Evaluating State Innovation Model (SIM) Grant States: A...

EVALUATING STATE INNOVATION MODEL (SIM) GRANT STATES: A SCORECARD FOR CONSUMER ADVOCATE ENGAGEMENT 1

Health System Transformation

Evaluating State Innovation Model (SIM) Grant States: A Scorecard for Consumer Advocate Engagement

ISSUE BRIEF / SEPTEMBER 2015

WWW.FAMILIESUSA.ORG

ISSUE BRIEF / SEPTEMBER 2015 WWW.FAMILIESUSA.ORG

The State Innovation Model (SIM) grant program gives states funding and technical assistance to design or test new methods of providing and paying for health care. To ensure that these changes make the health care system work better for patients, it is critical that consumer advocates be involved in SIM grant activities. This brief examines the six states that received Round 1 SIM Testing grants to identify best practices for—and common challenges to—engagement of consumer advocates.

State Innovation Model (SIM) grants provide states with financial and technical support to design and test state-led reforms that improve how health care is delivered and paid for, also called “payment and delivery reform.”

Payment and delivery reform has the potential to drastically change how consumers experience health care and how well they can afford that care.

To make these reforms successful, states must bring together a variety of stakeholders, including consumers and consumer advocates. Consumer advocate engagement and input can help ensure that these reforms protect and improve consumers’ access to high-quality care and don’t create additional barriers to care or increase health care disparities. For this reason,

consumer advocates must be involved in both the design and testing phases of SIM-related reforms.

This brief presents the results of our evaluation of consumer advocate engagement in SIM decision making in the six states that received Round 1 SIM Testing grants: Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont.

We used both quantitative and qualitative methods (web-based analysis and interviews with state consumer advocates) to compare these states. (See the Methodology on page 15 for more details.) This allowed us to identify common challenges that states face and best practices that shape and support consumer advocate engagement. We’ve included a scorecard that evaluates and compares these states on 39 basic components of public and transparent engagement (see pages 9-13), as well as an analysis of the qualitative factors that are equally important to effective advocate engagement.

Consumer advocates and other stakeholders in states with SIM grants, particularly new grantees, can use this brief as a resource for developing or improving their stakeholder engagement processes. The brief can also serve as a guide for other decision-making bodies on how to design and manage effective stakeholder engagement processes.

The six states that we evaluated for this report (states that received Round 1

SIM Testing grants) are Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont.

STAT

ES


» In the first round, six states received Model Testing grants (these are the states we evaluated), and 16 states received Model Design grants.

» In the second round, 11 states received Model Testing grants, all of whom previously had Design grants, and 21 states and territories received Model Design grants.1

Grantee states are required to develop reform models that are designed to improve population health; decrease the cost of care; improve the quality of care; and bring a variety of stakeholders to the table, including insurance companies, health care providers, government officials, and consumer advocates.2 Every state has developed its own governance structure to administer its grant and to ensure that it is meeting these requirements.

While each state’s governance structure is unique, there are some elements that are common across states. For example, most states have created a governance structure that includes the following:

» a host of working groups that research specific topics related to the state’s SIM project

» an advisory body that oversees work groups’ or stakeholders’ findings and turns them into policy recommendations

» a decision-making body that makes policy decisions specifically related to the SIM project

Background on the State Innovation Model (SIM) Grant ProgramStates are leading the way in reforming how health care is paid for and delivered. Many states have been able to jump-start this work by developing and implementing payment and delivery reforms using grants from the SIM initiative, which is run by the Center for Medicare and Medicaid Innovation (CMMI). This competitive grant program gives states and territories an opportunity to receive federal grants and technical assistance to develop, pilot, and implement reforms to improve their health care systems.

States can apply for two types of SIM grants: Model Design grants and Model Testing grants.

» Model Design grant awardees receive smaller grants to design plans and strategies for statewide innovation.

» Model Testing grant awardees receive larger, multi-year grants that help them pilot and implement plans for comprehensive, statewide payment and delivery reform.

