ACO Practice Transformation Program

Transcription

1 ACO Overview ACO Practice Transformation Program PROGRAM OVERVIEW As healthcare rapidly transforms to new value-based payment systems, your level of success will dramatically improve by participation in our training program. We provide you with a comprehensive training program for executive leadership, trustees, clinicians, care coordinators, IT staff and practice managers. Through frequent webinars, local quality improvement workshops and leadership summits, we will help you better manage your population, improve quality scores and patient satisfaction, and achieve financial success. Many of these meetings can be attended real time or at your own convenience, using our online educational portals. VALUE-BASED TRAINING FOR YOUR TEAM We have a lot to learn together. The faster we can all get up to speed, the sooner we will begin to realize the benefits of the new value-based payment systems. Our program offers targeted, timely information that is available real-time or on demand. We recommend the following participation for each role in your organization: Executive Leaders attend the Pre-Launch Webinar Series, Launch Meeting, Steering Committee Meetings, Annual Delivery System Reform Workshop and Monthly CEO Cohort Calls. Care Coordinators attend the Pre-Launch Webinar Series, Launch Meeting, Steering Committee Meetings, Quarterly Quality Improvement Workshops, All Program Webinars (Live or On Demand) and Monthly Care Coordinator Cohort Calls. IT Staff attend the Nurse Advice Hotline, Introduction to Lightbeam Data Warehouse and Introduction to Quality Measures and Reporting Webinars in addition to the Launch Meeting and Steering Committee Meetings. Practice Champions and Practice Managers attend the Pre-Launch Webinar Series, Launch Meeting, Steering Committee Meetings, Quarterly Quality Improvement Workshops, All Program Webinars (Live or On Demand) and Monthly Practice Manager Cohort Calls. Clinicians attend the Launch Meeting, Steering Committee Meetings, Annual Delivery System Reform Workshop, Evidence-Based Medicine Webinars and Monthly Physician Cohort Calls. 1

2 A SECURE FUTURE FOR PROVIDERS In order to be successful under new payment models, practices must optimize workflow to promote population health and maximize quality. They must deploy care coordinators to manage the chronically ill and ensure patients are satisfied with their experience of care. Our program will get your healthcare system ready step-by-step, setting up programs, redesigning processes and sharing best practices to deliver the results you need while at the same time protecting your financial security. The following is a list of all programs and trainings available to your practice: Welcome to your new program: Get a complete overview of all program requirements, learn what is expected from you and your practices, and discover how you can be successful in the program. Care Coordination: Everything you need to know to help chronically ill patients get the care they need, build market share and begin billing Medicare for new Chronic Care Management and Transitions of Care Management codes. Data and Analytics: Learn more about your patients and your health system than ever before, including where they go for care, what services they seek, what drugs they are really taking, and where you need to focus to achieve better care at lower costs. Quality Improvement: Optimize your workflow to improve quality scores, patient outcomes and practice revenues. Quality Reporting: Simplify your quality reporting by using the Lightbeam platform with pre-loaded data and easy to use processes for documenting your scores. Patient Engagement: Improve patient satisfaction and engagement in management of their health, and increase compliance, loyalty and market share. Evidence-Based Medicine: Keep your clinicians up-to-date with the latest evidence supporting population health and earn Continuing Medical Education (CME) credits. Delivery System Reform: Learn about new payment models that reward you for improving the health and well-being of the community, and how to adapt and succeed under Delivery System Reform. Clinically Integrated Networks: Join other independent organizations in your state to take advantage of value-based contracts that will reward you for high quality and managing cost. Application, Legal and Administrative Services: Use our proven, turnkey system to successfully apply for shared savings programs and use our pre-existing legal documents to reduce cost and minimize risk. For more information, please see the detailed descriptions of each program. 2

3 WELCOME TO YOUR NEW PROGRAM FOR LEADERS, PRACTICE MANAGERS, CLINICIANS, PRACTICE CHAMPIONS, CARE COORDINATORS, IT STAFF, MARKETING STAFF Get a complete overview of all programs, learn what is expected from you and your practices, and discover how you can be successful in the program and hit the ground running. Once you have submitted your application, your organization waits five months for final approval by Medicare. Our pre-launch webinars keep your staff engaged and help them learn about the program. Once approved, our experts will come on-site to launch your program and engage your staff and clinicians. Pre-Recorded Webinars: Program Basics Assembling Your Team Roadmap for Success Care Coordination Program Overview The Clinician s Role in Transformation Nurse Advice Hotline Introduction to Lightbeam Data Warehouse Introduction to Quality Measures and Reporting Patient Satisfaction Practice Champion Role & Provider List Management Communication / Marketing About Your Program Legal and Governance 101 Waivers and Compliance Launch Meeting Our staff will come to your community to meet with clinicians, hospital staff, board members and community members to kick off your program and prepare you for success. After a general education session, we will meet with your Steering Committee, sharing data that is unique to your community. We will map out the strategies that have been shown to be effective and get your team motivated, informed and prepared to begin changing how they interact with patients to improve population health. 3

