Meeting Agenda August 5, 2016 9:30 am to 12:00 pm Health Services - - PDF document

All Payer Hospital System Modernization Payment Models Workgroup

Meeting Agenda

August 5, 2016 9:30 am to 12:00 pm Health Services Cost Review Commission Conference Room 100 4160 Patterson Avenue Baltimore, MD 21215

• I. Introductions and Meeting Overview
• II. GME Pilot Program in Rural and Medically Underserved Areas
• III. GBR Contract Addendum
• IV. Market Shift Update
• V. TCOC Dashboards

CY16 TCOC Data Update CRISP Presentation ALL MEETING MATERIALS ARE AVAILABLE AT THE MARYLAND ALL-PAYER HOSPITAL SYSTEM MODERNIZATION TAB AT HSCRC.MARYLAND.GOV

1

Pilot Program to Expand Graduate Medical Education in Rural and Medically Underserved Areas for Primary Care

2

Introduction

 All payers contribute to GME through hospital rates.

GME funding is part of the hospital’s total rate structure.

 The Innovations in Graduate Medical Education

Workgroup proposed using partial rate reviews for hospitals seeking to change or establish new residency programs.

 Partial rate reviews would only look at GME funding and

not the full rate structure of the hospital.

3

Health Measures in Rural Areas 2016 PCNA Quartile Rankings by Jurisdiction based on PQI & SHIP Indicators



The 2016 Primary Care Office Needs Assessment (PCNA) created a matrix using Prevention Quality Indicators (PQI) and State Health Improvement Process (SHIP) that ranks counties based on health indicator scores.



Fifty percent of the 18 state- designated rural areas fall in the third

• r bottom quartile for PQI and SHIP

measures.

4

Pilot Program

 We have outlined a policy for a targeted 5-year pilot

program for a new primary care GME program based on population health needs.

 Only direct medical education expenses will be funded

through partial rate reviews.

 Applicants will be expected to submit a narrative

describing how their program will meet the goals and

• bjectives outlined in the policy.

5

Criteria for GME Funding

 Located in a state-designated rural area  Located in or near an Medically Underserved Area (MUA)

• r Health Professional Shortage Area (HPSA)

 Hospital not part of a Maryland health system with

existing GME program

 Quality and population health indicators identify

improvement needs

6

Additional Requirements

 Hospitals submitting a GME partial rate application must

provide information on the following:

 Needs Justification: hospitals should justify their need for the

• program. Examples would include low population health

metrics and provider shortages.

 Triple Aim: hospitals should describe how the program would

enhance care delivery quality, reduce cost, and improve population health outcomes.

 Retention: hospitals should describe a plan to retain residents

after their program ends to ensure the growth of primary care physicians in the area.

7

Measurement of Success

 The HSCRC will consider the following factors in

evaluating the success of the GME program over the course of the 5-year pilot:

 Physician retention  Health status improvement  Care coordination efforts  T

• tal cost of care performance

SECOND ADDENDUM TO GLOBAL BUDGET AGREEMENT OF ________________________ UNDER DATE OF ___________________ EFFECTIVE JULY 1, 2016 Purpose: The purpose of this Second Addendum is to address the application of penalties to charges that exceed the December 31 target. This Second Addendum will also clarify conditions the Hospital must meet to receive increased inflation dollars for the time period January through June 2017. Amendment 1: This modification is intended to add clarification surrounding overcharge penalties that may occur relative to the December 31 target. Section V. C. of the Addendum to the Global Budget Agreement effective July 1, 2014, as amended herein, is provided in its entirety to avoid confusion: V.C. December 31 Target As indicated in Section V. A. above, the Hospital agrees that it will not overcharge the limits of the Approved Regulated GBR Revenue. In order to assure compliance with the All-Payer Model limits, the Hospital is provided a December 31 interim limit in Approved Regulated GBR Revenue of one-half of the total Approved Regulated GBR Revenue for the year, unless otherwise specified in the Agreement. For Rate Year 2017, the limit for the first half of the year is lower, to reflect that the Commission approved a higher update for the second half of the Rate Year, subject to certain conditions. The Hospital agrees that it will maintain its charges at or below this limit in calculating revenue compliance for December 31 of the Rate Year. The Hospital also agrees that should charges exceed the December 31 target, the

