Virginia Garcia Memo morial He Health Cen enter er Alternative - PowerPoint PPT Presentation

Virginia Garcia Memo morial He Health Cen enter er

Alternative Payment Methodology Transforming Primary Care Maine PCA Conference Gil Muñoz, MPA CEO Virginia Garcia Memorial Health Center April 29, 2019

Our Mission Virginia Garcia’s mission is to provide high- quality, comprehensive, and culturally appropriate health care to the communities of Washington and Yamhill counties with a special emphasis on migrant and seasonal farm workers and others with barriers to receiving health care. Virginia inspires the work we do every day. Started in 1975 by a small group of community activists determined to improve the health of the most vulnerable in our community, Virginia Garcia Memorial Health Center serves over 45,000 patients today.

Our Community Approximately 600,000 people in service area (Washington/Yamhill counties) Mix of rural and urban area Mix of industry- agricultural and high tech nurseries, vineyards, Intel, Tektronix, Nike Migrant and Seasonal Farmworkers (May- August- peak season) Refugee Population (Africa, Middle East, Russia, Somalia)

Responding to Community Need We e ser erve o e over er 46,500 46,500 patient nts i in n Washi hing ngton a n and nd Yamhi hill cou count nties a at:  Five primary care and six dental clinics in Newberg, McMinnville, Beaverton, Hillsboro and Cornelius  Six school-based health centers located in Willamina, Tigard, Tualatin, Century, Beaverton and Forest Grove  A mobile outreach clinic Our pati tien ents ts  Speak over 60 different languages  40% of our patients are under 18  56% of our patients are of Hispanic descent  60% are covered by Medicaid  20% are uninsured

Services Offered  Immunizations  OB/GYN and Prenatal  Chronic Disease Management  Well-Baby and Well-Child Visits  Dental Care  Vision Care  Behavioral and Mental Healthcare  Pharmacy  Health and Wellness Education  Farmworker Outreach

Drivers of Change Time Line 2006 Delegation to South Central Foundation Pre-PCP CPCH/ CH/APM Volume Driven Care 2007 Primary Care Renewal Collaborative • Provider & Patient Dissatisfaction • Spread PCR/EHR across VG Sites 2007-2009 Provider Centric Care • Lack of Coordination • 2012 APM Implementation Lack of Flexibility in service delivery • 2013-19 CCO Roll Out/Value Based Pay Lack of Preventive Focus • 2019-beyond CCO 2.0/Pop Health/VBP

Model of Care Transformation “We’re not in the pill and procedure business. Healing is being in relationship over time with caring, knowledgeable people. We’re in the service business first.” - Dou oug Eby, M MD. V . VP SCF

5 Pillars of the Primary Care Renewal Team eam-Based C Care PATIENT CENTERED PRIMARY CARE HOME Proactive Pa Panel Manag agemen ement Bar arrier Free A ee Acces ess Integr egrat ated ed Behav avioral al Heal ealth Customer D Driven/ Pa Patient-Ce Centric c Care

T eam Based Care

APM ADMINISTRATIVE INFRASTRUCTURE Making APM work from the ground up

BUILDING THE FINANCIAL FOUNDATION FOR PATIENT -CENTERED PRIMARY CARE Phase V V: Payment for Outcomes/ Value-Based Pay (VBP) Phase I IV: Development of Alternative Payment Methodology with payers to support model (baseline indicators, pay for process) Policy Change Phas ase III: III: Change in Scope Application (Adjust PPS rate to support new model) Phase II: Coding to reimburse for elements of model. Review of possible CPT codes aligned with model (Example: Behavioral Health Assessment Codes) Phase I: Grants- Establish systems: Team formation, co-location, data systems, Training, Meaningful Use, PCPCH

Financial Considerations Changes to budgeting and reporting • Income Analysis needs to take membership projections into account • Projection of revenue across CCO’s • Projection of quality incentive payments •

