Transforming Clinical Practices Initiative Overview CMS through its Center for Medicare & Medicaid Innovation is launching its Transforming Clinical Practices Initiative (TCPI), which over a four-year period seeks to assist approximately 150,000 U.S. clinicians (primary and specialty care) in ambulatory and non-acute care settings in transforming their practices to deliver better health outcomes at lower costs. Although a portion of physicians across the United States have already moved to coordinated and value driven care through participation in programs such as ACOs, Medicare Shared Savings Program, Patient Centered Medical Homes, and Advanced Practice Payment Models, a far greater number have yet to transform their practices to move from a volume-based reimbursement model to value-based care. TCPI provides an opportunity for this larger-scale practice transformation. Vizient s role as a practice transformation network CMS has selected Vizient to be one of approximately 29 Practice Transformation Networks (PTNs) to assist clinicians in changing the way they deliver care by integrating quality and process improvements to build on (and spread) existing change methodologies and practice transformation tools. The Vizient PTN will serve as a trusted partner to provide clinicians with quality improvement expertise, best practices, coaching, and additional support to build the evidence base on which practice transformation can occur. Effective solutions will be identified, shared and scaled. Vizient s PTN approach Through collaborative efforts and guided by quality improvement experts and faculty mentors, Vizient participants will assess opportunities; prioritize efforts; improve processes, outcomes and patient experience; and reduce cost so the populations served receive high-quality, cost-effective, equitable care. Eligibility to participate in TCPI Under TCPI, eligible clinicians include primary and specialty care physicians, nurse practitioners, physician assistants, clinical pharmacists, and their respective practices. All clinicians are eligible to participate, unless they are already participants in programs that involve comprehensive practice transformation; specifically, the Medicare Shared Savings Program (MSSP), the Pioneer ACO programs, the CMS Comprehensive Primary Care Initiative (CPCI) or the CMS Multi-Payer Advanced Primary Care Practice (MAPCP).
Reasons to participate in Vizient s PTN Growing evidence gathered from a body of published literature including the Commonwealth Fund s 2008 Organizing the US Health Care Delivery System for High Performance, indicates that a focused effort on health delivery redesign through clinician practice transformation can improve the quality of care for patients and prepare clinicians to participate in new payment models. The TCPI model will assist clinicians in changing the way they deliver care by integrating quality and process improvement to build on and spread existing change methodologies, practice transformation tools, published literature, key learnings, and technical assistance programs. By participating in TCPI, clinicians will receive the technical assistance and peer-level support they need to deliver care in a patient-centric and efficient manner and be better positioned for success in the healthcare market of the future one that rewards value and outcomes rather than volume. We are able to provide unique perspectives, expertise, and best practices from a wide hospital base, including community-based hospitals, critical access hospitals, and the country s academic medical centers (AMCs). Vizient, through legacy UHC, has a long history of working nationally with faculty physician organizations to assist them in optimizing cost, quality, and access to care. We maintain several large databases to support this effort, particularly the UHC-AAMC Faculty Practice Solutions Center (FPSC), which includes over 3 billion de-identified, patient-level transaction records. Nearly 100 faculty practice plans use the FPSC to compare and track clinical, operational, and financial performance. We currently have 22 organizations and 3,355 primary care clinicians and 17,456 specialty care clinicians totaling 20,811 clinicians committed to participating in this project. The Vizient PTN model The Vizient practice transformation model will focus on improving quality of care (clinical process and outcomes), improving access to care (time to appointment and optimal clinic utilization, including patients per room per hour), efficiency (reduction of unnecessary testing, hospitalizations, revisits, and readmissions), and patient satisfaction (likelihood to recommend). A defined structure for engagement and effective implementation will be utilized; best practice solutions; tools, guidelines and checklists; innovative resources that define action steps for executive, service, and unit levels of leadership; and data for decision making and evaluation. The engagement structure includes dedicated Quality Improvement (QI) Advisors to provide 1:1 coaching to ensure successful attainment of practice goals. Each QI Advisor will have responsibility for up to five organizations.. Participants will have access to improvement collaboratives on specific PTN focus areas. The collaborative model takes participants through the improvement cycle of activities from developing a charter to implementing new processes and measuring outcomes in a 9-month period using a structured Performance Improvement Toolkit. Organizations will receive reimbursement for an FTE up to $115,000 per year to manage the project locally. Organizations with greater than or equal to 500 enrolled clinicians will receive the