4 CARE COORDINATION FOR CARE COORDINATORS, PRACTICE CHAMPIONS AND IT STAFF Everything you need to know to help chronically ill patients get the care they need, build market share and begin billing Medicare with the new Chronic Care Management and Transitions of Care Management codes. The essential element for value-based payment success is the coordination of care for patients with multiple chronic diseases. Special attention will be paid to managing the chronically ill, promoting evidence-based practices and helping patients learn selfmanagement of their disease. Patients with two or more chronic conditions will be encouraged to participate in your Care Coordination program, resulting in better outcomes, lower per capita costs and better alignment with the 20% of your patients that comprise 80% of healthcare spending in your community. Generally led by a nurse in your practice or community, the Care Coordination program will use both local and virtual care teams of pharmacists, mental health professionals, advice nurses, nutritionists and community resources to support this fragile population. They will take the burden off of the physicians in the clinics and the emergency room by providing the support needed to manage their disease and avoid unnecessary hospitalizations and readmissions. Regular physician visits will be supported by clear patient goals to maximize compliance and adherence to the care plan. Referrals will be tracked and accompanied by patient data and care coordination support, ensuring a closed loop of information and the avoidance of wasteful, duplicate procedures. The care coordinator will use the Lightbeam Health Care Management module to develop care plans, track patients progress and document their work for Chronic Care Management billing. Lightbeam predictive analytics will be used to create patient registries to identify patients who can benefit from Care Coordination. Our evidence-based Nurse Advice Hotline has 24/7 access to the electronic care plan through Lightbeam, enabling you to successfully bill Medicare an average of $40 for each patient your care coordinator provides care management support for a minimum of 20 minutes per calendar month. Our care coordinator mentors, cohort calls, training, workshops and certification are all designed to develop this important skill within your practice. 4

5 CARE COORDINATION CONTINUED Nurse Advice Hotline Questionnaire Care Coordinator Questionnaire Quarterly Quality Improvement Workshops Lightbeam Health Care Management Module Sample Care Coordinator Care Plans 24-Hour Nurse Advice Hotline with access to your Electronic Care Plans Iowa Chronic Care Consortium Online Training Program In-Person Health Coach Certification Chronic Care Management Billing and Coding Workflows and Assistance Individual Care Coordinator Mentoring Care Coordinator Cohort Calls Quality Improvement Workshops Iowa Chronic Care Consortium Online Training Program Webinars On Demand Care Coordinator Cohort Calls WEBINAR AND WORKSHOP TOPICS Transitions of Care Management / Chronic Care Management Overview Establishing Your Nurse Advice Hotline Chronic Care Management Billing for Medicare Lightbeam Health Care Management Module Iowa Chronic Care Consortium Training Program NOTE: THE NURSE ADVICE HOTLINE CAN BE EXPANDED FOR PATIENTS BEYOND MEDICARE FOR A FEE OF $0.25 PER PATIENT PER MONTH. 5

6 DATA AND ANALYTICS FOR EVERYONE Learn more about your patients and your health system than ever before, including where they go for care, what services they seek, what drugs they are really taking, and where you need to focus to achieve better care at lower costs. The most important element of participating in a value-based payment model is getting complete claims data on your patient, regardless of where the patient received care. Every community health system has unique strengths and weaknesses. Getting claims data on your patients will help you focus on the issues that are meaningful and impactful for improving quality and lowering costs, and help you avoid spending valuable time and resources on issues that are not relevant to you and your patients. Generally, 25% or more of high-risk, high-cost patients are not receiving regular care from a primary care clinician. Getting the full claims data helps you identify these patients and provide them with the support they need to help them manage their disease. In value-based payments, you become accountable for all of the care your patients receive, regardless of where they went for care or why. This makes you the quarterback -- the coach of your patient s health and well-being. This means that if they over-utilize the Emergency Department, whether it is local or outside the community, it is your job to find out why and help them get the care they need in the most appropriate setting. Claims data will help you identify those patients. Being successful in value-based payments also requires that you are more selective about where your patients are referred. Claims data is a rich source of information about the quality and cost of your tertiary, specialty and post-acute care network. Our analysts will work with your clinicians to better understand the best partners for your patient s care. Your care coordinator will use Lightbeam to identify high-risk patients for additional support and to set up transition programs with your high-volume providers. Your practice will use the program to identify gaps in care and improve quality scores. Your practice staff will use the program to provide clinicians with data about where the patient has been, what drugs are being refilled and how often, and to identify gaps in care that can be addressed at the time of the visit. 6