» States do not necessarily need to get a Model Design grant before they can receive a Model Testing grant, but in practice, most states have followed this pattern.

So far, CMMI has issued two rounds of awards. In some cases, states received Model Design grants in both rounds in order to continue work they started in the first grant cycle.


improvements to focus on, determining how quality of care will be measured, and figuring out how to hold providers and payers accountable for achieving system transformation goals that reflect consumer priorities.

Evaluating SIM Consumer Advocate Engagement To evaluate SIM consumer advocate engagement, we developed a scorecard that compares the six Round 1 SIM testing states on 39 components that states should implement as a part of their work to create a robust and inclusive stakeholder engagement process. These 39 components pertain to four main factors we identified as influencing consumer advocates’ ability to engage in SIM activities:

Why is consumer advocate engagement in SIM grants important?There are three key reasons why consumer advocates should be involved in the SIM grant process.

These Grants Affect Millions of Consumers

SIM-funded efforts to improve the health care system are taking place in 34 states, the District of Colombia, and three territories, affecting the health care of 61 percent of Americans.3 With the health care of millions of consumers at stake, consumer advocate participation in SIM decisions is critical to ensuring that, first and foremost, all reforms have safeguards to protect consumers’ access to timely, high-quality care.

Grant Activities Should Include Consumer Protections

Why are consumer safeguards so important? Because efforts to reduce overall health care spending could potentially shift costs to consumers or restrict their access to necessary care. Consumer advocate participation can help make sure that these efforts improve the quality of care without negatively affecting consumers.

Grant Activities Should Address Consumer Priorities

To make the health care system work better for patients, decision makers need to understand what is important to consumers. Decision makers need the consumer perspective when they are deciding which quality

What kinds of consumer groups should participate in SIM work?There are a variety of advocates who can provide a consumer perspective and that states should consider integrating into their SIM grant work. These include traditional health care consumer advocates, disability advocates, health equity advocates, advocates representing children and families, LGBTQ advocates, and advocates for seniors. States should strive to engage advocates representing these and any other key communities. This will help ensure that states are developing SIM programs and policies that reflect the diverse needs of their residents.

Individual consumers who are affected by SIM programs and policies can also provide a valuable perspective and help shape a state’s program. However, these consumers may need additional supports and resources—beyond those discussed in this brief—to meaningfully engage in these processes.


consumer advocates to engage in SIM decision-making processes, they must have a voice that is equal to that of other stakeholders, and they must have access to adequate resources to support their full contribution to the process.

Our scorecard measures factors that are the building blocks for consumer advocate engagement, but there are numerous other, less-quantifiable factors that influence the effectiveness of stakeholder engagement within a state’s SIM process. Through our conversations with state-based advocates, we identified a number of factors that shaped the degree to which consumer advocates could influence policy decisions around SIM-related payment and delivery reform projects. We discuss these factors below.

The Number and Diversity of Consumer Advocates

The number of consumer advocates who are working on SIM in a state—and the diversity of perspectives they offer—shape how effectively any one consumer advocate can engage. Even when advocates hold positions on SIM governing or advisory bodies, they may feel that their effectiveness is limited if they are the lone consumer advocate.

Lone consumer advocates who sat on SIM tables reported feeling isolated or feeling that their position was more of a token gesture that was not intended to provide input or help shape the direction of the program. In contrast, when more—and more diverse—advocates were involved, those advocates reported

» Consumer Advocate Involvement in SIM Governance

» Support for Consumer Advocates

» Transparent SIM Planning and Implementation

» Opportunities for Public Engagement

Each scorecard component is based on a specific question that was answered through our research (see the Appendix on page 17 for the full list of questions).4

These components represent the basic steps a state can take to create opportunities for consumer advocates to sit at SIM decision-making tables and to remove some barriers that could limit consumer advocate engagement. And while implementing these procedures and policies in and of itself will not ensure that consumer advocate input is considered in the process, it is a foundation upon which states can build meaningful consumer advocate engagement.

The scorecard, along with best practices to improve the four main factors of engagement, can be found on pages 9 through 13.

