Technical Assistance. Available. Physicians in small, rural and underserved practices can benefit. Know a Physician Interested. in Joining AFMC?

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AR K AN SA S PHYSICIAN Technical Assistance Know a Physician Interested Now Available in Joining AFMC? OUR MEMBERS ARE LEADERS WHO HELP SHAPE ARKANSAS HEALTH CARE SYSTEM AND ITS FUTURE.

Made possible by funding from The Centers for Medicare & Medicaid Services (CMS), the goal is to provide direct, individualized help with the Quality Payment Program (QPP).

1 AR K AN SA S PHYSICIAN Technical Assistance Know a Physician Interested Now Available in Joining AFMC? OUR MEMBERS ARE LEADERS WHO HELP SHAPE ARKANSAS HEALTH CARE SYSTEM AND ITS FUTURE. If you re a doctor of medicine or osteopathy with a current license recognized by the Arkansas State Medical Board and serve Arkansans, you re eligible. TO JOIN: ArkansasPhysician@ afmc.org NEW: You can now receive the Arkansas Physician via your . To sign up, send your address to ArkansasPhysician@ afmc.org. Physicians in small, rural and underserved practices can benefit A FMC is providing free hands-on technical assistance to eligible Arkansas and Mississippi health care clinicians and physician practices. Made possible by funding from The Centers for Medicare & Medicaid Services (CMS), the goal is to provide direct, individualized help with the Quality Payment Program (QPP). The training and education resources, available now, are provided at no cost to eligible clinicians and practices of 1 to 15 clinicians. The technical assistance will help small practices, especially those in historically under-resourced areas including rural, health-professional shortage and medically underserved areas. The U.S. Congress recognized the importance of small and rural practices by funding the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA). It helps clinicians navigate the new alternative payment model without losing focus on their patients needs. Nationally, CMS is leading the transition to alternative payment models as a way to both improve health care and control its costs. Transitioning from the ARKANSAS PHYSICIAN IS A QUARTERLY MEMBERSHIP COMMUNICATION OF AFMC CONTINUED, PAGE 2 VOLUME 7, ISSUE 2 MAY 2017

2 TECHNICAL, CONTINUED FROM FRONT traditional fee-for-service reimbursement, CMS now reimburses a large part of Medicare services based on patient outcomes or valuebased care. MACRA addresses the resources gap between large and small practices by helping transform small practices so they can succeed in the value-based care environment. Without this assistance, CMS feared a large number of physicians would stop serving Medicare patients. AFMC President and CEO Ray Hanley said, AFMC is excited about this new work to help local physicians be more effective and efficient. We have 45 years of experience helping physicians and small practices improve their quality of care, control costs and better engage patients in taking responsibility for their health. These practices are critical to serving the 607,800 Arkansans who rely on Medicare for their health care. Nationally, CMS awarded approximately $20 million to 11 organizations for the first year of a five-year program. CMS intends to invest an additional $80 million over the remaining four years. AFMC expects to enroll 3,486 clinicians representing 2,020 small practices in Arkansas and Mississippi. The unique needs of each clinician and practice are assessed and an individualized action plan is developed. The plan guides AFMC s customized technical assistance, such as help to choose and report on quality measures, assess and optimize health information technology, and direct The Quality Payment Program is modernizing Medicare s reimbursement system to provide better health care and control costs. support to implement change management and strategic planning. AFMC also provides an information technology (IT) specialist to assist clinicians with electronic health record vendor selection, health information technology interoperability, e-prescribing, Meaningful Use optimization, privacy and security assessments. The Quality Payment Program is modernizing Medicare s reimbursement system to provide better health care and control costs. Thousands have received free training and education from CMS staff since the Quality Payment Program began in October Through the established Quality Innovation Networks, the Transforming Clinical Practice Initiatives, and the Alternative Payment Model Learning Systems, every clinician in the Quality Payment Program can receive in-person training, including information about the Merit-based Incentive Payment System (MIPS), as well as the Alternative Payment Model track. For more information, contact the QPP help desk at or qpp-surs@tmf.org. s ARKANSAS PHYSICIAN is a publication for the membership of the Arkansas Foundation for Medical Care (AFMC). Be sure to visit AFMC on our social media outlets: LinkedIn: Go to linkedin.com and search Arkansas Foundation for Medical Care. YouTube: youtube.com/afmctv Facebook: facebook.com/afmcar Twitter: twitter.com/afmc President and Chief Executive Officer Chief Medical Officer Chief Operating Officer Chief Financial Officer Chief Outreach Services Officer Chief Technology Officer Chief Administrative Officer Chief Compliance Officer Chief Public Affairs Officer Ray Hanley Chad Rodgers, MD, FAAP Marilyn Little Mary Counts Peggy Starling, FACMPE Nathan Ray, MBA Catherine Bain Susie Moore, CCEP Melissa Masingill CONTENT COPYRIGHT 2017, ARKANSAS FOUNDATION FOR MEDICAL CARE, INC. PORTIONS OF THIS MATERIAL WERE PREPARED BY THE ARKANSAS FOUNDATION FOR MEDICAL CARE INC. (AFMC) PURSUANT TO A CONTRACT WITH THE ARKANSAS DEPARTMENT OF HUMAN SERVICES, DIVISION OF MEDICAL SERVICES. THE CONTENTS PRESENTED DO NOT NECESSARILY REFLECT ARKANSAS DHS POLICIES. THE ARKANSAS DEPARTMENT OF HUMAN SERVICES IS IN COMPLIANCE WITH TITLES VI AND VII OF THE CIVIL RIGHTS ACT. 2 AFMC ARKANSAS PHYSICIAN MAY 2017

