Comprehensive Primary Care Plus (CPC+): What You Need to Know Before Applying

Medical Group Strategy Council Physician Practice Roundtable Comprehensive Primary Care Plus (CPC+): What You Need to Know Before Applying August 8, 2016

2 Today s Presenters Ingrid Lund, PhD Practice Manager, Physician Practice Roundtable Lundi@advisory.com Eric Cragun Senior Director, Health Policy CragunE@advisory.com Rivka Friedman Practice Manager, Medical Group Strategy Council FriedmaR@advisory.com

Road Map 3 1 2 Overview of CPC+ 3 Strategic Considerations for Successful CPC+ Application Q & A and Appendix Materials

4 Introducing CPC+ We see CPC+ as the future of primary care in the U.S. and are pleased to partner with payers across the country that are aligned in this mission to transform our health care system. This model allows primary care practices to focus on what they care about most serving their patients needs when and how they choose Patrick Conway, MD Chief Medical Officer, CMS Program in Brief: Comprehensive Primary Care Plus (CPC+) Five year program coming out of CMS Centers for Medicare and Medicaid Innovation (CMMI) to be launched on January 1, 2017 Modification and geographical extension of the current CPC initiative Involves 14 statewide or multi-county regions and 57 payers Individual practices in these regions are invited to apply until September 15, 2016 Up to 5,000 practices to be selected, impacting up to an estimated 3.5 million beneficiaries CPC+ s new payment methodologies offer greater upfront funding for care transformation investments than MSSP track one, current CPCI Practices must provide specific medical home capabilities to qualify that can meet expanded capabilities can reap even higher rewards under track two of CPC+ program Source: CMS, available at: https://www.cms.gov/newsroom/mediareleasedatabase/pressreleases/2016-press-releases-items/2016-08-01.html; Advisory Board interviews and analysis.

5 Before CPC+ Was CPCI Similar to an Existing Program in Core Design Comprehensive Primary Care Initiative (CPCI) Four year program launched in October 2012 Covers 7 regions, 482 practice sites and approximately 2.7 million patients CPCI Regions Arkansas (statewide) Colorado (statewide) New Jersey (statewide) New York (Capital District-Hudson Valley region) Ohio and Kentucky (Cincinnati-Dayton region Oklahoma (Greater Tulsa region) Oregon (statewide) What CPCI and CPC+ Have in Common CMS, private payer collaboration model designed to strengthen primary care Focused in only select regions based on private payer interest Provides upfront payments to selected practices to improve five functions: Access and care continuity Chronic condition and preventive care planning Risk-stratified care management Patients and caregiver engagement Coordination of care across the medical neighborhood 1) Single bricks and mortar location where patients are seen, unless the practice has a satellite office a separate physical location that is a duplicate of the application practice. Source: Comprehensive Primary Care Plus, CMS, April 2016, available at: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus; Advisory Board Company interviews and analysis.

6 Intended Outcomes Not Yet Achieved Under CPCI No Decrease in Spending Under CPCI Medicare Expenditures Higher for CPCI Practices Total Medicare Expenditures 1 (2012-2014) $802 $798 With Little Change In Performance Performance data from first two years of CPCI 3% Decrease in number of visits to PCPs 2% Decrease in hospital readmissions rates 2 CPCI Practices Non-CPCI Practices 1% Increase in inpatient admissions 3 1% Decrease in emergency department visits 4 1) Total Medicare expenditures (per beneficiary per month) with initiative care-management fees. 2) Percent likelihood of 30-day readmission after discharge. 3) Admissions for ambulatory-care-sensitive conditions (annualized rate per 1,000 beneficiaries). 4) Outpatient emergency department visits (annualized rate per 1,000 beneficiaries). Source: Dale, Stacy, et al. "Two-Year Costs and Quality in the Comprehensive Primary Care Initiative," New England Journal of Medicine, 2016; available at: http://www.nejm.org/doi/full/10.1056/nejmsa1414953#t=article; Advisory Board Company interviews and analysis.

