DSRIP Year 3 Master Participation Agreements. Primary Care and Acute Care October 2, 2017

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2 DSRIP Year 3 Master Participation Agreements Primary Care and Acute Care October 2, 2017

3 DY3 Timeline Date August 1, 2017 August 16, 2017 September 11 September 15 October 1 October 2 October 15 October 15 Activity Finance Committee votes to approve MPA Board of Managers votes to approve funding methodology returning partners Mail amendments to returning partners Distribute billing templates Webinar for PCP, BH, and hospital partners Deadline for returning partners to object to amendment = 30 days Post Reference Guides to website 3

4 Changes to MPA Exhibits for DY3 Exhibit A: Provider Requirements (provider type specific) 1.1 Project managers 1.2 Baselines and reporting Dates Performance targets New deliverables and substantiations 4

5 Changes to MPA Exhibits for DY3 Exhibit B: Patient engagement definitions and targets Added dates and instructions Corrected targets 5

6 Changes to MPA Exhibits for DY3 Exhibit C: Payment Schedule DY3 funding methodology Updated payment dates 6

7 Provider Type Specific Exhibit As 1.1 Primary Care Providers (extra small, small, medium, large) 1.2 Behavioral Health (outpatient) 1.3 Skilled Nursing Facilities 1.4 Acute (Hospitals) 1.5 Home Care Agencies 1.6 Maternal/Child Health 1.7 Developmental Disability Providers New in DY3: 1.8 Behavioral Health Inpatient 1.9 Pediatric Practices 1.10 Planned Parenthood 1.11 Extra Large Primary Care Providers 7

8 MPA Financial Concepts The general all partner MPA spend for DY3 will be $12,500,000 o This has been funded from expected revenue and will not be adversely impacted by Millennium s performance on their overall NYS P4P targets Pay for performance deliverables will make up at least 70% of MPA incentive dollars Failure to meet any individual deliverable does not impact the provider s ability to earn the full incentive on other deliverables 8

9 MPA Financial Concepts, cont. Some performance measures have multiple targets associated with multiple incentives o A higher target earns a higher incentive o Each partner can only earn one of the incentives Program Participant Activity Substantiation Dollar Allocation Primary Care Access Adherence Rate Improvement Improve 12 month visit adherence rate over historical baseline SELECT ONLY ONE TIER Target #1: Provide evidence of adherence rate improvement 10% over baseline $24,640 Target #2: Provide evidence of adherence rate improvement 15% over baseline $36,960 Target #3: Provide evidence of adherence rate improvement 20% over baseline OR Demonstrate overall adherence rate 94% (over 18 years) and 98% (under 18 years) with maintenance $49,280 9

10 MPA Financial Concepts, cont. The allocation of funds by provider type was determined based on the following factors: o Number of deliverables o Complexity of deliverables o Number of total providers within each category o Return on investment for deliverables (pay forperformance optimization) o High performance fund opportunity 10

11 Financial Concepts: Impact Primary care and behavioral health will receive the largest allocations of MPA funds PCP size categories were updated (based on number of Medicaid lives): Last Year s Thresholds Updated Thresholds Extra Large 10,000+ Large 3,000+ 5,000 9,999 Medium 500 1,000 1,000 4,999 Small Under Under 200 Under 200 Hospitals: o Remain at the same allocation percentage o Individual awards are increased secondary to: A reduction in the number of facilities An increase in the total MPA funding when compared to last year o Dollars have been added and allocated for the ED Care Triage Program 11

12 DY3 Funds Distribution Provider Type Allocation % Allocation $ Primary Care/Clinics 43% $5,375,000 Behavioral Health/ Developmentally Disabled 25% $3,125,000 Hospitals 20% $2,500,000 Skilled Nursing Facilities 4% $500,000 Home Health Agencies 1% $125,000 Maternal & Child Health Pilot 1.5% $187,500 Bonus Program 5.5% $687,500 TOTAL 100% $12,500,000 12

