eLTSS Plan Content Sub-Work GroupWeek 2 Meeting

May 12, 2015

11:00am–12:00pm

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Meeting Etiquette

• Remember: If you are not speaking, please keep your phone on mute

• Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call– Hold = Elevator Music = frustrated speakers and

participants• This meeting is being recorded

– Another reason to keep your phone on mute when not speaking

• Use the “Chat” feature for questions, comments,and items you would like the moderator or other participants to know.– Send comments to All Panelists so they can be

addressed publically in the chat, or discussed in the meeting (as appropriate).

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From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute

All Panelists

Agenda

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Topic Time Allotted

Welcome and Announcements 5 minutes

Kickoff Meeting Recap 15 minutes

Introduction to Domain Harmonization Matrix 25 minutes

Discussion/Reactions 10 minutes

Homework and Next Steps 5 minutes

Meeting Reminders

• eLTSS Plan Content SWG Meetings are held Tuesdays @ 11:00am – 12:00pm Eastern– Next meeting: May 19, 2015 from 11:00am–12:00pm Eastern– Meeting information can be found on the Wiki:

• http://wiki.siframework.org/eLTSS+Plan+Content+SWG– Duration: May 5–July 21 (11 Weeks)

• eLTSS All-Hands Meetings are held Thursdays @ 12:30pm Eastern– Next meeting: May 14, 2015 from 12:30–2:00pm Eastern– This meeting will be a working session for the Plan Content SWG!– Meeting information can be found on the Wiki:

• http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29

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REMINDER - Please check the Wiki for the latest meeting schedule –meeting link and call in numbers may change.

eLTSS Use Case Context for SWG

• This initiative will identify key domains that will inform the creation of a structured, longitudinal, person-centered electronic LTSS plan for CB-LTSS beneficiaries.

• The eLTSS plan will be designed in such a way that it can be shared electronically across multiple CB-LTSS settings (e.g., adult day services, beneficiary homes, group homes, foster homes, assisted living, supportive housing, home health and hospice), institutional settings (e.g. hospitals, nursing facilities, primary care, post-acute care) and with beneficiaries and payers.

• eLTSS Initiative Project Charter– http://wiki.siframework.org/electronic+Long-Term+Services+and+Su

pports+%28eLTSS%29+Charter

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eLTSS Plan Content SWG Objectives

Identify and harmonize a core set of domains that will inform the creation of a structured, longitudinal, person-centered electronic LTSS plan for CB-LTSS beneficiaries:• clinical and non-clinical domains with terminology consistent

across the seven TEFT states and• example set of discrete data elements for the purpose of

clarifying the type of information that will be collected per domain area.

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Primary Focus Secondary Focus

TEFT State Requirements Non-TEFT State Initiative Requirements

Common Clinical Data Set RequirementsUse Case Requirements

eLTSS SWG Focus

The eLTSS Plan Content SWG will prioritize TEFT state domain requirements; however, we welcome non-TEFT organizations to provide input and participate in the process based on their respective organization requirements and real-world implementation experience. Non-TEFT organization requirements will be considered for future revisions of the eLTSS Implementation Guide.

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TEFT States… We Need You! (1 of 2)

• For each state to be able to pilot, we must identify and harmonize relevant domains and data elements:– Understand requirements of each state in greater detail– Pinpoint required domains and develop consensus list

• Target Populations: Aged, Disabled, TBI, Intellectual/Developmental Disability, SMI– Draft example list of data elements based on final list of domains

• This SWG will focus specifically on the requirements of the TEFT states, who will use the Implementation Guide (IG) to pilot their eLTSS Solution– Domains and data elements provide framework for IG– By identifying now, do not inhibit IG development later– IG developers can select and harmonize standards that meet the needs of each

state’s eLTSS system• Public process by nature of S&I Initiative

– TEFT State piloting is a priority; will recognize community input but not harmonize at this time

• By addressing the requirements of the TEFT States, we ensure they are set up for eLTSS System piloting success! 8

TEFT States… We Need You! (2 of 2)

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Community Services Required

Neighborhood Support

County Services

Community Data

Neighborhood Information

Community Supports

Community Needs

States: What do you call the domain for service information?

Collaboration Among the TEFT states = Key to Initiative Success

eLTSS Plan Content SWG Method & Approach

The eLTSS Plan Content SWG will:• Identify a core set of domains

– Pinpoint concrete definitions and key attributes for the domains

• Define criteria for evaluating each domain– Relate to state, Common Clinical Data Set, and Use Case

requirements– Look for synergies within other initiatives (i.e. IMPACT Act, National

Core Indicators Domains, NQF Domains, etc.)

