The Physician Alliance

Transcription

1 The Physician Alliance 2019 Infrastructure Support Distribution Model for Specialty Physicians in the Physician Group Incentive Program How To Achieve Maximum Distribution Final 1/7/2019

2 2019 Infrastructure Support Distribution Model Distribution dollars are dependent upon our physicians level of participation in processes to: Improve care coordination o Receive BCBSM the Specialist Valued Based Reimbursement program o Receive a > 3 Star rating in The Physician Alliance Service Excellence Award for Care Coordination o Implement specific care coordination capabilities Build new PCMH-N capabilities (2 per year or reach 100 capabilities) Improve quality o Receive recognition for The Physician Alliance Service Excellence Award for Quality Reduce healthcare cost and utilization o Reducing duplicate or non-value added testing o Provide same day appointments for urgent patients to reduce ED use

3 Model Supports Your Success PCMH-N capabilities positions practices for healthcare reform Promotes population health strategies for all payers and pay for performance programs Meet requirements to be included in The Physician Alliance Organized System of Care (OSC) network and BCBSM Physician Choice PPO network Specialist with more PCMH-N capabilities in place will more likely be invited to join narrow networks and received BCBSM Value-Based Reimbursement (VBR) recognition o With VBR, specialist received 5% - 10% on BCBSM RVU billing o VBR rewards specialist for collaborating with their community of caregivers to optimize use, efficiency and quality in their shared populations

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-N self assessment validation surveys twice a year (Winter 2019 & Summer 2019 survey) 2. Completes a physician champion visit between January 1 July 30, At least one physician in the practice completes TWO Coding Educational offerings between January 1 September 27, 2019 Failure to complete ANY of the above eligibility requirements results in no payment

5 Practice Resource Team Key to your success is your engagement with your Practice Resource Team member! Identifies opportunities to implement additional PCMH-N capabilities Identifies quality metrics that apply to your specialty type and assist in developing processes to improve performance Shares best practice processes Provides many tools/resources/education

6 2019 Infrastructure Support Distribution PCMH-N capabilities do not readily apply to all specialty types such as anesthesiology, hospitalist, neonatology, pathology, radiation oncology, radiology, etc. Opportunity within the 2019 Infrastructure Support Distribution model may be limited for these specialty types. The above specialty types have their incentive opportunity in the BCBSM Value-Based Reimbursement (VBR) initiative with a 5% - 10% VBR on BCBSM RVU billing.

7 Specialty Practices Infrastructure Support Distribution Model There are four categories for distribution: 1. Receive at least one of two program recognitions: a. The Physician Alliance Specialist Service Excellence Award with a star rating of > 3 in 2019 b. Receive the BCBSM Specialist VBR recognition in Build new patient centered medical home neighborhood capabilities 3. Have specific care coordination capabilities fully in place 4. Patient centered medical home neighborhood capabilities in place maintenance Distribution occurs once a year in the Fall (November-December*) *Payment timing varies slightly based on complexity of data and deliverables by BCBSM.

8 1. Receive Program Recognition This metrics is weighted 30% of the available incentive distribution dollars There are two recognition programs that meet the requirement for this incentive metrics. Practices must have at least one of the following: 1. Received the BCBSM Specialist Valued Based Reimbursement recognition in Received > 3 Star rating in The Physician Alliance Specialist Service Excellence Award for Care Coordination in 2019

9 2. Build New PCMH-N Capabilities This metrics is weighted 20% of the available incentive distribution dollars Practice must put in > 2* new capabilities in place within a years timeframe or have > 100 capabilities in place. *Number of capabilities are calculated comparing the Summer 2018 survey capability count to the Summer 2019 survey capability count.

10 3. Care Coordination Capabilities in Place This metrics is weighted 20% of the available incentive distribution dollars There are three categories for distribution: 1. Intermediate capability 13.7 fully in place 13.7 = Practice has written procedures and/or guidelines on care coordination processes, and appropriate members of care team are trained on care coordination processes and have clearly defined roles within that process. *Capabilities fully in place are determined from the Summer 2019 survey

11 3. Care Coordination Capabilities in Place - Continued 2. Advanced has intermediate capabilities in place and has capability fully in place = Following hospital discharge, a tracking method is in place to apply the practice s defined hospital discharge followup criteria, and those patients who are eligible receive individual transition of care phone call or face-to-face visit within hours *Capabilities fully in place are determined from the Summer 2019 survey

12 3. Care Coordination Capabilities in Place - Continued 3. Best Practice has intermediate and advanced capabilities in place and has capabilities 13.3 and 13.6 fully in place 13.3 = Approach is in place to systematically track patient population selected for initial focus 13.6 = Process is in place to coordinate care with payer case manager for patients with complex or catastrophic conditions *Capabilities fully in place are determined from the Summer 2019 survey

13 3. Total number of PCMH-N capabilities in place This metrics is weighted 30% of the available incentive distribution dollars There are four categories for distribution: 1. No Incentive Payment - < 23 capabilities in place 2. Basic - > 24 - < 45 capabilities in place 3. Intermediate - > 46 - < 62 capabilities in place 4. Advanced - > 63 - < 78 capabilities in place 5. Best Practice - > 79 capabilities in place *Total number of capabilities are calculated using the Summer 2019 survey capability count.

14 Physician Group Incentive Program 1. Meet with your Practice Resource Team (PRT) member regularly. 4. 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. 5. Complete a practice PCMH-N self assessment validation survey twice a year with PRT member. 6. Develop a plan to continue to implement PCMH-N capabilities and maintain current capabilities. 7. Work with PRT to assure yearly nomination for Specialist Valued-Based Reimbursement. 3. Identify a physician champion to review performance reports at least biannually to identify opportunities for improvement. 8. Work with PRT to improve you star rating in The Physician Alliance Specialist Service Excellence Award for care coordination and engage in the Specialist Service Excellence Award in Quality Improvement.

15 Physician Group Incentive Program Specialist Expectations Completes a self assessment validation survey twice a year Maintain capabilities in place and implement new capabilities Work towards BCBSM Valued-Based Reimbursement nomination Achieve a > 3 stars rating in TPA Specialist Service Excellence Award Work towards receiving TPA Specialist Service Excellence Award in Quality Engage your PRT member quarterly or as indicated for your specialty type Review performance reports, identify opportunities and develop process improvement plans Attend educational sessions Review practice data on TPA secure physician portal

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