13 Exhibit A Corresponds to Billing Template 13

14 Billing Template Components Primary Payment Category Program Participant Activity Secondary Payment Category Substantiation Payment Category Key Dollar Allocation Met (Y/N) Dollar Value Earned Engagement and Reporting Workforce Data Enter required staffing impact data into HWApps on biannual basis Provide updated roster of providers on annual/biannual basis Reporting Reporting Successful upload of practice workforce data in HWApps (biannually) Submission of updated provider roster (annually/ biannually) ER $2,873 Y $2,873 ER $2,873 Y $2,873 14

15 DY3 Incentive Components Engagement and Reporting: 10% Transformation only: 20% Transformation with Performance: 70% 15

16 Engagement and Reporting Workforce Value Based Payment Claims and Data HEALTHeLINK Usage Roster Updates Patient Engagement Reporting ED Care Triage (acute only) 16

17 Engagement and Reporting Workforce Objective: Current workforce statistics must be compiled and given to the state in order to measure the effect DSRIP initiatives are having on the healthcare workforce over the time of the program. Projections of staffing need, bed reductions (or additions), and utilization trends are generated from workforce data. HWApps will continue to be utilized for reporting. Value Based Payment (VBP) Objective: Submit a value based transition plan that includes the minimum components outlined within the billing template. Support further preparation and positioning for the transition to VBP. Data Objective: Millennium is committed to developing a comprehensive 360 view of a member, as this is a key component of effective population health management. Partners will provide or sign a release to have their claims data shared with Millennium for the purpose of population health management. Use of HEALTHeLINK is critical for clinical interoperability and sharing of patient data across providers and systems in order to provide informed, appropriate care. Partners will share CCD As with HEALTHeLINK. 17

18 Engagement and Reporting Program Participant Activity Substantiation Workforce Enter required staffing impact data into HWApps on biannual basis Successful upload of practice workforce data in HWApps (biannually) VBP Data Data (Primary Care Only) Data (XL Primary Care and Acute Care) Engagement (Primary Care Only) Data (Acute Care Only) ED Care Triage (Acute Care Only) Create a VBP transition plan to include the following required minimum elements: Technology and analytics Utilization and care management tactics Staffing expertise Financial feasibility and impact Timeline for implementing VBP Implement CCDAs Provide updated roster of providers on annual/biannual basis Execute MCC developed managed care organization data consent form Provide claims data Provide quarterly engagement reporting for behavioral health and cardiovascular disease Meet with MCC at least quarterly (all practice locations). Topics for discussion may include Patient Activation Measure ( PAM ) training (if applicable) and behavioral health best practices. Continue to consent patients with HEALTHeLINK consistent with developed workflows and HEALTHeLINK utilization. Implement ADT messaging for admission, discharge or transfer to HEALTHeLINK. Create lists of PCPs accepting EDCT referrals and appointments. Listing of PCPs must 18 include physician name, license number and address. Submission of report (For entities with multiple provider types, each shall be required to provide either a separate report or to have a specific portion of the report dedicated to each provider type.) CCDAs successfully implemented as evidenced by activity on the HEALTHeLINK monthly reporting dashboard Submission of updated provider roster (annually/biannually) Provide copy of signed data consent form Submission of electronic claims to MCC for PPS attributed lives Successful upload of all quarterly engagement reports as indicated by MCC project managers Provide sign in sheets, meeting minutes, and workflows (if applicable). ADTs successfully implemented as evidenced by activity on the HEALTHeLINK monthly reporting dashboard. Provide evidence of active consenting and query activity as per MCC HEALTHeLINK reports Provide required lists

19 Transformation Acute Care Health Literacy/H CAHPS Survey Enhanced Primary Care Acute Linkage Non Utilizer Management Crisis Stabilization Primary Care Health Literacy/CG CAHPS Survey Medical Record Review Non Utilizer Management SBIRT PAM 19

