WMC Performing Provider System(PPS) Presentation to Primary Care - - PowerPoint PPT Presentation
WMC Performing Provider System(PPS) Presentation to Primary Care Physicians March 11, 2015 8:00AM-9:00AM 1 http://www.policymed.com/2015/01/secretary-burwell-announces-hhs-quality-payment-goals-introduces-timeline-for-shifting-
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http://www.policymed.com/2015/01/secretary-burwell-announces-hhs-quality-payment-goals-introduces-timeline-for-shifting- medicare-reim.html
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/dsrip_vbp_webinar_slides.pdf
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Discussion Topic Welcome & Introduction Brief Recap of DSRIP: Payment Reform Brief Recap of DSRIP: NYS MRT and the 1115 Waiver WMC PPS & DSRIP Timeline An Incredibly Ambitious and Complex Set of Projects Role of Primary Care Patient Centered Medical Home & “Meaningful Use” of HIT Next Steps Questions
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payment-waivers-issue-brief/
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014
7 https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014
the game by creating the Medicaid Redesign Team (MRT)
– Improved primary/coordinated care – Moved Medicaid members from fee-for-services to managed care.
– Investments in high-quality primary care and care coordination
8 https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014
billion of the $17.1 billion in federal savings generated by MRT reforms.
– Transform the state’s Health Care System – Bend the Medicaid Cost Curve – Assure Access to Quality Care for all Medicaid members
PERFORMING PROVIDER SYSTEMS (PPS): LOCAL PARTNERSHIPS TO TRANSFORM THE DELIVERY SYSTEM
Partners should include: Hospitals, Health Homes, Skilled Nursing Facilities, Clinics & FQHCs, Behavioral Health Providers, Home Care Agencies, Other Key Stakeholders
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014
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# Project Description Domain 2: Systems Transformation Projects
2.a.i Create an Integrated Delivery System Focused on Evidence-Based Medicine and Population Health Management –Advanced Primary Care—Patient Centered Medical Home for all PCPs; support for Information informed care, “Meaningful Use,” Closing the Referral Loop, Medication Reconciliation 2.a.iii Health Home At-Risk Intervention Program –PCP linked care coordination for Chronic Conditions 2.a.iv Create a Medical Village Using Existing Hospital Infrastructure 2.b.iv Care Transitions Intervention Model to Reduce 30-day Readmissions for Chronic Health Conditions-Link discharge planning to Primary Care 2.d.i Implementation of Patient Activation Activities to Engage, Educate and Integrate the uninsured and low/non-utilizing Medicaid populations into Community Based Care (Project 11) Focus on Primary Care sites serving the uninsured (FQHCs & Hospital Clinics) and Community Based Organizations
Domain 3: Clinical Improvement Projects
3.a.i Integration of Primary Care and Behavioral Health Services 3.a.ii Behavioral Health Community Crisis Stabilization Services 3.c.i Implementation of Evidence-Based Strategies in the Community to Address Chronic Disease – Diabetes 3.d.iii Implementation of Evidence-Based Guidelines for Asthma Management
Domain 4: Population-Wide Prevention Projects
4.b.i Promote Tobacco Use Cessation, Especially Among Low SES Populations and Those with Poor Mental Health – Promote tobacco cessation counseling—Primary Care, Dental, Behavioral Health providers 4.b.ii Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings – Cancer Support PCP based cancer screening FU and referral for treatment
Confidential – Not for Distribution
Component IDS Health Home at Risk 30 day Readmission BH – Primary Care BH Crisis Stabilization Diabetes Asthma Tobacco Cessation Cancer 2.a.i 2.a.iii 2.b.iv 3.a.i 3.a.ii 3.c.i 3.d.iii 4.b.i 4.b.ii Protocols/ Evidence- based Care X X X X X X X X X Contracts/ DEAA/BAA X X X X X X X X X EHRs/HIE X X X X X X X X X Health Home/ Care Management X X X X X X X X X Coordination
X X X X X X X X X Performance Reporting X X X X X X X X X Cultural Competence X X X X X X X X X
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ACTIVATED PATIENTS: Patients residing in counties served by the PPS having completed a RHIO Consent Form (including agreeing or denying consent).