7 CPC+ Introduces New Payment Methodology CPC+ Introduces New Payment Methodology Designed to Enhance Upfront Payment Payment Type CPCI CPC+ Shared Savings: Opportunity to share in cost savings if quality targets are met Monthly Care Management Payments: Per beneficiary per month payment Performance Based Incentive Payments: Prepaid at the beginning of a performance year, but returned if quality and utilization performance thresholds are not met Comprehensive Primary Care Payments: A hybrid of fee-forservice and a percentage of their expected E&M 1 reimbursements upfront 1) Evaluation & Management. 2) Based on risk tier, payments range from $6-$30 in track one, $9-$100 in track two. 3) Per beneficiary per month/ Only available under track two of CPC+ program Average 2 PBPM 3 Care Management Payments, By Program $20 CPCI Years 1-2 $15 $15 CPCI Years 3-4 CPC+ Track 1 $28 CPC+ Track 2 Higher monthly payments incentivize opting for track two Source: CMS, Advisory Board Company interviews and analysis

8 CPC+ Offered in Fourteen Regions Only Practices in Selected States/Counties May Apply 1. Arkansas: Statewide 2. Colorado: Statewide 3. Hawaii: Statewide 4. Kansas and Missouri: Greater Kansas City Region 5. Michigan: Statewide 6. Montana: Statewide 7. New Jersey: Statewide 8. New York: North Hudson- Capital Region 9. Ohio: Statewide and Northern Kentucky Region 10. Oklahoma: Statewide 11. Oregon: Statewide 12. Pennsylvania: Greater Philadelphia Region 13. Rhode Island: Statewide 14. Tennessee: Statewide Source: CMS, available at: https://www.cms.gov/newsroom/mediareleasedatabase/press-releases/2016- Press-releases-items/2016-08-01.html.

9 Multi-Payer Support Critical in Region Selection Partner Payers Must be Aligned with Medicare. Required Payer Alignment CPC+ Payers in Brief CMS solicited payer proposals to partner with Medicare in CPC+ from April 15 through June 8, 2016. Required alignment on overall structure of CPC+ payments but allowed flexibility beyond that Chose 57 total- full list in appendix Number of payers per region, ranges from 1 to 15, average of 5 Includes 8 state Medicaid programs Enhanced, non-ffs support Change in cash flow mechanism from feefor-service to at a least a partial alternative payment methodology for Track 2 practices Performance-based incentive Aligned quality and patient experience measures with Medicare FFS and other payers in the region Practice- and member-level cost and utilization data provided at regular intervals Source: CMS, Advisory Board interviews and analysis.

10 Application Period Currently Open Next Step: Practice Applications Due Mid-September CPC+ Rollout Timeline April 11, 2016 CPC+ unveiled August 1, 2016 CMS announces 14 selected regions, 57 payers; begins soliciting applications from practices within those regions January 1, 2017 Program begins for five years June 8, 2016 Deadline for payer proposals 2,500 Maximum number of practices selected under each track September 15, 2016 Deadline for practices in selected regions to apply 150 Minimum number of Medicare beneficiaries attributed to each practice to qualify Source: Comprehensive Primary Care Plus, CMS, April 2016, available at: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus; Taylor, E, et al, Evaluation of the Comprehensive Primary Care Initiative: First Annual Report, January 2015, available at: https://innovation.cms.gov/files/reports/cpci-evalrpt1.pdf; Advisory Board interviews and analysis.

11 Two Tracks to Choose From in CPC+ 1 Track One Up to 2,500 primary care practices. $15 average PBPM 2 care management fee, $2.50 PBPM performance incentive payment No Health IT partnership required Choice for practices ready to build the capabilities to deliver comprehensive primary care 1) Practices must remain in the same track for the duration of the program. 2) Per beneficiary per month. Track Two Up to 2,500 primary care practices. $28 average PBPM 2 care management fee, $4 PBPM performance incentive payment Must have letter of support from Health IT vendor Choice for practices poised to increase the comprehensiveness of care by: Enhancing health IT Improving care of patients with complex needs Supporting patients psychosocial needs Source: CMS, Advisory Board interviews and analysis