• Perform domain validation– Internal validation tools (e.g. matrix)– Gap mitigation

• Finalize and present consensus list of domains• Outline example data elements based on approved domains

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eLTSS Initiative Timeline

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Phase 1 Pilots &Testing …

Standards & HarmonizationUse Case &Functional

RequirementsPre-Discovery

DEC 14 JUNJAN FEB MAY JUL AUG SEP OCT NOV

Kick Off11/06/14

Evaluation...

ContentWork Stream

eLTSS All-Hands Work Group

Use Case WG1. eLTSS Use Case

eLTSS Plan Content SWG1. eLTSS Plan Domains &

Data Elements

Standards & Harmonization WG1. Candidate Standards2. Solution Plan3. Implementation Guide (Phase 1)

MAR APR DEC 15 JAN 16

eLTSS Plan Content SWG Timeline

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Week TargetDate eLTSS Plan Content SWG Meeting Tasks Homework

due Fridays 12pm Eastern

1 5/5 Kickoff• Introduction to Domains and Data Elements

• States begin to identify current relevant domains

2 5/12• Introduce/Review Domain Harmonization Matrix• Validate Domain Mappings

• Review domain mappings• Continue to identify relevant

domains

3 5/19• Finalize Validation of Domain Mappings• Validate/Populate Additional State Domains within

Matrix

• Review domain mappings• Continue to identify relevant

domains

4 5/26• Finalize List of Additional State Domains• Identify Baseline for Domain Standards Evaluation• Validate Criteria for Domain Standards Evaluation

• Review criteria for domain standards evaluation

5 6/2 • Identify Baseline for Domain Standards Evaluation• Validate Criteria for Domain Standards Evaluation

• Review criteria for domain standards evaluation

6 6/9• Finalize Validation Criteria for Domain Standards

Evaluation• Begin Evaluation of Domains per Validated Criteria

• Perform domain evaluation per assigned section

7 6/16 • Continue Evaluation of Domains per Validated Criteria

• Perform domain evaluation per assigned section

Introduction to Domains and Data Elements (1 of 2)

For eLTSS Initiative, want to list domains and example data elements present within the eLTSS Plan

– Requires input from data sharing experts = YOU

Top-down approach to classifying eLTSS plan elements:• Domain = High-level description that specifies a sub-domain• Sub-Domain = More granular groupings which define

categories for individual data elements• Data Element = Even more specific term that serves a

specific function– Function is described by field labels and definition

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Introduction to Domains and Data Elements (2 of 2)

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Domain

Sub-Domain

Data Element

Vitals ProblemsLab

Results

Medications

Blood Pressure (BP)

Heart Rate

Systolic BP Diastolic BP

Allergies

Unit of data for which the definition, identification, representation, and permissible values are specified by means of sets of attributes

Logical, high-level groupings that categorize many sub-domains

More granular groupings of criteria specified within the domain that is used to define categories for individual data elements

Common Clinical

Data Set

Normal

Tachy.Brady.

Introduction to Domain Harmonization Matrix (1 of 7)

Domain Harmonization Matrix will serve as the primary conduit for identified domains and validation tool within the SWG:• Initial spreadsheet created with information from current

initiatives• Additions to the spreadsheet include:

– TEFT State Domains– Use Case Requirements

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Develop Consensus List of Harmonized Domains

Create Domain Harmonization Matrix

Add/Validate Use Case Requirements

Validate TEFT State Domains

Identify TEFT State Domains

Repeat Process for Sub-Domains

Introduction to Domain Harmonization Matrix (2 of 7)

Current Initiatives present in the Domain Harmonization Matrix include:

• eLTSS Initiative Community (Based on Use Case)• CMS Balancing Incentive Program• IOM: Capturing Social & Behavioral Domains (Phase I)• IMPACT Act• NCI Domains and Sub-Domains• ACL Person Centered Planning• NQF PRO Domains• LCC Care Plan Data Set Requirements• CARE Item Set Domains• MU2 Data Sets (Common Clinical Data Set)

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Introduction to Domain Harmonization Matrix (3 of 7)

Internal validation of initiative domains demonstrated that many domains have the same meaning, even though the label may not be consistent

• Example: Clinical Information Domain vs. Medical Information Domain

• Varying definitions and labels for the domain across six initiatives• Understood that even though definitions/labels vary, the specified

domain is collecting the same type of information

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Introduction to Domain Harmonization Matrix (4 of 7)

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Source eLTSS Community CMS BIP

ACL Person Centered

CounselingNQF PRO Domains

LCC Care Plan Data Set Reqs.

