WMC Performing Provider System(PPS) Presentation to Primary Care - PowerPoint PPT Presentation

WMC Performing Provider System(PPS) Presentation to Primary Care Physicians March 11, 2015 8:00AM-9:00AM 1

http://www.policymed.com/2015/01/secretary-burwell-announces-hhs-quality-payment-goals-introduces-timeline-for-shifting- medicare-reim.html

https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/dsrip_vbp_webinar_slides.pdf

Agenda Discussion Topic Welcome & Introduction Brief Recap of DSRIP: Payment Reform Brief Recap of DSRIP: NYS MRT and the 1115 Waiver WMC PPS & DSRIP Timeline An Incredibly Ambitious and Complex Set of Projects Role of Primary Care Patient Centered Medical Home & “Meaningful Use” of HIT Next Steps Questions 4

Acronyms • DSRIP- Delivery System Reform Incentive Payment • PPS- Performing Provider System • P4R- Pay for Reporting • P4P- Pay for Performance • VBP-Value Based Purchasing/Payments • MRT- Medicaid Redesign Team • PAM- Patient Activation Measure • PCMH- Patient Center Medical Home • MU- Meaningful Use • RHIO- Regional Health Information Organization • IDS- Integrated Delivery System 5

What is DSRIP? • The Delivery System Reform Incentive Payment (DSRIP) Program is an incentive payment model that rewards providers for performance on delivery system transformation projects that improve care for low-income patients • Funded federally via Medicaid 1115 waivers, DSRIPs shift hospital supplemental payments from paying for coverage to paying for improvement efforts SOURCE: Kaiser Family Foundation, http://kff.org/report-section/an-overview-of-delivery-systemreform-incentive- • payment-waivers-issue-brief/ https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014

7 https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014

New York’s DSRIP Program: A Model for Reforming the Medicaid Delivery System BEGINNINGS OF MEDICAID MAJOR MRT REFORMS REDESIGN IMPLEMENTED In 2011, Governor Cuomo changed Cost Control: • • the game by creating the Medicaid Global Spending Cap: • Redesign Team (MRT) Care Management for All: • – Improved primary/coordinated care – Moved Medicaid members from fee-for-services to managed care . PCMH and Health Homes: • – Investments in high-quality primary care and care coordination https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014 8

NYS STATEWIDE TOTAL MEDICAID SPENDING (CY 2003-2013) https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014

MEDICAID REDESIGN: MRT WAIVER AMENDMENT PERFORMING PROVIDER SYSTEMS In April 2014, Governor Andrew (PPS): LOCAL PARTNERSHIPS TO M. Cuomo announced that New TRANSFORM THE DELIVERY SYSTEM York State and CMS finalized Partners should include: Hospitals, Health agreement on the MRT Waiver Homes, Skilled Nursing Facilities, Clinics & Amendment. FQHCs, Behavioral Health Providers, Home Care Agencies, Other Key Stakeholders Allows the state to reinvest $8 • billion of the $17.1 billion in federal savings generated by MRT reforms. The MRT Waiver Amendment will: • – Transform the state’s Health Care System – Bend the Medicaid Cost Curve – Assure Access to Quality Care for all Medicaid members https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/chcs_presentation_slides.pdf December 11, 2014

Confidential – Not for Distribution WMC PPS DSRIP Projects highlighting the role of primary care. # Project Description Domain 2: Systems Transformation Projects Create an Integrated Delivery System Focused on Evidence-Based Medicine and Population Health Management – Advanced 2.a.i Primary Care—Patient Centered Medical Home for all PCPs; support for Information informed care, “Meaningful Use,” Closing the Referral Loop, Medication Reconciliation 2.a.iii Health Home At-Risk Intervention Program – PCP linked care coordination for Chronic Conditions 2.a.iv Create a Medical Village Using Existing Hospital Infrastructure 2.b.iv Care Transitions Intervention Model to Reduce 30-day Readmissions for Chronic Health Conditions -Link discharge planning to Primary Care Implementation of Patient Activation Activities to Engage, Educate and Integrate the uninsured and low/non-utilizing Medicaid 2.d.i populations into Community Based Care (Project 11) Focus on Primary Care sites serving the uninsured (FQHCs & Hospital Clinics) and Community Based Organizations Domain 3: Clinical Improvement Projects 3.a.i Integration of Primary Care and Behavioral Health Services 3.a.ii Behavioral Health Community Crisis Stabilization Services 3.c.i Implementation of Evidence-Based Strategies in the Community to Address Chronic Disease – Diabetes 3.d.iii Implementation of Evidence-Based Guidelines for Asthma Management Domain 4: Population-Wide Prevention Projects Promote Tobacco Use Cessation, Especially Among Low SES Populations and Those with Poor Mental Health – Promote tobacco 4.b.i cessation counseling—Primary Care, Dental, Behavioral Health providers Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings – 4.b.ii Cancer Support PCP based cancer screening FU and referral for treatment 12

Common Elements Across Projects Health BH – 30 day BH Crisis Tobacco IDS Home at Primary Diabetes Asthma Cancer Readmission Stabilization Cessation Component Risk Care 2.a.i 2.a.iii 2.b.iv 3.a.i 3.a.ii 3.c.i 3.d.iii 4.b.i 4.b.ii Protocols/ Evidence- X X X X X X X X X based Care Contracts/ X X X X X X X X X DEAA/BAA EHRs/HIE X X X X X X X X X Health Home/ Care X X X X X X X X X Management Coordination X X X X X X X X X of Care Performance X X X X X X X X X Reporting Cultural X X X X X X X X X Competence

2.a.i Create an Integrated Delivery System Total # providers Domain 1 Requirements Completion Date: committed (as December 2017 per project plan application) Project Requirements (2 of 11) : Primary Care Physicians 609 Ensure that all PPS safety net providers are • Non-PCP Practitioners 1878 actively sharing EHR systems with local health Hospitals 20 information exchange/RHIO/SHIN-NY and sharing Clinics 50 health information among clinical partners, Health Home / Care including direct exchange (secure messaging), 27 Management alerts and patient record look up, by the end of Behavioral Health 324 Demonstration Year (DY) 3. Substance Abuse 28 Achieve 2014 Level 3 PCMH primary care • certification for all participating PCPs, expand Skilled Nursing Facilities / 43 access to primary care providers, and meet EHR Nursing Homes Meaningful Use standard Pharmacy 4 Hospice 7 ACTIVATED PATIENTS: Patients residing in Community Based Organizations 148 counties served by the PPS having All Other 1152 completed a RHIO Consent Form (including agreeing or denying consent). 14

3.d.iii Evidence-Based Guidelines for Asthma | Domain 1 Metrics Project Requirements : Implement evidence based asthma management guidelines between primary care practitioners, • specialists, and community based asthma programs (e.g., NYS Regional Asthma Coalitions) to ensure a regional population-based approach to asthma management. All participating practices have a Clinical Interoperability System in place for all participating • providers. PPS has agreements from participating providers and community programs to support evidence • based asthma guidelines. Establish agreements to adhere to national guidelines for asthma management and protocols for • access to asthma specialists, including EHR-HIE connectivity and telemedicine. Agreements with Asthma educations and asthma specialists are established. • EMR meets connectivity to RHIO's HIE and SHIN-NY requirements. • Telemedicine implemented based on evaluation of impact to underserved areas • Ensure coordination with the Medicaid Managed Care Plans and HHs serving the affected population. • Participating providers receive training in evidence-based asthma management . • Use EMR or other technical platform to track all patients engaged in this project. • 15