ACO Update. LVHN Scholarly Works. Lehigh Valley Health Network. Lehigh Valley Health Network. Spring 2017

Size: px

Start display at page:

Download "ACO Update. LVHN Scholarly Works. Lehigh Valley Health Network. Lehigh Valley Health Network. Spring 2017"

Ami Brianna Copeland
5 years ago
Views:

1 Lehigh Valley Health Network LVHN Scholarly Works ACO Update Newsletters Spring 2017 ACO Update Lehigh Valley Health Network Follow this and additional works at: Recommended Citation Lehigh Valley Health Network, "ACO Update" (2017). ACO Update.. This Book is brought to you for free and open access by the Newsletters at LVHN Scholarly Works. It has been accepted for inclusion in ACO Update by an authorized administrator of LVHN Scholarly Works. For more information, please contact

FACP; Maryanne Peifer, MD; Jennifer Stephens, DO MEDICAL DIRECTOR S NOTE It never ceases to amaze me how many things can change in such a short period of time.

2 QUARTERLY NEWSLETTER Spring 2017 INSIDE THIS ISSUE Medical Director s Note Performance Metrics Update MSSP Track 1 Program Renewal ACO Spotlight Lehigh Valley Internist Updated Distribution ACO Team Updates MACRA National Impact Annual Wellness Performance STAFF Editor: Compliance Connection Beth Downing Contributing Authors: Michelle Crespo, RN, MHA; Tina Casey, DO; Ida Erlemann, MBA, LPN; FACP; Maryanne Peifer, MD; Jennifer Stephens, DO MEDICAL DIRECTOR S NOTE It never ceases to amaze me how many things can change in such a short period of time. It has been three months since our last newsletter and in that timeframe we have had multiple local and national changes that impact our work as an Accountable Care Organization. It is important to remember that every change yields opportunity for appreciation and new beginnings. Nationally, our executive leadership has changed in Washington, with the noted appointment of Dr. Tom Price as HHS Secretary. The reporting period for MACRA began January 1 st. See our section on MACRA / National Impact for further details on what that means to you. Despite the uncertainty, we are confident we will weather any upcoming transitions smoothly. Calendar year (CY) 2017 is our third and final year in the CMS Medicare Shared Savings Program (MSSP). Our final quarter results from the end of Program Year 2 (CY16) demonstrate improved performance at the end of the year. Given that, the final data from Program Year 2 will not be received until over the summer. That timeline allows for claims run-out and data analysis to determine if we were successful in achieving shared savings. In response to the question, Were we successful in Program Year 2? the answer is that the data suggests we cut costs, the degree of which is not fully known. Please attend our upcoming ACO / PHO joint education session to learn more about our last quarter results in Program Year 2. We are preparing our application for another three-year upside-only Track 1 MSSP program. You will see more coming from our ACO team to re-commit into the program for the CY18-20 cycle. Last but not least, we are continuing to grow as an ACO. Please join me in welcoming these 6 new offices into our program for this last track year. They include: Northwestern Medical Center, Dr. James C. Wasson, Dr. William J. Gould, Colon Rectal Surgery Associates, Allentown Radiation Oncology Associates, Eastern Pennsylvania Gastroenterology and Liver Specialists Through all these transitions, moves and additions, we are grateful to stand together as a team. Our collaboration and integrated model have allowed us the flexibility to leverage all available resources to our providers and patients. Best wishes for a successful 2017! ~ Jennifer Stephens, DO