• vercharge and any accumulated penalties will be applied to the total Approved Regulated GBR Revenue

for the same Rate Year. Amendment 2: Section XIV Inflation Amount for RY17 is amended to add new section. This modification is intended to detail the conditions which the Hospital must meet in order to receive an increased inflation amount for the time period January through June 2017. For rate year 2017, the Hospital agrees to charge lower rates (.56% lower) in the first half of the rate year to achieve a mid-year target that is 49.73% of the total Approved Regulated GBR target to help meet the needs of the calendar year waiver test. In addition to the lower mid-year target, the Hospital agrees to the following:

• a. Monitor the growth in Medicare’s total cost of care and total hospital cost of care for its service

area;

• b. Work with CRISP, HSCRC, and MHA to obtain available information to support monitoring and

implementation efforts;

• c. Work with CRISP, HSCRC, and CMMI to obtain data for care redesign activities as soon it is

available;

• d. Monitor the Hospital’s performance on PAUs for both Medicare and All Payers;
• e. Implement programs focused on complex and high needs patients with multiple chronic

conditions, initially focusing on Medicare patients;

• f. Work with CRISP to exchange information regarding care coordination resources aimed at

reducing duplication of resources, ensuring more person centered approaches, and bringing additional information to bear at the point of care for the benefit of patients;

• g. Increase efforts to work in partnership with physicians, post-acute and long term facilities, and
• ther providers to create aligned approaches and incentives to improve care, health, and reduce

avoidable utilization for the benefit of patients;

• h. Participate in the All Payer Model progression planning efforts, and;

i. Work with physicians with the goal of developing and enhancing value based approaches that are applied under MACRA (Medicare Access and CHIP Reauthorization Act of 2015).

• a. Hospitals and any care redesign participants must agree to use CEHRT (Certified

Electronic Health Record Technology) to document and/or communicate clinical care to their patients or other health care providers.

• b. In addition to CEHRT, Hospitals must attest to the following three items relating to

information exchange and blocking:

• i. Hospitals will not knowingly and willfully take action to limit or restrict the

compatibility or interoperability of certified EHR technology;

• ii. Hospitals will implement technologies, standards, policies, and agreements

reasonably calculated to ensure, to the greatest extent practicable and permitted by law, that the certified EHR technology was, at all relevant times: connected in accordance with applicable law; compliant with all standards applicable to the exchange of information, including the standards, implementation specifications, and certification criteria adopted at 45 CFR part 170 (Health Information Technology Standards, Implementation Specifications, and Certification Programs for Health Information Technology); implemented in a manner that allowed for timely access by patients to their electronic health information; and implemented in a manner that allowed for the timely, secure, and trusted bi- directional exchange of structured electronic health information with other health care providers;

• iii. Hospitals will respond in good faith and in a timely manner to requests to retrieve
• r exchange electronic health information, including from patients, health care

providers.

IN WITNESS WHEREOF, the parties have caused this Second Addendum to be executed by their duly authorized representatives as of the effective date below: Effective Date: July 1, 2016 Attest: ________________________ by_______________________ Date____________ Chief Executive or Financial Officer Attest: ________________________ by_______________________ Date____________ Executive Director Health Services Cost Review Commission

Market Shift Adjustments Update

2

Market Shift Adjustments

 Market shift adjustment should not undermine the

incentives to reduce avoidable utilization

 Market shift adjustment should provide necessary

resources for services shifted to another hospital

 Calculations are based on

 66 inpatient and outpatient service lines  Zip codes and county level  Excludes Potentially Avoidable Utilization  Hospital service line average charge per ECMAD**  50% variable cost factor applied

 Staff send out preliminary results for outpatient oncology

service lines

*AHRQ Prevention Quality Indicators **Equivalent CaseMix Adjusted Discharges

Market Share vs. Market Shift

50 250 50 100 50 100 150 200 250 300 YEAR1 YEAR2 Hospital A Hospital B 50 250 50 25 50 100 150 200 250 300 YEAR1 YEAR2 Hospital A Hospital B

Market Shift Adjustment=25 Market Shift Adjustment=0

4

RY 2016 and FY 2017 Year to Date Statewide Impact*

*excludes oncology/radiation therapy/infusion service line and other manual adjustments Statewide Impact FY 2016 FY 2017 A B C Grand Net Total

• $756,341
• $5.7 mil

Positive Adjustment Total $27.7 mil. $53.6 mil. Negative Adjustment Total

• $28.5 mil.
• $46,8 mil.

