Pacific Business Group on Health Practice T Transformation I Initiative Diane Stewart, PBGH January 2016
Ab About t the Practice Transform rmation Initi tiative Centers for Medicare & Medicaid Services (CMS) designed the Transforming Clinical I. Practice Initiative (TCPI) to help clinicians achieve large-scale health transformation . The TCPI initiative will support more than 140,000 clinician practices over the next four years in sharing, adapting and further developing their comprehensive quality II. improvement strategies. Pacific Business Group on Health’s California Quality Collaborative was chosen as one of 29 Practice Transformation Networks (PTNs) to provide technical assistance and peer-level III. support to assist clinicians in delivering care in a patient-centric and efficient manner. PBGH’s program name is the Practice Transformation Initiative (PTI). IV. 2
PTN G Geographic Distribu bution National PTNs in CA: • VHA/UHC Alliance Newco, Inc. • National Rural Accountable Care PBGH/CQC Consortium LA Care Children’s Hospital of OC 3
PBGH/CQ CQC’s A Award Awarded $18.4 million in partnership with the Integrated Healthcare Association (IHA), Center for Care Innovations (CCI), and Hospital I. Quality Institute (HQI). 45% of the total award will be reinvested back into delivery systems. Working with 16 public and private provider organizations (POs) supporting 4,800 clinicians in their efforts to measurably improve II. patient care. PTI’s strategy: build capacity within POs and continually improve III. care at the practice site. 4
The PTI Program PTI works with provider organization (PO) leaders guiding • Practice Coach transformation within their systems; and and leadership PTI trains practice coaches , hired by the POs, to work intensively • support with clinicians PTI measure set aligns with IHA P4P, Medi-Cal, and other key • Data feedback measure sets and reporting IHA is data aggregator • Customized Data experts deployed to practices to strengthen data systems, • technical staff assistance • Build capacity to report on, analyze, use data 5
PT PTI M Measure Set et PTI Clinical Quality Utilization Patient Experience • Controlling blood pressure • Emergency Department • # of clinicians receiving regular with HTN Visits/1000 patient feedback Asthma Medication Ratio Hospital days/1000 • • • For Patients with Diabetes: • Imaging for Low Back Pain HbA1c testing Appropriate Cervical Cancer • • • HbA1c < 8.0 Screening • HbA1c > 9.0 Eye exams • • Nephropathy BP < 140/90 • 6
PTI M Measure Specifications • Measure definitions are those used by the Integrated Healthcare Association (http://www.iha.org/) • IHA follows NCQA HEDIS standards for all measure definitions • A Measure Specification Manual will be available in January 2016 7
Prop opos osed ed Improv oveme ment Go Goals Care Experience Cost Savings 75% of clinicians receive Cost Savings of over $242M regular feedback from over four years by reducing patients about their utilization measures personal care experience by over 5% PTI Improvement Goals Medicare Clinical Quality Measures 75% of clinicians participate 15% average relative in Medicare value-based improvement across clinical payment programs quality measures 8
Benefi fits ts to Provider Organizati tions • Capacity-building stipend given to support hiring of Practice Coach & data Payment infrastructure support Stipend as milestones are achieved through meeting data submission reporting • Customized hands-on coaching on quality, data use and achieving • Coaching improvement for leadership team (C-suite) & practice coaches Support • Other training provides opportunity to connect with peers, share ideas Customized consulting support on building systems to capture data, generate • Data Technical reports Assistance Includes acquisition of hospital data • Reporting and • Quarterly reports by organization, site and provider Feedback 9
Program Year PTI Achievement Milestones Expected Date Payment per Clinician Total Payment Percent of Total Payment PTI Milestone Payment Structure Progres ess Paymen ents 1/29/16 $85.00 $17,000.00 Contract signed $17,000.00 2/29/16 $85.00 Aim statement completed Project manager, practice 30.0% 1 coach(es), IT lead identified and 3/31/16 $170.00 $34,000.00 present at February & March trainings Submission of baseline data and $34,000.00 5/10/16 $170.00 Q1 data Submission of all quarterly reports $102,000 30.0% 2 Q2 through Q5, and attendance at 5/10/17 $510.00 trainings and LLN for those periods Submission of all quarterly reports $68,000.00 20.0% 5/10/18 $340.00 3 Q6 through Q9, and attendance at trainings and LLN for those periods Submission of all quarterly reports Q10 through Q14, and attendance $34,000.00 10.0% 4 8/10/19 $170.00 at trainings and LLN for those periods Improveme ment P Pay ayme ments Achieve improvement over baseline on a monthly basis for at least 12 months on four (4) clinical measures and two (2) cost of care $17,000.00 5.0% As achieved and not before Q6 $85.00 measures. Improvement for each Measure is evaluated independently. Achieve 20% relative improvement over baseline on four (4) clinical $17,000.00 5.0% As achieved and not before Q10 $85.00 measures and two (2) cost of care measures as of the reporting quarter. 10 Assumptions: • start date of 1/29/2016 • the number of clinicians is equal to 200
Implem emen entation on • Project team and Leadership Learning Network training will start in February • POs can report on all clinicians, or those that are participating • Option to invest in improvement in two clinician waves 11
Joining PTI: M Minimum Qualificati tions I. An organizational strategy that includes practice transformation. Ability to collect, aggregate and share NPI-level electronic data with II. clinicians on at least a monthly basis. III. Ability to initially report half of the PTI outcome measures. IV. Ability to commit at least 200 clinicians to the program. 12
Eligible Clinicians • Per CMS, all types of clinicians will able to participate , but only those that are on the PQRS list of eligible professionals (http://go.cms.gov/1WcAByY) will count towards the number of recruited clinicians . • Includes: MD, DO, NP, PA, CSW, RD • Clinicians must work enough hours to have data that is meaningful and valid 13
PTI P Parti ticipati tion G Guidelines Secure staff for program I. • Practice coach(es) to work with participating clinicians • Project Manager Data lead • Attend PTI training sessions and program staff meetings II. Submit NPI level data quarterly to IHA III. Share monthly data with clinicians IV. 14
Key Tasks through F Febru ruary The following tasks will begin during the recruitment process and be completed on or by February 12, 2016 . Task Due Date Identify participating clinicians Identify practice coaches Work with PTI staff to submit baseline Friday, February 12, 2016 data Hold kick-off meeting with PTI staff to begin planning Attend Pre-Work Webinar 15
Imme mediate Next Steps Task Due Date Sign-off on Contract Friday, January 29, 2016 Schedule & hold Welcome Webinar with Monday, February 8, 2016 your Project Team Attend Pre-Work Webinar Tuesday, February 9 or Date TBD 16
Qu Ques estion ons? Contact Us Us! Diane Stewart Pacific Business Group on Health/California Quality Collaborative dstewart@pbgh.org 17
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