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Primary Care Alternative Payment Methodology Delivery System Reform - PowerPoint PPT Presentation

Oct 03, 2022 •497 likes •721 views

Primary Care Alternative Payment Methodology Delivery System Reform Team Aug-17 1 APM Goal Provide sustainable, appropriate funding for primary care that rewards high value, high quality care. Sustainable investment that rewards

  1. Primary Care Alternative Payment Methodology Delivery System Reform Team Aug-17 1

  2. APM Goal Provide sustainable, appropriate funding for primary care that rewards high value, high quality care. ➢ Sustainable investment that rewards performance and creates delivery system alignment Payments for Volume Payments Payments for Volume for Value 2

  3. Alternative Payment Methodology How does it work? Achieve Enhanced Points Payment 3

  4. Who Participates? • Primary Care Medical Practices that contract with the Accountable Care Collaborative • Exclusions: ➢ Federally Qualified Health Centers ➢ Rural Health Centers ➢ The Department is working on defining a minimum threshold in paid practitioner claims for procedure codes in the PC APM benefit package. PCMPs below the threshold will be excluded from the APM. 4

  5. Performance and Structural Measures Performance Measures – Clinical processes and outcomes ➢ Depression screening ➢ Controlling high blood pressure Structural Measures – Practice characteristics ➢ Integrating behavioral health care ➢ Providing alternative types of clinical encounters 5

  6. Performance and Structural Focus Areas Claims Based Clinical eCQM Reported Self- Reported Performance Clinical Performance Structural Measures Measures Measures 16 adult and 13 10 adult and 4 30 choices pediatric choices pediatric choices • Continuous Quality • Behavioral Health • Behavioral Health Improvement • Chronic Care • Chronic Care • Team Based Care Management Management • Access • Cost Containment • Preventive • Care Management • Preventive Services • Care Coordination Services • Providing Self- Management Support 6

  7. Attribution • Determining which clients practices will be measured on • ACC Phase II methodology 7

  8. Payment Design • Beginning July 1, 2020 the Department will tie a portion of FFS rates of certain codes to value and quality • Each practice will select up to 10 measures from a list of 60 • Measure scores are compiled into an APM score which will determine the level of FFS rate enhancement 8

  9. Close the gap 9

  10. Example Calculation Possible Performance Performance Provider's Performance Pass/Fail Earned Measure Name Measure Type Points Baseline Standard Target Actual Points Structural Accepting New Patients 50 - - - - Fail 0 Structural Improving Access 35 - - - - Pass 35 Structural ED & Hospital Follow-Up 45 - - - - Fail 0 Structural Assess Self-Management Support Capability 25 - - - - Pass 25 Performance Maternal Depression Screening 30 20% 80% 26% 22% N/A 10 Performance Diabetes: A1c Test during Msrmt Year 10 75% 80% 75.5% 75% N/A 0 Performance Controlling High Blood Pressure 50 45% 85% 49% 46% N/A 12.5 Performance Total Cost of Care 60 70% 50% 68% 70% N/A 0 Performance Prenatal & Post-Partum Care 40 50% 75% 52.5% 55% N/A 40 Performance Adult BMI 20 15% 20% 15.5% 19% N/A 20 Points Required for 100% FS Rate 190.00 Percent Enhancement Available 4.00% PC APM Total Points 143.00 Earned FS Percentage 3.01% 10

  11. Score to FFS Enhancements Scores will translate into the following FFS rate enhancements: 11

  12. 12

  13. Primary Care Payment Changes Over Time 13

  14. APM Code Set Identified common primary care codes from a variety of sources Procedure Codes 99201 - new patient office or other outpatient visit, 10 minutes Delphi panel from the 99202 - new patient office or other outpatient visit, 15 minutes 99203 - new patient office or other outpatient visit, 25 minutes University of Colorado Hospital reviewed and .....and more! modified code set to represent primary care

  15. What to do and when? • Choose measures by December 1 st , 2017 • Department guidance on process to report measures coming in late summer/early fall • Information posted on Department website 15

  16. Tools, Resources and Practice Supports RAE support ➢ PMPM ➢ Practice transformation assistance ➢ Data to measure improvement 16

  17. Health System Changes to Support Primary Care 17

  18. Where to get information • This webinar will be posted on the Department’s website here • All documents will be posted as well • Check the website for new information. 18

  19. Questions or Concerns? 19

  20. Contact Information Delivery System Reform Team HCPF_PrimaryCarePaymentReform@hcpf.state.co.us 20

  21. Thank You! 21

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