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3
• Post Election Implications
• MACRA Overview
• CPC+ Program Review
• Conclusion
• Q & A
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Coni Westmoreland, MHA, MSPH Business Development & Programs Manager, Salem Health Medical Group
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On 3/26, the House passed H.R. 2 by 392-37 vote.
On 4/14, the Senate passed the House bill by a vote of 92-8, and the
President signed the bill.
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• MACRA exists separately from the ACA
• Unlikely to repeal MACRA due to bipartisan majority votes
• New HHS Secretary: what decisions will be made with
MACRA regulations? With CMMI?
• Repeal & Replace of ACA • Full repeal unlikely (Requires 60 Senate votes; Republicans
hold 52 seats)
• Budget reconciliation can be used to repeal parts of the
ACA with budget implications
• If repeal passes in January 2017, provisions won’t become
effective for two to three years.
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• Final rule released on October 14, 2016
• “Pick your pace” for 2017 implementation
• Mandates CMS payment reform to value based contracts
• Consolidates current quality metric reporting
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Performance Year
Payment Year
Merit-Based Incentive
Payment System (MIPS)*
Advanced Alternative Payment Models
(APMs)
2017 2019 +/- 4% +5%
2018 2020 +/- 5% +5%
2019 2021 +/- 7% +5%
2020 2022 +/- 9%
(and beyond) +5%
(to 2024)
*Additional bonus for exceptional performers; scaling factor applies if funds
are sufficient.
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• First year billing to Medicare Part B
• Low volume threshold:
• >$30,000 in Medicare Part B charges
• Provide care for 100 or fewer Medicare Part B patients
per year
• Participation in a qualifying Advanced Alternative Payment
Model
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13 3
Advanced Alternative Payment Models
Medicare Shared Savings Program Track Two
Medicare Shared Savings Program Track Three
Next Gen ACO
Comprehensive Primary Care Plus (CPC+)
Comprehensive ESRD Care (Large Dialysis Organization
[LDO] Arrangement)
Comprehensive ESRD Care (non-LDO arrangement)
Oncology Care Model (two sided risk arrangement)
• New models being announced by CMS for 2018
• CMS re-opening CPC+ and Next Gen ACO in 2018
CPC+ and Primary Care Value Based
Payment Reform in Oregon
Presentation to the Marion – Polk County Medical Society
January 12, 2017
Dr. Jim Rickards, MD, MBA - Chief Medical Officer, Oregon Health Authority
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Overview
• OHA Coordinated Care Model - CCOs
• OHA Patient Centered Primary Care Home Program
• CMS CPCI Program
• SB231 Oregon Legislation
• CMS CPC+ Program
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OHA Patient Centered Primary Care
Home (PCPCH) Program
• 647 Clinics
• ~$240M savings first 3 years
• 4.2% reduction PP spending
• 13:1 ROI
• Existing FFS Payment Models Challenges
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CMS CPCI Program
• National CMS Comprehensive Primary Care Initiative (CPCI)
• 4 Years – ended in 2015
• 7 Regions
• 65 Oregon Clinics
• Monthly Care Management Fee + Shared Savings
• Oregon $12.8 million in Medicare Cost Savings
• Shared savings payments totaling $1 million (2015)
SB 231 Collaborative: Payment Reform
• “Direct greater health care resources and investments
toward supporting and facilitating health care innovation
and care improvement in primary care”
• Multi-stakeholder & Multi-payer facilitated meetings
• Monthly meetings: April to November 2016
• Membership defined in legislation, other experts added
• Supported Oregon CPC+ participation
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Comprehensive Primary Care Plus (CPC+)
• CMS national model to strengthen primary care
• Advanced Alternative Payment Model under MACRA
• CPCI program continuation & expansion
• Regional multi-payer payment reform & care transformation
• Oregon is one of 14 CPC+ regions
• Five years: 2017 to 2021
• 159 Oregon practices
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Oregon CPC+ Payers
Commercial Payers
•ATRIO Health Plans, Inc.
•CareOregon
•Moda Health Plan, Inc.
•Providence Health Plan and Providence
Health Assurance
•Tuality Health Alliance
•OHA (Fee-for-Service Medicaid)
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Coordinated Care Organizations
•AllCare Health, Inc.
•Columbia Pacific Coordinated Care Organization
•Eastern Oregon Coordinated Care Organization,
•FamilyCare Health
•HealthShare of Oregon (not a CPC+ payer, but
represented by other participating HealthShare of
Oregon payer partners)
•Jackson Care Connect
•PacificSource Central Oregon
•PacificSource Gorge
•PrimaryHealth of Josephine County
•Umpqua Health Alliance
•Western Oregon Advanced Health
•Willamette Valley Community Health
Organization
•Yamhill Community Care Organization
CPC+: Advancing Care Delivery and
Payment
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• Focus on efficient, high
quality care
• High-value utilization
• Population-based care
delivery
• Engaged patients,
caregivers, and families
• Multi-payer support
• Coordination across the
medical neighborhood and
community services
• Focus on volume
• High-cost services
• In-person encounters
• Fragmented care
• Provider burnout
• Payer segregation
• Little attention to social
determinants of health
Practice Transformation
Payment Redesign
Fee-for-Service
Primary Care
Comprehensive
Primary Care Actionable milestones to deliver high quality,
whole-person, patient-centered care
Effective use of health information
technology (HIT) and data analytics
Practice learning networks
Non-visit based care management fees
Regional shared savings opportunity
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• Are you eligible for exclusion?
• Select Track 1 or Track 2 pathway
• Get started. 2017 is measurement year 1.
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• Final Ruling:
https://www.congress.gov/114/plaws/publ10/PLAW-
114publ10.pdf
• CMS Overview: https://www.cms.gov/Medicare/Quality-
Initiatives-Patient-Assessment-Instruments/Value-Based-
Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-
APMs.html
• Timeline: https://www.cms.gov/Medicare/Quality-Initiatives-
Patient-Assessment-Instruments/Value-Based-
Programs/MACRA-MIPS-and-APMs/Timeline.PDF
• FAQs: https://innovation.cms.gov/Files/x/macra-faq.pdf
• Past Webinars: https://www.cms.gov/Medicare/Quality-
Initiatives-Patient-Assessment-Instruments/Value-Based-
Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-
Events.html
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Dean Andretta, CFO, WVP Health Authority
Merrin Permut, MHA, Executive Director Legacy Health Partners and Director of Care Transformation for Legacy Health
Bahaa Wanly, MHA, Chief Operating Officer and Vice President of Salem Health Medical Group
Jim Rickards, MD, MBA, OHA Chief Medical Officer
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