Total # providers committed (as per project plan application) Primary Care Physicians 609 Non-PCP Practitioners 1878 Hospitals 20 Clinics 50 Health Home / Care Management 27 Behavioral Health 324 Substance Abuse 28 Skilled Nursing Facilities / Nursing Homes 43 Pharmacy 4 Hospice 7 Community Based Organizations 148 All Other 1152
Domain 1 Requirements Completion Date: December 2017 Project Requirements (2 of 11) :
actively sharing EHR systems with local health information exchange/RHIO/SHIN-NY and sharing health information among clinical partners, including direct exchange (secure messaging), alerts and patient record look up, by the end of Demonstration Year (DY) 3.
certification for all participating PCPs, expand access to primary care providers, and meet EHR Meaningful Use standard
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Project Requirements:
specialists, and community based asthma programs (e.g., NYS Regional Asthma Coalitions) to ensure a regional population-based approach to asthma management.
providers.
based asthma guidelines.
access to asthma specialists, including EHR-HIE connectivity and telemedicine.
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Total # providers committed (as per project plan application) Primary Care Physicians 524 Non-PCP Practitioners 800 Clinics 15 Health Home / Care Management 27 Pharmacy 4 Community Based Organizations 35 All Other 455 All Committed Providers 1860
NYS Designated Provider Types for 3.d.iii Domain 1 Metrics for 3.d.iii
Evidence-based asthma mgmt. guidelines between PCPs, specialists and community asthma programs PPS has agreements from providers and community programs to support ..asthma guidelines. …participating practices have a Clinical Interoperability System in place .. …adhere to national guidelines for asthma management; protocols for access to asthma specialists; EMR- HIE connectivity; telemedicine. Agreements with Asthma educations and asthma specialists are established. EMR (meets) RHIO's HIE and SHIN- NY requirements. Telemedicine implemented Deliver educational activities addressing asthma management to participating primary care providers. Participating providers receive training in evidence-based asthma management. Ensure coordination with the Medicaid MCO and HHs serving the affected population. establish agreements with MCOs (on) coverage of patients with asthma..; establish agreements with HH care managers…. Use E.HR or other technical platform to track all patients engaged in this project. identify targeted patients and track actively engaged patients for project milestone reporting.
Domain 1 Requirements Completion Date: December 2016
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Activated Patients: The number of participating patients with asthma action plan.
June 2015 Dec 2015 June 2016 Dec 2016 June 2017 Dec 2017 June 2018 Dec 2018 500 1200 2500 6800 2500 6800 2500 6800
Measure DSRIP Year 2 (July ‘16-June ’17) DSRIP Year 3-5 PQI #15 Younger Adults with Asthma* P4P P4P PDI #14 Pediatric Asthma* P4P P4P Asthma Medication Ratio P4P P4P Medication Management for people with Asthma (5-64 Years) P4P P4P
*AHRQ measure: ambulatory sensitive admissions
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Project Requirements: (Model 1, BH services at primary care site)
must meet 2014 NCQA level 3 PCMH or Advance Primary Care Model standards.
engagement process.
engagement processes.
patients to identify unmet needs.
industry standard questionnaires such as PHQ-9, SBIRT).
documentation in Electronic Health Record.
reporting.
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Domain 1 Requirements Completion Date: December 2017 NYS Designated Provider Types for 3.a.i Domain 1 Metrics for 3.a.i
Total # providers committed Primary Care Physicians 100 Non-PCP Practitioners 100 Clinics 25 Behavioral Health 115 Substance Abuse 11 Community Based Organizations 20 All Other 200 All Committed Providers 571
Co-locate behavioral health services at primary care practice
practices must meet 2014 NCQA level 3 PCMH or Advance Primary Care Model standards by DY 3. All practices meet NCQA Level 3 PCMH and/or APCM standards by the end of DY3. Behavioral health services are available within PCMH practices. Develop collaborative evidence- based standards of care including medication management and care engagement process. Regularly scheduled formal meetings are held to develop collaborative care practices. Coordinated evidence-based care protocols are in place, including medication management and care engagement processes. Conduct preventive care screenings, including behavioral health screenings (PHQ-9, SBIRT) implemented for all patients to identify unmet needs. Policies and procedures are in place to facilitate and document completion of screenings. Screenings are documented in Electronic Health Record. 100% of Individuals receive screenings at the established project sites (Screenings are defined as industry standard questionnaires such as PHQ-9, SBIRT). Positive screenings result in "warm transfer" to behavioral health provider as measured by documentation in Electronic Health Record. Use EHRs or other technical platforms to track all patients engaged in this project. EHR demonstrates integration of medical and behavioral health record within individual patient records. PPS identifies targeted patients and is able to track actively engaged patients for project milestone reporting.
