Patient Centered Specialty Practice: Are We Ready for. Course Schedule

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1 Patient Centered Specialty Practice: Are We Ready for MACRA? Xiaoyan Huang, MD, MHCM, FACC Providence Heart Clinic December 5 th, th IHI National Forum Course Schedule Morning: Introduction Xiaoyan Huang, MD MACRA overview Joel Sauer IPA project overview Xiaoyan Huang, MD Project management---laura George PCSP success stories: Compass Oncology Brad Perrigo, Lucy Langer, MD Women s Healthcare Associates Samantha Beatty, Damon Warhus, MD Providence Heart Clinic Lesley Jones Larson, Xiaoyan Huang, MD Afternoon: Hands-on tutorial on PCSP Compass Oncology Women s Healthcare Associates Providence Heart Clinic 2 1

2 Outline Who are we? What is PCSP? Why PCSP? Our journey Success stories from 3 practices How to achieve PCSP? 3 Portland IPA Largest and oldest independent practice association in Oregon 3300 physicians 2244 specialists in 209 practices 62 specialties 1056 PCPs in 136 practices 4 2

3 What Does the IPA Do? Group contracting Credentialing Quality improvement support Innovation grants EHR adoption Referral management PCMH, PCSP Physician & staff education Leadership training 5 Outline Who are we? What is PCSP? Why PCSP? Our journey Success stories from 3 practices How to achieve PCSP? 6 3

4 What is PCSP? A set of Patient Centered Specialty Practice Standards issued by NCQA in 2013 Corresponds to Standards for Patient Centered Medical Home (PCMH) for primary care 6 Standards, 22 Elements, 5 of which are Must- Pass 3 levels of recognition Single site vs. corporate application 2016 Standards are now available. 7 7 What are the Standards in PCSP? (6 Standards/22 Elements) 1. Track and Coordinate Referrals A. Referral Process and Agreements B. Referral Content C. Referral Response 2. Provide Access and Communication A. Access B. Electronic Access C. Specialty Practice Responsibilities D. Culturally and Linguistically Appropriate Services E. The Practice Team 3. Identify and Coordinate Patient Populations A. Patient Information B. Clinical Data C. Coordinate Patient Populations 4. Plan and Manage Care A. Care Planning and Support Self-Care B. Medication Management C. Use Electronic Prescribing 5. Track and Coordinate Care A. Test Tracking and Follow-up B. Referral Tracking and Follow-up C. Coordinate Care Transitions 6. Measure and Improve Performance A. Measure Performance B. Measure Patient/Family Experience C. *Implement and Demonstrate Continuous Quality Improvement D. Report Performance Must pass elements are in red. 8 4

5 PCSP 2016 Standards 1. Working With Primary Care and Other Referring Clinicians 2. Provide Access and Communication 3. Identify and Coordinate Patient Populations 4. Plan and Manage Care 5. Track and Coordinate Care 6. Measure and Improve Performance *2013 vs Cross Walk available 9 9 Outline Who are we? What is PCSP? Why PCSP? Our journey Success stories from 3 practices How to achieve PCSP? 10 5

6 A Personal Story We Are Not As Good As We Thought Survey questions Response # of responses Percentage Provider ordered test in last 3 months Yes % No % Total % Office follow-up with test results Never 45 13% Sometimes 10 3% Usually 43 12% Always % % Health team ask about Rx meds Never 61 9% Sometimes 95 14% Usually % Always % Total % PHC Gateway Press Ganey Report

7 Background: Patient Centered Medical Home Defined by pediatricians in 1967 NCQA has certified 27,000 providers in over 5,000 sites State and private payer certification Benefits: Population management; Marker of quality; Lower copay for patients; PMPM extra payment; Narrow network; 13 Background: Patient Centered Medical Neighborhood Started as a concept in 2008 by Elliot Fisher Result of quality improvement and cost savings mixed from PCMH programs Primary care only accounts for 6% of total health care cost Typical primary care clinic has 229 providers in 117 clinics to coordinate care Communication occurs only 35-81% of time Fisher, Elliott S N Engl J Med 359 (12):

