Practice Transformation Network (PTN) An Overview for FQHC Leadership

Transcription

1 Practice Transformation Network (PTN) An Overview for FQHC Leadership

2 PTN What Is It? The Practice Transformation Network is: A group that joins together (CHCACT member organizations, specialty providers, and others) To provide provider practices with resources, quality improvement expertise, coaching & training, and shared best practices To build on-the-ground infrastructure and processes to deliver high quality care.

3 PTN What Is It, Really? Culture Change This is not a project with a start and end date. PTN is a new way of conducting business. Your resources learn best practices on creating a highly effective clinical and team-based care environment for your patients.

4

5 Why Should You Care? Top 3 Reasons: Payment reform Clear benefits for FQHCs Patient impact

6 Payment Reform Migration away from encounter-based reimbursement toward a payment model that is derived from a combination of factors, including but not limited to: - Quality of care as measured by clinical effectiveness - Patient engagement (care compliance) - Reductions in high-cost behaviors (hospital ED visits) Your financing model is going to change.

7 How Did We Get Here? Transforming Clinical Practice Initiative - Sponsored by Centers for Medicare & Medicaid (CMS) - Link: - Create an environment where large-scale transformation can occur within practice settings - Share information among all participants to accelerate best practices and new learning on a national level - Focus on the practice and their performance in order to improve the clinical experience for the patient - Gain reductions in cost through performance improvements in operations, effective use of clinical data, and increased knowledge sharing

8

9

10 And the Winner Is CHCACT applied for and received a Practice Transformation Network grant. Year 1 of the grant is funded at $4.9M Years 2 through 4 are dependent on meeting goals of year 1 Specifically, this grant will provide FQHCs with a number of benefits, including resources, but only if they commit to participate and commit to transparency.

11 Benefits to FQHCs The primary benefits to FQHCs are as follows: 1. Practices receive a 3 rd -party readiness assessment in other words, to what extent is your FQHC ready to adopt best practices, take on learning, and commit to data-driven process improvement activity? 2. Practices receive on-the-ground support in the form of resources designed to bring operational improvements to the organization. Examples: a) QI Lead to interface with senior leadership and PCMH leads b) Practice Transformation Specialist to bring process improvement activity into the clinical setting c) Information Services Specialist to facilitate the use of data in all improvement activity 3. Efforts are designed to support clinicians to work to the full extent of their license and training. 4. Practices receive extensive free training at all levels of the organization and gain access to a national learning collaborative.

12 Benefits to FQHCs (con t) 5. Practices gain access to tools and resources created by subject matter experts to enhance clinical performance, data reporting, communication, and other processes. 6. Practices gain access to performance data. Clinical performance data is available through on-line portal which will provide real-time results against measurement criteria. Data set is available by provider, by practice, and in aggregate. Data analytics can support targeted interventions for high-cost patients and/or conditions. Benchmarks are shared across participating sites. 7. Practices can use PTN as a leadership development opportunity for employees.

13 What Comes Next? Commitment Practices must agree to the terms outlined in the document of expectations in order to participate. - A committed and engaged leadership team with an identified organizational sponsor (usually QI lead) - PCMH recognition is a basis for transformation and must be embraced - Alignment with Joint Commission / NCQA performance standards - Logistical support for resources (space, etc.)

14 What Comes Next? (Con t) Launch How is CHCACT going to help FQHCs prepare for the opportunity? - Snapshot of available tools FQHCs will get a full debrief on the resources, reports, tools, and data-sets available for use today: - CareAnalyzer, POPHealth, Intensive Case Management, etc. - Work with clinical leads at health centers to review reports to see how effective they think the reports are or could be. - Conduct 3 rd -party assessments and share examples of the best practices already in place. - Create mechanisms for on-going feedback.

15 What Comes Next? (Con t) Grant Requirements Goal achieve a cost reduction in Medicaid spending of $2.5M and participation of 750 clinicians in year 1. Measurement criteria based on 3 key high-cost clinical conditions: Asthma, Hypertension, Diabetes Participation of 1,500 clinicians, sharing best practices, by Year 4.

16 The Timeline of Urgency NGA dated September 24, 2015 The Next 90 Days: 1. Communication with FQHC leadership and agreement on level of commitment. 2. Enrollment of clinicians in learning portal. 3. Accelerated staffing activity to get resources in place for the development of training, etc. 4. Pre-assessments (readiness) and stratification of FQHCs.

17 The Timeline of Urgency (Con t) NGA dated September 24, 2015 The Next 90 Days: 5. Establish benchmark data for measurement dashboards. 6. Define learning objectives and instructional design needs. 7. Develop schedule of interaction with FQHCs.

18 Other Matters The relationship with SIM and other State-sponsored Initiatives: PTN focuses on the practice, the providers, and what happens in the clinic. SIM is primarily focused on the relationship between the patient and the community of care-givers, including the primary care provider. While many objectives are the same, the methods of achieving those objectives differ in their approach. For example, SIM will pay for Care Coordination (CHW or Patient Navigator) either through direct allocation or through a billing mechanism. PTN will teach the Care Coordinator how to improve care coordination.

19 CT Health Reform Initiatives Part of CCTs Can become CCBHC FQHC PTN PTN and CCIP will complement but not duplicate each other Part of MQISSP SIM initiatives Part of CCIP

20 CT Health Reform Initiatives Name Description Funder Notes Certified Community Behavioral Health Clinics (CCBHC) CCBHCs will be a new behavioral health delivery model, similar to FQHCs, with many of the same requirements (e.g., turn no one away) and also funded through a PPS system. The federal government has chosen 24 states to develop a certification process for CCBHCs. CCBHCs can be FQHCs. SAMHSA CT received a Planning Grant. Of the 24 states awarded the planning grant, up to 8 will be awarded grants for a 2-year demonstration, beginning 1/1/17.

21 CT Health Reform Initiatives Name Description Funder Notes Community Care Teams (CCT) CCTs are regional teams of providers, including hospitals, primary care providers, housing agencies and other social service agencies. CCTs enroll high ED-utilizers and develop care plans for them, to improve health outcomes, quality of life and save costs; a navigator connects with the patients and achieves care coordination. Fourteen regional teams exist in Connecticut. DMHAS has funded the Middletown program; others are funded through hospitals and in-kind donations from service agencies.

22 CT Health Reform Initiatives Name Description Funder Notes State Innovation Model (SIM) Overall health reform project to impact 80% of state residents; contains multiple initiatives, including MQISSP and CCIP. CMMI Medicaid Quality Improvement Shared Savings Program (MQISSP) Upside-only shared savings program which will be RFP d to FQHCs and advanced networks. Slated to be RFP d 6/16 and begin 1/1/17. CMMI Part of SIM Will include advanced monthly payments for care coordination and the opportunity for shared savings for providers meeting quality benchmarks.

23 CT Health Reform Initiatives Name Description Funder Notes Community & Clinical Integration Program (CCIP) Technical Assistance to help practices transform for better care delivery and integrating non-clinical community services to help combat Social Determinants of Health. CMMI Part of SIM MQISSP participants will be required to participate in CCIP.

24 FAQ Q1: When is payment reform going to happen? A1: CMS hasn t announced an official date, but they are taking steps to get organizations ready. Our assumption is that we all need to be ready within the next three years. Q2: When will resources be available? A2: Once the assessments are completed, and we have signed agreements in place, the passthrough funds will become available. Q3: When will access to tools, support, and training become available? A3: Over the next 60 to 90 days, CHCACT will start to make resources available to all participating FQHCs.