The Power of the Portal GUEST EDITORIAL Many recent technological advances have helped improve health care delivery.

Many patients are discovering they can use technology and internet-based tools to learn about and improve their health by monitoring daily activity, heart rate, calorie intake, medication schedules

This helps meet the triple aim of improved health outcomes, better patient care and lower costs.

3 The Power of the Portal GUEST EDITORIAL Many recent technological advances have helped improve health care delivery. While increasing the time we spend with our computers, tablets and smartphones, technology has decreased the time we spend with our patients. Many patients are discovering they can use technology and internet-based tools to learn about and improve their health by monitoring daily activity, heart rate, calorie intake, medication schedules and more. In an attempt to improve everyone s health, the focus continues to be on increasing patient engagement to manage their health care. This helps meet the triple aim of improved health outcomes, better patient care and lower costs. To help achieve Meaningful Use (MU) requirements, electronic health record vendors have developed patient portals to help doctors achieve the goal of engaging patients electronically. Patient portals provide a variety of functions including requesting medical records (care plans, labs, visit notes, etc.), making appointments, requesting refills, paying bills, and communicating with the physician and staff in a secure way that meets HIPAA guidelines. Patients can access portals through their home computer, tablet, laptop or smartphone. Through a contract with Arkansas Medicaid, AFMC conducted the 2016 Patient Engagement Satisfaction Survey of Medicaid recipients and physicians. The majority of recipients surveyed, who had used their PCP s patient portal, reported they were very satisfied or somewhat satisfied. Also of interest, the majority of recipients were unaware that their PCP had a patient portal, despite the fact that the majority (80%) of physicians surveyed had one. In order to meet MU requirements, physicians need to make timely access available to 50 percent of their unique patients during a reporting period and have 5 percent of their patients log onto their portal and view, download or transmit a part of their medical record. What can your practice do to help patients become more engaged through the use of a portal? Physicians and staff can use these best practices. First, educate patients that portals are a secure way to view and communicate their health information. Patients should receive a temporary login at registration. If tablets are available, patients can login during their first clinic visit and set up their account. Make educational materials and posters about the portal available at multiple touch points throughout the clinic including the lobby, exam room, lab waiting room and checkout. Having clinic staff discuss and encourage portal use throughout the visit is helpful. The physician should encourage patients to use the patient portal. Physician leadership and encouragement to use the portal is the most fundamental step to successful patient portal use. Patient portals vary widely and most can be tailored to meet both practice and patient needs. As portal use increases, so will its technological capabilities and ease of use. AFMC is developing materials and working with practices to help meet these goals. s Chad Rodgers, MD, FAAP Chief Medical Officer, AFMC AFMC ARKANSAS PHYSICIAN MAY

Preparing for the Future of Health Care By Rhelinda McFadden, RN; Chad Rodgers, MD, FAAP; and Steven Chasteen, MNSc, RN Since the launch of the Arkansas Healthcare Payment Improvement Initiative