Additional Factors That Affect Consumer Advocate EngagementStates that include consumer advocates in their SIM work are more likely to design and implement reforms that will truly make the health care system work better for everyone. However, having consumer advocate representation at decision-making tables is not enough. In order to develop truly meaningful opportunities for


and resources they needed to participate as equal partners to other stakeholders.

Other stakeholders involved in the SIM process, such as providers and insurers, often have financial support from their employers to cover time, travel, SIM-related training, and consultants’ expenses, and they may have more technical expertise in a SIM initiatives’ areas of focus. By contrast, many consumer advocates work on a wide range of other policy issues in their state that compete for their limited time, funding, and other resources.

Advocates who sit on advisory boards and work groups in several states noted that they lacked the resources necessary to make meaningful contributions to SIM discussions. For example:

» One advocate we interviewed mentioned spending hours outside of work pouring over technical materials, but despite having an extensive knowledge base, that advocate did not have the time to keep up with the discussions that were driven by insurers and health care provider associations who work on these issues as a part of their full-time jobs.

» In other cases, advocates reported that, despite their desire to work on SIM issues, they did not have the support necessary to make the time, travel, and resource commitments to accept positions they were offered to participate in SIM governing or advisory bodies.

feeling more effective and found it easier to overcome resource-related barriers to participation, such as limited time or lack of subject matter expertise.

In states that had more consumer advocates involved in SIM processes, advocates were able to share knowledge and expertise, support each other, and become a more powerful voice alongside other stakeholder groups. For example, advocates we interviewed reported that when more—and more diverse—advocates were involved in SIM processes, this engagement helped the advocates shape the direction of the reforms taking place on specific issues, like behavioral health. It also helped those advocates effectively challenge and work with other stakeholders to revise recommendations they disagreed with.

Having a diversity of consumer groups involved in SIM work can also strengthen the consumer voice overall. While it can sometimes be challenging for consumer groups that represent different constituencies and priorities to come to agreement, speaking with a unified voice and developing a network of support across groups can help assure that SIM polices are favorable for consumers. Advocates that convene and work together can more effectively develop policy priorities and an advocacy agenda for complicated payment and delivery issues.

The Amount of Support and Resources

A consistent theme across the states we evaluated is that many consumer advocates did not have the support


These experiences demonstrate that even if there are ample, clearly defined opportunities for consumer advocates to engage in SIM decision-making processes, and even when all pertinent information and activities are open and transparent, many consumer advocates still need financial and technical support—as well as dedicated time—to effectively contribute. Without these resources, advocates reported feeling frustrated with their ability to engage in SIM work.

The Strength of Advocates’ Relationships with Decision Makers

Ongoing relationships and frequent communications with decision makers and key stakeholders can shape consumer advocates’ overall experiences with SIM work and their ability to influence decisions regarding SIM projects. These relationships can help advocates know where to focus their efforts or where to turn for help and support. Without these relationships and lines of communication, advocates may have a more difficult time learning about and engaging in SIM-related processes even when they have the time, resources, positions, and transparent information necessary to do the work.

Strong relationships can also help advocates make a big difference even when the basic components of engagement are not in place. For example, some advocates who have strong relationships with decision makers in their state agencies or with SIM project staff reported that their voices were taken into account in decision-making processes and that they were kept up

to date on SIM activities through informal channels, even if they did not have formal opportunities to engage with the SIM project.

The Extent of Advocates’ Influence on Decision Making

It is also important to evaluate to what degree consumer advocates’ roles at SIM tables affect the decisions that are made.

It may look like states are doing a good job of engaging stakeholders at many levels in the SIM process if there is consumer representation on work groups, in advisory groups, and at stakeholder information meetings. However, advocates’ impact may be limited if there aren’t mechanisms in place to ensure that their input is part of a decision-making process and that their opinions are given equal weight to the opinions of other stakeholders. For example:

» In some cases, advocates reported feeling that they could not use their role at a SIM table to provide input and influence decisions because meetings were used as a forum for sharing information about decisions that had already been made.

