Primary Care - CCHAP

Primary Care - CCHAP

PRACTICE MANAGER MEETING Wednesday Jan. 10th 2018 Noon 1:00PM Instructions to join the meeting remotely: 1. 2. Open a web browser and enter URL: www.readytalk.com Enter participant access code: 2093166 Phone in for the audio portion of the conference: 1-866-740-1260 - then enter the access code: 2093166 MEETING HANDOUTS: www.cchap.org/pmmeeting Primary Care Alternative Payment Methodology Delivery System Reform Team 8/23/17

2 APM Goal Payments for Volume Payments for Value Payments for Volume Provide sustainable, appropriate funding for primary care that rewards high value, high quality care.

3 Alternative Payment Methodology How does it work? Achieve Points Enhanc ed Paymen t 4 APM Code Set Identified common primary care codes from

a variety of sources Delphi panel from the University of Colorado Hospital reviewed and modified code set to represent primary care 5 Who Participates? Primary Care Medical Practices that contract with the Accountable Care Collaborative 6 Excluded

Rural Health Centers Federally Qualified Health Centers (have a different APM) PCMPs below the defined minimum threshold 7 Does This Impact Me?

How will I know? 8 Attribution Accountab le Care Collaborati ve Determining which clients practices will be measured Phase II Methodology

9 Performance and Structural Measures Self Reported Structural Measures 30 choices Claims eCQM Based Reported Clinical Clinical Performanc Performanc e Measures e Measures 16 adult & 13 pediatric choices

10 adult & 4 pediatric choices 10 Close the Gap 11 Score to FFS Enhancements Scores will translate into the following FFS rate enhancements: 12 13

Tools, Resources, and Practice Supports Download the Primary Care Alternative Payment Model Survival Guide Resources are available at Primary Care Paymen t Reform 14 Survival Guide 15 Structural Measure

Example Possible Points Measure Name Measure Descriptio n Documentat ion Requiremen ts SIM/CPC+/ PCMH

16 Performance Measure Example Definition Numerator Numerat or Codes Numerat or Exclusion s Denomina tor Denominato r Exclusions Exclusion Codes

Measur e Stewar d 17 eCQM Measure Example CMS Measure ID Versio n NQF Number Measure Description Initial Pat. Populati Denomina

on tor Statement Denominat or Exclusions Numerat or Stateme nt Controlling High Blood Pressure Numerator Exclusions Denominator Exceptions Measure Steward

Domain Previous Version Improveme nt Notation Guidance 18 Goals Measure Name Adolescent Immunizations Combo 1 Adolescent Well Visits Adult BMI Assessment Alcohol Use: Screening & Brief Counseling Appropriate Testing for Children with Pharyngitis Breast Cancer Screening

Childhood Immunizations Combo 7 Chlamydia Screening Colorectal Cancer Screening Controlling High Blood Pressure Depression Remission at 12 months Diabetes: A1c Test During Measurement Year Diabetes: Eye Exam Diabetes: Foot Exam Diabetes: HbA1c >9 (Poor Control) (INVERTED) Diabetes: Nephropathy Screening ED Utilization (per 1000) Initation and Engagement of Alcohol and Other Drug Dependence Treatment Maternal Depression Screening Medication Management for People with Persistent Asthma Prenatal and

Post Partum Care Readmissions Screening for Clinical Depression & Follow-up Plan Suicide Risk Assessment for MDD Tobacco Use: Screening and Cessation Intervention Measure Type Claims Claims claims, eCQM HCPF Goal 83.00% 80.00%

eCQM Report* Claims 82.00% Claims Claims Claims Claims claims, eCQM eCQM 66.00% 62.00%

62.00% 60.00% Report* Claims 92.00% Claims Claims claims, eCQM Claims Claims claims, eCQM claims, eCQM claims,

eCQM 62.00% Claims 90.00% 70.00% 36.00% 93.00% 43.00% Report* 50.00% 68.00% 88.00% Claims

eCQM 80% eCQM Report* Claims Use of Imaging Studies for Low Back Pain Well Child Visits 15 months (6 visits) Well Child Visits 3-6 years Weight Assessment, Counseling for Nutrition & Physical Activity for children/adolescents Claims Claims

Claims claims, eCQM Measure Type HCPF Goal Adolescent Immunization Combo 1 Claims 83.00% Adolescent Well Visit Claims

80.00% Adult BMI Assessment Claims, eCQM 90.00% Report* Claims Total Cost of Care Measure Name reduce 2%

82.00% 80.00% 80.00% 78.00% 71.00% 64.00% 19 Model Demonstration 20 Measure Selection What are you working on for other payers?

What are you working on for yourself? What are the needs of the population you serve? Where can you realistically make change? 21 How Am I Doing? Feedba ck

22 Baseline Period and Performance Measure Period 2018 2018 2019 Baseline Year January 1thru December 31, 2018 Performance Year

January 1thru December 31, 2019 2019 2020 23 What to Do and When? 1. Submission of measure selection begins December 1, 2017

2. Department guidance coming in late summer/early fall 3. Check CO.gov /HCPF for information 24 Where to get Information? APM Webs ite

25 Questions or Concerns? 26 Contact Information Delivery System Reform Team [email protected] us 27 Thank You! 28

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