7 DATA AND ANALYTICS CONTINUED IT Questionnaire Lightbeam Health Analytics Platform Lightbeam Health Care Management Module EHR Interface to Lightbeam Platform Monthly Training Webinars Lightbeam User Group Quarterly Community Performance Scorecards Quarterly Expenditure and Utilization Reports Quarterly Community Expenditure and Utilization Reports Analyst Support at Quarterly Steering Committee Meetings Practice-Specific Improvement Recommendations Quarterly Quality Improvement Workshops Quality Improvement Workshops User Group Meetings Webinars On Demand Super-User Cohort Calls Steering Committee Meetings WEBINAR AND WORKSHOP TOPICS Introduction to Lightbeam Data Warehouse Introduction to Quality Measures and Reporting Transitions of Care Management / Chronic Care Management Overview Lightbeam Health Care Management Module Nurse Advice Hotline Implementation Lightbeam User Group NOTE: THE ANALYTICS PLATFORM CAN BE EXPANDED FOR PATIENTS BEYOND MEDICARE WHERE CLAIMS DATA IS AVAILABLE FOR A FEE OF $1.00 PER PATIENT PER MONTH. 7

8 QUALITY IMPROVEMENT FOR PRACTICE MANAGERS, PRACTICE CHAMPIONS, CARE COORDINATORS, IT STAFF Optimize your workflow to improve quality scores, patient outcomes and practice revenues. High quality scores show your community that you have implemented critical patientcentered processes that promote prevention, wellness and standards of care for high risk populations, and will have a dramatic impact on your payments under delivery system reform. This program is designed to help you attain the highest level of quality scores with the least amount of wasted effort and confusion. We begin with teaching your staff our version of the Medicare Wellness Visits at your Quality Improvement Workshop, which addresses 100% of your preventive measures and lays the groundwork for improved coding and documentation. Successfully implementing this program for at least half of your Medicare patients will help keep your community healthy, extend life expectancy, prevent progression of silent diseases and generate significant income. We will develop an individual work plan for your practice and follow up to help your staff implement the programs that will get your quality scores into the top percentiles with the least amount of disruption to your practice. Once your staff has mastered optimizing prevention and wellness, we will work with your practice managers to redesign workflows to manage diabetics, patients with heart disease, ischemic vascular disease, pulmonary disease and other diseases that are routinely measured for value-based payments. We will interface your electronic health record and monitor your progress using the Lightbeam Health Quality Reporting module. If data is not being collected or recording properly, our quality improvement specialists will help you modify your workflow to ensure your quality scores reflect your work. On a monthly basis, practice managers can participate in cohort calls to share best practices, and learn from their peers about how they are able to overcome barriers, innovate solutions and share their successes. Pre-recorded webinars are also available for more information. 8

9 QUALITY IMPROVEMENT CONTINUED Quarterly Quality Improvement Workshops Lightbeam Health Quality Reporting Module Lightbeam EHR Interface Quality Improvement Specialists Practice Manager Cohort Calls IT Questionnaire Practice Assessments Quality Improvement Workshops Webinars On Demand Practice Manager Cohort Calls WEBINAR AND WORKSHOP TOPICS Using Lightbeam to Improve Quality Measures Prevention and Wellness Billing and Coding for Value-Based Payments Post-Acute Care Diabetes CHF Vascular Disease Pulmonary Disease Behavioral and Mental Health 9

