The Physician Alliance

Transcription

1 The Physician Alliance 2018 Infrastructure Support Distribution Model for Primary Care Physicians in the Physician Group Incentive Program How To Achieve Maximum Distribution Revised 2/21/2018

2 2018 Infrastructure Support Distribution Model Distribution dollars are dependent upon our physicians level of participation in population health goals and implementing Physician Group Incentive Program (PGIP) Patient Centered Medical Home (PCMH) capabilities. Improving PCMH standing Increasing the number of PCPs who are PCMH designated Increasing the number of PCMH capabilities in each practice Improvement in quality scores Practices demonstrating best practice in quality improvement Practices implementing performance improvement plans for identified opportunities Improvements in electronic data capture for reporting

3 Model Supports Your Success Promotes population health strategies for all payer pay for performance programs and positions practices for healthcare reform Enhances quality improvement processes Promotes implementation of more PCMH capabilities PCPs with improved quality and more PCMH capabilities will be more likely to receive BCBSM Patient Centered Medical Home designation With PCMH, practices earn 10% - 50% additional Valued Based Reimbursement (VBR) Helps meet the requirement for inclusion in The Physician Alliance Organized System of Care (OSC), BCBSM Physician Choice PPO network, other narrow networks

4 Incentive Model Eligibility Requirements Your Practice Resource Team member will assist you in meeting the 3 requirements below to be eligible for the incentive program: 1. Practice completes the PCMH self assessment validation surveys twice a year (Winter 2018 & Summer 2018 survey) 2. Practice reviews quality performance reports at physician champion visit between January 1 st July 30 th 3. At least one physician in the practice completes the Population Health Educational offering between January 1 st July 30 th Failure to complete ANY of the above eligibility requirements results in no payment

5 Practice Resource Team Engage with your Practice Resource Team member! Identifies opportunities to implement additional PCMH capabilities Identifies opportunities to improve quality metrics and assists in developing processes to improve performance Shares best practice processes Provides many tools/resources/education

6 Primary Care Practices Infrastructure Support Distribution Model Four categories for distribution: 1. New patient centered medical home (PCMH) Capabilities 2. PCMH capabilities - maintenance 3. BCBSM PCMH designation status 4. BCBSM Valued Based Reimbursement recognition Distribution occurs once a year in the Fall (November -December*) *Payment timing varies slightly based on complexity of data and deliverables by BCBSM.

7 1. New PCMH Capabilities This metrics is weighted 20% of incentive distribution At least 3 new capabilities* in place or has > 120 capabilities** in place. *New capabilities are calculated using Summer 2017 compared to Summer 2018 survey **Total number of capabilities are calculated using the Summer 2018 survey

8 2. PCMH Capabilities - Maintenance This metrics is weighted 10% of incentive distribution Distribution levels: 1. No incentive payment - < 85 capabilities in place 2. Intermediate - > 86 - < 99 capabilities in place 3. Advanced - > < 113 capabilities in place 4. Best Practice - > 114 capabilities in place *Number of capabilities are calculated using the Summer 2018 survey

9 3. BCBSM PCMH Designation This metrics is Weighted 50% of incentive distribution Practices that are BCBSM Patient Centered Medical Home designated in 2018*

10 4. BCBSM Valued Based Reimbursement Recognition This metrics is Weighted 20% of incentive distribution Distribution levels: 1. No payment - No VBR* applied 2. Intermediate - 5% VBR* earned 3. Advanced - 10% VBR* earned 4. Best Practice - 15% VBR* earned *Source of score: BCBSM 2018 VBR % earned

11 Physician Group Incentive Program 1. Meet with your Practice Resource Team (PRT) member at least quarterly. 5. Focus on metrics that have the biggest opportunity for improving quality overall scores. 2. Use your electronic registries at the point of care and perform patient outreach to improve quality. 6. Complete a practice PCMH self assessment validation survey twice a year with PRT member. 7. Develop a plan to continue to implement new PCMH capabilities yearly and maintain current capabilities. 3. Identify a physician champion to review performance reports at least biannually to identify opportunities for improvement. 4. Review population report cards with PRT and develop written plans to improve metrics and improve data capture. 9. Use an electronic EMR or registry system and agree to share discrete data through an interface with WellCentive to provide supplemental clinical data to improve quality scores. 8. Be Patient Centered Medical Home (PCMH) Designated. Work with PRT to assure yearly nomination for PCMH.

12 Physician Group Incentive Program PCP Expectations Complete a self assessment validation survey twice a year Maintain capabilities that are reported in place and implement new capabilities Work towards PCMH designation within one year of PGIP enrollment Engage with your PRT member at least quarterly Review performance reports, identify opportunities and develop process improvement plans Participate in supplemental data submission to health plans to improve quality scores and assist in improving data capture Attend educational sessions Review practice data on TPA secure physician portal

13 Incentive Model Resources Contact your Practice Resource Team member Or Contact The Physician Alliance at We want you to be successful!