12 Care Delivery Enhancements by Track Across Five Functions of Comprehensive Primary Care Track 1 Track 2 1 CARE MANAGEMENT Risk stratified patient population Care plans for high-risk chronic disease patients ED visit and hospital follow-up Two-step risk stratification process for all empanelled patients Care plans for high-risk chronic disease patients 2 ACCESS AND CONTINUITY Empanelment 24/7 patient access Assigned care teams Alternative to traditional office visits, e.g., e-visits, phone visits, group visits, home visits, alternate location visits, and/or expanded hours. Source: CPC+ Practice Care Delivery Requirements, CMS, April 2016, available at: https://innovation.cms.gov/files/x/cpcpluspracticecaredlvreqs.pdf; Advisory Board interviews and analysis.

13 Care Delivery Enhancements by Track (cont d) Across Five Functions of Comprehensive Primary Care Track 1 Track 2 3 COMPREHENSIVENESS AND COORDINATION Identification of high volume/cost specialists Improved timeliness of notification and information transfer from EDs and hospitals Behavioral health integration Psychosocial needs assessment and inventory of resources and supports to meet psychosocial needs? How Do The Tracks Compare? Track 2 Capabilities are inclusive of and build upon Track 1 requirements Collaborative care agreements with specialists Development of practice capability to meet needs of high-risk populations Source: CPC+ Practice Care Delivery Requirements, CMS, April 2016, available at: https://innovation.cms.gov/files/x/cpcpluspracticecaredlvreqs.pdf; Advisory Board interviews and analysis.

14 Care Delivery Enhancements by Track (cont d) Across Five Functions of Comprehensive Primary Care Track 1 Track 2 4 PATIENT AND CAREGIVER ENGAGEMENT At least annual Patient and Family Advisory Council Improved timeliness of notification and information transfer from EDs and hospitals At least biannual Patient and Family Advisory Council Patient self-management support for at least three highrisk conditions 5 PLANNED CARE FOR POPULATION HEALTH At least quarterly review of payer utilization reports and practice ecqm 1 data to inform improvement strategy At least weekly care team review of all population health data 1) Electronic clinical quality measures. Source: CPC+ Practice Care Delivery Requirements, CMS, April 2016, available at: https://innovation.cms.gov/files/x/cpcpluspracticecaredlvreqs.pdf; Advisory Board interviews and analysis.

15 Three Types of Payment Provided to Practices Objective How calculated Care Management Fee (PBPM) Support augmented staffing and training for delivering comprehensive primary care Based on HCC 1 risk quartile Performance-Based Incentive Payment (PBPM) Reward practice performance on utilization and quality of care Prospective, based on quality and utilization score Track 1 $15 average PBPM $2.50 PBPM Track 2 $28 average PBPM; including $100 to support patients with complex needs $4.00 PBPM Payment Structure Redesign Reduce dependence on visit-based fee-for-service to offer flexibility in care setting Offers prepayment for fee-for-service N/A (Standard FFS 2 ) Reduced FFS in exchange for upfront Comprehensive Primary Care Payment (CPCP) 1) Hierarchical condition category 2) Fee for service.. Source: CMS, Advisory Board interviews and analysis

16 CPC+ Care Management Fees by Risk Tier Track 1: Four Risk Tiers (Average $15) $6 $8 $16 $30 Track 2: Five Risk Tiers (Average $28) $9 $11 $19 $33 1 st risk quartile HCC 2 nd risk quartile HCC 3 rd risk quartile HCC 4 th risk quartile HCC 0% 25% 50% 75% 90% 100% Care Management Fees in Brief Risk-adjusted, PBPM (non-visit-based) payment Designed to augment staffing and training, according to specific needs of patient population No beneficiary cost sharing; risk tiers relative to regional population Precludes practices from billing the CCM 1 code for CPC+ attributed beneficiaries Complex Tier: $100 Top 10% of risk or dementia diagnosis 1) Chronic Care Management. Source: CMS; Advisory Board interviews and analysis.

