Northern New England Practice Transformation Network (NNE-PTN) Introduction & Overview November 2015
Today s Presenters Lisa Letourneau, MD, MPH Executive Director Maine Quality Counts Catherine Fulton, MS, CPHQ Executive Director Vermont Program for Quality in Healthcare, Inc. Jeanne Ryer, MS Director New Hampshire Citizens Health Initiative Dan Mingle, MD, MS CEO Mingle Analytics, LLC Eric Anderson Data Operations Manager Maine Health Management Coalition
Objectives Introduce CMS Transforming Clinical Practice Initiative (TCPI), NNE-PTN Review NNE-PTN goals, strategies for supporting practice transformation Introduce PTN partners in ME, NH, & VT Highlight opportunities, supports available to participating clinicians, practice teams 3
The Rapidly Changing World of Provider Payment DHHS Secretary Burwell s historic announcement (Jan 2015): Goal #1: move Medicare provider payments from FFS to alternative payment models 30% by 2016, 50% by 2018 Goal #2: ensure virtually all Medicare fee-forservice payments are tied to quality and value At least 85% by 2016, 90% by 2018 4
The Rapidly Changing World of Provider Payment Current CMS Value Modifier for providers Applies up to 4% payment bonus or penalty in 2017 based on 2015 performance MACRA (aka SGR fix Feb 2015): moves current CMS provider payments & penalties into new Merit-based Incentive Payment System (MIPS) by 2019 Applies up to 9% payment penalty by 2020 5
Rapidly Changing World of Clinical Practice EMRs, Meaningful Use Quality reporting requirements Continued pressure for generating pt volume Measurement, public reporting of patient experience of care Clinician, staff change fatigue & burn-out Realities of continuous change 6
Current Maine Environment Currently in Maine ~50% primary care & specialty providers participate in PQRS reporting ~50% primary care practices participate in PCMH/HH efforts ~50% do not! Est. <10% specialty practices participating in transformation efforts High primary care participation in Medicare ACOs but no guarantee of escape under MIPS! Requires significant share of provider revenue in APMs, with two-sided risk arrangements 7
Bottom Line? CMS on clear & unstoppable trajectory to move from FFS to value-based payments Commercial payers likely to follow Experts project that at least 25% physician payments will be based on cost/quality by 2019 Pressure to participate in global payment budgets not far behind Practices, clinicians can succeed by preparing for inevitable change, or??? 8
Introducing NNE-PTN! Improve health of your patients Build better systems for providing high-quality, patientcentered care Improve health of clinicians & practice team Get support for building stronger team-based care Access resources to strengthen individual and team resilience Improve health of the practice Get help to avoid penalties & succeed in rapidly evolving value-based payment systems 9
CMS Transforming Clinical Practice Initiative (TCPI) New effort from CMS to support & scale practice transformation $840M, 4-year effort CMS effort to support practice readiness to participate in new value-based payment models 10
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CMS 5 phases of Practice Transformation Set Aims Use Data to Drive Care Achieve Progress on Aims Benchmark Status Thrive as a Business via Pay for Value Approaches 12
CMS TCPI PTN Awards CMS awarded $685M to 39 organizations through 4-year cooperative agreements 29 PTNs NNE PTN: ME, NH, VT 4 in New England Several hospitals/health systems, universities 10 Support & Alignment Networks (SANs) National associations 13
TCPI Structure: PTNs & SANs Practice Transformation Networks (PTNs) Serve as trusted partners to provide clinician practices with QI expertise, best practices, coaching, and assistance for clinical and operational practice transformation Support & Alignment Networks (SANs) Formed by professional associations and others that align their memberships, communication channels, CME credits, and other work to support PTNs and clinical practices 14
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PTN Expectations Recruit clinician practices & build strategic partnerships (with at least 20% small, rural, or serving underserved populations) Serve as champions for continuous improvement, culture change, and patient & family engagement Facilitate improved clinical practice management Use quality measures & data for improvement Collaborate with CMS on transformation activities & provide ongoing feedback towards goals 17 17
Northern New England PTN (NNE-PTN) QC led ME-NH-VT application $15M/4 yrs (1 yr contract, renewable annually) through CMS Cooperative Agreement QC: $6.4M/4yrs - will fund PTN Learning Collaborative QI Specialists / Practice Facilitators to work locally with primary care & specialty practices (1:30) Technical expert consultants 18
NNE-PTN Strategy for Supporting Practice Transformation 1. Conduct readiness assessment for each practice 2. Provide direct technical assistance through network of practice facilitators/coaches 3. Offer range of options and opportunities for regional and distance-based collaborative learning 4. Provide evidence-based team trainings (e.g. TeamSTEPPS) 5. Build networking and tools to improve care coordination across participating practices 6. Support quality measurement and reporting 19
