Virginia Garcia Memo morial He Health Cen enter er Alternative - - PowerPoint PPT Presentation

Virginia Garcia Memo morial He Health Cen enter er

Alternative Payment Methodology

Maine PCA Conference Gil Muñoz, MPA CEO Virginia Garcia Memorial Health Center April 29, 2019

Transforming Primary Care

Our Mission

Virginia Garcia’s mission is to provide high- quality, comprehensive, and culturally appropriate health care to the communities

• f Washington and Yamhill counties with a

special emphasis on migrant and seasonal farm workers and others with barriers to receiving health care. Virginia inspires the work we do every day.

Started in 1975 by a small group of community activists determined to improve the health of the most vulnerable in our community, Virginia Garcia Memorial Health Center serves over 45,000 patients today.

Our Community

Approximately 600,000 people in service area (Washington/Yamhill counties) Mix of rural and urban area Mix of industry- agricultural and high tech nurseries, vineyards, Intel, Tektronix, Nike Migrant and Seasonal Farmworkers (May- August- peak season) Refugee Population (Africa, Middle East, Russia, Somalia)

Responding to Community Need

We e ser erve o e over er 46,500 46,500 patient nts i in n Washi hing ngton a n and nd Yamhi hill cou count nties a at:

• Five primary care and six dental clinics in Newberg, McMinnville, Beaverton,

Hillsboro and Cornelius

• Six school-based health centers located in Willamina, Tigard, Tualatin, Century,

Beaverton and Forest Grove

• A mobile outreach clinic

Our pati tien ents ts

• Speak over 60 different languages
• 40% of our patients are under 18
• 56% of our patients are of Hispanic descent
• 60% are covered by Medicaid
• 20% are uninsured

Services Offered

• Immunizations
• OB/GYN and Prenatal
• Chronic Disease Management
• Well-Baby and Well-Child Visits
• Dental Care
• Vision Care
• Behavioral and Mental Healthcare
• Pharmacy
• Health and Wellness Education
• Farmworker Outreach

Drivers of Change

Pre-PCP CPCH/ CH/APM

• Volume Driven Care
• Provider & Patient Dissatisfaction
• Provider Centric Care
• Lack of Coordination
• Lack of Flexibility in service delivery
• Lack of Preventive Focus

2006 Delegation to South Central Foundation 2007 Primary Care Renewal Collaborative 2007-2009 Spread PCR/EHR across VG Sites 2012 APM Implementation 2013-19 CCO Roll Out/Value Based Pay 2019-beyond CCO 2.0/Pop Health/VBP

Time Line

Model of Care Transformation

“We’re not in the pill and procedure business. Healing is being in relationship over time with caring, knowledgeable people. We’re in the service business first.” - Dou

• ug Eby, M
• MD. V

. VP SCF

5 Pillars of the Primary Care Renewal

Team eam-Based C Care Proactive Pa Panel Manag agemen ement Bar arrier Free A ee Acces ess Integr egrat ated ed Behav avioral al Heal ealth Customer D Driven/ Pa Patient-Ce Centric c Care

PATIENT CENTERED PRIMARY CARE HOME

T eam Based Care

APM ADMINISTRATIVE INFRASTRUCTURE

Making APM work from the ground up

Phase I: Grants- Establish systems: Team formation, co-location, data systems, Training, Meaningful Use, PCPCH Phase II: Coding to reimburse for elements of model. Review of possible CPT codes aligned with model (Example: Behavioral Health Assessment Codes) Phas ase III: III: Change in Scope Application (Adjust PPS rate to support new model) Phase I IV: Development of Alternative Payment Methodology with payers to support model (baseline indicators, pay for process) Phase V V: Payment for Outcomes/ Value-Based Pay (VBP) Policy Change

BUILDING THE FINANCIAL FOUNDATION FOR PATIENT

• CENTERED PRIMARY CARE

Financial Considerations

• Changes to budgeting and reporting
• Income Analysis needs to take membership projections into account
• Projection of revenue across CCO’s
• Projection of quality incentive payments