17 Performance-Based Incentive Payments Prospectively Paid, Retrospectively Reconciled Two Components of Incentive Payment Quality and patient experience measures Examples: ecqms 1, CAHPS 2 Measured at practice level PBPM Payments by Track Track 1 Track 2 $1.25 $2.00 Utilization measures that drive total cost of care Examples: inpatient admissions, ED visits Measured at practice level $1.25 $2.00 Total $2.50 $4.00 1) Electronic clinical quality measure 2) Consumer assessment of health professional satisfaction. Source: CMS, Advisory Board interviews and analysis

18 Who s In and Who s Out? Eligibility Criteria for CPC+ by Clinician, Organization and Risk Model Clinicians Organizations Risk Models Eligible Types: Physicians, NP 1, PA 2, CNS 3 Specialty designations: Family medicine, Internal medicine & Geriatric medicine Eligible: Independent, hospitalsponsored Primary care-only, multispecialty Practices involved in IPA 4 s, CIN 5 s Preferred: CPCI participating practices 6 Ineligible:: 1) Nurse practitioner. 2) Physician assistant. 3) Clinical nurse specialist. 4) Independent practice association. 5) Clinically integrated network. 6) CPCI practices, assuming application demonstrates requirements needed, will not be subject to lottery if number of eligible applying practices exceeds slots available. 7) Federally qualified health center. 8) Rural health clinic. 9) Defined as a practice that charges a monthly retainer fee. 10)Bundled Payments for Care Improvement Initiative. 11)Comprehensive Care for Joint Replacement Model. FQHC 7, RHC 8 and concierge practices 9 Pediatric practices Eligible: Medicare Shared Savings Program (MSSP) Tracks 1, 2 and 3 The Oncology Care Model BPCI 10, CJR 11 Ineligible:: Next Generation ACO Model ACO Investment Model Source: CMS, Advisory Board interviews and analysis.

Road Map 19 1 2 Overview of CPC+ 3 Strategic Considerations for Successful CPC+ Application Q & A and Appendix Materials

20 Successful CPC+ Application Six Key Considerations to Tackle for Successful CPC+ Application 1 Is my practice eligible? 2 Is it worth it? 3 What are the implications of CPC+ practice involvement in my organization s broader risk based payment model involvement? 4 How might CPC+ involvement impact overall organization strategy? 5 6 How can I ensure success in executing on the 5 CPC+ functions? What are the next steps to get my organization prepared for CPC+? Source: CMS, Advisory Board interviews and analysis

#1: Is my practice eligible? 21 An Eligibility Checklist Answer These Questions Affirmatively Before Proceeding For each practice under consideration, ask: Is it physically located in a CPC+ region? Does it have primary care practitioners 1? Does it have at least 150 Medicare attributed beneficiaries? Does at least 40% of the revenue associated with services of the primary care practitioners at that practice come from Medicare or other CPC+ payers 2? Does it use Certified EHR Technology? Is it not a FQHC 3, RHC 4 or concierge provider? Is it not going to be part of a NGACO, ACO Investment Model, or other shared savings model in 2017 (besides MSSP)? 1) Defined as physicians, NPs, Pas, CNS with primary designation of family medicine, internal medicine or geriatric medicine. 2) CMS suggests, but does not require at least 50% of revenue. 3) Federally qualified health center. 4) Rural health center. Source: CMS, Advisory Board interviews and analysis.

#2: Is it worth it? 22 Calculating Potential Practice Revenue Under CPC+ Hypothetical Example of Potential Additional Revenue Annual total CPC+ payment assuming 700 attributed Medicare beneficiaries (average number of patients attributed to CPCI practices) Care Management Fee 1 Track 1 +$126,000 Track 2 +$235,200 Performance-Based Incentive Payments Extra Comprehensive Primary Care Payments (CPCP) 2 Approximate Total Annual Incremental Revenue +$21,000 $147K +$33,600 +$5,376 $274.2K 1) Based on expected average payment by track ($15 fro track one, $28 for track two). If patients are in higher risk tiers, payment would ne higher, if patients are in lower risk tiers than average, payment would be lower 2) Assumes practice is receiving 40% of E&M payments upfront, under which option CMS expects to boost practice E&M revenue by 4% per month and assumes E&M revenue is $16 per beneficiary per month (approximate amount for CPCI practices). Estimate only includes new revenue under CPCP; in addition, practices would prospectively receive a portion of historical fee-for-service payments Source: CMS, Advisory Board interviews and analysis