Absolute Adjustment as Percent of Total Charges in MSA 1.02% 0.98%

5

Market shift adjustments and volume growth is more closely linked in the FY 2017 period

• 20.00%
• 15.00%
• 10.00%
• 5.00%

0.00% 5.00% 10.00% 15.00% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

CY 2015 Volume Growth vs Market Shift Adjustments

% Growth % Market Shift

6

Market Shift Updated for CY 2016 Measurement period

 CY 2015 was based on an annual adjustment except for a few

large market shift cases which was done mid-year

 CY 2016 is moving to a semi annual adjustments

 Jan-June 2016 period will be added to FY 2017 GBRs in January  Jan-December 2016 period will be reconciled and adjusted in FY 18

GBRs in July 2017.

 Any changes in hospital service provisions (closure of services,

deregulation etc) are reflected immediately.

 Service line updates for CY2016

 Add Sepsis cases to PAU exclusions  Alignment of inpatient and outpatient cases (cardiac procedures etc.)  Possible update to weight calculations

Progression Strategy Discussion

August 5, 2016

Current All-Payer Model

3

Original All-Payer Model Application: Maryland’s Strategy

Aim: Over a 5 year period, achieve the goals of better care, better health and lower costs.

4 Focus Areas

Description

• Connect providers (physicians, long-term care, etc.) in addition to hospitals
• Develop shared tools (e.g. common care overviews)
• Bring additional electronic health information to the point of care

Health Information Exchange and T

• ols
• Build on existing models (e.g. hospital GBR model, ACOs, medical homes,

etc.)

• Leverage opportunities for payment reform, common outcomes measures

and value-based approaches across models and across payers to help drive system transformation

Provider Alignment

• Improve care delivery and care coordination across episodes of care
• Tailor care delivery to persons’ needs with care management interventions,

especially for patients with high needs and chronic conditions

• Support enhancement of primary and chronic care models
• Promote consumer engagement and outreach

Care Delivery

Recap: Stakeholder-Driven Strategy for Maryland

Aligning common interests and transforming the delivery system are key to sustainability and to meeting Maryland’s goals

5

Recap: Strategy for Implementing the All-Payer Model

Year 1 Focus

Initiate hospital payment changes to support delivery system changes Focus on person-centered policies to reduce potentially avoidable utilization that result from care improvements Engage stakeholders Build regulatory infrastructure

Years 2-3 Focus (Now)

Work on clinical improvement, care coordination, integration planning, and infrastructure development Partner across hospitals, physicians, other providers, post-acute and long-term care, and communities to plan and implement changes to care delivery Alignment planning and development

Years 4-5 Focus

Implement changes, and improve care coordination and chronic care Focus on alignment models Engage patients, families, and communities Focus on payment model progression, total cost of care and extending the model

Progression of the All-Payer Model

Maryland All-Payer Model Driver Diagram With Updates for the Model Progression

• 1. Reduce total all payer per capita

hospital expenditures

• Decrease hospitalizations
• Decrease ED use
• Match patients with appropriate

care setting

• 2. Improve quality of health
• Decrease admissions
• Decrease hospital acquired

conditions

• 3. Improve population health measures
• 4. Limit the growth in Medicare total

cost of care, including the Medicaid costs for dually eligible beneficiaries

• Improve efficiency and quality of

episodes of care

• 5. Consider all patients, all payer

principles and their application in the development of models, measures, and infrastructure

Coordinate interdisciplinary care across settings and providers Improve clinical processes Improve patient and caregiver engagement and education Improve access to care Improve communication across providers, patients, and settings Enhance and align outcome measures and financial incentives for all types of providers Data driven continuous process improvement

• “Whole person” care management and care planning
• Effective transitions across settings and as care needs

change

• Data-driven, population care management
• Effective management of chronic and co-morbid

conditions

• Effective medication management
• High quality, efficient episodes
• Patient self-management
• Informed and shared decision making
• Patient engagement
• Integration with Patient Centered Medical Homes
• Care coordination
• Enhanced, community-based behavioral health
• Sharing information at the point of care
• Optimal HIT use and information sharing
• Effective patient and caregiver communication
• Accountability for cost and quality
• Standardized clinical measures
• Shared savings
• All-payer innovations
• Peer-based, rapid cycle learning
• Enhanced data capture and analysis

Over a 10 year period, achieve the goals of better care, better health, and lower costs driven by a person- centered approach to health care that optimizes outcomes and value for all Maryland residents.