» In other cases, advocates reported that it was unclear who reviewed the work they did in a work group or advisory body, or how their recommendations were supposed to be used by the officials in charge of making decisions regarding SIM implementation.

Relationships can help advocates know where to focus their efforts or where to turn for help and support.


» In both such situations, some advocates felt that their role on a work group or advisory body had so little impact and required so much time and effort that these were not effective avenues for influencing policies related to SIM and may not be worth their time.

This is not to say that consumer representation at SIM tables is ineffective. In many other instances, the roles of specific SIM working groups, advisory bodies, and decision-making bodies were better defined, and the outputs of those bodies had clearly defined impacts on decision making. In these instances, such bodies were a forum where consumer advocates could make their voices heard. Advocates in those states reported being able to influence which discussions were happening and having an impact on those decisions.

Best Practices for Improving Engagement of Consumer Advocates As states with new SIM grants develop their stakeholder engagement plans, and as states with existing grants look to improve their engagement processes, there are opportunities for advocates to push for policies that mandate meaningful engagement of consumer advocates in SIM processes.

Through our interviews with state-based advocates, we have identified a number of best practices that increase and support consumer advocate representation in the SIM process. Advocates can use these best practices as

menu of options for their state to consider, focusing on those issues that are most relevant to their state.

Consumer Advocate Involvement in SIM Processes

Have Your State Require Consumer Advocate Participation in All Decision-Making Bodies, Working Groups, and Advisory Bodies

From the outset, states should explicitly require consumer representation in all of their SIM governance structures, operational plans, stakeholder engagement plans, and other governing documents. Consumer advocates should make sure that they will be involved at every level of the SIM process, including decision making, advising, and participating in working groups.

This requirement can also help consumer representatives earn the respect of other stakeholders, because the state will have made a clear commitment to including the input of those representatives.

Have Your State Require That Consumer Representatives Be Given a Proportion of the Seats on All Decision-Making, Advisory, and Working Group Bodies That Is Equal to That of Other Stakeholders

States should also specify in their SIM governing documents that each body will include at least as many consumer voices as there are representatives of each of the other types of stakeholder groups. For example, if there are representatives of three different types of insurers or three different provider trade associations on a body, there should also be at least three consumer


ARKANSAS MAINE* MASSACHUSETTS** MINNESOTA OREGON** VERMONT

Consumer Advocate Involvement in SIM Governance

Decision-Making Processes (e.g., leadership team)

Consumer representatives on all decision-making bodies? n/a n/a

Multiple consumer representatives? n/a n/a

Multiple consumer groups represented? n/a n/a

Health equity groups represented? n/a n/a

Clear, open process to get on decision-making body? n/a n/a

Advisory Processes (e.g., advisory council)

Consumer representatives on all advisory bodies? n/a n/a n/a

Multiple consumer representatives? n/a n/a n/a

Multiple consumer groups represented? n/a n/a n/a

Health equity groups represented? n/a n/a n/a

Clear, open process to get on the advisory body? n/a n/a n/a

Working Group Processes

Consumer representatives on all working groups? n/a

Multiple consumer representatives? n/a

Multiple consumer groups represented? n/a

Health equity groups represented? n/a

Clear, open process to get on working groups? n/a

Table notes on page 20


advocates. Having a large presence on all of these bodies gives the consumer voice more clout, and it helps ensure that consumers’ priorities are given the same consideration as the priorities of other stakeholders.

This requirement can also prevent consumer representatives from feeling isolated and may increase the likelihood that they are heard at SIM tables.

Have Your State Establish a Body That Is Responsible for Addressing Consumer Representation within SIM Grant Activities

States should establish a body that is responsible for ensuring that consumer representatives are an adequate part of SIM grant discussions and governance. This body should ensure that there is a large volume and diversity of consumer representatives working on SIM, elevate consumer issues to the decision-making level, and oversee other governance activities to provide recourse when consumer representation is inadequate or consumer input is not being heard.