Governance Considerations

• Ens

nsure t the he B Board und nderstand nds a and nd is eng ngaged i in n the he m mov

• ve to
• AP

APM

• Educa

cate Fina nanc nce C Com

• mmittee on
• n methodolo

logy

• Dialogue w

with B h Board on

• n value o
• f holi

holistic a c approach

• Office Visits
• Health Education
• CareSTEPs
• Wellness Activities
• Investments in

in non billa llable se servic ices, f facili lities to a accommodate welln llness a activitie ies

Data & APCM Reporting Workflow

Decease d Patient Roster

Membership

Dismissed Patient Report

EPIC/BO O REPOR ORTS

(Run weekly)

Internal A Audit R Report

(weekly)

31 3131 31 – MMIS IS (weekly)

ECR CR (week

eekly)

Error

• r

Error

• r

SQL/A /APM PM ACCESS D S DB

APM Patient Roster Invalid ID, Date Issues, etc.

NECR

(quarterly)

Leakag age

(monthly)

• utside VG

18 Month Care S STEP EP Report (monthly)

18 month non- engagement

Fix issues in Epic Membersh ship/Car are Team am Outreach

• Establish Care

Step

• No contact /

Wait for NECR PDR

(monthly)

• r removed

Patien ent Patient Encounter

• Covered by

OHP

• Billable OV,

Home, Group,

• r Telemed
• TBD – codes

for qualified non-billable visits (OPCA?) Membership HM Modifier added

Membership Department

• Ma

Mana nages t the he AP APM R M Ros

• ster t

r to

• ens

nsure a accu ccuracy

• Medicaid ID, coverage dates, etc.
• Attri

ribut ution

• n
• Audits enrollment change report, leakage reports, scrubs lists prior to submittal to

OHA

• Performs O

Outreach t h to a

• assigne

ned b but non non established p patients

• Performs O

Outreach t h to p

• patients f

for s

• r sche

cheduling ng o

• f key p

preventive visi isits (e (ex. w well ll child ild checks, w well ll w woma man e exams, C CRC, Hypertension

• n, D

, Diabetes)

APM OUTCOMES

Access to Care

• Slot T

t Targets ets

• Physicians

3,600

• APC’s

3,300

• Panel

el S Size p e per F FTE

• Family Practice

1,200

• Internal Medicine 1,000

0% 20% 40% 60% 80% 100% 120% 140% 160% 180% Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

3rd Next Available % Established/Engaged Patients Uninsured Waitlist Goal

APM CCO Assigned and Established

20,146 96% 50% 70% 90% 110% 10,000 14,000 18,000 22,000 # of Patients Established % of Established Patients with Engagement

Q4 APM Clinical Quality Metrics

CARE STEPS (Care and Services That Engage Patients)

# Telepho ephone Encount nters with h Care e STEPs

CareSTEPs 12 Month Trend

Q4 T

• p 5 CareSTEPs

39% 25% 17% 11% 7%

Behavioral_or_Mental_Health_Screening Education provided: group setting Health Education Supportive Counseling Accessing community resource/service Exercise class participant

Oregon Health Authority Evaluation - APM

Optu tumas as St Study-(2018) ) Fin indin ings

• Nearly $25 Million in avoided costs over first 3 years of program
• Decrease in utilization for high cost services (inpatient, ED)
• Increase in preventive services
• Overall cost effectiveness improves with time on methodology
• Overall improving access to care
• Enhancing Patient Experience, quality, and efficiency through care coordination and care

managment

APM Lessons Learned

• Transformative in providing alignment between model of care and payment
• Emphasizes the right care, right time, right person
• Requires significant investment in data and membership
• Requires significant investment in Change Management
• Prepares for Value Based Pay/Population Health
• Need to maintain focus on balanced scorecard: quality, access, patient experience,

financials, staff engagement

Thank You!

@VGMHC @VirginiaGarcia @VGMHC Virginia Garcia Memorial Health Center and Foundation Virginia Garcia Memorial Health Center @VGMHCComunidad (Spanish-only page)