NNE-PTN Contracted Partners NH: UNH/Citizens Health Initiative: VT Program for Quality in Health Care (VPQHC) MHMC: Data Partner Subcontractor: Mingle Analytics PQRS Solutions Hanley Center for Health Leadership ME: 4-5 Health Systems/Provider Groups (TBD) Subcontracts for QI coaching RFP coming soon! 20
Introduction to NNE-PTN Partners Maine: Maine Quality Counts NH: Citizens Health Initiative VT: VT Program for Quality in Health Care (VPQHC) MHMC Mingle Analytics PQRS Solutions 21
NNE-PTN Practice Recruiting Targets Target total participating practices: 505 ME: 284 NH: 192 VT: 29 Target total participating clinicians: 1665 Clinician = Medicare Eligible Provider Est. 4/primary care practice; 3/specialty practice 22
Practice Recruiting Strategy Outreach to practice owners i.e. Hospitals/health systems Provider groups FQHCs Independent practices Align with current health system, provider group, practice priorities Opportunity to bring direct resources to support practice transformation 23
(Current) CMS ACO Exclusion CMS decision to prohibit practices in Medicare alternative payment models (e.g. ACOs) from participating in PTNs Identified by CMS at time of proposal (fall 2014) Secretary Burwell bold goals for moving providers to Value-Based Payment (Jan 2015) Currently estimate 60-70% ME, NH; 80% VT practices ineligible QC lobbying CMS to reconsider, modify exclusion 24
Overarching Benefits of Participation Improve health of your patients Build better systems for providing high-quality, patientcentered care Improve health of clinicians & practice team Get support for building stronger team-based care Access resources to strengthen individual and team resilience Improve health of the practice Get help to avoid penalties & succeed in rapidly evolving value-based payment systems 25
NNE-PTN Opportunities New resources to support Maine practice transformation efforts Opportunity to build from, align with current practice transformation efforts (PCMH/HH) New opportunity to bring in specialty, BH providers Opportunity to work with NH, VT partners Opportunity to learn from PTNs nationwide 26
Specific Benefits of Participation Receive baseline assessment of practice status, readiness for transformation Participate in PTN Learning Collaborative Access direct, practice-based QI support from Practice Coach Obtain no-cost access to PQRS Solutions, assistance with PQRS reporting to CMS (sign up by Jan 1, 2016 for CY2015 PQRS reporting!) 27
PQRS Solutions from Mingle Analytics Over 30,000 Successful Submissions since 2012 with Success Rate over 99% Qualified to submit all PQRS measures Leading-edge tools and processes Recognized by CMS in Medicare s top 10 GPRO Registry Vendors for 2013 11/25/2015 28
PQRS Solutions Your PQRS quality reporting partner Will help: Practices of all sizes solo providers to 6000 provider healthcare systems Providers of all Credentials and Specialties Any EMR or PM System Practices still on paper charts Participating practices will receive personalized support from knowledgeable PQRS Consultants backed by full clinical team 29
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Specific Benefits of Participation Get assistance with leveraging existing Medicare payment opportunities e.g. Annual Wellness Exam, Transitional Care Codes, Chronic Care Management (CCM) code Access team-building resources e.g. TeamSTEPPS for ambulatory practices Gain opportunity to network with, learn from best practices with primary care, specialty, BH peers 31
Why Specialist Practices? Network, collaborate with primary care partners - opportunity to get in the game! Strengthen relationships with referral base Improve communication with primary care to create more efficient referral process, ensure right patient in the chair Improve efficiency of specialty visits Avoid upcoming CMS payment penalties 32
Expectations for PTN Practices Participate in baseline practice assessment Participate in PTN Learning Collaborative Network with peers, share learnings, best practices Work with PTN staff to submit clinical quality measures through PQRS solutions Work with PTN staff to identify/submit other data as required by CMS (cost/utliz, pt exp) 33
Collaboration with New England QIN/QIO Actively working with, building on strong relationship w/ QIN QINs to contract w/ CMS to conduct baseline (and f/u) assessments on 20% PTN practices QC will work with QIN to align, coordinate learning opportunities 34
Next Steps Review specific benefits & expectations for practices Complete online PTN registration form and practice agreement: www.surveymonkey.com/r/nneptn Identify practice leadership team (dyad) Lead clinician (MD/DO, NP, PA) Lead administrator 35
NNE-PTN Timeline QC actively communicating opportunity to primary care, specialty & BH practices & practice owners Begin baseline assessments by Jan 2016 PQRS Solutions available to practices anytime after baseline assessment - sign up by Jan 1, 2016 to participate in CY2015 PQRS reporting! Learning activities to start spring 2016 CMS offering 4-year opportunity 36
More Information CMS Transforming Clinical Practice Initiative (TCPI) https://innovation.cms.gov/initiatives/transforming- Clinical-Practices/ NNE-PTN www.mainequalitycounts.org/nneptn (or, QC Programs NNE-PTN) Online registration: www.surveymonkey.com/r/nneptn 37
Contact Info / Questions Maine: Maine Quality Counts Lisa Letourneau, Lisa Tuttle, Lesley Myska ptn@mainequalitycounts.org NH: Citizens Health Initiative Jeanne Ryer: Jeanne.Ryer@unh.edu VT: VT Program for Quality in Health Care (VPQHC) Cathy Fulton: CatherineF@vpqhc.org 38