To most effectively improve consumer representation in SIM governance, this body should:

» Have decision-making authority or directly advise decision-making bodies

» Oversee consumer representative participation in all levels of SIM activities, ensuring that it remains proportionate to other stakeholders and is revised when structures or priorities change

» Conduct outreach activities to build consumer representation, including actively recruiting well-established consumer advocates, disseminating position information and applications, and holding events in communities to search for diverse applicants

» Review applications from consumers and consumer advocates and select the consumer representatives to serve on other SIM-related bodies

» Replace consumer representatives when vacancies occur

Some states already have consumer-focused bodies built into their SIM governance as working groups, advisory boards, or outreach mechanisms—but these bodies have limited decision-making power. In these states, such bodies should play a larger role in decision-making processes.

Especially in states that are transitioning from Design grants to Testing grants, advocates should push to change the role of these bodies to give them a stronger voice in influencing decision-making. Advocates could urge their state to elevate the importance of these bodies in the SIM grant governance structure, make these bodies more powerful, and give these bodies more decision-making authority.

Develop or Strengthen Relationships among Advocates and Officials at State Agencies

These relationships are informal channels that reinforce the input that advocates give through their formal


positions at SIM tables. Building up these relationships is especially important when advocates feel that their voice is overshadowed by other stakeholders.

In some states, these relationships may be the best way for consumer advocates to stay updated and provide as much input as possible even if they are not formally involved at all levels of SIM governance.

Support for Consumer Advocates

Have Your State Establish a Body That Is Responsible for Convening Consumer Advocates

While other stakeholders have the advantage of organizational structures—like medical associations or large companies—that bring them together, consumer advocates do not always have this kind of advantage. A body dedicated to ensuring that there is adequate consumer advocate representation or outreach can take on this role most easily because that body is constantly in touch with consumer representatives at all levels of SIM work.

Have Your State Create Online Resources Where Advocates Can Find and Contact Each Other

At minimum, states should design and provide materials that facilitate communication among consumer advocates and other stakeholders. These can include directories or online forums that help consumer representatives convene and share knowledge. This is particularly important in geographically large states where travel is expensive and time-consuming.

Establish Coalitions to Bring Advocates Together and Help Them Connect

Even without state-established help, advocates can create their own groups and resources that bring consumer representatives together to set unified goals, share knowledge, and support each other. In some states, advocates may already have strong coalitions that were formed to address other issues that can help build a unified consumer agenda for their state’s SIM program.



Clear contact online to answer SIM-related questions?

Is online contact responsive? n/a

Explicit conflict of interest standards in SIM governance?

Does state sponsor technical training opportunities?



Look for Resources and Training from a Variety of Sources

Advocates should push for state-sponsored support, but they may be able to get other organizations to support their participation in SIM-related work. For example, in some states, foundations have provided funding for issue-specific trainings for consumer advocates. In other states, individuals and advocate groups have brought in consultants to help consumer advocates stay up to speed on the complex issues covered in their state’s SIM projects.

Transparent SIM Planning and Implementation

Have Your State Establish a Transparent Application Process for All SIM-Related Positions

States should establish an application process for SIM-related positions that is clearly explained and easy to understand. The application should also be easy to find online. The selection criteria should be publicly posted, objective, and fair.

It will be easier to get consumer advocates to the table at all levels of SIM decision making if it is clear how and when advocates can demonstrate their interest and apply for seats on SIM-related bodies.

Have Your State Establish Strong Conflict of Interest Standards as Part of the Application Process for Seats at SIM-Related Tables

Conflict of interest standards require applicants for SIM-related positions to disclose all external interests that have the potential to influence their decision making around SIM policies. Such standards also limit these peoples’ involvement in decisions that are related to those interests. Conflict of interest standards can help ensure that all stakeholder representatives truly convey the interests of the groups they are meant to represent and that stakeholders are not influenced by any external financial or other interests.



Members of decision-making body listed online?

Members of advisory body listed online? n/a n/a

Working groups listed online?

Members of working group listed online?

SIM budget documents posted online?