23 Calculate Your Potential Care Management Fees Number of Medicare beneficiaries 1 + Number of other CPC+ payer beneficiaries 1 x Average Monthly Care Management Fee 2 $15 (track one) or $28 (track two) x Annual 12 Performance-Based Incentive Payments Number of Medicare beneficiaries 1 + Number of other CPC+ payer beneficiaries 1 Monthly Performance- Based Incentive Payment 3 $2.50 (track one) or $4.00 (track two) 12 Total 1) Beneficiaries will be attributed to a practice if that practice either billed the plurality of their primary care allowed charges or that billed the most recent claim (if that claim was for Chronic Care Management services) during the most recently available 24 month period. CMS will provide each practice with a list of prospectively attributed beneficiaries for each quarter. 2) Average payment by track assumes average HCC risk profile of patients. If patients are in higher risk tiers, payment would be higher, if patients are in lower risk tiers than average, payment would be lower. Figures also assume that participating private payers pay the same PBPM as Medicare. 3) Paid prospectively. Practices may keep if it meets quality and utilization performance thresholds Source: CMS, Advisory Board interviews and analysis

24 Considering the Investments Needed- Track One Start Here to Determine Track One Feasibility Does the practice Already have in place Planning on it or feasible to achieve Not in plans and not feasible Provide 24-hour access to care? Have practice teams dedicated to patient panels? Risk-stratify all patients? Have targeted care management plans for patients at increased risk? Provide short term care management to patients with recent hospital visits? Support patients in achieving health goals? Have enhanced communication between PCP practices and ED? Have a Patient and Family Advisory Council? Use data to influence utilization and quality performance? Source: CMS, Advisory Board interviews and analysis

25 Considering the Investments Needed- Track Two Continue Here If Track One Components Sufficiently in Place Does the practice Already have in place Planning on it or feasible to achieve Not in plans and not feasible Offer an alternative to office visits? Use a plan of care centered on patient s actions? Assess patients psychosocial needs? Have collaborative care agreements with specialists? Integrate behavioral health into primary care? Provide more comprehensive services for complex patients? Implement patient self-management support for high-risk conditions? Review panel data with care team on a weekly basis? Have IT vendor commitment? Source: CMS, Advisory Board interviews and analysis

#3: What are the implications in my organization s broader risk based payment model involvement? 26 A Practice Model Within Organizational Risk Models Consider How Individual Practice Involvement Impacts Broader Strategy Participating in MSSP PCP Practice Multispecialty Practice Independent oncology practice Multispecialty Practice Multispecialty Practice PCP Practice PCP Practice Independent radiology practice Independent PCP Practice Owned by health system or large independent medical group Participating in CPC+ Track one Participating in CPC+ Track two Source: CMS; Advisory Board interviews and analysis.

27 Comparing CPC+ and MSSP Track One CPC+ May Serve As Alternative To MSSP For Some Practices Payment Model Considerations under MACRA Other Considerations Dual Participation 1) Alternative Payment Model. 2) Based on MACRA proposed rule and may change once final rule is released in Nov 2016. 3) Eligible Clinicians. 4) Starting in 2018. 5) Merit-Based Incentive Payment System. 6) Clinical Practice Improvement Category. Comprehensive Primary Care Plus (CPC+) Upfront payments, ongoing care management fees provide capital to support care transition Cash reserves needed in case upfront payments must be repaid Qualifies as Advanced APM 1 under MACRA proposed rule 2, only for organizations with 50 or fewer EC s 3 Qualifies as medical home model under MIPS 4 track, giving participants 100% of total points under CPIA 5 category Aligns CMS payment, quality performance with commercial payers Participants are individual practices in CPC+ regions Medical Shared Savings Program (MSSP) Track 1 Requires large upfront investment, uncertain return Benchmark methodology may make it difficult to achieve savings year-over-year Does not qualify as Advanced APM under MACRA proposed rule 2 Under MACRA proposed rule, gives participants 50% of total points under CPIA category of the MIPS track, re-weights Resource Use category to 0% No alignment across public, private payers Participants can be multi-practice medical groups in any region Limit of 1500 practices that are involved in MSSP (any track) will be allowed into CPC+, lottery utilized if qualified applicants exceed MSSP participants get monthly care management fee but forego CPC+ performancebased incentive payment in CPC+ Source: Comprehensive Primary Care Plus, CMS, April 2016, available at: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus; Medicare Program; Merit- Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models, May 9, 2016, available at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf ;Advisory Board interviews and analysis.

