Joint Meeting of the Care Delivery and Payment System Transformation - PowerPoint PPT Presentation

Joint Meeting of the Care Delivery and Payment System Transformation and Quality Improvement and Patient Protection Committees October 18, 2017

AGENDA  Call to Order  Approval of Minutes  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

AGENDA  Call to Order  Approval of Minutes  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

AGENDA  Call to Order  Approval of Minutes – Joint CDPST/QIPP Meeting: June 7, 2017  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

AGENDA  Call to Order  Approval of Minutes – Joint CDPST/QIPP Meeting: June 7, 2017  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

VOTE: Approving Minutes MOTION: That the joint Committee hereby approves the minutes of the joint CDPST/QIPP Committee meeting held on June 7, 2017, as presented. 6

AGENDA  Call to Order  Approval of Minutes  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

AGENDA  Call to Order  Approval of Minutes  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

ACO Certification Program: Application Submission and Timeline Beta Launch Certified ACOs Community Care Cooperative (C3) Boston Accountable Care Organization (BACO) Full Launch 15 additional applications now under review Timeline and Next Steps October 1, 2017 – ACOs submit certification applications By January 1, 2018 – HPC issues certification decisions Full certification decisions are valid until December 31, 2019 2018 – HPC analyzes and reports on information received, re-opens application system as needed, Applicants with provisional certification submit for full certification, etc. 9

ACO Certification Program Current Applicants • Atrius Health Inc. • Baycare Health Partners Inc. • Beth Israel Deaconess Care Organization • Cambridge Health Alliance • Children’s Medical Center Corporation • Health Collaborative of the Berkshires LLC • Lahey Health System Inc. • Merrimack Valley Accountable Care Organization LLC • Partners Healthcare System Inc. • Reliant Medical Group Inc. • Signature Healthcare • Southcoast Health System Inc. • Steward Healthcare Network Inc. • The Mercy Hospital Inc. • Wellforce Inc. 10

AGENDA  Call to Order  Approval of Minutes  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program – NCQA Criteria Changes – Presentation: Myra Sessions, Health Management Associates – Technical Assistance Program Changes  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

AGENDA  Call to Order  Approval of Minutes  Blue Cross Blue Shield of Massachusetts Foundation  ACO Certification Operations Update  PCMH PRIME Program – NCQA Criteria Changes – Presentation: Myra Sessions, Health Management Associates – Technical Assistance Program Changes  Proposed 2018 RPO Reporting Requirements for Public Comment  Schedule of Next Meeting (November 29, 2017)

Practices Participating in PCMH PRIME Since January 1, 2016 program launch: 42 practices are PCMH PRIME Certified 108 Total Practices 65 practices Participating are on the Pathway to PCMH PRIME 1 practice is working toward NCQA PCMH Recognition and PCMH PRIME Certification concurrently 13

Alignment of PCMH PRIME and NCQA’s PCMH 2017 Program To align with NCQA PCMH 2017, an updated version of the PCMH PRIME standards will be effective November 17, 2017. • This update will impact the content and/or scoring of 3 criteria • For the remaining 10 criteria some criteria language and documentation requirements have been slightly modified to align with PCMH 2017 • Beginning November 17, 2017, all practices applying for PCMH PRIME Certification must follow the updated PCMH PRIME standards 14

Summary of Changes to PCMH PRIME Criteria # 2016 Criteria 2017 Criteria The practice coordinates with behavioral healthcare providers The practice works with behavioral healthcare providers to 1B through formal agreements or has behavioral whom the practice frequently refers to set healthcare providers co-located at the practice site. expectations for information sharing and patient care Meeting 2B = No double automatic The practice integrates BHPs into the care delivery credit for point for 1B 2B The practice integrates BHPs within the practice site. meeting 1B system of the practice site. also The practice tracks referrals until the consultant or specialist’s Tracks referrals to behavioral health specialists and has a 3B report is available, flagging and following up on overdue process to monitor the timeliness and quality of the referral reports. response. The practice has at least one care manager qualified to identify The practice has at least one care manager qualified to identify 1C and coordinate behavioral health needs. and coordinate behavioral health needs. The practice has at least one clinician who is providing The practice has at least one clinician located in the practice who medication-assisted treatment (naltrexone, buprenorphine, provides medication-assisted treatment and provides 2C and/or methadone) and providing behavioral therapy directly or behavioral therapy directly or via referral, for substance use via referral, for substance use disorder. disorders. The practice collects and regularly updates a comprehensive The practice conducts a comprehensive health assessment that 1D health assessment that includes behaviors affecting health and includes behaviors affecting health, and the mental mental health/substance use history of patient and family. health/substance use history of patient and family The practice collects and regularly updates a comprehensive The practice conducts developmental screening using a 2D health assessment that includes developmental screening for standardized tool for patients under 30 months of age. children under 3 years of age using a standardized tool. 15

Summary of Changes to PCMH PRIME Criteria (cont’d) # 2016 Criteria 2017 Criteria The practice collects and regularly updates a comprehensive The practice conducts depression screenings for adults and 3D health assessment that includes depression screening for adults adolescents using a standardized tool. and adolescents using a standardized tool. The practice collects and regularly updates a comprehensive The practice conducts anxiety screenings for adults and 4D health assessment that includes anxiety screening for adults and adolescents using a standardized tool. adolescents using a standardized tool. The practice collects and regularly updates a comprehensive The practice conducts alcohol use disorder or other SUD 5D health assessment that includes SUD screening for adults and screenings for adults and adolescents using a standardized tool. adolescents using a standardized tool. The practice collects and regularly updates a comprehensive health assessment that includes postpartum depression The practice conducts postpartum depression screenings using 6D screening for patients who have recently given birth using a a standardized tool. standardized tool. The practice implements clinical decision support following The practice implements clinical decision support following 1& evidence based guidelines for a mental health and substance use evidence-based guidelines for care of mental health conditions 2E disorder. and substance use disorders. The practice establishes a systematic process and criteria for The practice establishes a systemic process for identifying 1F identifying patients who may benefit from care management . The patients who may benefit from care management , and criteria process includes consideration of behavioral health conditions. that include consideration of behavioral health conditions. 16