Opportunities for Public Engagement

Decision-Making Body

Meetings open to public?

Time, location posted online?

Remote participation possible?

Meeting minutes posted online?

Do processes include opportunities to comment?

Advisory Body

Meetings open to public? n/a n/a

Time, location posted online? n/a n/a

Remote participation possible? n/a n/a

Meeting minutes posted online? n/a n/a

Do processes include opportunities to comment? n/a n/a

Working Groups

Meetings open to public?

Time, location posted online?

Remote participation possible?

Meeting minutes posted online?

Do activities include opportunities to comment?



If there are a limited number of positions that consumer advocates can fill in SIM working groups, advisory bodies, and decision-making bodies, it is critical that these advocates disclose any conflicts during the application process in order to ensure that the advocates fully represent consumer priorities and not any external interests, financial or otherwise.

Post All SIM Meeting Information Online, Including Meeting Notices, Minutes, Agendas, and Committee Memberships

Meeting notices that include information on when and where meetings will take place and an overview of what will be discussed (written in plain language), as well as minutes from previous meetings and lists of committee members, should be posted publicly. Giving the public this information enables interested consumers to easily follow the SIM process. It also helps advocates and the public make informed

decisions about when and where to participate in public comment opportunities.


Have Your State Provide Opportunities for Public Comment on All SIM-Related Activities

States should ensure that all SIM-related meetings and decisions include opportunities for the public to express their opinions and concerns. States should also establish channels for the public to voice their concerns or submit comments in writing and should consider this input in finalizing SIM policies.

In addition, meetings should be open to the public and offered at times and locations that are convenient to all stakeholders, as well as to the interested public. At the very least, meeting schedules and minutes should be posted online so stakeholders know that they are taking place and can respond to issues discussed in those meetings through written comments or other channels.

The State Innovation Model (SIM) grant program gives consumer advocates an opportunity to influence their state’s efforts to reform how health care is paid for and delivered. To ensure that consumers are not adversely affected by these changes, consumer advocates should be meaningfully involved in designing and implementing SIM programs. The best practices discussed in this brief can equip advocates to push their states to design SIM governing processes that include adequate consumer representation.


MethodologyThis project evaluates the six Round 1 State Innovation Model (SIM) Testing grantee states—Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont—on consumer advocate representation in their SIM-related activities. Families USA developed a scorecard to evaluate these states on 39 components of public and transparent consumer advocate engagement. We also conducted a qualitative analysis to highlight additional factors that build on this foundation and influence the effectiveness of consumer advocate engagement.

Families USA used both web-based analysis and interviews with state health care consumer advocates to evaluate opportunities for consumer advocate engagement in each of the six states. Our conclusions are based on careful review of each state’s online resources for their SIM grant and on consumer advocates’ testimonies. We also verified the results of our scorecard evaluations with state SIM officials.

First, we identified the basic components necessary to build consumer advocate engagement. Although there is no existing body of research that defines these components, based on our years of experience with stakeholder engagement and consumer advocacy research, we identified the elements that we have

consistently seen as being important to building effective stakeholder engagement.

We developed 39 questions that measure these components of engagement, focusing on SIM governance structures, decision-making processes, advisory groups, working groups, resources available to advocates, transparency of SIM governing structures, meetings and budget documentation, and opportunities for public comment. These questions served as the framework for our research and allowed us to compare states on the most basic components of public and transparent engagement.

Next, we evaluated the information that is made available to the public through each state’s online SIM resources. We gathered information from each SIM web page, links to related websites,5 and documents about the project. Documents include sources such as the state’s State Health Innovation Plan (SHIP), the state’s operational plans that lay out exactly what steps the state will take to achieve the goals in its SHIP, and SIM grant budget documents. We used this information to assess states on the 39 components of consumer advocate engagement enumerated in our scorecard.

We then conducted targeted interviews with consumer advocates in each state.


We interviewed advocates with different levels of involvement in SIM. In each state, we spoke with at least one advocate who sat at a SIM decision-making, advisory, or working group, and we supplemented our findings with interviews of other consumer advocates in the state.

