Practice Transformation Networks

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1 Practice Transformation Networks The project described was supported by Funding Opportunity Number CMS-1L from the U. S. Department of Health & Human Services, Centers for Medicare and Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. 1

2 CMS TCPI Practice Transformation Network Goal Prepare both primary care and specialty care practices to succeed in new payment models which go into effect in This will be accomplished by providing free practice transformation support to participating practices. This support will focus on areas that have been identified by CMS as measures that will be used to establish these payments. SGR TO MACRA Current FFS Starting in 2019, clinicians will be required to transition to one of two systems that determine future payment updates Merit Based Incentive Program (MIPS) Alternative Payment Models (APM) Potential for positive or negative adjustments based on achievement on a composite quality score Potential for lump sum bonus equaling 5% of prior years payments MU Quality Utilization Clinical Improvement 2

3 MIPS/APM Impact on Reimbursement Composite Quality Score 3

4 Composite Quality Score Source: MedLearn Matters MACRA Presentation May 2016 What is Practice Transformation? 4

5 Five Phases Of TCPI Aligning TCPI Aims with MACRA Set Aims Complete PAT 2.0 Assessment and identify gaps Use Data to Drive Care Use the Rapid Cycle Improvement process to address gaps Achieve Progress on Aims Standardize change and move on to next priority gap and repeat cycle Achieve Benchmark Status Practice prepared for MIPS (Merit Incentive Payment System) under MACRA Thrive as a Business Practice prepared to participate in AAPM (Advanced Alternative Payment Models) 10 5

6 PTN Focus Areas Developing Internal Competencies Developing a culture of continuous quality improvement Q15 Practice builds QI capabilities in the practice and empowers staff to innovate and improve. Maximizing Internal Quality Performance (PCMH) Support in demonstrating quality being provided clinicians Q7 Practice has a reliable process in place for identifying risk levels for each patient and providing care appropriate for each level External Care Delivery (PCMN) Development of coordination within the medical neighborhood Q9 Practice works with Primary Care practices within the medical neighborhood to develop criteria for referrals and co-managed protocols. Patient Engagement Engaging patients as partners in care Q4 Practice can demonstrate that it encourages patients to collaborate in goal setting, decision making and self-management. HealthVisions Delmarva Support 12 6

7 But I Am Not Eligible for TCPI You can use the free PTN resources to prepare practices prior to entry into your MSSP ACO You can use the free PTN resources to create a high value network of specialists who support your MSSP ACO You can use the free PTN resources to attract practices to your Clinically Integrated Network as a value added offering You can use the free PTN resources to create standardization across your Clinically Integrated Network through establishment of a patient centered medical neighborhood HealthVisions Delmarva Primary Geography: Delaware, Maryland, Virginia, Pennsylvania Focus/Specialization: Specialty Practices and Primary Care Customized, one-on- one support from a Quality Improvement Advisor to help meet clinical, operational and reporting needs using: Rapid cycle quality improvement education and coaching Workflow optimization Performance science, including Lean and Six Sigma PTN clinical faculty and peer-based networks/affinity groups to support clinicians and practices to accomplish the following: Successfully participate in the Physician Quality Reporting System (PQRS) Modify clinic workflow to address care gaps Promote evidence-based medicine Understand reimbursement changes and prepare to succeed in the Merit- Based Incentive Payment System (MIPS) or in an Alternate Payment Model (APM), such as an Accountable Care Organization (ACO) or bundled payment system Cindy Eiseman (724) HVDPTN@gmail.com 7

8 Rhode Island PTN Primary Geography: Rhode Island Focus/Specialization: Specialty Practices and Primary Care No cost individualized support in practice transformation Technical assistance, one-on-one coaching, education and training Data driven quality improvement skill building Readiness and ongoing assessments Leadership Academy for select practices to train as health care leaders and inspire peers Improved coordination between primary care and specialist providers Business success planning: Prepare for and succeed under new value based payment models (MACRA) Make your practice attractive as a potential partner in a shared savings program Increased satisfaction in your work Better patient outcomes Darlene Morris (401) dmorris@riqi.org Rhode Island PTN Alignment of local practice transformation and payment reform efforts Office of the Health Insurance Commissioner (OHIC): Population based contracting: 45% covered lives (10% in downside risk) By 2016 Payment targets: APM: 40% by 2017, 50% by 2018 Non-FFS: 60% by 2017, 10% by 2018 Care Transformation Plan TCPI named an option, opportunity for incentives Rhode Island HHS: 50% of Medicaid reimbursements made through alternate payment models by end of 2018 State Innovation Model (SIM): 80% of provider payments linked to value by 2018 Darlene Morris (401) dmorris@riqi.org 8

9 Southern New England PTN Primary Geography: Connecticut, Massachusetts Focus/Specialization: Quadruple Aim, All Clinicians, Robust Medical Neighborhood Practice-Centered Approach: Transformation agenda and pace of change determined by each practice Extensive experience in PCMH transformation SNE-PTN strives to: Provide effective coaching on change management and new care delivery models Help practices enhance effective use of health information technology Strengthen the medical neighborhood through communication, coordination and formalized agreements Disseminate proven best practices across the network Work with payers and clinicians to implement sustainable payment methodologies Ron Adler, MD, FAAFP Southern New England Practice Transformation Network The Value Proposition Succeed in Value-Based Payment Optimize current revenue Prepare for alternative payment models Optimize Use of Health Information Technology Calculate and report clinical quality measures Give clinicians actionable care gap information Strengthen Connections to Community Partners Improve coordination across primary and specialty care, hospitals, behavioral health and communitybased providers Free Technical Assistance Quality Improvement Advisors Faculty Experts Professional Resources CMEs, etc. Achieve the Quadruple Aim and Bring Joy Back to Your Clinical Practice! Ron Adler, MD, FAAFP

10 Next Steps: The PTN Process 1. Complete Participation Registration 2. Work with your PTN Advisor to identify operational gaps using CMS assessment tool 3. Identify areas of overlap and prioritize needs 4. Measure Key Indicators related to those needs to verify if improvement is needed 5. Perform 90 day small test of change implementing new processes 6. Re-measure and readjust process as needed 7. Participate in Peer Affinity Groups There is no cost associated with this program. A dedicated practice advisor will be assigned to support the transformation activities. Participation is voluntary and practices can withdraw at anytime. Questions 10

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