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ACTIVATED PATIENTS: Number of patients screened (PHQ-9 / SBIRT)
June 2015 Dec 2015 June 2016 Dec 2016 June 2017 Dec 2017 June 2018 Dec 2018
2000 5000 5000 12000 9000 23000 19000 31000
Measure DSRIP Year 2 (July ‘16-June ’17) DSRIP Year 3-5 PPV (for persons with BH diagnosis) P4P P4P Antidepressant Medication Management P4P P4P Diabetes Monitoring for People with Diabetes and Schizophrenia P4P P4P Diabetes Screening for People with Schizophrenia./BPD Using Antipsychotic Medication P4P P4P Cardiovascular Monitoring for People with CVD and Schizophrenia P4P P4P Follow-up care for Children Prescribed ADHD Medications P4P P4P Follow-up after hospitalization for Mental Illness P4P P4P Screening for Clinical Depression and follow-up P4R P4P Adherence to Antipsychotic Medications for People with Schizophrenia P4P P4P Initiation and Engagement of Alcohol and Other Drug Dependence Treatment P4P P4P
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Project Actively Engaged Patients June 2015
2.a.i IDS Patients residing in counties served by the PPS having completed a RHIO Consent Form (including agreeing or denying consent). 2.a.iii Health Home At Risk The number of participating patients who completed a comprehensive care management plan. 500 2.a.iv Medical Village (Orange+Ulster) The number of participating patients who had two or more distinct non-emergency services from at least two distinct participating providers at a Medical Village in a year. 600 2.b.iv 30 d Readmits (all hospitals) The number of participating patients with a care transition plan developed prior to discharge who are not readmitted within that 30-day period. 250 3.a.i BEH/PC Integration Number of patients screened (PHQ-9 / SBIRT) 2000 3.a.ii Crisis Stabilization Participating patients receiving crisis stabilization services from participating sites, as determined in the project requirements 150 3.c.i Diabetes The number of participating patients with at least one hemoglobin A1c test within previous Demonstration Year (DY). 500 3.d.iii Asthma (primary DX
The number of participating patients with asthma action plan 500
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Attain PCMH recognition by DSRIP DY3 Attain MU certification/ Connect with RHIO Share data on PPS Medicaid beneficiaries Participate in Quality Council & other committees Participation in “Value Based Payment”
Confidential – Not for Distribution
Help with PCMH Support for MU—connection to RHIO Care manager/ care coordination support Hospital transitions Closing the referral loop Medication reconciliation Regional coordination with other initiatives including other PPS Possibility for DSRIP Incentive payments based on metrics
https://www.corvallisclinic.com/mycc/pebb-medical-home-concepts-principles
http://healthaffairs.org/blog/2012/03/15/meaningful-use-of-health-it-stage-2-the-broader-meaning/
Initial Survey
Data Collection In-depth Partner Assessment Convene local planning councils Launch PCMH
Melissa Thomas Belmar Physician Liaison Center for Regional Healthcare Innovation P: (914) 326-4208 E: belmarm@wcmc.com www.crhi-ny.org
Janet (Jessie) Sullivan, MD Medical Director Center for Regional Healthcare Innovatio P: (914) 326-4202 E: SullivanJanet@WCMC.com
Marcie Colon Program Manager Center for Regional Healthcare Innovation P: (914) 326-4213 E: colonm@wcmc.com www.crhi-ny.org