Aim Primary Drivers Secondary Drivers

Focus on prevention and health

• Population health plans
• Patient education

8

Maryland’s Updated Strategy

 Updated Aim: Over a 10 year period, achieve the goals of better care,

better health, and lower costs driven by a person-centered approach to health care that optimizes outcomes and value for all Maryland residents.

 1. Reduce total all payer per capita hospital expenditures

 Decrease hospitalizations  Decrease ED use  Match patients with appropriate care setting

 2. Improve quality and efficiency of health care

 Decrease admissions  Decrease health care acquired conditions  Improve efficiency and quality of episodes of care

 3. Improve population health measures  4. Limit the growth in Medicare total cost of care, including the Medicaid

costs for dually eligible beneficiaries

 5. Consider all patients, all payer principles and their application in the

development of models, measures, and infrastructure

9

Progression Plan: Scope

Notes:

1)

Regulated hospital revenues incorporate ~$4.8 billion of Medicare spend.

2)

Medicare spend includes only payments by Medicare.

3)

Medicare non-regulated hospital spend is primarily out-of-state hospital spend. Also includes in-state specialty hospital spend.

4)

Medicaid figures are estimated and may be updates.

Approximate CY 2015 Figures (for 6 million Marylanders) All Payer Hospital Revenues (Maryland Residents in Maryland hospitals) $14.8 billion Medicare Non-Hospital Spend (Maryland Beneficiaries anywhere) $3.9 billion Medicare Hospital Spend Non-Regulated $0.5 billion Medicaid Costs for Dual Eligible Patients $2.0 billion T

• tal Costs to be Addressed in the Strategic Plan

$21.2 billion

10

Test Several Concepts Along with Hospital Model to Take on Responsibility for TCOC and Outcomes

200,000 beneficiaries? 200,000 beneficiaries? 400,000 beneficiaries? 91,000 beneficiaries?

Geographic (Hospital + Non- Hospital) Model Medical Home

• r other

Aligned Models ACOs Duals Model (TBD)

Need to address all Medicare beneficiaries

11

Tackling TCOC

 How to start addressing TCOC

 Start receiving TCOC data and data to support care coordination and

chronic care improvement and more efficient high quality episodes (the Amendment)

 Learn how to utilize data and make delivery system changes that act on

the most significant opportunities for care improvement and controlling costs, including:

 A medical home approach that cuts across payers and models  Patients with high needs and chronic conditions  Population health  Episode costs and outcomes (including post-acute)

All-Payer Model: Progression Strategy Blueprint

13

Strategic Considerations:

 Allow all system components and consumers, including physicians, long-

term care, behavioral health, and others, to participate in care delivery and payment transformation initiatives

 Align hospital and provider performance measures and incentives  Support providers/practitioners in practice transformation (e.g. streamlining

administrative requirements)

 Assist providers with qualifying for additional funding under MACRA

(financial incentives under MIPS and Advanced APM bonuses)

 Leverage current strengths, works in-progress, and available funding from

the federal government

 Build in the flexibility to:

 Improve models over time  Allow for adaptation in a dynamic health care system

Please refer to Progression Strategy Blueprint document for Design Principles

14

Starting to Address the Strategic Considerations: Care Redesign Amendment

 In response to stakeholder input, the State is proposing a Care Redesign

Amendment to the All-Payer Model, which will allow needed approvals (Safe harbors, Stark, etc.) and data for care redesign and alignment

 Opportunity to incorporate physicians and other providers in focus on All Payer

hospital costs and Medicare TCOC



Have a “living” program that allows for annual adjustments as we learn how to deploy interventions, test new models (e.g. considering episodes) and focus on TCOC



Focus on addressing MACRA coverage for the All Payer Model

Long-term / Post-acute Models

Align community providers Align providers practicing at hospitals Align other non- hospital providers

Complex & Chronic Care Improvement Program Hospital Care Improvement Program

 T

• ols:



Shared care coordination resources



Detailed Medicare data for care coordination



Medicare TCOC data



Shared savings from hospitals



Possible MACRA Advanced APM status

15

Progression Strategy Blueprint: Areas for Consideration

 Consider transformation in the following strategy areas:

1.

