PCMH 2.0 2019 Medicaid PCMH Program August 24, 2018 AGENDA CARE - - PowerPoint PPT Presentation

PCMH 2.0

2019 Medicaid PCMH Program August 24, 2018

AGENDA

• CARE PLANS (Fast Track for 2019)
• PASSE (How will it affect PCMH)
• PCMH 2.0 (2019 Medicaid PCMH Program)
• POPULATION HEALTH MANAGEMENT MONTHLY REPORT
• (Introduction and Overview)
• SHARE (Update)
• UPDATE (Reports/Payments/Shared Savings)

Fast Track ck Care Plan Au Audit

Shelley G. Ruth PCMH Quality Assurance Manager, AFMC August 24, 2018

Fast Track Care Plan Au Audit De Details

§ Fast Track Audit vs. Regular Audit

• Only required to submit five care plans for Fast Track
• 20% of the attested to care plans are selected for regular audit

§ Qualifications for the Fast Track Care Plan Audit

• Must pass at least two consecutive years of care plans audits
• Must not have been placed in remediation for care plans

Fa Fast Track Care Plan Audit Details § PCMHs Eligible for 2018 Fast Track

• 95 PCMHs out of 202 eligible
• Reduced burden

§ Fast Track Disqualifications

• Not meeting the 80% target
• Placed in remediation

§ Scoring method used for 2018 audit

• Two points for each required element
• Care Plan validation spreadsheet

PASSE

HOW WILL PCMH BE AFFECTED

CURRENT PASSE ATTRIBUTION

• Currently there are around 33,424 beneficiaries attributed to a

PASSE

• Arkansas Total Care

5,747

• Empower Health Solution

13,526

• Forevercare

5,534

• Summit Community Care

8,617

• There are currently around 18,000 PCMH beneficiaries that are

attributed to a PASSE. That is around 5.5% of the PCMH population

HOW IS MY PCMH ATTRIBUTION BE AFFECTED

• CURRENT 2018 PERFORMACE PERIOD
• Even though they are assigned to a PASSE they are still counted in your

PCMH attribution and you will continue receiving PCCMs and PBPMs

• 2019 PERFORMANCE PERIOD
• Beginning January 1, 2019, No longer counted in your Attribution
• You will no longer receive PCCMs or PCMH PBPMs for those attributed to

a PASSE

HOW WILL MY PCMH PERFORMANCE BE AFFECTED

• CURRENT 2018 PERFORMANCE PERIOD
• These beneficiaries are still counted toward your PCMH Performance.
• 2019 PERFORMANCE PERIOD
• Those attributed to a PASSE will no longer be counted in you PCMH

Performance

• You may continue to provide services for these patients but through your

contract with one of the PASSE

QUESTIONS?

PCMH PCMH 2.0 .0

2019 Medicaid PCMH Program Performance Based Incentive

Enrollment

• October 10th – November 21, 2018
• Practice must have at least 150 attributed beneficiaries at time of

enrollment

• Previously Suspended Practices may return to the PCMH Program

contingent on:

• submission of a completed PCMH Program enrollment application
• successful implementation of all the activity(s) which the practice failed

that resulted in suspension from the program

KE KEY NE NEW T W TERMS RMS

• SHARED PERFORMANCE ENTITY - A PCMH or Pooled

PCMHs that, contingent on performance, may receive performance based incentive payments

• PERFORMANCE BASED INCENTIVE PAYMENTS (PBIP)–

Payments made to a Shared Performance Entity for delivery of economic, efficient and quality care.

PERFORMANCE BASED INCENTIVE PAYMENTS ELIGIBILITY (ATTRIBUTION)

• A Shared Performance Entity must have a minimum of 1,000

attributed beneficiaries after exclusions are applied.

• This is down from the previous years requirement of 5,000 for Shared

Savings

• This can be achieved one of four ways:
• Independently
• Voluntarily pooling with other PCMH(s)
• Those Practices with attribution of 150-299 will be allowed to join Voluntary pool

for 2019

• Practices performances will be aggregated together for both Performance Based

Incentive Payments AND Quality Metrics

PERFORMANCE BASED INCENTIVE PAYMENTS ELIGIBILITY (ATTRIBUTION)

• Default Pool-minimum of 300 attributed beneficiaries and do not wish to participate in

voluntary pool

• Utilization performance and focus measure will be aggregated together.
• Quality Metrics will be measured on individual PCMH level.
• Petite Pool-practices with less than 300 attributed beneficiaries and not wishing to

participate in voluntary pool

• Practices performances will be aggregated together for both Performance Based Incentive

Payments AND Quality Metrics

PERFORMANCE BASED INCENTIVE PAYMENTS ELIGIBILITY (ACCOUNTABILITY)

• ACTIVITIES – Practices must complete activities tracked for

Practice Support

• METRICS – PCMHs must pass 2/3 of Quality Metrics
• CORE METRIC – Minimal Performance on Selected Core Metric
• 2019 Infant Wellness - A PCMH will be placed in remediation for the

Wellness Metric tracked for Practice Support if, 15% or greater of the patient panel (0 – 15 months), have 0 – 1 wellness visits AND the PCMH does not meet the 2019 Quality Metric Target for 5 or more visits.

