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Value by Design: A Population Health Primer for Provider Groups

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This presentation throws light on:
• Key aspects of MACRA including how to navigate the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs)
• Patient-centered medical homes, their benefits, and how to gain recognition
• How to manage population risk to ensure lower costs and higher clinical quality
For more information on our Care optimization solutions or Population health management solutions, please http://www.sciohealthanalytics.com/offerings/solutions/care-optimization

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Value by Design: A Population Health Primer for Provider Groups

  1. 1. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |1©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |1 Value by Design A Population Health Primer for Provider Groups August 24, 2016
  2. 2. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |6 Accelerating Shift to Value-Based Care 2007 PQRS Quality Measures 2009 ARRA 2010 ACA & Meaningful Use 2013 Value-Based Modifier 2014 ACO / Risk Contracting 2017* MACRA Per Capita Cost Experience of Care The Triple Aim Health of a Population
  3. 3. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |7 MACRA Makes 3 Key Changes to How Medicare Pays Providers
  4. 4. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |8 How Will MACRA Quality Payment Programs Work? 95% 5%Participation by Providers Participation by Providers MIPS APMs
  5. 5. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |9 MACRA’s Quality Payment Programs • Streamlines PQRS, VM, and EHR reporting programs • Will apply to most Medicare Part B clinicians with a few exceptions • Generates a MIPS composite performance score (0-100) based on: – Quality (50%) – Resource Use (10%) – Clinical Practice Improvement Activities (15%) – Advancing Care Information (25%) Merit-Based Incentive Payment System (MIPS) • Use certified EHR technology • Payments based on quality measures similar to what’s listed in MIPS’ quality category • Entities bear “more than nominal” financial risk ~or~ is a Medical Home Model under CMMI • Examples of Advanced APMs for 2017 are: MSSP ACO (Tracks 2 & 3), Next Gen ACO Model, Comprehensive ESRD Care (CEC), Comprehensive Primary Care Plus (CPC+), Oncology Care Model (OCM) • “MACRA does NOT change how any particular APM functions or rewards value. Instead, it creates extra incentives for APM participation.”* Advanced Alternative Payment Models (APM) Criteria * https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based- Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MACRA-NPRM-slides-consumer-version.pdf
  6. 6. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |10 How to Choose Between MIPS and APMs? http://www.brookings.edu/research/papers/2016/07/12-how-the-money-flows-under-macra-patel-adler-darling-ginsburg July 12, 2016
  7. 7. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |11 Timeline for MACRA Implementation April 2015 MACRA Signed Into Law April 2016 Proposed MACRA Rule Fall 2016 MACRA Final Rule November 1, 2016 Deadline for Final Quality Measures for Performance Period #1 January 1, 2017 MIPS Data Collection Begins* January 1, 2019 First MIPS Payment Adjustment (+/- 4%) or 5% Incentive Bonus for APMs
  8. 8. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |14 Trend: Risk Bearing Contracts “There will come a time when the realization occurs that this is a partnership and that the risk needs to be spread around.” Two Types of Arrangements: Upside Risk Provider only shares in the savings (not the losses) Example: MSSP Track 1 Upside & Downside Risk Provider shares in (a greater) portion of savings but also responsible for a portion of any losses Example: MSSP Tracks 2 &3
  9. 9. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |15 Trend: Provider Organizational Structures PCMH IPA CINACO
  10. 10. |16©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. | WHAT CAN I DO NOW?
  11. 11. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |17 Patient-Centered Medical Home Recognition Tip: Make Sure The Payers You Work With Accept The Accreditation You Are Applying For National Committee for Quality Assurance (NCQA) Joint Commission Accreditation Association for Ambulatory Health Care (AAAHC) Utilization Review Accreditation Commission (URAC)
  12. 12. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |18 Becoming a Patient-Centered Medical Home Access to Care Team-Based Care Population Health Continuity of Care Performance Measurement & Quality Improvement
  13. 13. |19©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. | 6 TIPS TO THRIVE IN VALUE-BASED REIMBURSEMENT
  14. 14. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |20 6 Tips to Thrive in Value-Based Reimbursement Have a Plan & Set Goals Cultivate an Organization That is Receptive to Change Continual & Evolving Communication Treat Your Practice Like Your Own Checkbook Pay Attention to Your Quality Measures Use Technology To Your Advantage