Payment and Delivery Approaches

1.

Primary/Complex Care

1.

Amendment--Complex and Chronic Care

2.

Comprehesive Primary Care

3.

Behavioral health

4.

Long term care

2.

Episodes

1.

Amendment—Hospital Care Improvement

2.

Post acute

2.

TCOC Focus

1.

Geographic Population Model (including leveraging Amendment) transitioning to upside/downside incentive payments and or risk

2.

Dual Eligibles ACO/PCMH transitioning to upside/downside risk

3.

Continuing/Increasing ACO/PCMH approaches transitioning to upside/downside risk  Questions for consideration:



Are these elements the right ones?



What is the timeline? How should the strategies and models be prioritized? What is the best phased approach?



How should we go about developing the plan and the models?

16

Envisioning Core Strategic Elements

 Primary Care/Complex and Chronic Care

 Create a person-centered locus of care with supporting interdisciplinary

care teams across all care settings, data-driven care coordination, and financial incentives that move towards greater accountability.

 Behavioral Health

 Improve access to community-based, behavioral health services, promote clinical

integration between primary care and behavioral health, and develop value-based payment mechanisms  Long-term Care

 Create value-based payment and care delivery mechanisms that improve care

coordination and delivery of long-term care and home and community-based services

17

Envisioning Core Strategic Elements (cont.)

 Post-acute Care

 Create alignment between hospitals and post-acute providers and

facilities that optimizes transitions and resource use across care settings (e.g. acute, post-acute, long-term care, home, etc.)  Geographic Population Model

 Promote All-Payer Model progression through an accountability model

that creates local responsibility for patient health outcomes and total cost of care in an actionable geographic area, first focusing on Medicare  Dual Eligibles

 Create payment and care delivery mechanisms that improve care

coordination and access to care for Dual Eligible beneficiaries, and incorporate payer accountability for Dual Eligible total cost of care (e.g. including medical and custodial care)

18

Potential Timeline

• Primary Care

model*

• Geographic

Population model*

• Shared savings

component added to Care Redesign Amendment programs*

• Geographic

Model*, ACOs*, and PCMH* models begin to take on more responsibility

• Dual Eligible

model*

• Care Redesign

Amendment

– Complex and Chronic Care – Hospital Care Improvement

• Post-acute
• Behavioral

health

• Long term

care

2017 2018 2019 2020 TBD

MACRA APM status provides bonus for participating

• providers. Bonus

adjusted based on model outcomes Note: * Indicates anticipated MACRA-eligible models (Advanced Alternative Payment Models). Begin to implement MACRA-eligible models

MACRA

Appendix- Strategies & Models To be Worked Through

20

Geographic Population Model

 Concept:

 Global budget(s) + non-hospital costs  Medicare total costs

for a geography

 Focuses on services provided in a particular geography  Creates responsibility for a patient population in an actionable

geographic area

 Includes services provided in local geographic area (excludes

tertiary and quaternary care provided in other hospitals)

 Allows for local focus and increases opportunities for

population health partnerships

 Creates a larger pool that mitigates high-cost patients, allowing

providers to learn how to effectively share responsibility gradually

21

Geographic Population Model (cont.)

 Rationale:

 While the global budget already distributes responsibility for ~ 56% of

Medicare costs, CMS expects Maryland to take on increasing accountability for TCOC over time

 A geographic model can cover the additional 15%-20% of Medicare spend for

non-hospital services related to hospitalizations (e.g. post acute, physician costs, etc.)

 More partnerships with community providers are needed to continue

reducing avoidable utilization and improving outcomes for the sustainability of the All-Payer Model

 A geographic model can create an approach to engage non-hospital providers,

• rganize resources, and create accountability approaches across providers

 MACRA is creating significant financial consequences for providers to

support value-based payments, rather than volume-based payments

 A geographic model can help physicians and others qualify for greater funding

under MACRA if they work with hospitals that take some responsibility for TCOC and thus become Advanced APM entities

22

Geographic Population Model (cont.)

 Geographic Population Model: Promote All-Payer Model progression

through a payment model that creates local responsibility for patient health

• utcomes and total cost of care in an actionable geographic area, first

focusing on Medicare

 Model Considerations:

 Base the model on geography/episodes or a combination of approaches  Consider regional organizations to service local health care community  Consider value-based payment in CY 2017/FY 2018 based on TCOC for

Medicare to use with global budgets/engage physicians through Amendment

 Physician idea—value based payment could be applied to physician payment

 Assists with MACRA eligibility

 Accelerate TCOC focus for Medicare while limiting risk  For 2019, could become a shared savings model or increase value based portion of

payment tied to Medicare TCOC and outcomes

 Works along with ACOs and PCMH models

23

Primary Care

 Rationale:

 The population is aging and chronic diseases are becoming more

prevalent (e.g. 18% of MD population >65 by 2025)

 Need for more care coordination and chronic care management

 Taking on Medicare T

• tal Cost of Care (for the sustainability of

the All-Payer Model) relies heavily on primary and complex and chronic care

 CMS is focused on enhancing chronic care and primary care, and is

providing significant funding sources. E.g. Chronic Care Management fees

(CCM), Comprehensive Primary Care Plus model (CPC+)

 Main idea--Focus on the opportunity to replace the CCM fee with a

CPC+ type of model that pays care management dollars on a risk- adjusted per person basis rather than a fee schedule, and support primary care transformation

24

Primary Care (cont.)

 Primary Care Strategy: Create a person-centered locus of

care with supporting interdisciplinary care teams across all care settings, data-driven care coordination, and financial incentives that move towards greater accountability

 Concept:

 Tailor care according to persons’ needs  Engage consumers and families  Help people with chronic disease and complex needs live healthier

lives, reducing downstream utilization

 Continue to build care coordination infrastructure and resources  Improve care and reduce potentially avoidable utilization

Update on Medicare Data & Analysis

August 5, 2016

2

Disclaimer

Data contained in this presentation represent analyses prepared by HSCRC staff based on data summaries provided by the Federal Government. The intent is to provide early indications of the spending trends in Maryland for Medicare patients, relative to national trends. HSCRC staff has added some projections to the summaries. This data has not yet been audited or verified. Claims lag times may change, making the comparisons inaccurate. ICD-10 implementation could have an impact on claims lags. These analyses should be used with caution and do not represent official guidance on performance or spending trends. These analyses may not be quoted until public release.

3

Medicare Hospital Spending per Capita

Actual Growth Trend (CY month vs. prior CY month)

• 12.0%
• 10.0%
• 8.0%
• 6.0%
• 4.0%
• 2.0%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% Maryland Maryland Projected National National Projected Recent trend shows Maryland below the nation

4

Total Cost of Care per Capita

Actual Growth Trend (CY month vs. prior CY month)

• 12.0%
• 10.0%
• 8.0%
• 6.0%
• 4.0%
• 2.0%

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% Maryland Maryland Projected National National Projected Recent trend shows Maryland below the nation

5

Non-Hospital Spending per Capita

Actual Growth Trend (CY month vs. prior CY month)

• 12.00%
• 10.00%
• 8.00%
• 6.00%
• 4.00%
• 2.00%

0.00% 2.00% 4.00% 6.00% 8.00% 10.00% Maryland Non Hospital Maryland Non Hospital Projected US Non Hospital US Non Hospital Projected

Recent trend shows Maryland above the nation

6

Non Hospital Part A Spending per Capita

Actual Growth Trend (CY month vs. prior CY month)

• 12.00%
• 10.00%
• 8.00%
• 6.00%
• 4.00%
• 2.00%

0.00% 2.00% 4.00% 6.00% 8.00% 10.00% Maryland Non Hospital Part A Maryland Non Hospital Part A Projected US Non Hospital Part A US Non Hospital Part A Projected

Recent trend shows Maryland climbing above the nation in Part A spending

7

Non Hospital Part B Spending per Capita

Actual Growth Trend (CY month vs. prior CY month)

• 12.00%
• 10.00%
• 8.00%
• 6.00%
• 4.00%
• 2.00%

0.00% 2.00% 4.00% 6.00% 8.00% 10.00% Maryland Non Hospital Part B Maryland Non Hospital Part B Projected US Non Hospital Part B US Non Hospital Part B Projected

Recent trend show Maryland above the nation in non hospital part B

CRISP R CRISP Reporting Ser porting Services ices

Augus August 5, 5, 2016 2016

Medicare Data

• Maryland hospital leaders have expressed

considerable interest in access Medicare data to support planning and implementation activities for the new All-Payer Model