PERFORMANCE BASED INCENTIVE PAYMENTS

• A Shared Performance Entity is eligible to received a Performance

Based Incentive Payments (PBIP) in One or Multiple of the following ways:

• Inpatient Rates
• Emergency Department Rates
• Focus Metric (2019 Adolescent Wellness)

PBIP FOR INPATIENT RATE

• Shared Performance Entities that are in the top 10th percentile for

Lowest Inpatient rates can receive $12 times the number of attributed member months

• Shared Performance Entities that fall between the top 11th-35th

percentile for Lowest Inpatient rates can receive $6 times the number of attributed member months

PBIP FOR EMERGENCY DEPARTMENT RATE

• Shared Performance Entities that are in the top 10th percentile for

Lowest Emergency Department rates can receive $8 times the number of attributed member months

• Shared Performance Entities that fall between the top 11th-35th

percentile for Lowest Emergency Department rates can receive $4 times the number of attributed member months

PBIP FOR FOCUS METRIC (2019 Adolescent Wellness)

• Shared Performance Entities that are in the top 10th percentile for

Highest Focus Metric rates can receive $5 times the number of attributed member months

• Shared Performance Entities that fall between the top 11th-35th

percentile for Highest Focus Metric rates can receive $2.50 times the number of attributed member months

Performance Metric

Infant Wellness ˂15% 0-1 Visits for Children 0-15 Months

• Meeting State Metric For 5 Visits Satisfied Metric

QUESTIONS?

www.gdit.com/health

Monthly Metrics Report Tool

Patient-Centered Medical Home

EJ Shoptaw Jerry Cohen July 30, 2018

Purpose of Presentation

• Introduce Monthly Metric Report Tool
• Tool Operation Guide
• Overview of Additional Features
• Overview of Prospective Benefits

Introducing: Monthly Metric Report Tool

Overview

• GDIT is developing a tool to aid in the generation of

monthly metric reports containing patient level metrics.

─ The tool utilizes more current data, so providers can become

familiar with beneficiary population.

─ These reports will assist PCMH providers in understanding

gaps in care related to any quality metrics based on point in time beneficiary panel profiles.

─ The reports assist at a beneficiary level, where future action

can be assessed and taken by the PCMH to close gaps in care.

• Although the initial tool is specific for the PCMH

program, GDIT’s tool represents the initial step toward monitoring of “best practice” medicine for all Arkansas Medicaid beneficiaries.

Operation Guide

Generation Process

• Monthly Metric spreadsheets are generated using drop

down boxes to control parameter selections.

─ Once generated, reports will be easily accessible through a

web based portal and appear in a multi-tabbed Excel format (a tab for each enrolled PCMH for the current configuration year).

• This format allows filtering for easy identification and sorting of

patients where outreach is needed to close a “gap” in their care.

• The Summary tab of the report will contain metric results for all

quality measures.

• Subsequent tabs will include detailed metrics for each qualified

patient.

Sample Report: Summary

Sample Report: Detail Wellness (0-15 months)

Sample Report: Detail Wellness (3-6 yrs)

Sample Report: Detail Wellness (12-20 yrs)

Sample Report: Detail Diabetes

Sample Report: Detail HPB

Additional Features

Additional Features

• The monthly metric reports will be incorporated into GDIT’s Quality Insight

Application.

─ This will allow Arkansas DMS and call center users the ability to monitor or answer

questions from PCMH providers.

Benefits

Benefits

• This tool not only provides valuable information to PCMH physicians to

better manage their patients, but also summarizes where they are on their metrics linked to the Arkansas PCMH payment model.

• The data in each metric report will contain 2-3 month old data, which will

be delivered monthly (vs the quarterly reports released with 6 month old data).

─ This will allow providers more time to interact with their patient population.

HEALTH INFORMATION EXCHANGE (HIE)

SHARE

SHARE STAFFING

qNEW staffing recently hired

qAnne Santifer, Executive Director OHIT

• qDr. Thomas Powell, SHARE Clinical Director

qRhonda Hill, SHARE HIT Policy Director

qVACANT, SHARE HIT Technical Director q7 VACANT SHARE Technical positions qwww.ark.org/arstatejobs (AR Dept. of Health)

SHARE

SHARE

Recruit stakeholders to provide insight, feedback (through 4/6) Conduct user group conversations with recruited stakeholders

March-April 2018 Conduct needs assessment and gap analysis of SHARE

HIE COUNCIL

Stakeholder user groups

Launch end user advisory / work groups Re-establish

STAKEHOLDER USER GROUPS

qRespond to new and/or changing needs, requirements, tools, issues qReview and provide suggestion/edit to client- facing solutions qSuggest new functionality qRepresent the user community qIf interested in learning more, contact Rhonda.Hill@hit.Arkansas.gov or 501-410-1993

SHARE

THANK YOU

Questions? New contact: Anne Santifer, 501-410-1996 Anne.Santifer@hit.Arkansas.gov

SHARE

UPDATES

• Reports
• Payments
• 2016 Shared Savings