20 Transformation, cont. Health Literacy Surveys Objective: A targeted approach to addressing health literacy and improving the H CAHPS and CG CAHPS results. Patient and caregiver understanding, compliance, and satisfaction are key to patient success in maintaining health in the community post discharge. Enhanced Primary Care Acute Linkage (acute care only) Objective: Ensuring definitive, timely linkages are made to primary care following a hospital stay is crucial for followup and maintenance of health conditions in the community setting. Primary care needs to be the center of care coordination strategies. Patients must be given appropriate resources to be successful in their linkage to primary care. Non Utilizer Management Objective: Provide additional care coordination resources for non utilizing patients of primary care services with the goal of linking to a PCP. Provide list of non utilizer patients to Millennium contracted community based organization (CBO). Crisis Stabilization (acute care only) Objective: Workflows in place and staff trained to handle instances of crisis in a positive, effective way through utilization of crisis stabilization resources available in the community and/or hospital setting. 20

21 Transformation, cont. Medical Record Review Objective: To ensure appropriate documentation and follow up via medical record review for blood pressure control and depression screening with follow up Screening, Brief Intervention, and Referral to Treatment (SBIRT) Objective: Primary care settings screen and develop an approach for early intervention and treatment services for person with substance use disorders, as well as those who are at risk for developing these conditions. Patient Activation Measure (PAM) Objective: The Patient Activation Measure (PAM) is a measure that assesses patient knowledge, skill, and confidence for self management. Incentives are being offered for practices that are currently completing PAM sreenings or would like to implement this process in their office 21

22 Transformation (Primary Care) Program Participant Activity Substantiation Health Literacy / Survey Medical Record Review Non Utilizer Management SBIRT PAM Participate in MCC PCP office training and workgroup sessions on MCC specific CG CAHPS survey measures. Develop and implement work plan including strategies for improvement based on survey results. Revise patient facing materials to improve and enhance patient literacy according to CG CAHPS standards. * Attend MCC led education on documentation requirements. * Provide evidence of appropriate documentation and at least 75% documentation accuracy of blood pressure control and depression screen with follow up Contact Non Utilizers via new phone call or letter to attempt to schedule preventative appointment. If outreach is unsuccessful and/or scheduled Non Utilizer fails to show for new preventative appointment, provide a list of outstanding Non Utilizers to MCC contracted community based organizations ( CBOs ). Accept Non Utilizer referrals from MCC contracted CBOs. 90% of Non Utilizer referrals must be scheduled for appointments within 30 days of referral Train at least one key clinical staff member per site Implement SBIRT Administer PAM surveys in PCP offices. Participants must perform PAMs on a minimum of 10% of Medicaid visits. Minutes from training and working session that include identification of strategies to improve results. Provide copy of work plan.l Provide revised patient facing materials Sign in sheets reflecting training attendance. MCC shall conduct initial medical review audit. If original findings by MCC indicate less than 75% documentation accuracy, then MCC will re audit again at a later time. Provide Non Utilizer list to MCC. Completion of MCC sampling audit on documentation of Non Utilizer outreach efforts. Non Utilizer referral appointments substantiated by MCCcontracted CBO reports Demonstrate completion of training (e.g., certificates or sign in sheets) Provide workflow and quarterly reporting on number of screenings Provide workflow and quarterly reporting on number of PAM surveys administered 22

