PCMH 2017:What’s Next?

William Golden MD MACP

Medical Director, AR Medicaid

UAMS Prof. of Medicine and Public Health

Agenda

• Primary Care Payment Reform

• PCMH 2016

• CPC+ vs PCMH

• Quality Measures

• Medical Neighborhood Report

PRIMARY CARE PAYMENT MODEL (PCPM) WORK GROUPMAY 2016

Primary Care Payment Reform

• LAN white paper

• Insurance Risk vs Small Practice Participation

5

Q14 Lowest and Highest Risk-Adjusted Expenditure Practices

All CPC Regions 1

70 Lowest RA Expenditure Practices Average

National Median70 Highest RA

Expenditure Practices Average

Risk-adjusted Expenditure* $656 $776 $958

Number of Attributed Beneficiaries 512 816 656

Average Patient Risk Score 1.010 0.979 0.977

Risk-adjusted Expenditure Trend* -5% 6% 19%

6

Cohorts include the 10 practices regionally with highest or lowest RA expenditures (70 in each group respectively). “Primary at Practice” = Primary care visit at CPC site. “Primary at Other” = Primary Care visit at non-CPC site.Source: CMS Q4–Q14 Regional Feedback Report, practice level excel reports. * Statistical significance at p<.05.

7

Q14 Lowest and Highest Risk Adjusted Expenditure Practices

Arkansas

10 Lowest RA Expenditure

Practices

RegionalAverage

10 Highest RA Expenditure

Practices

Risk-adjusted Expenditure*

$645 $753 $877

Number of Attributed Beneficiaries

580 625 1006

Average Patient Risk Score

0.99 0.94 0.96

Risk-adjusted Expenditure Trend*

-6.2% 2.0% 14.5%

*

“Primary at Practice” = Primary care visit at CPC site. “Primary at Other” = Primary Care visit at non-CPC site.Source: CMS Q4–Q14 Regional Feedback Report, practice level excel reports. * Statistical significance at p<.05.

8

Medicaid PCMH 2015

• 342,000 beneficiaries

• 133 practices

• $14.7 million in PMPM payments

• $657.6 M expected costs vs $608.2 M actual

• 5.3% net savings after PMPM

• $2.7 M preliminary shared savings

PCMH 2016

• Enrollment

• Shared savings

• Performance metrics

• Quality metrics

CPC+ vs PCMH

• CPC+ enrollment ̶ 184 sites 50/50 Tracks 1 and 2• Current PCMH enrollees = Track 2 Medicaid

– Future Track 1 = lower PMPM, fewer patients, fewer requirements

• CPC – Medicaid PMPMs paid by CMS• CPC+ - Medicaid PMPMs paid by AR Medicaid• Practice activity requirements more rigorous for CPC+• CPC+ practices in good standing

– Meet PCMH standards, subject to validation

2017 PCMH Activities for Practice Support3 Month

Activity A: Identify top 10% of high-priority patients (including BH clients)

6 Month

Activity B: Provide 24/7 access to care

Activity C: Document approach to expanding access to same-day appointments

Activity D: Capacity to receive direct e-messaging from the patients: Describe method of e-messaging (New for 2017)

Activity E: Enrollment in the Arkansas PDM program: All PCPs must enroll in PDM program. Report method(s) used to monitor controlled substance prescriptions using PDM program (New for 2017).

2017 PCMH Activities for Practice Support12 Month

Activity F: Childhood/Adult Vaccination Practice Strategy

Activity G: Join SHARE or participate in a network that delivers hospital discharge information to practice within 48 hours

Activity H: Incorporate e-prescribing into practice workflows

Activity I: Care plans for high-priority beneficiaries: create care plans

Activity J: Patient Literacy Assessment Tool: Choose any health literacy tool and administer the screening to at least 50 beneficiaries (enrolled in the PCMH program) or their caregivers (New for 2017)

Activity K: Ability to receive patient feedback: Indicate method used to receive patient feedback and describe how feedback is used to make improvement (New for 2017)

2017 PCMH Activities for Practice Support

12 Month

Activity L: Care Instructions for HPB: Create and share with the patient an after-visit summary of patient’s visit. Include updated/reconciled medication list, vital signs, purpose of the visit, procedures and other information or instructions based on clinical discussions that took place during the visit, summary of topics covered/considered, and follow-up instructions. (New for 2017)

Activity M: Medication Management: Describe the practices EHR reconciliation process. Document updates to active medication list in EHR for HPB (New for 2017)

Activity N: 10-day follow-up after an acute inpatient hospital stay (New for 2017)

Milestone 2: Percent of practices with >75%

of empanelled patients risk stratified

17

Note: Milestone 2 target is to reach at least 75% risk stratification per practice.Source: Q1 2015 – Q2 2016 Milestone Practice Reporting, Section 2.0.2.

Milestone 6: Percent of ED patients receiving timely follow-up

18

Note: Timely follow up = contact within one week. Source: Q1, Q3, Q4 2015, Q1 2016, Q2 2016 Milestone Practice Reporting, Question 6.2. Q2 2015 data is currently unavailable.

Unique PCMH Activities

• Enrollment in PDMP Program

• Vaccination strategy

• Patient literacy tool

• Medication reconciliation strategy

• Visit information printout

Quality Measures

• Target Thresholds Based on 2015 Performance (50th Percentile)– Well child visits – Arkansas lags national performance

– Most measures carry over from 2016

– eCQMs will grow in importance• AFMC/Medicaid survey

• MiHIN

Medical Neighborhood Report

• Practice variation

• Goes live first quarter 2017

• ER antibiotics, ER UTI management, endoscopy, hysterectomy

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15

33

14

3

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5

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0-15% 16-30% 31-45% 46-60% 61-75% 76-90% 91-100%

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CBC Rate

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12 12

14

16 16

4

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2

4

6

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18

0-15% 16-30% 31-45% 46-60% 61-75% 76-90% 91-100%

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Urine Culture

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41

29

6

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5

10

15

20

25

30

35

40

45

0-15% 16-30% 31-45% 46-60% 61-75% 76-90% 91-100%

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CT Scan Rate

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15%

Questions?Comments!