from the Oklahoma Health Improvement Plan (OHIP), the SIM Executive Steering Committee and workgroups.
• A list of stakeholders engaged has been added in Appendix C (SHSIP Appendices, Pg. 48)

D. Plan for Healthcare Delivery System Transformation

This section covers population health outcomes, health system performance trends, and current initiatives for health improvement. 

E. Health System Design and Performance Objectives

This section details the population health flagship issues and healthcare value-based payment and delivery strategies for the SIM project.

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

F. Value-Based Payment and/or Service Delivery Model

This section details the proposed Oklahoma Model: Regional Care Organizations (RCOs), multi-payer quality metrics, and episodes of care.

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

• Clarification of how Oklahoma can reach the 80% threshold of value based payments (VBP).
• In order to achieve a decline in per capita expenditures, the Per Member Per Month (PMPM) growth rate will be capped by the state to ensure that cost targets are met.
• Page 100 has been changed to reflect that the Health Care Payment and Learning Action Network continuum of payment will serve as a guide as the State develops direct links to population health outcomes within RCO adopted APAs.
• Clarification has been added to explain that the model has an option for partial capitation arrangements.
• Clarification has been added regarding the role of the Provider Advisory Committee. The Committee will be an overarching statewide committee that will consist of those providing care within the RCO model.
• Clarification has been added to address that the State Governing Body will have a formal charter that defines the scope and authority, term limits and rotating seats.
• The Board of Accountable Providers (BAP) will include representation from provider types (or their representative organizations) active in the RCO’s healthcare delivery system.
• Clarification has been added to explain that the Community Advisory Board will be comprised of consumers, patients and advocates, who will form a majority of the membership.
• The descriptions of Joint Replacement and COPD Episodes of Care have been updated (SHSIP, Figure 36, pg. 123).
• Clarification has been made to the model tenets to acknowledge the model will sustain activities/practices and processes that already exist and are showing they meet the triple aim. Stakeholders have expressed that they want to preserve currently successful integrated health care delivery models.
• Clarification has been made that as the RCO matures, it is envisioned that other private markets could be incorporated as desired by commercial insurers.
• The title of Page 103 has been updated as "Shared Risk".
• A section has been added to the SIM plan on Tribal Health and the impact on Native American populations.

G. Plan for Improving Population Health

This section details how overall population health will be improved through current initiatives and the proposed Oklahoma Model.

H. Health Information Technology Plan

This section details objectives and strategies to achieve HIT interoperability in Oklahoma and move toward value-based purchasing.

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

• Additional information has been added to state that data will be standardized in relation to any quality measures that are proposed. The committee will help standardize quality data sources and measurement across providers and payers

I. Workforce Development Strategy

This section details the core areas of the SIM workforce development strategy, including data collection and analysis and workforce re-design.

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

• Information on the top 25 Health Occupations in Oklahoma has been added as Appendix J. (Appendices, pg. 144)

J. Financial Analysis

This section of the SHSIP will be updated at a future date.

K. Monitoring and Evaluation Plan

This section covers a plan for quality monitoring and improvement as well as an evaluation strategy that can illuminate unique and combined effects of different innovations. 

• This section has been added to the SHSIP (March 2016).

L. Operational and Sustainability Plan

This section covers population health outcomes, health system performance trends, and current initiatives for health improvement. 

• This section has been added to the SHSIP (March 2016).

Based on stakeholder feedback, technical assistance, and CMS feedback, we made the following changes to this section of the SHSIP:

• Additional information has been added to state that data will be standardized in relation to any quality measures that are proposed. The committee will help standardize quality data sources and measurement across providers and payers.