10 QUALITY REPORTING FOR CLINICIANS, PRACTICE MANAGERS, IT STAFF, PRACTICE CHAMPIONS Simplify your quality reporting by using the Lightbeam platform with pre - loaded data and easy to use processes for documenting your scores. All value-based payments are affected both by quality scores and total expenditures. Accurate and complete reporting of the quality measures is required. Low quality scores reduce your income and can disqualify you from participation. We will interface your Electronic Health Record to Lightbeam using easy-to-maintain and inexpensive flat files to transfer the clinical data needed for your quality scores. Most vendors do not charge fees on their end for this connection. Our IT and quality improvement staff will review your data and work with your team to identify data gaps and determine how to overcome them either though modifying where and how your staff enters data or modifying the fields we use for extraction. We will also work with your practice to improve your quality scores over time. Our proprietary version of the Annual Wellness Visit addresses eleven Clinical Quality Measures in a single visit, improves patient outcomes and brings significant new revenue to the practice. The Lightbeam platform generates care gap reports as part of a comprehensive face sheet for each patient. You can also drill down on your measures to generate a list of your patients that are out of compliance. Once a year, CMS will send us the list of patients and the measures required for quality reporting from your practice. We will pre-load those patients into Lightbeam, where you can enter additional data from their charts, and upload supporting documentation for worry-free audits. When ready, we will upload your data to the CMS GPRO website, so you can avoid common system crashes and unnecessary training. In addition, if you are required to perform annual CAHPS patient satisfaction surveys to a list of patients provided by CMS, we will use a CMS-approved vendor to complete the survey, and give your participants a breakdown of their individual scores. We also provide in-office patient satisfaction surveys with monthly reports that will help you predict your performance on the survey and address areas that need improvement. 10

11 QUALITY REPORTING CONTINUED IT Questionnaire Lightbeam Health Analytics Platform EHR Interface to Lightbeam Platform Training Webinars Evidence-Based Medicine Webinars Quality Reporting User s Group CAHPS Surveys CAHPS Community Performance Scorecards Quality Measures Community Performance Scorecards Analyst Support at Quarterly Steering Committee Meetings Practice-Specific Improvement Recommendations Quarterly Quality Improvement Workshops In-Office Patient Satisfaction Survey Quality Improvement Workshops Lightbeam User Group Meetings Webinars On Demand Quality Reporting Cohort Calls Steering Committee Meetings WEBINAR AND WORKSHOP TOPICS Introduction to Lightbeam Data Warehouse Introduction to Quality Measures and Reporting Lightbeam User Group Using Lightbeam to Improve Quality Measures Prevention and Wellness Billing and Coding for Value-Based Payments Post-Acute Care Diabetes CHF Vascular Disease Pulmonary Disease Behavioral and Mental Health Integration 11

12 PATIENT ENGAGEMENT FOR PRACTICE MANAGERS AND PRACTICE CHAMPIONS Improve patient satisfaction and engagement in management of their health, and increase compliance, loyalty and market share. Value-based payments are heavily weighted toward patient satisfaction, which frequently comprises up to 25% of your total quality score and quality score payment. CMS requires patients to be surveyed for population health programs about their experience in the ambulatory setting asking them whether they are getting timely care and access to specialists, how the provider communicated and whether they felt included in the decision-making, whether they were given educational materials and support that promoted their health, and asking them to rate their provider and their overall health status. Getting high scores in patient satisfaction often translates to better patient loyalty and engagement in managing their disease, resulting in better outcomes and financial performance. We provide a brief in-office survey using electronic tablets so that you can get inexpensive, real-time feedback from your patients about their experience of care. You can view your results at any time, and we also monthly patient satisfaction reports to your practice manager. We will also focus a local quality improvement workshop specifically on patient satisfaction, so that your practice manager can learn best practices to achieve the highest possible rating. Patient Satisfaction Survey Questionnaire Patient Satisfaction Survey Tablets Patient Satisfaction Survey Reports Patient Satisfaction Quality Improvement Workshop Practice Assessments Practice Manager Cohort Calls Quality Improvement Workshops Webinars On Demand Practice Manager Cohort Calls WEBINAR TOPICS Patient Satisfaction Survey Implementation Patient-Centered Medical Homes 12

13 EVIDENCE-BASED MEDICINE FOR CLINICIANS Keep your clinicians up-to-date with the latest evidence supporting population health and earn Continuing Medical Education (CME) credits. Our Evidence-Based Medicine program will keep your clinicians abreast of the latest recommendations for prevention, wellness and managing chronic diseases. New topics are introduced each quarter via an interactive webinar and via our online CME webinar bank. Evidence-Based Medicine Webinars Continuing Medical Education Credits Chief Medical Officer Medical Director Choosing Wisely Patient Education Materials Evidence-Based Medicine Webinars Quarterly Clinician Cohort Calls WEBINAR AND WORKSHOP TOPICS Introduction to ACO Quality Measures and Reporting Lightbeam User Group Annual Wellness Visits, Prevention and Wellness Billing and Coding for Value-Based Payments Post-Acute Care Diabetes Heart Failure Vascular Disease Pulmonary Disease Behavioral and Mental Health 13

