Exhibit A.11.DY3 DSRIP Year 3 Extra Large Primary Care Provider ( PCP ) Requirements 1. Generally. This Exhibit contains the requirements and substantiations associated with each of the metrics required to be met from the beginning of DSRIP Year 3 through the end of DSRIP Measurement Year 4 ( DY3, spanning April 1, 2017 June 30, 2018). Participants may refer to the additional details and best practices associated with these requirements in the Millennium Reference Guide, which will be provided by the MCC project managers. 1.1. MCC Project Managers. Participants primary point of contact on all DSRIP projects and deliverables are the MCC project managers. Participants shall work closely with the project managers to develop programs that will meet deliverables and DSRIP goals. All reports, deliverables, and substantiations must include the content and be provided in the required format and in the timeframes defined by MCC project managers. 1.2. Baselines and reporting. A number of substantiations in DY3 are based on the Participant successfully establishing a baseline for certain deliverables and evidencing certain improvements or reductions over the baseline over a period of time designated by MCC project managers. Unless otherwise instructed by MCC project managers, Participants shall be responsible for accurately self-reporting the required data. MCC may take on responsibility for data analysis and reporting upon thirty (30) days notice. 1.3. Payment contingency. All payments for metrics listed below are contingent upon receipt of funds by MCC from DOH. Funds will be paid in accordance with Exhibit C.DY3 upon MCC s receipt of (1) such funds from DOH and (2) all necessary and related documentation of achievement of associated metrics from Participant. Participants must achieve each requirement and provide each for the Participant Activities listed in order to receive the associated Allocations. 1.4. Funding. Participants are expected to appropriately allocate and budget the funds received from MCC to cover expenses associated with DSRIP projects in DY3 as well as anticipated future DSRIP expenses in DSRIP Years 4 and 5. 2. Metrics and deliverables. Upon successfully achieving the metrics described below, and following provision of the required substantiations, Participants shall be eligible for the distribution of funds as outlined in Exhibit C.DY3. 2.1. Engagement and Reporting. Engagement refers to Participant s active participation in PPS activities. Reporting refers to Participant s timely and accurate completion of reporting requirements established by DOH and MCC. Workforce Enter required staffing impact data into HWApps on biannual basis. Data Provide updated roster of providers on annual/biannual basis. Successful upload of practice workforce data in HWApps biannually. Submission of updated provider roster (annually/biannually). Exhibit A.11.DY3 XL, p. 1
Provide claims data. Submission of electronic claims to MCC for PPS attributed lives. Implement CCDAs. CCDAs successfully implemented as evidenced by activity on the HEALTHeLINK monthly reporting dashboard. Engagement Provide quarterly engagement reporting for behavioral health and cardiovascular disease ( CVD ). Meet with MCC at least quarterly (all practice locations). Topics for discussion may include Patient Activation Measure ( PAM ) training (if applicable) and behavioral health best practices. Value-Based Payments ( VBP ) Create a VBP transition plan to include the following required minimum elements: Technology and analytics Utilization and care management tactics Staffing expertise Financial feasibility and impact Timeline for implementing VBP Successful upload of all quarterly engagement reports as indicated by MCC project managers. Provide sign-in sheets, meeting minutes, and workflows (if applicable). Submission of report. For entities with multiple provider types, each shall be required to provide either a separate report or to have a specific portion of the report dedicated to each provider type. 2.2. Transformation. DY3 focuses on the achievement of metrics via processes implemented in DY1 and DY2, as well as the additional processes required below for DY3. Participants will be required to achieve the below Participant Activities and provide the associated s in order to capture relevant data that will show performance in targeted areas required by DOH. Health Literacy and survey Participate in MCC PCP office training and workgroup sessions on MCC specific CG-CAHPS survey measures. Develop and implement work plan including strategies for improvement based on survey results. Revise patient facing materials to improve and enhance patient literacy according to CG-CAHPS standards. Medical Record Review Attend MCC-led education on documentation requirements. appropriate documentation and at least 75% documentation accuracy of blood pressure control and depression screen with follow-up. Minutes from training and working session that includes identification of strategies to improve results. Provide copy of work plan. Provide revised patientfacing materials. Sign-in sheets reflecting training attendance. MCC shall conduct initial medical review audit. If original findings by MCC indicate less than 75% documentation accuracy, Exhibit A.11.DY3 XL, p. 2