4 Preparing for the Future of Health Care By Rhelinda McFadden, RN; Chad Rodgers, MD, FAAP; and Steven Chasteen, MNSc, RN Since the launch of the Arkansas Healthcare Payment Improvement Initiative (APII) in 2012, providers have placed Arkansas in the national transforming how you provide care, you may not be able to avoid upcoming payer penalties. In addition, you could be leaving earned incentive payments on the table. In 2017, Arkansas providers will continue to be at the national forefront requirements and become more user friendly. The redesigned PCMH recognition program now has a single recognition level. It evaluates and builds on a practice s transformation successes through continuous improvement and health policy spotlight. Our state has with the Comprehensive Primary Care annual check-ins to strengthen practices become a leader by shifting a majority of Plus (CPC+) program and PCMH. Both as medical homes. Arkansas beneficiaries care in Medicaid programs put Arkansas providers ahead The NCQA PCMH 2017 recognition and private health insurance to value- of the curve in utilizing transformation standards seamlessly align with with the Arkansas PCMH program, CPC+, for NCQA PCMH recognition. AFMC employee. It s work done for Arkansans, based models. Arkansas patient-centered efforts that align with the nation s health the CMS Medicare Access and CHIP NCQA PCMH recognition or the QPP. offers a baseline readiness assessment by Arkansans. As a designated NCQA medical home (PCMH) model is one of care goals: better care, smarter spending Reauthorization Act s (MACRA) Quality In Arkansas, there are currently 229 to pinpoint activities, workflows PIQ, AFMC can provide support services the largest in the United States. It has and healthier people. Payment Program (QPP) Merit-Based NCQA recognized providers in 88 NCQA and policies to address as practices to help practices achieve NCQA PCMH grown from 123 practices in 2014 to more than 190 in Supported by scientific evidence, PCMHs are saving money by reducing Incentive Payment System (MIPS) track. Clinicians will receive Medicare recognized practice locations. TIED TO VALUE-BASED PAYMENTS begin PCMH transformation. AFMC is committed to guiding each practice recognition. Entities designated as NCQA PIQ receive an application Arkansas APII program has designed a treatment costs, improving quality of bonuses or penalties based on their The CMS and Arkansas payers have through the process. NCQA PCMH may discount code. This allows AFMC to PCMH model that mirrors national PCMH care and improving outcomes. Patient- performance in four measure areas: proven their commitment to patient- not be the best option for every practice offer financial discounts per clinician/ standards and aligns with the Centers centered care is no longer just a buzz quality (formerly PQRS), advancing care centered care through payment redesign and AFMC will provide the information per practice for their NCQA recognition for Medicare & Medicaid Services (CMS) phrase. It is the heartbeat of the type of information (formerly the EHR incentive efforts. The majority of care must be tied needed to make a well-informed application fees. AFMC is the only goals. It embraces payment innovation to incentivize providers for decreasing costs and improving outcomes. In 2014, care that Arkansas providers must offer in order to transform their practices. BENEFITS OF NCQA RECOGNITION program/meaningful use), clinical practice improvement activities (CPIA) and resource use measures. Each of the to value-based payments by There is no requirement by Arkansas Medicaid or Arkansas Blue Cross Blue Shield that a decision. DISCOUNTS AVAILABLE AFMC has consistently been non-health plan company in Arkansas to have NCQA PIQ designation. If your practice is considering NCQA PCMH Arkansas Medicaid s PCMHs received AFMC is a National Committee for four measures align with the goals of PCMH participate in a designated PCMH Arkansas providers primary resource for recognition, contact your AFMC practice more than $12 million in per member Quality Assurance (NCQA) Recognition PCMH. A practice can achieve full credit recognition or accreditation program. education and support for the constantly transformation team to learn how AFMC per month (PMPM) payments and 19 Program Partner in Quality (PIQ) and can for the CPIA category by earning NCQA AFMC has taken a proactive approach changing health care landscape. AFMC s can help, at pcmhpt@afmc.org s practices shared more than $8 million of assist Arkansas providers in achieving recognition. However, a practice must to support Arkansas providers who want core mission remains the same: help the more than $20 million in savings with NCQA PCMH recognition. NCQA PCMH is earn recognition by Oct. 1, 2017, to to achieve NCQA PCMH recognition. health care providers deliver the best Ms. McFadden is AFMC s manager the state. TRANSFORMING PRACTICES the most widely adopted PCMH model for primary care practice transformation. receive full credit in the CPIA category, which is 15 percent of the MIPS score. AFMC s team consists of six PCMHcertified content experts (CCE) who can quality care, at the lowest cost, and empower patients to take control of of PCMH practice transformation; Dr. Rodgers is AFMC s chief medical officer; Health care is undergoing major Since the NCQA PCMH recognition The AFMC Practice Transformation help practices identify transformation their health. This is the personal and Mr. Chasteen is AFMC s director of practice changes. If your practice is not program began in 2008, it has simplified team can support Arkansas practices opportunities and streamline processes professional commitment of each AFMC transformation. 4 AFMC ARKANSAS PHYSICIAN MAY 2017 AFMC ARKANSAS PHYSICIAN MAY