14 DELIVERY SYSTEM REFORM FOR EXECUTIVE LEADERSHIP, TRUSTEES, CLINICIANS, PRACTICE CHAMPIONS Learn about new payment models that reward you for improving the health and well-being of the community, and how to adapt and succeed under Delivery System Reform. The pace of change in healthcare payment is unprecedented. New policies and acronyms are introduced constantly, making it very hard for leaders, clinicians and board members to keep apprised of the changes while still serving their patients needs. We will review all of the policies that are currently proposed and in development, and give you specific instructions about how you can engage in developing those new policies and programs to ensure they work for you and your patients. We will notify you of these proposed policies by , and have policy update webinars to keep you abreast of where change is going and to give you an opportunity to provide feedback to policymakers. We also provide a local annual Delivery System Reform workshop for clinicians and trustees to clearly explain all of the different value-based programs and payments under Medicare. These are designed to enable you to bring your entire board and the majority of your clinicians together so that we can facilitate conversations among you about how to approach these new models of care and payment. We will provide advice from top legal firms and nationally recognized leaders about how you should modify your contracts, programs and policies to keep pace with delivery system reform and work with your teams to develop an individual work plan for your community health system. Policy Update s Policy Update Webinars Annual Delivery System Reform Workshop Practice Assessments Sample Physician Contracts Policy Update s Policy Update Webinars Delivery System Reform Workshop 14

15 CLINICALLY INTEGRATED NETWORKS FOR EXECUTIVE LEADERSHIP, CLINICIANS, PRACTICE CHAMPIONS Join other independent organizations in your state to take advantage of valuebased contracts that reward you for high quality and managing cost. The key to accessing value-based payments is critical mass. Payors are reluctant to engage with individual practices due to the high variability of healthcare spending. Most require thousands of attributed lives to participate in their programs. Our providerowned and governed Clinically Integrated Networks allow you to access extra payments, claims data and other resources to help support your patients. We aggregate independent providers in your state to take advantage of these contracts, providing the legal structure and documents, leadership and governance model that has been tested in dozens of Accountable Care Organizations that aggregate unaffiliated and independent providers. Our professional negotiator will develop value-based contracts on behalf of the Network members, which each practice is free to either accept or reject. These contracts typically pay an additional care coordination fee and have a quality reporting and bonus component in addition to a shared savings component. These contracts do not affect existing reimbursement in any way. We do not negotiate rates and we do not bind anyone to risk-bearing contracts. Entity Formation Legal Documents Payor Negotiator Governance Support Clinically Integrated Network Webinar Clinically Integrated Network Conference Calls Clinically Integrated Network Meetings 15

16 FINANCIAL AND MANAGEMENT CONSULTING FOR EXECUTIVE LEADERSHIP AND CLINICIANS Work closely with highly trained financial consultants to analyze opportunities and threats, transition revenue from low-value programs that face obsolescence, and maximize reimbursement that supports managing your population s health. Healthcare reform is about transitioning payments as much as it is about providing greater support for our patients. Our network of Financial and Management Consultants have undergone unique training, making them experts in population health and value-based payments. In addition to helping you maximize earnings for providing the type of care that succeeds under value-based payment models, our CPAs and seasoned consultants will help you understand where payment is going in the near future and where your organization may be vulnerable. They will help you plan for transitioning payments, and educate your billers and coders on new codes and new methods of ensuring your patients are completely and accurately assigned risk scores that will have significant impact on your revenue. They can provide detailed analysis of the pros and cons of different methods of billing Medicare services, and help you fully understand the implications of entering into different shared savings models and/or risk-based contracts. Value-Based Reimbursement Trained Financial and Management Consultants Billing and Coding Webinars Policy Update Webinars 1:1 Meetings with Financial and Management Consultants 16

17 APPLICATION, LEGAL AND ADMINISTRATIVE SERVICES FOR EXECUTIVE LEADERSHIP, CLINICIANS, PRACTICE CHAMPIONS Utilize proven, turnkey systems to successfully apply for Advanced Payment Models, using our pre-existing legal documents to reduce cost and minimize risk. New programs can easily incur hundreds of thousands of dollars in fees creating the legal framework for participation. The application processes are not simple, and errors can prevent you from participation or result in you getting a small fraction of patients attributed. Our success rate on CMS applications is greater than 90%. You can leverage our experience, processes and time-tested legal agreements to reduce the cost, risk and complexity of your application and day-to-day operations. Application Template Participation Agreement Business Associate Agreement ACO/CIN Operating Agreements ACO/CIN Bank Account Setup Accounting Services ACO/CIN State License Organized Healthcare Arrangement Agreement Medicare Shared Savings Program-Enabled Waiver Compliance Plan Compliance Officer Executive Director Legal Services D&O Insurance /Cybersecurity Insurance Application Webinars Pre-Launch Webinars 1:1 Consultation 17