CPC+ Oregon Practice Application Webinar. David Dorr, MD, MS Ron Stock, MD, MA

Transcription

1 CPC+ Oregon Practice Application Webinar David Dorr, MD, MS Ron Stock, MD, MA

2 We Want To Hear From You! Type questions into the Questions Pane at any time during this presentation

3 Presenters David A. Dorr, MD, MS Professor of General Internal Medicine/Geriatrics & Vice Chair of Clinical Informatics Ron Stock MD, MA Clinical Innovation Advisor

4 Agenda 1) What is CPC+? 7) Questions 2) Oregon CPC Experience 3) Payer Information 4) Eligibility Requirements 5) How to Apply 6) Questions

5 Congratulations Oregon!

6 What is CPC+? 5-year model beginning January 2017 Largest primary care model implementation in U.S. history 14 states and regions Up to 5,000 practices Up to 20,000 physicians Up to 25 million patients Multi-payer design 15 Payers in Oregon

7 What are we trying to accomplish? 1) Achieve the Delivery System Reform core objectives of better care, smarter spending, and healthier people in primary care. 2) Advance care delivery and payment to allow practices to provide more comprehensive care that meets the needs of all patients, particularly those with complex needs. 3) Accommodate practices at different levels of transformation readiness through two program tracks (both offered in every region). 4) Engage multiple payers, including CCOs, to align payment, quality metrics, and care delivery in Oregon.

8 Program Design Two tracks for care delivery and payment Track 1: Pathway for practices ready to build the capabilities to deliver comprehensive primary care Track 2: Pathway for practices poised to increase the comprehensiveness of care through enhanced Health IT, improve care of patients with complex needs, and inventory of resources and supports to meet patients psychosocial needs.

9 CPC+ Timeline to Launch

10 Oregon Experience: CPC Reflection 35% 65% 77% 95% 100% improvement in overall PCMH-A scores from have a Patient Family Advisory Council for better patient engagement increase in Risk-stratified care management PCMH-A domain from of Oregon practices risk stratify 75% of empaneled patients of OR practices offer 24/7 access to care

11 Oregon Experience: CPC Reflection 8% decrease in hospital admissions 2.4% decrease in 30-day readmissions

12 CPC Oregon Testimonial: Grants Pass Clinic Founded in 1949 Independent, Multispecialty (mostly primary care) 20 physicians 2 PAs/2 NPs Christi Siedlecki, MSN, RN, CMPE Chief Executive Officer About 110 employees PCPCH 3-STAR designation

13 CPC Oregon Testimonial: Physicians Medical Center Independent McMinnville, OR 24,047 Active Patients William Koenig, DO Pediatrician Yamhill County Health Officer 15 Providers

14 CPC+ Topics 1) What is going to change? 2) How will practices be paid? 3) What kind of IT support will be needed? 4) More information on payer engagement

15 5 Primary Care Functions

16 5 Primary Care Functions

17 Payment Methodology by Track (PBPM) (PBPM)

18 Care Management Fees Determined by Risk Tier

19 Health IT Requirement Overview All Practices By January 1 st, 2017, practices will adopt a 2015 edition of a certified electronic health record technology (CEHRT) Remote access to EHR to ensure 24/7 access to care team members with real time access to medical record Report on electronic clinical quality measures (ecqms) and generate quality reports at practice and panel level. Track 2 Practices Only Work with vendors to support the development and optimization of a set of advanced HIT functions

20 15 Participating Payers in Oregon 1. AllCare Health, Inc. 2. ATRIO Health Plans 3. CareOregon 4. Eastern Oregon Coordinated Care Organization (EOCCO) 5. FamilyCare Health 6. Oregon Health Authority (Medicaid) 7. Moda Health Plan 8. Pacific Source 9. Primary Health of Josephine County 10. Providence Health Plan (PHP); Providence Health Assurance (PHA) 11. Tuality Health Alliance (THA) 12. Umpqua Health 13. Western Oregon Advanced Health, LLC 14. Willamette Valley Community Health 15. Yamhill County Care Organization Inc. Jim Rickards, MD, MBA OHA Chief Medical Officer

21 Practice Eligibility Requirements Primary care practices w/ 150 attributed Medicare FFS beneficiaries Family Medicine, Internal Medicine, Geriatric Medicine Includes MD, DO, NP, PA, CNS Demonstrated readiness in the following areas: Care management, patient access, and quality improvement Exclusions: Concierge Practices, Rural Health Clinics, Federally Qualified Health Centers Note: CMS will accept up to 1,500 practices that are also participating in Shared Savings Program ACOs

22 Application Topics: A. Preliminary Questions: Region, track, eligibility, participation in other Medicare initiatives B. Practice Structure and Ownership: Name, address, ownership type, TIN, CPC participation C. Contact Information: Primary contact, letter of support from clinical leader, HIT contact D. Practitioner & Staff Information: # of clinicians, Meaningful Use attestation progress and plans E. Practice Activities: Medical Home recognition and training of future PCPs F. Health Information Technology: EHR Certification ID, plans for purchasing EHRs Apply Online at:

23 Application Topics Continued: G. Patient Demographics: Race/ethnicity, preferred language H. Practice Revenue and Budget: 2015 revenue, % patients by insurance type I. Care Delivery: Drop-down options for capabilities in care plans, risk stratification, ED & hospitalization follow-up, patient access, and QI J. Letter of Support: Also needed by parent of owner organization if practice is owned by a larger organization or person not working in the practice site Note: Track 2 practices will also need a letter of support from their HIT vendor. Details for the letters of support can be found at the end of the application. Apply Online at:

24 Additional questions in web-based application NOTE: the following are not included in Appendix B of the original RFA 1. Status and details of enrollment in any programs with a no overlaps policy. 2. Participation or plans to participate in an ACO 3. Indication of any satellite offices of your practice 4. List of TINS your practice has used to bill Medicare since January 1, Name of clinical leader who is writing the Letter of Support

25 National Resources & Learning Opportunities Main CPC+ Website: 15 upcoming CPC+ Practice Open Door Forums in August and September. Schedule and registration list: Practice FAQs (updated frequently): Questions? or call the CPC+ Help Desk from 8:30 AM 7:30 PM EDT at

26 Oregon Practice Application Resources Care Management Plus (CMP) Oregon Rural Practice-Based Research Network (ORPRN) Oregon Health Care Quality Corporation (Q CORP) Oregon Health Authority PCPCH Program Oregon Academy of Family Physicians

27 What Questions Do You Have? Type questions into the Questions Pane at any time during this presentation

28 Contact Information Dr. David Dorr: Dr. Ron Stock: Oregon Technical Assistance: