Practice T Transformation I Initiative Diane Stewart, PBGH - - PowerPoint PPT Presentation

Pacific Business Group on Health

Practice T Transformation I Initiative

Diane Stewart, PBGH January 2016

Ab About t the Practice Transform rmation Initi tiative

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Centers for Medicare & Medicaid Services (CMS) designed the Transforming Clinical Practice Initiative (TCPI) to help clinicians achieve large-scale health transformation. I. The TCPI initiative will support more than 140,000 clinician practices over the next four years in sharing, adapting and further developing their comprehensive quality improvement strategies. II. Pacific Business Group on Health’s California Quality Collaborative was chosen as one of 29 Practice Transformation Networks (PTNs) to provide technical assistance and peer-level support to assist clinicians in delivering care in a patient-centric and efficient manner. III. PBGH’s program name is the Practice Transformation Initiative (PTI). IV.

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National PTNs in CA:

• VHA/UHC Alliance

Newco, Inc.

• National Rural

Accountable Care Consortium

PTN G Geographic Distribu bution

PBGH/CQC Children’s Hospital

• f OC

LA Care

PBGH/CQ CQC’s A Award

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Awarded $18.4 million in partnership with the Integrated Healthcare Association (IHA), Center for Care Innovations (CCI), and Hospital Quality Institute (HQI). 45% of the total award will be reinvested back into delivery systems.

I. Working with 16 public and private provider organizations (POs) supporting 4,800 clinicians in their efforts to measurably improve patient care. II. PTI’s strategy: build capacity within POs and continually improve care at the practice site. III.

The PTI Program

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• PTI works with provider organization (PO) leaders guiding

transformation within their systems; and

• PTI trains practice coaches, hired by the POs, to work intensively

with clinicians Practice Coach and leadership support

• PTI measure set aligns with IHA P4P, Medi-Cal, and other key

measure sets

• IHA is data aggregator

Data feedback and reporting

• Data experts deployed to practices to strengthen data systems,

staff

• Build capacity to report on, analyze, use data

Customized technical assistance

PT PTI M Measure Set et

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• Controlling blood pressure

with HTN

• Asthma Medication Ratio
• For Patients with Diabetes:
• HbA1c testing
• HbA1c < 8.0
• HbA1c > 9.0
• Eye exams
• Nephropathy
• BP < 140/90

PTI Clinical Quality

• Emergency Department

Visits/1000

• Hospital days/1000
• Imaging for Low Back Pain
• Appropriate Cervical Cancer

Screening Utilization

• # of clinicians receiving regular

patient feedback Patient Experience

PTI M Measure Specifications

• Measure definitions are those used by the Integrated

Healthcare Association (http://www.iha.org/)

• IHA follows NCQA HEDIS standards for all measure

definitions

• A Measure Specification Manual will be available in

January 2016

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Prop

• pos
• sed

ed Improv

• veme

ment Go Goals

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Cost Savings Cost Savings of over $242M

• ver four years by reducing

utilization measures by over 5% Care Experience 75% of clinicians receive regular feedback from patients about their personal care experience Medicare 75% of clinicians participate in Medicare value-based payment programs Clinical Quality Measures 15% average relative improvement across clinical quality measures

PTI Improvement Goals

Benefi fits ts to Provider Organizati tions

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• Capacity-building stipend given to support hiring of Practice Coach & data

infrastructure support

• Stipend as milestones are achieved through meeting data submission reporting

Payment

• Customized hands-on coaching on quality, data use and achieving

improvement for leadership team (C-suite) & practice coaches

• Other training provides opportunity to connect with peers, share ideas

Coaching Support

• Customized consulting support on building systems to capture data, generate

reports

• Includes acquisition of hospital data

Data Technical Assistance

• Quarterly reports by organization, site and provider

Reporting and Feedback

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• start date of 1/29/2016
• the number of clinicians is equal to 200

Assumptions:

Program Year PTI Achievement Milestones Expected Date Payment per Clinician Total Payment Percent of Total Payment

Progres ess Paymen ents

1 Contract signed

1/29/16 $85.00

$17,000.00 30.0%

Aim statement completed

2/29/16 $85.00

$17,000.00

Project manager, practice coach(es), IT lead identified and present at February & March trainings

3/31/16 $170.00

$34,000.00

Submission of baseline data and Q1 data

5/10/16 $170.00

$34,000.00

2 Submission of all quarterly reports Q2 through Q5, and attendance at trainings and LLN for those periods

5/10/17 $510.00

$102,000 30.0%

3 Submission of all quarterly reports Q6 through Q9, and attendance at trainings and LLN for those periods

5/10/18 $340.00

$68,000.00 20.0%

4 Submission of all quarterly reports Q10 through Q14, and attendance at trainings and LLN for those periods

8/10/19 $170.00

$34,000.00 10.0%

Improveme ment P Pay ayme ments

Achieve improvement over baseline on a monthly basis for at least 12 months on four (4) clinical measures and two (2) cost of care

• measures. Improvement for each Measure is evaluated

independently.

As achieved and not before Q6 $85.00

$17,000.00 5.0%

Achieve 20% relative improvement over baseline on four (4) clinical measures and two (2) cost of care measures as of the reporting quarter.

As achieved and not before Q10 $85.00

$17,000.00 5.0%

PTI Milestone Payment Structure

Implem emen entation

• n
• Project team and Leadership Learning Network

training will start in February

• POs can report on all clinicians, or those that are

participating

• Option to invest in improvement in two clinician

waves

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Joining PTI: M Minimum Qualificati tions

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An organizational strategy that includes practice transformation. I. Ability to collect, aggregate and share NPI-level electronic data with clinicians on at least a monthly basis. II. Ability to initially report half of the PTI outcome measures. III. Ability to commit at least 200 clinicians to the program. IV.

Eligible Clinicians

• Per CMS, all types of clinicians will able to participate, but
• nly those that are on the PQRS list of eligible professionals

(http://go.cms.gov/1WcAByY) will count towards the number of recruited clinicians.

• Includes: MD, DO, NP, PA, CSW, RD
• Clinicians must work enough hours to have data that is

meaningful and valid

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PTI P Parti ticipati tion G Guidelines

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I. II. III. IV.

Secure staff for program

• Practice coach(es) to work with participating clinicians
• Project Manager
• Data lead

Attend PTI training sessions and program staff meetings Submit NPI level data quarterly to IHA Share monthly data with clinicians

Key Tasks through F Febru ruary

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Task Due Date

Identify participating clinicians Friday, February 12, 2016 Identify practice coaches Work with PTI staff to submit baseline data Hold kick-off meeting with PTI staff to begin planning Attend Pre-Work Webinar The following tasks will begin during the recruitment process and be completed on or by February 12, 2016.

Imme mediate Next Steps

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Task Due Date

Sign-off on Contract Friday, January 29, 2016 Schedule & hold Welcome Webinar with your Project Team Monday, February 8, 2016 Attend Pre-Work Webinar Tuesday, February 9 or Date TBD

Qu Ques estion

• ns? Contact Us

Us!

Diane Stewart Pacific Business Group on Health/California Quality Collaborative dstewart@pbgh.org

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