full amount; organizations with less than 500 clinicians will receive reimbursement for 0.5 FTE or $57,500 per year. Additional resources include QI advisor conference calls, use of nationally recognized faculty/subject matter experts, online communities for collaboration among likeminded leaders in quality, downloadable materials for streamlining implementation and member spotlights that profile participants that have successfully achieved outcomes. The TCPI program provides an opportunity to showcase accomplishments on both a local and national stage as well as receive considerable resources at no direct cost to them. Vizient s PTN partners Stanson Health LLC Vizient will partner with Stanson Health to deliver real-time clinical decision support (CDS) related to Choosing Wisely, PQRS, and other evidence-based measures. Providers will receive alerts regarding potentially inappropriate care at the time and place of clinical decision-making. An alert will appear if a patient does not meet the evidence-based criteria for specified orders. By targeting specific orders for tests and interventions known to be generally over utilized and tracking overall provider trends, organizations will impact practice and care for the specifically targeted orders in real time and will, easily identify outliers and evaluate overall provider trends. Stanson Health will work with organizations in cohorts of 5 or 6, starting with organizations that have EPIC as their electronic medical record platform and follow with organizations that have Cerner. America s Essential Hospitals (AEH) Vizient will partner with AEH to emphasize the use of REAL (race, ethnicity, and language) information. Clinical practices participating in the Vizient PTN will utilize race, ethnicity, and language data to improve their quality, performance, and value. Participants will 1) collect REAL data; 2) select measures and stratify data by REAL; and 3) employ rapid cycle improvement strategies and measure outcomes over time. Avia Vizient will partner with Avia to identify the most pressing problems and opportunities related to understanding the patient experience and engagement in their plan of care. Avia will assist in the selection and implementation of technology solutions for real-time patient satisfaction data collection..
Requirements for participation Assign a clinical project leader locally who will be a liaison to the QI Advisor and help facilitate all TCPI activities within the organization. As a part of the TCPI, participants are required to measure improvement in key areas of quality, access, efficiency, cost and patient satisfaction. Data will be accessed from the Vizient Clinical Database (CDB) and Faculty Practice Solutions Center (FPSC) Database, and some additional data collection will be required. If you are not currently participating in these databases, we would encourage you to join. Over time, we will offer both a CDB lite and FPSC lite version. (Contact us to learn more about these options). Proposed Metrics (see Appendix A below) in the areas of quality and clinical processes, access to care, clinic utilization, cost savings, outcomes and patient satisfaction will be used to assess achievement of the program goals mentioned above. There will be an identified core set of metrics across the 29 Practice Transformation Networks (PTNs) by Year 2. For more information Cindy Abel, Vice President, PI Collaboratives, 312.775.4101, cindy.abel@vizientinc.com Karen Holtz, Director, TCPI, 312.775.4420, karen.holtz@vizientinc.com Appendix A Improvement area Baseline Within first 12 months of award: % improvement By the end of the 4 year contract: % improvement Quality/ Clinical Processes Controlling High Blood Pressure (NQF 018) Diabetes A1C control (NQF 59) Tobacco use: screening and cessation intervention (adults) (NQF 0028) 61.5% 20% (lower is better) 2.5% 10% 95.4% 2.5% 10% Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: Body
Mass Index Assessment for Children/Adolescents. Adult Body Mass Index (BMI) Assessment (PQRS 128) 66.68% Flu Shots for Adults 50 to 64 (PQRS 110) 61.54% on NQF 0041 (all adults) Access to care Avoid imaging for uncomplicated headache Avoid antipsychotics as first choice to treat behavioral and psychological symptoms of dementia Avoid benzodiazepines/other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium. Avoid non-steroidal antiinflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes. 20% 10% 8% 20% % of patients receiving an appointment with primary care within 7 days % of patients receiving an appointment with specialty care within 14 days No-show rate: patient did not show and did not cancel appointment in advance 7% 2.5% 10% Clinic utilization New patient ratio: Medical 20% New patient ratio: Surgical 24% Room turns (patients per room
per hour) % capacity used Approx. 50% Cost savings: Current cost per case and target for reduction $2,196 2.5% 10% Outcomes: All Cause 30 Day Readmission Rate 16.4% 2.5% 10% ED revisits 2.64% 2.5% 10% Hospital 30-day Riskstandardized Acute Myocardial Infarction (AMI) Mortality emeasure Patient satisfaction All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions % of patients that answer usually or always: In the last 12 months, when you phoned this provider s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? % of patients that answer usually or always, In the last 12 months, how often did this provider explain things in a way that was easy to understand? % of patients that answer usually or always, In the last 12 months, how often did this provider listen carefully to you?