3 PERFORMANCE METRICS UPDATE Maryanne Peifer, MD CMS updates its quality measures and benchmarks each year. For calendar year 2017 the following three measures were removed from Medicare s Shared Savings (MSSP) Quality Program: Screening for High Blood Pressure and Follow Up Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for patients with CAD and Diabetes or Left Ventricular Systolic Dysfunction (LVEF<40%) Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) The following three measures were added to our MSSP Quality Program. For any new measure, CMS provides two years in which we are only required to report the measure. In subsequent years performance relative to CMS s defined benchmarks will impact our reimbursement similar to other measures and programs. Ambulatory Sensitive Condition Acute Composite (AHRQ Prevention Quality Indicator (PQI) #91) Use of Imaging Studies for Low Back Pain Medication Reconciliation Post-Discharge Continued on p.5 MEDICARE SHARED SAVINGS PROGRAM (MSSP) - TRACK 1 PROGRAM RENEWAL Michelle Crespo, RN, MHA January 2017 started LVHN ACO s third and final year in our 3-year MSSP ACO term. Starting in the spring, LVHN ACO will reapply to continue in the MSSP Track 1 program (with no downside risk). This will be our second Track 1 program, and the last one we can pursue without bearing risk. It will start in January 2018 and continue through December The reapplication process is a multi-step process that starts with a Notice of Intent to Apply in the spring of 2017, with the application due in the summer. CMS will give their final determination of acceptance early winter. As part of the reapplication process and because CMS has required minor changes to the Participant Agreement, all contracts will be re-executed with our ACO providers. Individuals from the ACO will be reaching out in the near future to communicate how the contract renewal process will take place. Also, during this time, the ACO is able to add additional participants, which we are currently considering. If you have any questions, please don t hesitate to contact us for more information. 2

Lehigh Valley Internist 798 Hausman Road, #220 Allentown, PA 18104 By: Tina Casey, DO & Ida Erlemann, LPN, MBA Colorectal cancer is the third most commonly diagnosed non-skin cancer in both me and

In an office review of the preventative care data, it revealed that the practice screening rate for colorectal cancer had room for improvement. As a result, Dr.

3. The Clinical Informatics Business Intelligence Tool (CIBIT) was used to export a report with a list of patients that are overdue or have not had a documented colorectal screening test within the

The staff discovered a significant number of reports and developed a documentation workflow. This process change immediately reduced the number of patients on the report by 24%. 6.

4 Lehigh Valley Internist 798 Hausman Road, #220 Allentown, PA By: Tina Casey, DO & Ida Erlemann, LPN, MBA Colorectal cancer is the third most commonly diagnosed non-skin cancer in both me and women. If discovered at an early stage, it is a highly treatable cancer with survival rates reaching 90%. In an office review of the preventative care data, it revealed that the practice screening rate for colorectal cancer had room for improvement. As a result, Dr. Casey initiated a quality improvement project. Here are the steps the practice used to see success: 1. The practice evaluated the current process. 2. A plan was created to improve the screening rates. 3. The Clinical Informatics Business Intelligence Tool (CIBIT) was used to export a report with a list of patients that are overdue or have not had a documented colorectal screening test within the EMR. 4. The staff then reviewed the patient charts for colonoscopy reports that were not documented within the EMR. 5. The staff discovered a significant number of reports and developed a documentation workflow. This process change immediately reduced the number of patients on the report by 24%. 6. The practice then drafted and sent a letter to the remaining patients that were overdue for a colonoscopy and offered various ways to assist them in completing the exam. Colorectal After 6 months, the practice reviewed the colorectal screening report and noted an additional 18.4% improvement in screening rates. The practice was so encouraged by the success of the quality improvement initiative and the process that was developed, they have agreed it will be done on a yearly basis in order to continue to ensure that surveillance is being monitored. Kudos to the LVI team for all of their hard work. 3