Revenue at risk (%) 28 Under MACRA, CPC+ Can Qualify for APM Track Medical Home Models Must Meet One of Following Criteria to Qualify as Advanced APMs: Withhold payment for services to the APM entity and/or ECs 1 CPC+ Participants Must Meet Two Conditions to Qualify for APM track: 1 Be part of a group that has fewer than 50 clinicians 2 Reduce payment rates to the APM entity and/or ECs 1 2 Meet specific revenue at-risk thresholds 3 under the Medical Home Model! Require the APM entity to owe payments to CMS Lose the right to all or part of otherwise guaranteed payments CPC+ is the only Medical Home Model CMS has approved as an Advanced APM Revenue at risk thresholds under CPC+ to qualify for APM track 2.5% 3% 4% 5% 2017 2018 2019 2020+ 1) Eligible Clinicians. 2) Starting in performance year 2018. 3) Percentage of APM Entity s total Medicare Parts A and B revenue. Source: CMS, Advisory Board interviews and analysis.

#4: How might CPC+ involvement impact overall organization strategy? 29 CPC+ A Win for Small Practices? Aspects of CPC+ That Support Small Practices Participation is at the individual practice level Minimum number of beneficiaries required only 150 CMS voiced desire to have diverse set of organizations included CPC+ eligible for APM track qualification under MACRA for <50 clinician practices? Some Open Questions Remain Do smaller groups feel that they can make the necessary investments required by CPC+? Are the payments adequate to support these investments? Will CMS show preference to small groups in the application pool? Will smaller groups be able to meet the performance criteria to successfully participate in CPC+? Will any small groups in CPC+ meet patient or revenue threshold to make it into the APM track of MACRA? Source: CMS; Advisory Board interviews and analysis.

30 For Larger Organizations, a More Complex Calculus Special Considerations Driving Larger Groups Strategy 1 2 3 Competing Priorities Siphoning Interest? Opportunity to Double Down MACRA, MSSP readiness taking significant bandwidth CPC+ may not receive attention it deserves Some physicians may see CPC+ as off-ramp from MSSP Organizations participating in both should proceed with caution, communicate carefully to participants CPC+ helps fund transformation already in place for many groups Can also fund activities around access, responding to consumerism Source: CMS; Advisory Board interviews and analysis.

31 Strategic Considerations of CPC+ Key Takeaways Keep in mind CPC+ is a model offered at the individual practice level, whereas other models often involve an entire medical group or multiple organizations CPC+ qualifies as advanced APM entity under MACRA, but only for those with fewer than 50 clinicians in their group 1 Public, private payer collaboration under CPC+ may help streamline care transformation efforts, ease quality reporting burden CPC+ may serve as alternative to MSSP track one for smaller practices with less care transformation experience, less ability to invest upfront in care transformation efforts Larger organizations, are those involved in risk based payment models with other organizations should consider the implications of practice based CPC+ on these bigger initiatives 1) Starting in 2018 Source: CMS, Advisory Board interviews and analysis

#5: How can I ensure success in executing on the tasks within the 5 CPC+ functions? 32 Leverage Our Resources to Execute on CPC+ Function Enhancements Sample Suggested Resources 1 Access and Continuity Provide 24-hour access to care Organize practice teams dedicated to patient panels Offer one alternative to office visits Topic page: Access to care Topic page: Telemedicine Webinar: New Frontiers in Patient Access Study: Redesigning the Primary Care Clinic 2 Care Management 3 Comprehensiveness and Coordination Risk-stratify all patients Provide targeted care management to patients at increased risk Enhance communication between PCP practices and ED Integrate behavioral health Form collaborative care agreements with specialists Topic Page: Care management Study: Playbook for Population Health Study: High Risk Patient Care Management Topic page: Behavioral health Whitepaper: Medical Neighborhood Primer 4 Planned Care and Population Health Use data to influence utilization and quality performance Review panel data with care team on a weekly basis Topic Page: Utilization Product: Crimson Continuum of Care 5 Patient and Caregiver Engagement Create a Patient and Family Advisory Council Support patient s management of high risk conditions Topic: page: Patient engagement Tool: Patient and Family Advisory Implementation Guide Source: CMS; Advisory Board interviews and analysis.