Our discussions covered the questions included in the scorecard, as well as more subjective questions about their experiences. These conversations confirmed our findings in the scorecard. They also provided us with advocates’ perspectives on the qualitative factors that shaped the extent to which consumer advocates can leverage opportunities to be involved in the SIM process.

Finally, we verified our scorecard findings with state government officials in each Round 1 testing state. We contacted the grant administrator, project coordinator, or other SIM-designated officials in each state and sent them a draft of our findings. Most officials6 responded to our request, confirmed our findings, and provided additional resources to explain their activities.

Limitations of Our Research This analysis relies heavily on input from consumer advocates to ensure that it accurately captures advocates’ experience with the SIM process in their state. While we spoke with a range of advocates who work on SIM in different capacities, their experiences may not reflect the experiences of other consumer advocates in the state—or even other advocates who sit at the same tables.

For example, some advocates have strong relationships with key players in their state’s administration. These relationships are difficult to measure, but they suggest that those advocates are better-informed about the process and/or are more often invited to participate in SIM activities. Factors such as the working relationships advocates have with state officials, the responsibilities and level of experience of the advisory or working group that an advocate sits on, and other factors can shape advocates’ views on consumer advocate engagement in their state and could skew our analysis.


AppendixFull Text Questions behind the Scorecard Components

Consumer Advocate Involvement in SIM Governance

Decision-Making Processes (for example, steering committee with decision-making powers, leadership team, etc.)

» Are there consumer or consumer advocate representatives on every decision-making body? (yes/no)

» In each decision-making body with consumer representation, is there more than one consumer representative? (yes/no)

» In each decision-making body with multiple consumer representatives, is more than one consumer group represented? (yes/no)

» Are any health equity groups represented on any decision-making body? (yes/no)

» Is there a clear, open, standardized process for getting onto decision-making bodies? (For example, is the application posted online? Is there a public indication of who appoints members to the body and when?) (yes/no)

Advisory Processes (for example, steering committee with advisory powers, advisory council, etc.)

» Are there consumer or consumer advocate representatives on every advisory body? (yes/no)

» In each advisory body with consumer representation, is there more than one consumer representative? (yes/no)

» In each advisory body with multiple consumer representatives, is more than one consumer group represented? (yes/no)

» Are any health equity groups represented on any advisory body? (yes/no)

» Is there a clear, open, standardized process for getting onto advisory bodies? (For example, is the application posted online? Is there a public indication of who appoints members to the body and when?) (yes/no)

Working Group Processes

» Are consumers or consumer advocates represented on every working group? (yes/no)

» In each working group with consumer representation, is there more than one consumer representative? (yes/no)

» In each working group with multiple consumer representatives, is more than one consumer group represented? (yes/no)

A


» Are any health equity groups represented on any working groups? (yes/no)

» Is there a clear, open, standardized process for getting on to on to working groups? (For example, is the application posted online? Is there a public indication of who appoints members to the body and when?) (yes/no)


» Is it clear online who consumers or consumer advocates should contact with questions about their state’s SIM grant? (yes/no)

» Does this contact answer questions within two weeks of being asked? (yes/no)

» Are explicit conflict of interest standards incorporated into any part of the SIM governance structure? (yes/no)

» Are there any state-sponsored training or educational opportunities available for consumer advocates to develop expertise in technical, SIM-related issues? (yes/no)


» Are lists of current members of decision-making bodies readily available online? (yes/no)

» Are lists of current advisory body members readily available online? (yes/no)

» Are lists of current working groups readily available online? (yes/no)

» Are lists of current working group members readily available online? (yes/no)

» Are any SIM budget documents public and available online? (This could include proposed budgets submitted with grant applications, the actual budgets based on the size of the actual grant awarded, and records of where money has already been spent.)