23 Transformation (Acute Care) Program Participant Activity Substantiation Health Literacy / Survey Enhanced Primary Care Acute Linkage Non Utilizer Management Crisis Stabilization Identify H CAHPS/HL Champion. Participate in MCC training and workgroup sessions on H CAHPS survey measures. Develop and implement work plan for improvement based on survey results. Revise patient facing materials to improve and enhance patient literacy according to H CAHPS standards. Report results to MCC of the following survey questions: #23: Staff took preferences of patient/caregiver into account in deciding patient s health care needs for discharge. #24: Upon discharge patient had good understanding of responsibilities and discharge instructions. #25: Patient clearly understood purpose for taking each of patient s medications. Create enhanced linkages to PCPs for patients discharged from acute care Revise patient facing materials to include written documentation of when/where follow up appointment is and reason for appointment. Provide copy of materials to patients when PCP visit is scheduled Refer patients who fail to follow up with PCP visits after EDCT intervention or an acute admission to MCC contracted community based organizations ( CBOs ). Attend MCC led workgroups focused on: Identifying accessible behavioral health crisis services that allow access to appropriate level of service and providers. Developing and implementing protocols to divert patients from emergency department ( ED ) and inpatient services when medically appropriate 23 Documentation identifying an H CAHPS/HL Champion Sign in sheets reflecting attendance at workgroup sessions Submission of H CAHPS work plan and updated patient facing discharge material Evidence of distribution of workflow and training of key staff Report ongoing survey results to MCC as available Provide workflow and processes demonstrating patient linkage with PCPs Provide copies of revised patient facing materials Provide total number of patients referred to MCC contracted CBOs Sign in sheets reflecting attendance at workgroup sessions Copy of protocols, date of training, and material distribution to relevant staff

24 Transformation with Performance Acute Care ED Care Triage Program Health Home Integration Medical Neighborhood Manage Hospital Utilization Primary Care Primary Care Access CVD Best Practice Medical Neighborhood Depression Best Practice 24

25 Transformation with Performance (Primary Care) Program Participant Activity Secondary Payment Category Substantiation Primary Care Access CVD Best Practice Run 12 month annual visit adherence report and establish baseline Develop management plan for improvement of adherence rate and submit adherence rate reports Improve 12 month visit adherence rate over historical baseline SELECT ONLY ONE TIER PCPs will develop the following registry (or develop an alternate reporting/identification process): Patients with HbA1c 7% Blood pressure 140/90 ASCVD risk score 7.5% OR provide a documented process demonstrating how the practice will calculate the ASCVD risk score and record in EMR Process Outcome Process Produce report and plan Submit reports Improve number of patients with controlled blood pressure by 10% Outcome Provide evidence of achievement of metric Improve to or maintain 75% CAD patients on a statin Outcome Provide evidence of achievement of metric Provide evidence of adherence rate improvement 10% over baseline Provide evidence of adherence rate improvement 15% over baseline Provide evidence of adherence rate improvement 20% over baseline or demonstrate overall adherence rate 94% (over 18 years) and 98% (under 18 years) with maintenance Provide evidence of use of registry or alternate process (i.e. Category 2 codes) to automate case identification in electronic medical record Produce registries Produce documented process/plan to calculate and record the ASCVD risk score (if unable to produce registry only) 25

26 Transformation with Performance (Primary Care), cont. Program Participant Activity Secondary Payment Category Substantiation Review and revise care coordination policy to include the following: Address linkages with behavioral health, CBOs, health home, and hospitals; Confirm bi directional communication with all relevant hospitals and high volume specialists; Evaluate and revise criteria and process for follow up visits and calls; Enable ADTs with HEALTHeLINK; and Incorporate process to act upon and ensure outreach and follow up Process Participate in a facilitated meeting with MCC project manager regarding policy revisions. Submit revised care coordination policy with all required elements Medical Neighborhood Conduct outreach to and schedule follow up visits for acute inpatients that are discharged from a hospital with one of the following avoidable admission principal diagnoses ( Target Conditions ): COPD and related complications; diabetes and related complications; asthma; and other practice specific avoidable admission diagnosis driver as identified by MCC analytics. Maintain hospital patient follow up log. Enroll and/or refer patients eligible for care coordination and/or health home services consistent with internal policies and applicable health home guidelines Process Process Provide hospital patient follow up log substantiated by MCC sample audit of logs Report number and percentage of patients with target conditions enrolled in care coordination. Report number and percentage of patients referred to health homes. Report can be satisfied by practice or health home Reduce practice specific avoidable admission rate (including readmissions) for Target Conditions by 5% when compared to historical baseline Reduce practice specific preventable emergency department visit rate by 10% when compared to historical baseline 26 Outcome Provide evidence of achievement of metric Outcome Provide evidence of achievement of metric