5 PROVIDER SPOTLIGHT SAVE THE AFMC NEWS DATE The Center for Pediatric and Adolescent Medicine, Fort Smith Very few clinics in Arkansas see as many Medicaid patients as The Center for Pediatric and Adolescent Medicine in Fort Smith. The practice has grown a patient population in the thousands over its 32 years in business. But when it came to transforming the clinic into a patient-centered medical home, the team was pretty lost. We had an EMR (electronic medical record); we just weren t really using it, said Anita Deschryver, a registered nurse and the PCMH lead at The Clinic for Pediatric and Adolescent Medicine. The doctor did not want to touch it, he didn t want anything to interfere with his workflow. We had written out hundreds of care plans on paper, which of course didn t work for PCMH. We weren t doing so well. Two years ago, AFMC met with Deschryver and advanced practice nurse Mary Lynn Holland to discuss PCMH practice transformation services. It was a meeting that revealed a very tough path for the clinic to follow. However, AFMC guided the team through EMR use, care plan implementation and even nursing staff buy-in. Nobody wanted to do it, they (the nurses) didn t want it to interfere with their daily routine, AFMC board of directors election AFMC s physician membership has approved seven candidates to serve on the board of directors: Michael Moody, Salem, was elected to his first full term and is eligible for re-election Tom Butler, Little Rock, was elected to a second term and is eligible for re-election Amy Dunn-Johnson, Little Rock, was elected to a second term and is eligible for re-election Karen Pettit, Jonesboro, was elected to a second term and is eligible for re-election said Deschryver. Now, they re coming to me and recommending patients to be high-priority. They re coming back and asking if patients should be high-priority and whether they need a checkup when they re in the office. It s not just the nursing staff, either. Dr. James Cheshier has also bought in, making recommendations on high-priority beneficiaries and giving more detailed orders on care plans. Since Cheshier wanted to avoid using the computer to maintain his workflow, he dictates to his staff who then update the EMR. It s just one of the ways the clinic found its own unique ways to meet the requirements of PCMH. And it s working. Just two years after its first meeting with AFMC s practice transformation team, The Center for Pediatric and Adolescent Medicine is participating in shared savings, a feat that looked impossible not long ago. Had we not had the help of the AFMC team, we never would have achieved this, said Holland. The meetings we went to were so helpful. We had a lot of obstacles to get over, but with AFMC s help, we managed it. To find out how AFMC can help your clinic with practice transformation, visit afmc.org/pt. s Melissa Pierce, West Memphis, was elected to a second term and is eligible for re-election Ladell Douglas, Hope, was elected his first term Harvey Potts, Fort Smith, was elected to his first term The membership elected the directors at the annual AFMC membership meeting held May 5 at AFMC corporate offices in Little Rock. For additional information, contact AnnaMarie Sullivan at asullivan@afmc.org or s 6 AFMC ARKANSAS PHYSICIAN MAY 2017

ARKANSAS MEDICAL HISTORY SOURCE: Ray Hanley Arkansas Medical History Rail ambulances Now commonplace worldwide, the ambulance has been shuttling emergency patients from location to location since the

6 ARKANSAS MEDICAL HISTORY SOURCE: Ray Hanley Arkansas Medical History Rail ambulances Now commonplace worldwide, the ambulance has been shuttling emergency patients from location to location since the 1400s. While the automotive ambulance is the one we re most familiar with today, it has taken on various forms throughout history. One lesser known version is the rail ambulance, a motorized vehicle designed to operate on railroads. The rail ambulance pictured belonged to Dierks Lumber and Coal Company, a Nebraska company that owned lumber yards in Iowa and Southwest Arkansas. Companies used rail ambulances in areas where roads were hazardous or non-existent, providing relatively rapid medical service to injured workers. While these rail ambulances could only reach a top speed of 20 miles per hour, they were often the only means of medical transportation available. Most rail ambulances went out of commission by the 1970s as roads became ubiquitous and better maintained. However, they are still in service in countries like India, where they are used for both emergencies and as mobile medical facilities in non-emergency situations.s AFMC ARKANSAS PHYSICIAN JANUARY

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for the Future of Health Care Provider Spotlight AFMC News AFMC Board of Directors Election Arkansas Medical History The Center for

7 1020 W 4TH ST STE 300 LITTLE ROCK AR NONPROFIT ORG. U.S. POSTAGE PAID LITTLE ROCK, AR PERMIT NO ADDRESS SERVICE REQUESTED IN THIS ISSUE OF ARKANSASPHYSICIAN Technical Assistance Now Available The Power of the Portal Preparing for the Future of Health Care Provider Spotlight AFMC News AFMC Board of Directors Election Arkansas Medical History The Center for Pediatric and Adolescent Medicine, Fort Smith FOR MORE INFORMATION ABOUT JOINING AFMC OR TO SUBSCRIBE TO ARKANSAS PHYSICIAN: ArkansasPhysician@afmc.org

Here is what we know. Here is what you can do. Here is what we are doing.

Here is what we know. Here is what you can do. Here is what we are doing. With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the