  15. 15. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |21 Tip #1: Have A Plan & Set Goals Assessments  Gap Analysis Resources  Budget & operational cost  Evidence-based guidelines  Learning networks & staying up to date with best practices Technology  Do you have an EHR?  Does the EHR meet your reporting needs?  Connection to a health information exchange?  Have you optimized your operational workflow with your technology in mind? Staff  Is there an EHR “super user”?  Who owns tracking of healthcare trends?  Provider champion and a quality improvement team  Physician alignment on cost / quality reporting  How receptive is your staff to change?  Is your staff consistently working at the top of their skillset? Outreach  Do you know your patient panel & demographics?  What options do you have to contact a patient?  What does your patient satisfaction survey say?
  16. 16. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |22 Tip #2: Cultivate an Organization That is Receptive to Change There is no “right answer” for everybody and change doesn’t have to be slow – try lots of things in rapid succession and see what works for your organization Plan DoStudy Act Plan DoStudy Act Plan DoStudy Act • Engage all departments (360◦ view) • Be transparent internally with providers and give the feedback necessary to align behavior to outcomes • Communicate the impact of changes (good & bad) • Think outside the box for healthcare opportunities • All members of the team are important to patients! Make your staff aware of how they contribute to achieving the organization’s goals
  17. 17. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |23 Tip #3: Continual & Evolving Communication • Schedule all-staff meetings for education on trends and quality / referral team activities • Internal transparency with providers on goals / impact of actions to drive behavior change – Validate & communicate their patient panels • Pre-visit planning • Create a patient advisory council and send patient satisfaction surveys – Message accomplishments / mitigation plans • Develop open communications with hospitals and community agencies • Find a cadence and platform(s) that works with your patient populations Internal External
  18. 18. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |24 Tip #3: Continual & Evolving Communication It’s never been easier to engage with your patients! Use your website, portal, and email as a bi-directional communication tool • Practice announcements – Non-traditional hours • Post-visit report & referral information • Summary of care • Patient satisfaction surveys – Use a CAHPS vendor if possible • Treatment goal setting • Appointment scheduling • New patient forms • Prescription Refills ToPatientFromPatient
  19. 19. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |25 Tip #4: Treat Your Practice Like Your Own Budget “If you can’t measure it, you can’t improve it” – Peter Drucker In Network Care • Fix referrals then leakage • Increase “after hour” care options • Consider bringing out-of-network high cost services inside your network Cost Containment • Operational costs (workflow, staffing/provider ratio, supplies) • Enable staff to work at the top of their skill set • Increase preventative services (well visits including vaccinations & screenings) Overutilization • Readmissions within 30 days Optimize Revenue • Negotiate competitive pricing • Increase providers/services
  20. 20. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |26 Tip #5: Pay Attention to Your Quality Measures Ask Yourself: Do you know what your payers are measuring you on? “If you can’t measure it, you can’t improve it” – Peter Drucker don’t know what’s being measured Terri Gonzalez ^ ^ 5 Steps to an Effective Quality Measurement Program Compile all quality measures across payer contracts into a single place • Understand what your contracts require for quality measures (what measures are they looking at for your practice?) Use reporting dashboards for increased visibility into your current performance Focus on the most achievable measures first • Patients that haven’t been seen in 2+ years • Diabetic patients • BMI gaps Prioritize remaining gap closure based on which are closest to your contracted threshold Get creative on the most difficult gaps to close • e.g., Mobile eye exams, mobile mammography, teen health fair 1 2 3 4 5
  21. 21. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |28 Tip #6: Use Technology To Your Advantage Use analytics to manage your patient populations
  22. 22. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |29 Tip #6: Use Technology To Your Advantage How are we doing as a practice overall?1 What and where is my risk?2 What diagnostic categories are driving my costs?3 What are my quality measure gaps?4
  23. 23. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |30 Population 100% Impactability Prospective Risk Moderate Impactability 12% of Members Low Impactability 75% of Members High Impactability 12% of Members High Low Opportunity Goal Close Gaps and Steerage to Managed Networks Close Gaps and Steerage to Managed Networks Manage High Costs and Risk Factors Manage High Costs High Risk 10% Moderate Risk 1.5% Low Risk 0.5% High Risk 8% Moderate Risk 3% Low Risk 1% High Risk 13.5% Moderate Risk 27% Low Risk 34.5% High Cost 1% of Members Stratifying Populations by Financial Risk & Impactability
  24. 24. ©2016 SCIO Health Analytics®. Confidential and Proprietary. All rights reserved. |31 What To Do Next? Complete Your Organizational Assessment Understand Your Patient Panel (& Communicate with Providers) Form Your Quality Team • Compile Quality Measures • Measure Performance Select Your Industry SMEs & Technology “Super Users” Identify Your Most Vulnerable / High Risk Patients Schedule All Staff Meetings Socialize PDSA Cycles

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