5 UPDATED DISTRIBUTION Our first Program Year (PY1) was successful in achieving shared savings. The distribution strategy for PY1 was defined in our 2014 program application. The model covered ACO expenses first, with final monies to all ACO clinicians, regardless of impact to our MSSP beneficiaries. Moving forward, we have modified our distribution strategy to the following: 50% to LVHN (of which ACO expenses will be covered) 50% to ACO physicians and APCs based on amount of care and impact to MSSP population o Primary care = 70% Based on panel size and quality metric performance o Specialty care = 30% Based on number of episodes and associated cost In addition, any future potential ACO shared savings will occur through the PHO Achieving Clinical Excellence (ACE) program methodology. The new strategy has been approved and finalized by the ACO Board of Managers. NEW ACO INTRANET SITE RESOURCES ONLINE! You are just a few clicks away from resources geared towards the ACO, with a focus on areas of interest to clinicians. From the overview of the ACO s vision and goals to a deeper dive into quality, metrics and performance tracking, this site is meant to help us succeed in shared savings. Please log on to with any device connected to the LVHN network to explore. Share your feedback with us by clicking on Contact Us or calling ACO TEAM UPDATES Within our core LVHN ACO team, we have experienced the addition of our new Associate Medical Directors, Dr. Kevin McNeill (LVPG) and Dr. Nicole Sully (MATLV). You will find them to be outstanding physician colleagues, helping you navigate clinical situations that influence our work in the ACO. We will be replacing Ida Erlemann s position (Clinical Business Intelligence Specialist) to support our ACO practices in learning successful models for innovation and patient outcomes. We anticipate they will start connecting with practices in April. Our ACO Board welcomed Dr. Ron Julia (replacing Dr. Jack Lenhart) and Dr. Matthew McCambridge (replacing Dr. Tony Ardire). Lastly, our ACO senior leadership has transitioned from Dr. Michael Rossi to Dr. Robert Murphy. I want to take a moment and thank Dr. Rossi for all the leadership and guidance he provided to our ACO. He will maintain his role as Chair of our ACO Board. We are looking forward to working with Dr. Murphy. 4

6 PERFORMANCE METRICS UPDATE (Cont d from p.2) Maryanne Peifer, MD Below is a listing of the changes as well as the measures that are included in MIPS. MIPS CY 2017 Updates CMS ACO QUALITY MEASURES AND BENCHMARKS ^ MSSP Benchmark Percentiles ACO Measure Name p30 p40 p50 p60 p70 p80 p90 PATIENT/CAREGIVER EXPERIENCE CAHPS: Getting Timely Care, Appointments & Information CAHPS: How Well Your Doctors Communicate CAHPS: Patients' Rating of Doctor CAHPS: Access to Specialists CAHPS: Health Promotion and Education CAHPS: Shared Decision Making CAHPS: Health Status/Functional Status N/A N/A N/A N/A N/A N/A N/A Added Benchmarks CAHPS: Stewardship of Patient Resources* LVHN ACO Patient/Caregiver Experience Score CARE COORDINATION/PATIENT SAFETY Risk-Standardized, All Condition Readmission Added Benchmarks SNF 30-Day All-Cause Readmission Measure (SNFRM)* Added Benchmarks All-Cause Unplanned Admissions for Patients with Diabetes* Added Benchmarks All-Cause Unplanned Admissions for Patients with Heart Failure* Added Benchmarks All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions* New Measure 2017 Ambulatory Sensitive Condition Acute Composite Prevention Quality Indicator (PQI) #91 N/A N/A N/A N/A N/A N/A N/A ASC Admissions: COPD or Asthma in Older Adults (AHRQ PQI #5) nmp=6.86% ASC Admissions: Heart Failure (AHRQ PQI #8) nmp=18.19% %PCPs who Successfully Meet MU requirements Documentation of Current Medications in the Medical Record* N/A N/A N/A N/A N/A N/A N/A New Measure 2017 Medication Reconciliation Post Discharge N/A N/A N/A N/A N/A N/A N/A Falls: Screening for Future Fall Risk and Follow Up New Measure 2017 Use of Imaging for Low Back Pain N/A N/A N/A N/A N/A N/A N/A LVHN ACO Coordination/Patient Safety Score PREVENTIVE HEALTH Annual Wellness Visit (not a CMS measure) Preventive Care and Screening: Influenza Immunization: Age >=6mo Pneumonia Vaccination Status for Older Adults Preventive Care and Screening: BMI Screening and Follow Up Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Preventive Care and Screening: Screening for Clinical Depression and Follow Up Plan Colorectal Cancer Screening Breast Cancer Screening Statin Therapy for the Prevention and Treatment of Cardiovascular Disease N/A N/A N/A N/A N/A N/A N/A Measure Retired 2017 Preventive Care and Screening: Screening for High Blood Pressure and Follow-up Documented LVHN ACO Preventive Health Score AT RISK POPULATION Depression Remission at 12 Mo N/A N/A N/A N/A N/A N/A N/A Added Benchmarks Diabetes Composite HgA1c Poor Control Diabetes- Eye Exam* HTN: Controlling High Blood Pressure IVD: Use of Aspirin or Another Antithrombotic Measure Retired 2017 HF: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Asthma Classification (not a cms measure) Asthma Controller Medication (not a cms measure) Measure Retired 2017 ACE Inhibitor or ARB Therapy for Patients with CAD and Diabetes or LVSD (LVEF<40%) LVHN ACO At Risk Population Score Final LVHN ACO Quality Score Benchmarks-2016.pdf 5

MACRA / NATIONAL IMPACT The Medicare Access and CHIP Reauthorization Act (MACRA) is bipartisan federal legislation signed into law on April 16, 2015.

