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- Alabama was focused on outcomes around productive life in the future.
- "Wild world out there" - how do we zero in on what we are trying to measure? Doesn't work in a vacuum.
- How do we boil down something as broad as case management? Get at case management vs. health outcome measures.
- No magic measure - a lot of it is process measuring vs. impact.
- Opportunity for us to consider if we are giving enough support to a service (e.g., case load size).

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- DHS wants the measures to be meaningful and transparent to people being served, case managers.
- RTCOM did an "environmental scan" to see what measures are out there--but not a lot out there on the things that are meaningful to people being served.
- CM connects to so many different areas of services (incl. "soft services")--how are we measuring that?  But also not getting too "in the weeds"?
- Did people get referrals to the area that they wanted?
- Barriers, not enough services

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CMS' efforts to develop standards, MN's parallel efforts--chicken or the egg?  How can we be consistent (not creating more layers)?
- CMS blueprint in 2019 seems overly complex.  NQF's 11 domains seem to have a similar feel to our work.
- Can we align our protocol/qualities/ features with NQF?  Align around NQF?

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- We have different definitions even in MN of care coordination
- But this is a commonality with everybody--we all want value-based purchasing.
- CCBHC: Holistic; provides TCM
- Important to make sure measures, instruments are validated

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- Recognize how difficult it is to set a standard measure across populations with different diagnoses
- "It's important to be clear on the denominator"
- People receive different levels of a service based on need.  Shouldn't be measured as a failure of the service if people aren't receiving the same thing.
- Risk adjustment: Can adjust risk based on certain factors

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- 10% bonus for reaching targets (mostly health-specific)
- "Carrot" mechanism.
- Challenges may arise in MN--could be harder to attain targets.  Don't want to penalize.
- How to "lift people up"?
- AZ is using the NCI.  Difficult to obtain the response rate necessary for the data to be at a level granular-enough to hold providers accountable.
- NCI as a great guide for MN.
- Need a feedback loop with providers. What do we need to do that is "better than NCI" to do this?

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- Interesting that Family and Social Service Administration--led the long-term care transformation process
- Even though IN is looking at long-term care
- Like that they were looking at service provision documentation and compliance
- Cool that they were tying in transportation

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- PA: Isn't clear if they have measures or trying to develop them
- They are looking at developing measures that would be used for payment--this makes it a punitive measure!
- Easier to lure people with a carrot than "hit them with a stick"!
- Should be: If you meet a measure, we'll give you a bonus.
- PA probably has some of the same pain points as us.
- Disjointed-ness: If you're a person receiving multiple services, your providers may not know about each other!

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- AAAs not held at the same level of accountability
- Should there be a measure of the referral system? AAAs are not the service delivery providers

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- HCBS-heavy
- Care choice and control
- SNP: Do conduct an audit--they audit this
- Could this be another data pool?
- Community engagement: Talk about how they are SO worried about their case manager!  Worried that the case manager will leave!
- When you're out doing assessments, CMs say, "I'm worried they aren't going to like me!"

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- If a person isn't told about a service, it's kind of like it doesn't exist.
- Effectiveness of communication, coordination, referrals
- Service quality on the other end--what they're being referred to
- BHHs measuring reduced hospitalizations--health aspect

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- HPs: Proxy indicators; hospital re-admissions, emergency room visits
- But people have different diagnoses--what's going on may be outside of the realm of a service provider
- Advanced care directive.  Not sure if this is a good indicator.
- How many people receiving EW services (nursing home level of care need) are NOT in a nursing home? Preventing nursing home placement

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- Measurement focused on practice, not performance
- HPs also focuses on equity more on the "front end"
- Not all bad? LTSS tool has a Q on, "How well did the case manager work with me [within my culture]"?
- Most important thing is that we're doing engagement with communities--as part of the plan for this outcome measurement initiative.