27 Transformation with Performance (Primary Care), cont. Program Participant Activity Secondary Payment Category Substantiation Participate in MCC facilitated education and training on depression best practices. Develop and implement practice workflow to care manage newly diagnosed depressed patients prescribed an anti depressant Process Sign in sheets for education and training sessions. Report on number and percent of patients that were care managed Depression Best Practice Improve patient major depression medication adherence to antidepressant medications, acute phase (12 weeks) Outcome Provide evidence of improvement in patients major depression medication adherence to anti depressant medications, acute phase (12 weeks) by 10%; or If current major depression medication adherence is at or above 60%, maintain Improve patient major depression medication adherence to antidepressant medications, chronic phase (6 months) Outcome Provide evidence of improvement in patients major depression medication adherence to anti depressant medications, chronic phase (6 months) by 10%; or If current major depression medication adherence is at or above 44%, maintain 27

28 Transformation with Performance (Acute Care) Program Participant Activity Secondary Payment Category Substantiation ED Care Triage * Implement EDCT program if not already established. * Provide patient facing materials including written documentation of when/where appointment is and reason for appointment. * Identify Medicaid patients with low acuity triage levels in the ED. * Enhance Primary Care Linkage for ED patients via assistance and scheduling of immediate follow up appointment after discharge with outreach to PCP office. * Review monthly EDCT program report from MCC and report improvement opportunities to MCC * Hospitals with existing EDCT programs must increase engagement of Medicaid patients by at least 5%. * Hospitals that are new participants in EDCT programs must engage at least 5% of Medicaid low acuity patients Process * Copy of materials distributed to patients when PCP visit is scheduled. * Provide monthly report of Key Performance Indicators with the following: Number of patients with EDCT acuity triage level 3 5. Number of EDCT patients engaged with Patient Navigator. Number of patients completing Patient Activation Measure survey. Number of patients linked to primary care and percentage of patients who attended their PCP appointment. * Minutes of meetings evidencing improvement opportunities Outcome * For hospitals with existing EDCT programs: year end report demonstrating increased engagement of low acuity Medicaid patients by at least 5% over previous year. * For hospitals that are new participants in EDCT programs: year end report demonstrating engagement of at least 5% of low acuity patients Health Home Integration Prepare workflow supporting health home s clinical integration within hospital ED * Integrate health homes within hospital setting. * Increase health home referrals by 10% over previous year. Process Outcome Provide documentation of workflow Report on number of patients referred to health homes the previous year demonstrating increase 28

29 Transformation with Performance (Acute Care), cont. Program Participant Activity Secondary Payment Category Substantiation Medical Neighborhood Manage Hospital Utilization Participate in MCC led workgroups and develop an at risk process or tool, to include both medical and social factors, that identifies patients at risk for readmission Review and revise care coordination policy to include the following: Address linkages with behavioral health, CBOs, health home, and hospitals; Confirm bi directional communication with all relevant hospitals and high volume specialists; Evaluate and revise criteria and process for follow up visits and calls; Enable ADTs with HEALTHeLINK; and Incorporate process to act upon and ensure outreach and follow up Establish Medicaid specific reports and baselines for the following: 30 day readmission rate (PPR); PPV visits (ambulatory sensitive conditions); and PQI measures Process Process Process Sign in sheets reflecting attendance at workgroup sessions. Provide copy of at risk process or tool development materials. Provide revised care coordination policy with all required elements Provide ongoing monthly report to MCC, including principal diagnosis (and DRG for acute discharges) for PQI, PPV, and PPR (including both the initial admission and the 30 day readmission) Reduce PPV rate by 10% compared to historical baseline Outcome Provide reports evidencing reduction Reduce PQI admission rate by 5% compared to historical baseline Outcome Provide reports evidencing reduction Reduce 30 day readmission rate by 5% compared to historical baseline Outcome Provide reports evidencing reduction 29

30 Next Steps Amendment automatically goes into effect 30 days from mailing date Millennium Relationship Managers will be following up with your specific organizations to provide support as needed 30