#6: What are the next steps to get my organization prepared for CPC+? 33 Your To Do List Want to Apply? Here is Your To Do List: 1. Ensure your organization meets eligibility requirements of region, type of provider, and eligible clinicians. 2. Calculate payer mix and likely financial impact. Ideally, 50% or more of revenue should come from Medicare and other payers participating in CPC+. 3. Assess level of investments required. Calculate potential cost. 4. Consider how involvement in CPC + affects overall organization strategy: risk based payment model adoption, performance under MACRA and alignment across physicians and with other organizations. 5. Educate and engage your clinicians. Use our board doc, containing slides and talking points. 6. Decide on track and engage IT vendor(s) partner if pursuing track 2. 7. Engage involved payers and begin to get a pulse check. Ask how might they structure CPC+ requirements? How different from Medicare? 8. Complete application check list and submit application on CMS portal. 9. Ensure 2016 documentation and coding is accurate for proper HCC risk scoring. Source: Advisory Board analysis.

34 Discussion Questions Discussion Questions 1 2 3 4 5 Overall, are the changes in how payment works from CPCI sufficiently addressing provider concerns? How does CPC+ fit in with other recent payment transformations in Medicare? payment? How can organizations leverage the investments to drive growth and increase market share? How should medical group leaders message CPC+ involvement across the larger organization? How might practices benefit from the multi-payer nature of CPC+? Source: Advisory Board analysis.

In Support of Our Members 35 The Advisory Board s Suite of MACRA Solutions Targeted Offerings to Meet Your Organization s Needs On-site MACRA Briefing On-site policy briefing available for key stakeholders Key insights to understand MACRA implications, prepare for the necessary reporting, and plan for larger strategic imperatives Recommended For: Organizations that need foundational understanding of MACRA policy implications across key stakeholder groups MACRA Intensive On-site custom engagement designed to identify readiness gaps and develop implementation strategy Three parts: policy education; performance assessment; and strategic discussion with leadership Organizations that need to assess MACRA readiness and confirm strategic planning approach If interested email: Lundi@advisory.com Quality Reporting Roundtable Service to help providers navigate quality reporting programs requirements, including MACRA and Meaningful Use On-call experts, policy monitoring, audit support, best practices, and networking opportunities Organizations that need ongoing strategic guidance and long-term program management support Additional Support Available Hands-on consulting support to help organizations design and implement large-scale business transformation needed for health care reform. Areas of expertise include value-based payment models, physician alignment, and EHR optimization. Research memberships for ongoing access to best practice research and support around MACRA as well as other related strategic priorities

Road Map 36 1 2 Overview of CPC+ Strategic Considerations for Successful CPC+ Application 3 Q & A and Appendix Materials

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39 Care Delivery Enhancements by Track CPC+ Track One Provide 24-hour access to care Organize practice teams dedicated to patient panels Risk-stratify all patients Provide targeted care management to patients at increased risk Provide short term care management to patients with recent hospital visits Support patients in achieving health goals Enhance communication between PCP practices and ED Create a Patient and Family Advisory Council Use data to influence utilization and quality performance CPC+ Track Two Meet all track one requirements Offer one alternative to office visits Use plan of care centered on patient s actions Assess patients psychosocial needs Form collaborative care agreements with specialists Integrate behavioral health into primary care Provide more comprehensive services for complex patients Implement patient self-management support for high-risk conditions Review panel data with care team on a weekly basis Prove IT vendor commitment 1 1) Those practices found eligible for Track 2 must submit a letter of support from their Health IT vendor; CMS will sign memorandum of understanding with vendor. Source: CPC+ Practice Care Delivery Requirements, CMS, April 2016, available at: https://innovation.cms.gov/files/x/cpcpluspracticecaredlvreqs.pdf; Advisory Board interviews and analysis.