7 MACRA / NATIONAL IMPACT The Medicare Access and CHIP Reauthorization Act (MACRA) is bipartisan federal legislation signed into law on April 16, The law does many things, but most importantly it establishes new ways to pay physicians for caring for Medicare beneficiaries. This Act is separate from the Affordable Care Act (ACA) that is currently undergoing changes in Washington. As an Accountable Care Organization (ACO) participating in Track 1 (upside only) in the CMS Medicare Shared Savings Program (MSSP), we are eligible to multiple benefits in this new system. The Merit-Based Incentive Payment System (MIPS) is a new payment mechanism that will provide annual updates to physicians starting in 2019, based on performance in four categories: quality, resource use, clinical practice improvement activities and meaningful use of an electronic health record system. As the MIPS program begins, other payment programs (PQRS, Meaningful Use, etc.) will be sunset. We will be entering the program as a MIPS APM (Alternative Payment Model). The most important thing to know is that as a participant in our ACO, your focus can stay on performing high quality, efficient and effective healthcare. Our existing methods for submitting quality metric information and meaningful use will fulfill all the administrative requirements for MACRA. GREAT NEWS!! The ACO and the PHO have partnered to provide joint educational sessions* moving forward. Our focus will be on updates and information related to our accountable care arrangements. An upcoming meeting is scheduled for: Date: Tuesday March 21, 2017 Time: 5:30pm 6:30pm Place: CC Kasych ECC 7 Planned agenda: - Review of all Accountable Care Arrangements - Highlight of Best Practice - Highmark Update BE ON THE LOOKOUT We are in the process of setting-up a new Quarterly Report highlighting Quality Improvement efforts across LVHN, to be distributed electronically, and to coincide with our ACO / PHO educational sessions. Stay tuned - Capital Update - MSSP Update - ACE Program Review *See p.7 for a list of all 2017 scheduled sessions. 6

ANNUAL WELLNESS PERFORMANCE ACO COMPLIANCE CONNECTION MISSION STATEMENT ACO Compliance Committee Charter 2017 ACO / PHO Provider Educational Sessions Please mark your calendars

Organization Compliance Committee (ACOCC) is chartered, under authority of the LVHN ACO Board of Managers and the President of the LVHN ACO.

8 ANNUAL WELLNESS PERFORMANCE ACO COMPLIANCE CONNECTION MISSION STATEMENT ACO Compliance Committee Charter 2017 ACO / PHO Provider Educational Sessions Please mark your calendars to attend an upcoming session March 21 st June 20 th September 19 th December 5 th 5:30pm 6:30pm Cedar Crest ECC7 The Lehigh Valley Health Network (LVHN) Accountable Care Organization Compliance Committee (ACOCC) is chartered, under authority of the LVHN ACO Board of Managers and the President of the LVHN ACO. Its mission is to provide a regularly occurring forum in which the compliance issues, risks, and challenges that face the ACO can be vetted, discussed, and prioritized for the ACO Compliance Officer. The ACOCC shall engage in meaningful discussions that will help inform decision making and establish initiatives connected to the management and oversight of compliance throughout the LVHN ACO. The ACOCC exists to proactively solicit the varied perspectives of its members. COMPLIANCE HOTLINE LVHN PRIVACY & COMPLIANCE DEPT ONLINE REPORTING 7

Benchmark Data Sources

Benchmark Data Sources Medicare Shared Savings Program Quality Measure Benchmarks for the 2016 and 2017 Reporting Years Introduction This document describes methods for calculating the quality performance benchmarks for Accountable