Governance Considerations Ens nsure t the he B Board und nderstand nds a and nd is eng ngaged i in n the he m mov ove to o • AP APM Educa cate Fina nanc nce C Com ommittee on on methodolo logy • Dialogue w with B h Board on on value o of holi holistic a c approach •  Office Visits  Health Education  CareSTEPs  Wellness Activities Investments in in non billa llable se servic ices, f facili lities to a accommodate • welln llness a activitie ies

Data & APCM Reporting Workflow Membersh ship/Car are 18 Month Care S STEP EP EPIC/BO O Team am Report (monthly) REPOR ORTS Outreach (Run weekly) Establish Care • 18 month Step non- engagement APM No contact / • Patient SQL/A /APM PM Roster Wait for NECR ACCESS D S DB Internal A Audit R Report (weekly) Membership Patien ent Invalid Fix issues in ID, Date Patient Encounter Epic Issues, etc. Covered by • OHP NECR Leakag age PDR Dismissed Billable OV, • (quarterly) Patient (monthly) (monthly) Home, Group, Report or Telemed Non- Patient Visit Successfull engageme outside VG y nt Report TBD – codes • established Error or or removed for qualified non-billable visits (OPCA?) Birthdat e Error ECR CR (week eekly) 31 3131 31 – MMIS IS (weekly) Error or Membership Insert into 3131 3131 PDR / HM Modifier Decease Established Error Closed Other d Patient added Provide r Roster

Membership Department Ma Mana nages t the he AP APM R M Ros oster t r to o ens nsure a accu ccuracy •  Medicaid ID, coverage dates, etc. Attri ribut ution on •  Audits enrollment change report, leakage reports, scrubs lists prior to submittal to OHA Performs O Outreach t h to a o assigne ned b but non non established p patients • Performs O Outreach t h to p o patients f for s or sche cheduling ng o of key p preventive • visi isits (e (ex. w well ll child ild checks, w well ll w woma man e exams, C CRC, Hypertension on, D , Diabetes)

APM OUTCOMES

Access to Care 180% 160% 140% 120% 100% 80% 60% 40% 20% 0% Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 3rd Next Available % Established/Engaged Patients Uninsured Waitlist Goal Panel el S Size p e per F FTE Slot T t Targets ets • • Family Practice 1,200 Physicians 3,600 • • Internal Medicine 1,000 APC’s 3,300 • •

APM CCO Assigned and Established 22,000 110% 20,146 96% 18,000 90% 14,000 70% 10,000 50% # of Patients Established % of Established Patients with Engagement

Q4 APM Clinical Quality Metrics

CARE STEPS (Care and Services That Engage Patients) # Telepho ephone Encount nters with h Care e STEPs

CareSTEPs 12 Month Trend

Q4 T op 5 CareSTEPs 7% 11% Behavioral_or_Mental_Health_Screening 39% Education provided: group setting Health Education Supportive Counseling Accessing community resource/service 17% Exercise class participant 25%

Oregon Health Authority Evaluation - APM Optu tumas as St Study-(2018) ) Fin indin ings Nearly $25 Million in avoided costs over first 3 years of program • Decrease in utilization for high cost services (inpatient, ED) • Increase in preventive services • Overall cost effectiveness improves with time on methodology • Overall improving access to care • Enhancing Patient Experience, quality, and efficiency through care coordination and care • managment

APM Lessons Learned Transformative in providing alignment between model of care and payment • Emphasizes the right care, right time, right person • Requires significant investment in data and membership • Requires significant investment in Change Management • Prepares for Value Based Pay/Population Health • Need to maintain focus on balanced scorecard: quality, access, patient experience, • financials, staff engagement

Thank You! @VGMHC @VGMHCComunidad (Spanish-only page) @VirginiaGarcia @VGMHC Virginia Garcia Memorial Health Center and Foundation Virginia Garcia Memorial Health Center