CARE Item Set

DomainClinical Information

Medical Conditions/Diagnoses

Medical Needs

Symptoms and Symptom Burden

Health Concerns

Medical Status/Clinical Complexity

Definition

Push notification, medical conditions/diagnoses,medicationcomponent

Medical conditions or diagnoses that can potentially impact an individual’s daily functioning

E.g. pain, fatigue

Identifies issues, current status, and likely course of Care Team to increase likelihood of achieving goals of care

Measure patient medical status and include factors defining complexity in medical diagnoses

Introduction to Domain Harmonization Matrix (5 of 7)

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Source eLTSSCommunity CMS BIP

ACL Person Centered

CounselingNQF PRO Domains

LCC Care Plan Data Set Reqs.

CARE Item Set

DomainClinical Information

Medical Conditions/Diagnoses

Medical Needs

Symptoms and Symptom Burden

Health Concerns

Medical Status/Clinical Complexity

Sub-Domains

Current DiagnosisCurrent Health Status

Health Status Evaluation

Medication Mgmt.

Nursing ConcernsSurgical Concerns

Introduction to Domain Harmonization Matrix (6 of 7)

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Source eLTSS Community CMS BIP IOM LCC Care Plan

Data Set Reqs.

DomainDemographic/Background Info

Background Info Individual Factors/Socio-demographic

Patient Data

Definition

Basic contact and demographic info for the individual applying for services or supports

Demographic and clinical data used for any document

Introduction to Domain Harmonization Matrix (7 of 7)

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Source eLTSS Community CMS BIP IOM LCC Care Plan

Data Set Reqs.

DomainDemographic/Background Info

Background Info Individual Factors/Socio-demographic

Patient Data

Sub-Domains

Country of OriginSexual Orientation

Gender

Race/Ethnicity Race/EthnicityEducationEmploymentFood and Housing Insecurity

Domain Harmonization Matrix Working Session

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eLTSS Domain

Person Centered

ProfileClinical

InfoCare Team

Functional Status

Cognitive Function

Behavior Concerns

Service Info

Demographic/Background

InfoADLs IADLs Social

SupportFinancial

/Payer Info

MN Domain

Person Info

Support Options and Strengths

Summary of Services

Health and Safety

Cognitive and Behavioral Support Plan

Cognitive and Behavioral Support Plan

Summary of Services

Person Information

Support Options and Strengths

Support Options and Strengths

Community Support

Funding the Plan

• Homework 1: TEFT States Identify Current Relevant Domains• Responses added to Matrix and harmonized with current

validation criteria (based on community and initiatives)• Working Session will take place during Thursday’s All-Hands

Meeting

Discussion

Discussion/Reactions

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eLTSS Plan Content SWG Next Steps

• Sign up for the eLTSS Plan Content SWG on the Wiki– http://wiki.siframework.org/eLTSS+Plan+Content+SWG– Joining the eLTSS Plan Content SWG ensures that you are included on

workgroup communications and announcements.

• Homework– Verification of domains provided by TEFT States by SWG team– Due Thursday, May 14

• Next eLTSS Plan Content SWG Meeting– Working session during Thursday’s All-Hands meeting– Thursday, May 14 from 12:30 – 2:00pm Eastern

• http://wiki.siframework.org/electronic+Long-Term+Services+and+Supports+%28eLTSS%29

• Thank you! Your commitment and participation are critical to our success.

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eLTSS Plan Content SWG Contact Information

• For questions, please contact your support leads:– eLTSS Plan Content SWG Lead: Grant Kovich, grant.kovich@accenture.com– eLTSS Plan Content SWG Co-Lead (Arizona): Lauren Wiggins-Prole,

lauren.wiggins@azahcccs.gov– eLTSS Plan Content SWG Co-Lead (Colorado): Pam Russell,

prussell@corhio.org– eLTSS Plan Content SWG Co-Lead (Connecticut): Dr. Minakshi Tikoo,

tikoo@uchc.edu– eLTSS Plan Content SWG Co-Lead (Georgia): Irina Connelly,

irina.connelly@gtri.gatech.edu– eLTSS Plan Content SWG Co-Lead (Kentucky): Sheena Batts,

sheena.batts@ky.gov– eLTSS Plan Content SWG Co-Lead (Maryland): David Wertheimer,

david.wertheimer@Maryland.gov– eLTSS Plan Content SWG Co-Lead (Minnesota): Tom Gossett,

tom.l.gossett@state.mn.us– Initiative Coordinator: Evelyn Gallego, evelyn.gallego@siframework.org– Project Manager: Lynette Elliott, lynette.elliott@esacinc.org 25