• The two general types of data needs are:

1) Sufficiently detailed data to support performance monitoring, policy, and planning 2) Patient-level, identifiable data to support implementation of care coordination activities

• Each data need requires different processes for

access and rationales for use

2

Performance Monitoring and Planning

• HSCRC, MHA, and CRISP have access to non-

identifiable Medicare data through the Chronic Conditions Warehouse (CCW)

• Significant administrative challenges with CCW,

including cell size limits

• Two different reports (one current, one under

development) are based on the CCW access:

1) County-level total cost of care reports for 2011- 2015, currently available through CRISP 2) Service-area and per beneficiary total cost of care reports, under development for scheduled release in September through CRISP

3

Sample County Report (Available Now)

4

More Monitoring and Planning

• HSCRC have advocated for hospitals to have

direct access to Medicare claims data to support their unique needs

• CMMI established a process for Maryland

hospitals and other providers to access non- identifiable claims-level data through Limited Data Sets (LDS)

• Key attributes of the LDS are:
• All Medicare Part A and Part B claims for 2012-2015
• 100% of physician data (rather than 5% sample)
• All Maryland beneficiaries (except substance abuse)

5

LDS Request Process

• All hospitals must sign a Data Use Agreement

(DUA) with CMS to access LDS data and reports

• There are two options for receiving information:

1) Rely on CRISP for hosting and analytics, including reports without cell size suppression 2) Receive the raw data from CMS directly to run custom analytics

• All hospitals who execute the DUA will have

access to CRISP reports

• Directions and a pre-populated DUA (for option 1)

are available from laura.mandel@crisphealth.org

6

Care Coordination

• Identifiable data for care coordination activities

will be provided under the Care Redesign Amendment currently being processed by CMMI

• Hospitals that choose to do so, may access patient

claims data, share resources, and participate in financial alignment initiatives

• CRISP has prepared for the role of supporting

coordination activities with Medicare claims data

• Request for Proposal for Medicare Data and

Analytics vendors was posted in July

• CRISP will have a solution in place to support ACO-

like analytics for organizations requesting support

7

Current Statewide Infrastructure

• CRISP tools support enhanced patient care and

coordination:

• CRS reports for reviewing total hospital utilization (2

examples follow)

• Patient Care Overview in the Clinical Query Portal

shows real-time encounters, provider relationships, and care alerts

• Single-sign-on places this information within current

EHR workflows

• Ambulatory connectivity enables real-time data

for care coordination

• As CRISP engages more providers, hospitals and
• ther stakeholders will have better data than claims

for care management

8

Medicare High Utilizers

• Reporting and Analytics Subcommittee of the

CRISP Board, working with HSCRC and subject matter experts, requested a simple report to show:

1) Patients who use significant hospital resources 2) Which hospitals those patients use 3) Other relevant information when prioritizing resources

• “High Utilizers” dashboard, available in CRS

dynamic (Tableau) portal shows patients with 3+ bedded care visits and the hospitals they visit

• 50% of these patients visit a single hospital; 75%

visit just two hospitals

9

Medicare High Utilizers

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Purpose is to allow hospitals to view Medicare high utilizers of inpatient services and gather enough information to make care management decisions

• High utilizer = 3 or more

bedded care admissions (IP and Obs >24hrs) in 12 months

• Information included:

hospitals visited, dates, subscribed panels, utilization counts, chronic conditions

Report Headers

Hospital MRN Hospital1 Hospital2 Hospital3 Most Recent Hospital Discharge Date of Most Recent Discharge Panel Affiliation1 Panel Affiliation2 IP, OBV, ED Charges IP Visits OBV Visits ED Visits All Hospital IP, OBV, ED Visits All Hospital IP Visits All Hospital OBV Visits All Hospital ED Visits All Hospital Re- admissions Count of Hospital with Discharges Number of Panels Number of Chronic Conditions

Key Population Health Metrics

• HSCRC has identified specific metrics to

monitor performance

• CRISP worked closely with HSCRC to align

with many of the metrics

• CRISP developed a high level dashboard to

show each hospital how it is performing in their GBR PSA across time periods

• Enhancements are under development for

regional collaborations and detailed information

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HSCRC Key Metrics

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