Thursday June 15th 2017 Noon 100PM Instructions to join the meeting remotely Open a web browser and enter URL wwwreadytalkcom Enter participant access code 2093166 Phone in for the audio portion of the conference ID: 740453
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PRACTICE MANAGER MEETINGThursday June 15th 2017 Noon – 1:00PM
Instructions to join the meeting remotely:Open a web browser and enter URL: www.readytalk.comEnter participant access code: 2093166Phone in for the audio portion of the conference: 1-866-740-1260 - then enter the access code: 2093166MEETING HANDOUTS: www.cchap.org/pmmeeting Slide2
Primary CareAlternative Payment Methodology Delivery System Reform Team2Jun-17Slide3
APM Goal Provide sustainable, appropriate funding for primary care that rewards high value, high quality care. Sustainable investment that rewards performance and creates delivery system alignment3Payments for Volume
Payments for Value Payments for Volume Slide4
Alternative Payment Methodology How does it work?4Slide5
Who Participates?Primary Care Medical Practices that contract with the Accountable Care CollaborativeExclusions: Federally Qualified Health Centers (have a different APM)Rural Health Centers The Department is working on defining a minimum threshold in paid practitioner claims for procedure codes in the PC APM benefit package. PCMPs below the threshold will be excluded from the APM.
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Performance and Structural Measures Performance Measures – Clinical processes and outcomes Depression screeningControlling high blood pressure Structural Measures – Practice characteristicsIntegrating behavioral health careProviding alternative types of clinical encounters
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Performance and Structural Focus Areas 7
Self- Reported Structural Measures30 choices Continuous Quality ImprovementTeam Based CareAccessCare Management
Care
Coordination
Providing
Self- Management Support
Claims Based Clinical Performance Measures
16 adult and 13 pediatric choices
Behavioral Health
Chronic
Care Management
Cost
Containment
Preventive
Services
eCQM
Reported Clinical Performance Measures
1
0 adult and 4 pediatric choices
Behavioral Health
Chronic Care Management
Preventive Services Slide8
AttributionDetermining which clients practices will be measured on ACC Phase II methodology 8Slide9
Payment DesignBeginning July 1, 2020 the Department will tie a portion of FFS rates of certain codes to value and qualityEach practice will select up to 10 measures from a list of 60 Measure scores are compiled into an APM score which will determine the level of FFS rate enhancement9Slide10
Close the gap 10Slide11
Example Calculation11
Measure TypeMeasure NamePossible Points
Performance Baseline
Performance Standard
Provider's Target
Performance Actual
Pass/Fail
Earned Points
Structural
Accepting New Patients
50
-
-
-
-
Fail
0
Structural
Improving Access
35
-
-
-
-
Pass
35
Structural
ED & Hospital Follow-Up
45
-
-
-
-
Fail
0
Structural
Assess Self-Management Support Capability
25
-
-
-
-Pass25PerformanceMaternal Depression Screening3020802622N/A10PerformanceDiabetes: A1c Test during Msrmt Year10758075.575N/A0PerformanceControlling High Blood Pressure5045854946N/A12.5PerformanceTotal Cost of Care6070506870N/A0PerformancePrenatal & Post-Partum Care40507552.555N/A40PerformanceAdult BMI20152015.519N/A20
Average Possible Points
31.72
Points Required for 100% FS Rate
190.00
Percent Enhancement Available
4.00%
PC APM Total Points
143.00
Earned FS Percentage
3.01%Slide12
Score to FFS Enhancements12Scores will translate into the following FFS rate enhancements: Slide13
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Primary Care Payment Changes Over Time14Slide15
APM Code SetProcedure Codes
99201 - new patient office or other outpatient visit, 10 minutes99202 - new patient office or other outpatient visit, 15 minutes99203 - new patient office or other outpatient visit, 25 minutes.....and more!Identified common primary care codes from a variety of sourcesDelphi panel from the University of Colorado Hospital reviewed and modified code set to represent primary careSlide16
What to do and when?Choose measures by December 1st, 2017Department guidance on process to report measures coming in late summer/early fall Information posted on Department website 16Slide17
Tools, Resources and Practice Supports RAE support PMPMPractice transformation assistanceData to measure improvement 17Slide18
Health System Changes to Support Primary Care 18Slide19
Where to get information All information will be posted on the Department’s website here Check the website for new information and updates. 19Slide20
Questions or Concerns?20Slide21
Contact Information21Delivery System Reform TeamHCPF_PrimaryCarePaymentReform@hcpf.state.co.us Slide22
Thank You!22