Oklahoma State Innovation Model (OSIM)

Oklahoma State Innovation Model Application - PDF

The State Innovation Model (SIM) grant was awarded to Oklahoma in December 2014 and is to begin in February 2015. The goal of the Oklahoma SIM is to provide state-based solutions to Oklahoma’s healthcare challenges. Oklahoma’s plan aims to improve health, provide better care and reduce health expenditures for more than 1.2 million Oklahomans. Working through the Oklahoma Health Improvement Plan (OHIP) Coalition, a public-private partnership consisting of a broad spectrum of stakeholders across the state, the OSIM will design a comprehensive model that focuses on the improvement of statewide health outcomes through value-based payment and healthcare delivery system innovation and redesign, while integrating evidence-based population and clinical interventions.

The plan is divided into three phases of work; phase 1 seeks to achieve consensus among coalition stakeholders on the alignment of a socio-ecological model that includes clinical and population-based health measures for selected health topics: obesity, diabetes, hypertension and tobacco. In phase 2, stakeholders will assess and determine what multi-payer, value-based purchasing model realistically achieves common priorities and goals. Concurrently, in phase 3, stakeholders will identify strategies to increase adoption levels of Electronic Health Records (EHR) and attainment of Meaningful Use (MU) among providers; initiate planning for the development of a Value-Based Analytics Tool (VBA) for healthcare data analysis; determine benchmarks aimed at improving clinical and population health outcomes; and identify potential savings across multi-payer structures.

State Health System Innovation Plan

State Health System Innovation Plan: Final Draft

State Health System Innovation Plan: Executive Summary

State Health System Innovation Plan - Appendices

CMMI Feedback on the SHSIP

Summary: The final feedback from the Center for Medicare and Medicaid Innovation (CMMI) on the Oklahoma State Health System Innovation Plan.

Previous Versions

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 public comment period 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.

Regional Care Organizations

Regional Care Organizations (RCO) Overview: (December 2015)

Summary: RCOs are local provider and community led organizations that accept accountability for the overall quality and total cost of patients' care. This brief explains the key aspects of this healthcare delivery model.

OSIM Executive Session Meeting Notes

OSIM Executive Session Meeting Notes (September 2015)

Summary: Notes from the OSIM Executive Steering Committee meeting on September 16, 2015. The key outcome of the meeting was to consider various models and gain general consensus on a draft model proposal for the OSIM team to pursue.

Webinar and Outreach Materials

Value Based Analytics Tool: Stakeholder Meeting Notes (September 2015)

Value Based Analytics Tool: Full Report (October 2015)

Value Based Analytics Tool - Draft Interoperability Framework

Summary: The main topics of the Value Based Analytics (VBA) tool meetings focused on a conceptual model for a VBA design, a data system that aggregates information to allow for analysis of health outcomes, quality and cost. Separate meetings were held with various stakeholders in Oklahoma City and Tulsa.

OSIM Second Quarter Statewide Webinar Slides (August 13th, 2015)

Summary: The second quarterly webinar slides review all activity for the SIM grant from May-July. The presentation also reviews the next steps in the OSIM process and how to be involved.

This webinar includes the following deliverables, listed by OSIM Workgroup:

Health Workforce: Oklahoma Health Workforce Databook, Health Workforce Provider & Provider Organization Landscape, Health Workforce Gap Analysis, Health Workforce Environmental Scan.

Health Finance: Market Analysis, Care Delivery Models Analysis, High Cost Delivery Services, Financial Forecast of New Delivery Models

Health Efficiency and Effectiveness: Population Health Needs Assessment, Current Health Transformation Initiatives in Oklahoma.

Electronic Health Records and Health Information Exchange Survey, Health Information Exchange Environmental Scan.

OSIM First Quarter Statewide Webinar Slides (June 11, 2015)

Summary: Each quarter, the OSIM staff will provide updates and information to stakeholders to solicit their feedback and support. This feedback will be used to help develop the State Health System Innovation Plan (SHSIP). Additionally, the Webinar will share upcoming meeting dates and opportunities to participate in the development of the SHSIP.

OSIM Kick-Off Webinar Slides (March 18, 2015)

Summary: The presentation provides an overview of the OSIM project goals and objectives, alignment with the Oklahoma Health Improvement Plan (OHIP), the role of the OHIP Workgroups within the OSIM grant, strategies for stakeholder engagement, and an operations update on the OSIM project. Please share the webinar slides with your colleagues and communities, and let them know how they can participate in OSIM.

OSIM Stakeholder Engagement Plan (May 15, 2015)

Summary: This planning document identifies the outreach strategies to ensure the project has the necessary stakeholder involvement and subject matter expertise to develop the State Health System Innovation Plan (SHSIP). As one of the first deliverables of the OSIM project, the Stakeholder Engagement Plan was sent to the Center for Medicare and Medicaid Innovation (CMMI) for review.

OSIM Comments & Questions

For comments or questions regarding the Oklahoma State Innovation Model, contact OSIM@health.ok.gov