SIM PTO TRAINING NOVEMBER 28, 2018 9:00 AM Call Instructions: Please • Mute your phone, microphone, and speakers on your computer/device • Turn off the zoom video feature • Enter your name/organization in the chat box feature for attendance • Submit questions via the chat box feature • Questions will be answered following the presentation • Time to ask questions via audio will be offered for those on the phone 1
NOVEMBER 28, 2018 COLORADO SIM PTO TRAINING Presenters: Marjie Harbrecht, MD BB3 – EMPANELING THE POPULATION Stephanie Kirchner, MSPH, RD BB6 – RISK STRATIFICATION – ACTIVE Kelly Pearson, RN, MSN MANAGEMENT Andrew Bienstock, MHA BB7 – SCREENING AND LINKING FOR BH/SUD
TRAINING OBJECTIVES ▪ Review Assessment Results for Cohort 2 – Year 1 ▪ Review “Good Standing”, invoicing, and other associated issues ▪ PHASE 3 – Population Management ▪ BB3 – Empanel Patient Population ▪ BB6 – Risk Stratify and Actively Manage Patients ▪ BB7 – Screen and Link to BH/SUD Resources ▪ Upcoming Events and Due Dates 3
COHORT 2 - YEAR 1 ASSESSMENT RESULTS ANDREW BIENSTOCK 4
CLINICIAN & STAFF SURVEYS: COHORT 2 - YEAR 1
MAC RESULTS: COHORT 2 - YEAR 1
GOOD STANDING, INVOICING AND OTHER ASSOCIATED ISSUES ANDREW BIENSTOCK 8
GOOD STANDING: COHORT 2 - YEAR 2 ▪ SIM-Only Practices : ▪ Achieve a rating of (4) for at least 75% of activities in Year 2 Building Blocks 1, 2, 3, 4, and 7, and any two additional Year 2 building blocks (Building Blocks 5, 6, 8, 9, and 10) and a rating of (3) for remainder of activities. ▪ CPC+ Practices : ▪ Achieve a rating of (4) for at least 75% of activities in Year 2 Building Blocks 1, 2, 3, 4, 7, 8, 9 and 10, and a rating of (3) for remainder of activities. NOTE : Though not required for good standing, Cohort 2 practices should be scored on Year 1 BBs/Milestones on the MAC at baseline and at end of project period. 9
GOOD STANDING: COHORT 3 ▪ SIM-Only Practices : ▪ Achieve a rating of (4) for at least 50% of activities in Year 1 Building Blocks 1, 2, 3, 4, and 7, and a rating of (2) or (3) for the remainder of the activities. ▪ CPC+ Practices : ▪ Achieve a rating of (4) for at least 50% of activities in Year 1 Building Blocks 1, 2, 3, 4, 7, 8, 9 and 10, and a rating of (2) or (3) for the remainder of the activities. NOTE : Though not required for good standing, Cohort 3 practices should be scored on Year 2 BBs/Milestones on the MAC. 10
ACHIEVEMENT-BASED PAYMENTS: COHORT 2 - YEAR 2 Tier 1: If practice achieves the following scores on the MAC they will receive the achievement-based payments for all Year 2 Building Blocks: ▪ SIM-Only Practices : ▪ Achieve a rating of (4) for at least 75% of activities in Year 2 - BBs 1, 2, 3, 4, & 7 and any two additional Year 2 building blocks (BBs 5, 6, 8, 9, & 10) and rating of (3) for remainder of activities. ▪ CPC+ Practices : ▪ Achieve rating of (4) for at least 75% of activities in Year 2 BBs 1, 2, 3, 4, 7, 8, 9 & 10 , and a rating of (3) for remainder of activities. 11
ACHIEVEMENT-BASED PAYMENTS: COHORT 2 - YEAR 2 Tier 2: If practice does not reach requirements in Tier 1, they can still be eligible for achievement-based payments for all BBs if they meet the following: ▪ SIM-Only Practices: ▪ Achieve rating of (4) for at least 75% of activities in Year 2 - BBs 1, 4 & 7 , and rating of (3) for remainder. ▪ CPC+ Practices : ▪ Achieve rating of (4) for at least 75% of activities in Year 2 - BBs 4, 7, and two of BBs 8, 9 or 10, and rating of (3) for remainder. ▪ * CPC+ Practices only select two building blocks to work on from 8, 9, and 10. Because of small numbers of milestones in individual building blocks, we have combined BBs for SIM-Only and CPC+ Practices. Tier 3: If a practice does not receive their achievement-based payment based on the criteria in Tiers 1 or 2 we will default to the following methodology: SIM-Only Practices : ▪ ▪ Achieve rating of (4) for at least 75% of activities in Year 2 BB1 , and rating of (3) for remainder of activities = Payment for BB1. Achieve rating of (4) for at least 75% of activities in Year 2 BB4 , and rating of (3) for remainder of activities = Payment for BB4. ▪ Achieve rating of (4) for at least 75% of activities in Year 2 BB7 , and rating of (3) for remainder of activities = Payment for BB7. ▪ ▪ CPC+ Practices : Achieve rating of (4) for at least 75% of activities in Year 2 BB4 , and rating of (3) for remainder of activities = Payment for BB4. ▪ ▪ Achieve rating of (4) for at least 75% of activities in Year 2 BB7 , and rating of (3) for remainder of activities = Payment for BB7. ▪ Achieve rating of (4) for at least 75% of activities in at least two of Year 2 - BBs 8, 9, or 10, and rating of (3) for remainder of activities = Payment for those Building Blocks. 12
ACHIEVEMENT-BASED PAYMENTS: COHORT 3 Tier 1: If a practice achieves the following scores on the MAC they will receive the achievement-based payments for all Building Blocks: SIM-Only Practices : Achieve rating of (4) for at least 50% of activities in Year 1 - BBs 1, 2, 3, 4, & 7 , and rating of (2) or (3) for remainder. CPC+ Practices : Achieve rating of (4) for at least 50% of activities in Year 1 - BBs 1, 2, 3, 4, 7, 8, 9 & 10 , and a rating of (2) or (3) for remainder. 13
ACHIEVEMENT-BASED PAYMENTS: COHORT 3 Tier 2: If a practice does not reach the requirements in Tier 1, they can still be eligible for the achievement-based payments for all Building Blocks if they meet the following requirements: SIM-Only Practices : • Achieve rating of (4) for at least 50% of activities in Year 1 - BBs 1, 4 & and 7 , and rating of (2) or (3) for remainder. CPC+ Practices : Achieve rating of (4) for at least 50% of activities in Year 1 - BBs 4, 7, & two BBs from 8, 9 and 10, and a rating of (2) or (3) for • remainder. *CPC+ Practices only select two BBs to work on from 8, 9, and 10 . Because of small numbers of milestones in individual building ▪ blocks we have combined building blocks for SIM-Only Practices, and CPC+ Practices. Tier 3: If a practice does not receive their achievement-based payment based on the criteria in tiers 1 or 2 we will default to the following methodology: SIM-Only Practices : Achieve rating of (4) for at least 50% of activities in Year 1 BB1 , and rating of (2) or (3) for remainder of activities = Payment for BB1 . Achieve rating of (4) for at least 50% of activities in Year 1 BB4 , and rating of (2) or (3) for remainder of activities = Payment for BB4 . Achieve rating of (4) for at least 50% of activities in Year 1 BB7 , and rating of (2) or (3) for remainder of activities = Payment for BB7 . CPC+ Practices : Achieve rating of (4) for at least 50% of activities in Year 1 BB4 , and rating of (2) or (3) for remainder of activities = Payment for BB4 . Achieve rating of (4) for at least 50% of activities in Year 1 BB7 , and rating of (2) or (3) for remainder of activities = Payment for BB7 . Achieve rating of (4) for at least 50% of activities in at least two of Year 1 - BBs 8, 9, or 10 , and rating of (2) or (3) for remainder of activities = Payment for those Building Blocks . 14
DOCUMENTS FOR ACHIEVEMENT BASED PAYMENTS AVAILABLE AT: COHORT 2 YEAR 2: HTTP://RESOURCEHUB.PRACTICEINNOVATIONCO.ORG/2018/11/ 27/PRACTICE-ACHIEVEMENT-BASED-PAYMENT-COHORT-2- YEAR-2/ COHORT 3: HTTP://RESOURCEHUB.PRACTICEINNOVATIONCO.ORG/2018/11/ 27/PRACTICE-ACHIEVEMENT-BASED-PAYMENT-COHORT-3/ 15
COHORT 3 & COHORT 2 – YEAR 2 MILESTONES PHASE 3 MANAGING A POPULATION BB3 – BB6 – BB7 16
NOVEMBER 1, 2018 - JANUARY 31, 2019 COHORT 2 – YEAR 2 COHORT 3 ▪ BB3 – Empaneling Patient Population ▪ BB3 – Empaneling Patient Population ▪ BB6 – Risk Stratification/Actively Manage ▪ BB6 – Risk Stratification/Actively Manage Patients Patients ▪ BB7 – Screen and Link to BH/SUD Resources ▪ BB7 – Screen and Link to BH/SUD Resources 17
PHASED APPROACH TIMELINE: COHORT 3 18
PHASED APPROACH TIMELINE: COHORT 2 - YEAR 2 19
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