8 Rationale for PCSP Specialty care accounts for the majority of health care cost Issue of care fragmentation Specter of gatekeeping PCSP vital to the medical neighborhood Huang and Rosenthal, N Engl J Med 2014; 370: Will PCSP Prepare You for MACRA? MACRA MIPS Merit-based Incentive Payment System Advanced APMs Advanced Alternative Payment Systems 16 8

9 MIPS 11/28/ Domains in MIPS Pathway Quality (PQRS) Resource Use (VBM) Clinical Practice Improvement Meaningful Use 17 Close Match MACRA Clinical Practice Improvement: Expanded practice access Population management Care coordination Beneficiary engagement Patient safety and practice assessment Participating in APM PCSP Standards: 1.Track and Coordinate Referrals 2.Provide Access and Communication 3.Identify and Coordinate Patient Populations 4.Plan and Manage Care 5.Track and Coordinate Care 6.Measure and Improve Performance

10 PCSP Qualifies for Max CPI Score Outline Who are we? What is PCSP? Why PCSP? Our journey Success stories from 3 practices How to achieve PCSP? 20 10

11 PCSP Project at Portland IPA PCSP Pilot PCSP Expansion PCSP Learning Collaborative PCMH 21 Pilot Project Participated as NCQA s 64 Early Adopters 5 representative practices: women s health, ophthalmology, oncology, cardiology and liver disease Diverse organizational structure, specialty, geographic and referral base, ownership structure Onsite NCQA training sponsored by IPA IPA dedicated, experienced PCSP project manager Corporate or site level recognition 22 11

12 Successful Recognition Compass Oncology Women s Healthcare Associates Providence Heart Clinic Gateway The Oregon Clinic GI Liver Clinic Eye Health Northwest 23 Learning Collaborative Survey Resources needed are available Physician champion and project manager vital Key changes in workflow, data reporting Provider engagement and time commitment challenging Improvement in patient satisfaction, quality and reporting capability 24 12

13 Why did Practices Participate? Payment reform Patient care Standardization Best practices Referrals Confirmation 25 What Did the Practices Focus On? Referral process and agreement Referral response Redesign of the practice team Medication management Implement and demonstrate continuous quality improvement Patient access Specialty practice responsibilities Culturally and linguistically appropriate services Patient population identification and management Patient satisfaction 26 13

14 Key Project Results Standardization of workflow Readiness for MACRA and other new payment models Better referral coordination Access optimization Improved patient satisfaction Process and quality improvement Provider and staff engagement 27 Outline Who are we? What is PCSP? Why PCSP? Our journey Success stories from 3 practices How to achieve PCSP? 28 14

15 Compass Oncology Success Stories Women s Healthcare Associates Providence Heart Clinic 29 Outline Who are we? What is PCSP? Why PCSP? Our journey Success stories from 3 practices How to achieve PCSP? 30 15

16 Stages of PCSP Project Action Plan Transformation Submission Cost for PCSP Recognition No capital investment Increased staffing may be needed to better support new workflow and improve efficiency Total cost for license and application fee= $550 x N+$80 (N= number of of clinicians) For multi-site application: part-time project manager and part-time assistant

17 Action Plan Sample Documents Sample Document Sharepoint Site Workflow Document 33 Key for a Successful PCSP Project Leadership endorsement Dedicated time for the project Standardization of workflow Care Team organization Physician champion and dedicated project manager are vital Detailed documentation of workflow process Ability to report key practice & MU data

18 Potential Challenges Time commitment of project leaders Lack of organizational support Lack of detailed data reporting ability Conflicting initiatives 35 Summary of Benefits of PCSP MACRA readiness No need for capital investment Versatility and multi-payer applicability Blueprint for optimizing the core business of specialty practice Standardizes workflow, data reporting Improves access, referral tracking, care coordination, and patient satisfaction Improves quality of care, provider satisfaction and staff engagement

19 Available Resources NCQA website: PCSP Free on-line tutorials PCMH colleagues Contact us! Thank you! Xiaoyan Huang, MD, MHCM, FACC 38 19