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PRACTICE MANAGER MEETING PRACTICE MANAGER MEETING

PRACTICE MANAGER MEETING - PowerPoint Presentation

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PRACTICE MANAGER MEETING - PPT Presentation

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

performance care measures structural care performance structural measures apm primary health management support system payment codes information clinical high

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Slide1

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.

5Slide6

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

6Slide7

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

13Slide14

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