40 Full Region and Payer List Region Participating Counties Provisional Payer Partnerships Arkansas Statewide Arkansas Blue Cross Blue Shield Arkansas Superior Select, Inc. Arkansas Health & Wellness Solutions HealthSCOPE Benefits Medicaid QualChoice Health Plan Services, Inc Colorado Statewide Anthem Colorado Choice Health plans Medicaid Rocky Mountain Health Plans United Healthcare

41 Full Region and Payer List (cont d) Region Participating Counties Provisional Payer Partnerships Hawaii Statewide Hawaii Medical Service Association Greater Kansas City Johnson County, KS; Wyandotte County, KS; Clay County, MO; Jackson County, MO; Platte County, MO Blue Cross Blue Shield of Kansas City Michigan Statewide Blue Cross Blue Shield of Michigan Priority Health Montana Statewide Blue Cross Blue Shield of Montana Medicaid Pacific Source Health Plans New Jersey Statewide Anthem Delaware Valley ACO Horizon Blue Cross Blue Shield of New Jersey United Healthcare

42 Full Region and Payer List (cont d) Region Participating Counties Provisional Payer Partnerships North Hudson Capital Region (NY) Ohio & Northern Kentucky Montana New Jersey Albany County; Columbia County; Dutchess County; Greene County; Montgomery County; Orange County; Rensselaer County; Saratoga County; Schenectady County; Schoharie County; Sullivan County; Ulster County; Warren County; Washington County All counties in Ohio; Boone County, KY; Campbell County, KY; Grant County, KY; Kenton County, KY Empire Blue Cross Blue Shield (Anthem) Capital District Physicians Health Plan (CDPHP) MVP Health Plan, Inc. Aetna Anthem Aultman Health Foundation Buckeye Health Plan CareSource Gateway Health Plan of Ohio Inc. Medical Mutual of Ohio Molina Healthcare of Ohio, Inc. Medicaid Paramount Health Care SummaCare, Inc. The Health Plan UnitedHealthcare

43 Full Region and Payer List (cont d) Region Participating Counties Provisional Payer Partnerships Oklahoma Statewide Advantage Medicare Plan (AMP) CommunityCare Blue Cross Blue Shield of Oklahoma Medicaid United Healthcare Oregon Statewide AllCare Health, Inc. ATRIO Health Plans CareOregon Eastern Oregon Coordinated Care Organization (EOCCO) FamilyCare Health Oregon Health Authority (Medicaid) Moda Health Plan PacificSource

44 Full Region and Payer List (cont d) Region Participating Counties Provisional Payer Partnerships Oregon (cont d) Greater Philadelphia Area (PA) Statewide Bucks County; Chester County; Delaware County; Montgomery County; Philadelphia County PrimaryHealth of Josephine County Providence Health Plan (PHP); Providence Health Assurance (PHA) Tuality Health Alliance (THA) Umpqua Health Western Oregon Advanced Health, LLC Willamette Valley Community Health Yamhill Community Care Organization, Inc. PacificSource Aetna Delaware Valley ACO Independence Blue Cross/Keystone Health Plan East

45 Full Region and Payer List (cont d) Region Participating Counties Provisional Payer Partnerships Rhode Island Statewide Blue Cross Blue Shield of Rhode Island Medicaid Tufts Health Plan UnitedHealthcare Tennessee Statewide Anthem Medicaid UnitedHealthcare Volunteer State Health Plan

46 Helpful Links and How to Apply For full details on the model, see the Request for Applications here: https://innovation.cms.gov/files/x/cpcplus-rfa.pdf To apply, see application checklist here: https://innovation.cms.gov/files/x/cpcplus-appchecklist.pdf And submit applications to CMS portal here: https://app1.innovation.cms.gov/cpcplus For questions about the model or the solicitation process, email CPCplus@cms.hhs.gov or call the CPC+ Help Desk from 8:30a.m. 7:30p.m. EDT at 1-844-442-2672. Source: CMS.