PCMH 2.0 2019 Medicaid PCMH Program August 24, 2018
AGENDA • CARE PLANS (Fast Track for 2019) • PASSE (How will it affect PCMH) • PCMH 2.0 (2019 Medicaid PCMH Program) • POPULATION HEALTH MANAGEMENT MONTHLY REPORT • (Introduction and Overview) • SHARE (Update) • UPDATE (Reports/Payments/Shared Savings)
Fast Track ck Care Plan Au Audit Shelley G. Ruth PCMH Quality Assurance Manager, AFMC August 24, 2018
Fast Track Care Plan Au Audit De Details § Fast Track Audit vs. Regular Audit • Only required to submit five care plans for Fast Track • 20% of the attested to care plans are selected for regular audit § Qualifications for the Fast Track Care Plan Audi t • Must pass at least two consecutive years of care plans audits • Must not have been placed in remediation for care plans
Fa Fast Track Care Plan Audit Details § PCMHs Eligible for 2018 Fast Track • 95 PCMHs out of 202 eligible • Reduced burden § Fast Track Disqualifications • Not meeting the 80% target • Placed in remediation § Scoring method used for 2018 audit • Two points for each required element • Care Plan validation spreadsheet
PASSE HOW WILL PCMH BE AFFECTED
CURRENT PASSE ATTRIBUTION • Currently there are around 33,424 beneficiaries attributed to a PASSE • Arkansas Total Care 5,747 • Empower Health Solution 13,526 • Forevercare 5,534 • Summit Community Care 8,617 • There are currently around 18,000 PCMH beneficiaries that are attributed to a PASSE. That is around 5.5% of the PCMH population
HOW IS MY PCMH ATTRIBUTION BE AFFECTED • CURRENT 2018 PERFORMACE PERIOD o Even though they are assigned to a PASSE they are still counted in your PCMH attribution and you will continue receiving PCCMs and PBPMs • 2019 PERFORMANCE PERIOD o Beginning January 1, 2019, No longer counted in your Attribution o You will no longer receive PCCMs or PCMH PBPMs for those attributed to a PASSE
HOW WILL MY PCMH PERFORMANCE BE AFFECTED • CURRENT 2018 PERFORMANCE PERIOD o These beneficiaries are still counted toward your PCMH Performance. • 2019 PERFORMANCE PERIOD o Those attributed to a PASSE will no longer be counted in you PCMH Performance o You may continue to provide services for these patients but through your contract with one of the PASSE
QUESTIONS?
PCMH PCMH 2.0 .0 2019 Medicaid PCMH Program Performance Based Incentive
Enrollment • October 10 th – November 21, 2018 • Practice must have at least 150 attributed beneficiaries at time of enrollment • Previously Suspended Practices may return to the PCMH Program contingent on: • submission of a completed PCMH Program enrollment application • successful implementation of all the activity(s) which the practice failed that resulted in suspension from the program
KE KEY NE NEW T W TERMS RMS • SHARED PERFORMANCE ENTITY - A PCMH or Pooled PCMHs that, contingent on performance, may receive performance based incentive payments • PERFORMANCE BASED INCENTIVE PAYMENTS (PBIP)– Payments made to a Shared Performance Entity for delivery of economic, efficient and quality care.
PERFORMANCE BASED INCENTIVE PAYMENTS ELIGIBILITY (ATTRIBUTION) • A Shared Performance Entity must have a minimum of 1,000 attributed beneficiaries after exclusions are applied. • This is down from the previous years requirement of 5,000 for Shared Savings • This can be achieved one of four ways: • Independently • Voluntarily pooling with other PCMH(s) Those Practices with attribution of 150-299 will be allowed to join Voluntary pool • for 2019 Practices performances will be aggregated together for both Performance Based • Incentive Payments AND Quality Metrics
PERFORMANCE BASED INCENTIVE PAYMENTS ELIGIBILITY (ATTRIBUTION) • Default Pool-minimum of 300 attributed beneficiaries and do not wish to participate in voluntary pool • Utilization performance and focus measure will be aggregated together. • Quality Metrics will be measured on individual PCMH level. • Petite Pool-practices with less than 300 attributed beneficiaries and not wishing to participate in voluntary pool • Practices performances will be aggregated together for both Performance Based Incentive Payments AND Quality Metrics
PERFORMANCE BASED INCENTIVE PAYMENTS ELIGIBILITY (ACCOUNTABILITY) • ACTIVITIES – Practices must complete activities tracked for Practice Support • METRICS – PCMHs must pass 2/3 of Quality Metrics • CORE METRIC – Minimal Performance on Selected Core Metric • 2019 Infant Wellness - A PCMH will be placed in remediation for the Wellness Metric tracked for Practice Support if, 15% or greater of the patient panel (0 – 15 months), have 0 – 1 wellness visits AND the PCMH does not meet the 2019 Quality Metric Target for 5 or more visits.