Non-Utilizer* Management Contact Non-Utilizers via new phone call or letter to attempt to schedule preventative appointment. If outreach is unsuccessful and/or scheduled Non-Utilizer fails to show for new preventative appointment, provide a list of outstanding Non-Utilizers to MCC-contracted community-based organizations ( CBOs ). Accept Non-Utilizer referrals from MCC-contracted CBOs. 90% of Non-Utilizer referrals must be scheduled for appointments within 30 days of referral. then MCC will re-audit again at a later time. Provide Non-Utilizer list to MCC. Completion of MCC sampling audit on documentation of Non- Utilizer outreach efforts. Non-Utilizer referral appointments substantiated by MCCcontracted CBO reports. *Non-utilizers are patients with no preventive visit in previous 12 months Screening, Brief Intervention and Referral to Treatment Demonstrate completion of ( SBIRT ) training (e.g., certificates or Train at least one clinical staff member per site. sign-in sheets). Implement SBIRT. Provide workflow and quarterly reporting on number of screenings. PAM Administer PAM surveys in PCP offices. Participants must perform PAMs on a minimum of 10% of Medicaid visits. Provide workflow and quarterly reporting on number of PAM surveys administered. 2.3. Transformation with Performance. DY3 focuses primarily on the ability of Participants to achieve certain metrics or reductions in numbers from DY2. Successful implementation of the Process elements in the below is essential for Participants to succeed in meeting the associated outcome measures. Participants will be required to achieve the below Participant Activities and metrics, substantiated by the associated s, in order to maximize DSRIP incentives in DY3. Primary Care Access Adherence Rate Improvement Run 12-month annual visit adherence report and establish baseline.* Develop management plan for improvement of and submit reports. Process Produce report and plan. Submit reports. *See Section 1.2 of this Exhibit for additional details on establishing baselines and reporting requirements. Improve 12-month visit over historical baseline.** **Participants are only eligible for an award for achieving one of the performance benchmarks listed in the column. So, for example, if at year-end a Participant had improvement 10% over Exhibit A.11.DY3 XL, p. 3
achieved 15% improvement, they would be eligible for a single allocation as further outlined in the billing templates. CVD Best Practice PCPs will develop the following registry (or develop an alternate reporting/identification process) Patients with o HbA1c 7% o Blood pressure 140/90 o ASCVD risk score 7.5% OR provide a documented process demonstrating how the practice will calculate the ASCVD risk score and record in EMR Improve number of patients with controlled blood pressure by 10%. Improve to or maintain 75% CAD patients on a statin. Medical Neighborhood Review and revise care coordination policy to include the following: Address linkages with behavioral health, CBOs, health home, and hospitals; Confirm bi-directional communication with all relevant hospitals and high-volume specialists; Evaluate and revise criteria and process for follow-up visits and calls; Enable ADTs with HEALTHeLINK; and Incorporate process to act upon and ensure outreach and follow-up. improvement 15% over improvement 20% over Demonstrate overall 94% (over 18 years) and 98% (under 18 years) with maintenance Process use of registry or alternate process (i.e. 2 codes) to automate case identification in electronic medical record. Produce registries Produce documented process/plan to calculate and record the ASCVD risk score (if unable to produce registry only). Process Participate in a facilitated meeting with MCC project manager regarding policy revisions. Submit revised care coordination policy with all required elements. Conduct outreach to and schedule follow-up visits for acute inpatients that are discharged from a hospital with one of the following avoidable admission principal diagnoses ( Target Conditions ): Process Provide hospital patient followup log substantiated by MCC sample audit of logs. Exhibit A.11.DY3 XL, p. 4
o COPD and related complications; o diabetes and related complications; o asthma; and o other practice-specific avoidable admission diagnosis driver as identified by MCC analytics. Maintain hospital patient follow-up log. Enroll and/or refer patients eligible for care coordination and/or health home services consistent with internal policies and applicable health home guidelines. Process Report number and percentage of patients with target conditions enrolled in care coordination. Report number and percentage of patients referred to health homes. Report can be satisfied by practice or health home. Reduce practice-specific avoidable admission rate (including readmissions) for Target Conditions by 5% when compared to historical baseline. Reduce practice-specific preventable emergency department visit rate by 10% when compared to historical baseline. Depression Best Practice Participate in MCC-facilitated education and training on depression best practices. Develop and implement practice workflow to care manage newly diagnosed depressed patients prescribed an anti-depressant. Improve patient Major Depression Medication Adherence ( MDMA ) to anti-depressant medications, acute phase (12 weeks). Improve patient MDMA to anti-depressant medications, chronic phase (6 months). Process Sign-in sheets for education and training sessions. Report on number and percent of patients that were care managed. improvement in patients MDMA to anti-depressant medications, acute phase (12 weeks) by 10%; or If current MDMA is at or above 60% maintain. improvement in patients MDMA to anti-depressant medications, chronic phase (6 months) by 10%; or If current MDMA is at or above 44%, maintain. Exhibit A.11.DY3 XL, p. 5