Decision-Making Body

» Are meetings of decision-making bodies open to the public? (yes/no)

» Are the time and location posted online? (yes/no)

» Are there ways to participate in these meetings without attending in person (remote teleconference sites, call in numbers)? (yes/no)

» Are there ways to find out what happened at these meetings without attending them (minutes posted, status updates, etc.)? (yes/no)

» Are formal opportunities to comment (in writing or orally) built in to decision-making processes? (yes/no)


Additional Resources

A list of resources related to each Round 1 Testing SIM grant is available on the web page for this brief. These resources supported our web analysis and provided additional details about what each grant is funding and how each grant is being managed.

Advisory Body

» Are advisory body meetings open to the public? (yes/no)



» Are there ways to find out what happened at these meetings without attending them (minutes posted, status updates, etc.)? (yes/no)

» Are formal opportunities to comment (in writing or orally) built in to advisory processes? (yes/no)

Working Groups

» Are working group meetings open to the public? (yes/no)



» Are there ways to find out what happened at work group meetings without attending them (minutes posted, status updates)? (yes/no)

» Are formal opportunities (in writing or orally) to comment built in to working group processes? (yes/no)

B


Table Notes* Maine’s SIM governance structure does not include an advisory body.

** Massachusetts’ and Oregon’s SIM grant activities are structured differently than SIM projects in other states. In both states, there were exisiting health system reform efforts that were then augmented by the SIM grant funding. Neither state put new governance structures in place to administer its grant. Therefore, there is no direct consumer advocate participation in SIM grant governance in these states, but consumer advocates may participate in some of the structures that relate to health reform more broadly. Because of these differences, we did not evaluate either state on Consumer Advocate Involvement in SIM Governance. However, we did evaluate Support for Consumer Advocates, Transparent SIM Planning and Implementation, and Opportunities for Public Engagment. The information in these categories is based on exisiting online resources, decsion-making bodies, advisory boards, and working groups that oversee broader health reforms. These resources and bodies may not contribute directly to SIM work, but they are integral to the states’ maintaining open and transparent system reform activities.

Endnotes1 In the first two rounds, the following states and territories received either Design or Test SIM grants: American Samoa, Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Northern Mariana Islands, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Tennessee, Texas, Utah, Virginia, Vermont, Washington, and West Virginia. More information on the type of grant each state received and the size of the grant is available on the CMMI website at http://innovation.cms.gov/initiatives/state-innovations/.

2 Comprehensive program requirements are listed in the Round 1 and Round 2 Funding Opportunity Announcements. These are available on the CMMI website at http://innovation.cms.gov/initiatives/State-Innovations/archive.html.

3 Centers for Medicare and Medicaid Services, State Innovation Models Initiative: General Information (Baltimore: CMS, August 24, 2015), available online at http://innovation.cms.gov/initiatives/state-innovations/.

4 See the Appendix for the full text of all the questions.

5 In some states, like Arkansas, Massachusetts, and Oregon, online SIM information is combined with information on broader system transformation efforts. In these states, we expanded our research to include websites that were not SIM-specific but that did include information about the state’s SIM project.

6 While we reached out to state officials in all the Round 1 Testing states, we did not hear back from officials in Massachusetts or Oregon. However, local advocates reviewed our findings in these states.

1201 New York Avenue NW, Suite 1100 Washington, DC 20005 [email protected] / FamiliesUSA twitter / @FamiliesUSA

Publication ID: 000HST091115

This publication was written by: Melissa Burroughs, Health Action Associate, Families USA

The following Families USA staff contributed to the preparation of this material (listed alphabetically):

Nichole Edralin, Senior Designer

Lydia Mitts, Senior Health Policy Analyst

Caitlin Morris, Program Director, Health System Transformation

Evan Potler, Art Director

Ingrid VanTuinen, Director of Editorial

© Families USA 2015

A selected list of relevant publications to date:

Measuring Health Care Quality: An Overview of Quality Measures (May 2014)

Reforming the Way Health Care Is Delivered Can Reduce Health Care Disparities (May 2014)

Principles for Consumer-Friendly Value-Based Insurance Design (December 2013)

For a more current list, visit: www.familiesusa.org/publications

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