PERFORMANCE BASED INCENTIVE PAYMENTS • A Shared Performance Entity is eligible to received a Performance Based Incentive Payments (PBIP) in One or Multiple of the following ways: • Inpatient Rates • Emergency Department Rates • Focus Metric (2019 Adolescent Wellness)
PBIP FOR INPATIENT RATE • Shared Performance Entities that are in the top 10 th percentile for Lowest Inpatient rates can receive $12 times the number of attributed member months • Shared Performance Entities that fall between the top 11 th -35 th percentile for Lowest Inpatient rates can receive $6 times the number of attributed member months
PBIP FOR EMERGENCY DEPARTMENT RATE • Shared Performance Entities that are in the top 10 th percentile for Lowest Emergency Department rates can receive $8 times the number of attributed member months • Shared Performance Entities that fall between the top 11 th -35 th percentile for Lowest Emergency Department rates can receive $4 times the number of attributed member months
PBIP FOR FOCUS METRIC (2019 Adolescent Wellness) • Shared Performance Entities that are in the top 10 th percentile for Highest Focus Metric rates can receive $5 times the number of attributed member months • Shared Performance Entities that fall between the top 11 th -35 th percentile for Highest Focus Metric rates can receive $2.50 times the number of attributed member months
Performance Metric Infant Wellness ˂15% 0-1 Visits for Children 0-15 Months • Meeting State Metric For 5 Visits Satisfied Metric
QUESTIONS?
www.gdit.com/health EJ Shoptaw Monthly Metrics Report Tool Jerry Cohen Patient-Centered Medical Home July 30, 2018
Purpose of Presentation • Introduce Monthly Metric Report Tool • Tool Operation Guide • Overview of Additional Features • Overview of Prospective Benefits 25 | www.gdit.com/health
Introducing: Monthly Metric Report Tool
Overview • GDIT is developing a tool to aid in the generation of monthly metric reports containing patient level metrics. ─ The tool utilizes more current data, so providers can become familiar with beneficiary population. ─ These reports will assist PCMH providers in understanding gaps in care related to any quality metrics based on point in time beneficiary panel profiles. ─ The reports assist at a beneficiary level, where future action can be assessed and taken by the PCMH to close gaps in care. • Although the initial tool is specific for the PCMH program, GDIT’s tool represents the initial step toward monitoring of “best practice” medicine for all Arkansas Medicaid beneficiaries. 27 | www.gdit.com/health
Operation Guide
Generation Process • Monthly Metric spreadsheets are generated using drop down boxes to control parameter selections. ─ Once generated, reports will be easily accessible through a web based portal and appear in a multi-tabbed Excel format (a tab for each enrolled PCMH for the current configuration year). This format allows filtering for easy identification and sorting of o patients where outreach is needed to close a “gap” in their care. The Summary tab of the report will contain metric results for all o quality measures. Subsequent tabs will include detailed metrics for each qualified o patient. 29 | www.gdit.com/health
Sample Report: Summary 30 | www.gdit.com/health
Sample Report: Detail Wellness (0-15 months) 31 | www.gdit.com/health
Sample Report: Detail Wellness (3-6 yrs) 32 | www.gdit.com/health
Sample Report: Detail Wellness (12-20 yrs) 33 | www.gdit.com/health
Sample Report: Detail Diabetes 34 | www.gdit.com/health
Sample Report: Detail HPB 35 | www.gdit.com/health
Additional Features
Additional Features • The monthly metric reports will be incorporated into GDIT’s Quality Insight Application. ─ This will allow Arkansas DMS and call center users the ability to monitor or answer questions from PCMH providers. 37 | www.gdit.com/health
Benefits
Benefits • This tool not only provides valuable information to PCMH physicians to better manage their patients, but also summarizes where they are on their metrics linked to the Arkansas PCMH payment model. • The data in each metric report will contain 2-3 month old data, which will be delivered monthly (vs the quarterly reports released with 6 month old data). ─ This will allow providers more time to interact with their patient population. 39 | www.gdit.com/health
SHARE HEALTH INFORMATION EXCHANGE (HIE)
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