Let’s Leverage the Work you did on Healthy Hearts Northwest for MACRA April 26, 2017 Jeff Hummel, MD, MPH Qualis Health This project is supported by grant number R18HS023908 from the Agency for Healthcare Research & Quality

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Goals Is MACRA something I need to pay attention to? How do the quality metrics from H2N relate to MIPS Quality Measures? How does the work we are doing for H2N relate to the Clinical Practice Improvement Activities for MACRA? How can we use this first year of MACRA to best prepare ourselves for the future? So, what’s your plan? 3

Overview of the Quality Payment Program Qualifying participants develop incentives for better care, smarter spending and healthier people Consolidates PQRS/Value-Based Payment Modifier/EHR Incentive into a single program © Qualis Health, 2017

Do I need to pay attention to MACRA? Yes! > 100 Medicare Part B Patients (office visit) AND billed Medicare > $30,000 for Part B Similar QPP programs for FQHCs, RHCs, IHS are being developed that are aligned with MACRA Alternative Payment Model programs require managing the same quality metrics © Qualis Health, 2017

Maybe I’m Exempt from all this Clinicians new to Medicare are exempt for their first year Clinicians in Rural Health Clinics and FQHCs are exempt for now, unless they meet the visit and billing eligibility criteria individually CMS is sending out letters to all Tax ID Numbers informing practice manager about the of exemption status of individual clinicians © Qualis Health, 2017

6 Quality Measures Required for MIPS 5 can be directly mapped from the H2N work Statin therapy for preventing CVD Tobacco screening & cessation Controlling high blood pressure Use of ASA for ischemic vascular disease All or none ischemic vascular disease control 5 more can be readily adapted from H2N work Tobacco Use: help quitting among adolescents Screening for HTN and documented f/u Improvement in blood pressure Documentation of medications in EHR Anti-platelet therapy for coronary artery disease In October of 2016, we will publish an implementation guide – a toolkit – reflecting our experience field-testing the framework. This will include specific tools and resources practices found helpful, for example sample workflows and referral agreements. It will also include impact data and case examples from our field testing sites. The toolkit will be adopted in the Safety Net Medical Home Initiative Resource Library, joining a suite of behavioral health integration tools we published last year. All will be in the public domain and free to all to use and adapt.   © Qualis Health, 2017

Improvement Activities 8 major categories of activities Health equity Patient engagement Behavioral health Care coordination Increased access to care Emergency response and preparedness Patient safety Population management Leverage anything you’re passionate about – reporting is based on attestation © Qualis Health, 2017

4 Improvement Activities Required (2 if rural zip, < 15 providers, or HPSA) 16 to choose from that can be met directly with H2N work Use evidence-based decision aids to support shared decision-making Use of decision support and standardized treatment protocols Tobacco use: Groups and integrated prevention & treatment interventions Leadership engagement in regular guidance for practice improvement Integration of patient coaching practices between visits Improved practices that engage patients pre-visit Improved practices that disseminate appropriate self-management materials Implementation of formal QI methods for practice improvement Implementation of chronic disease self-management support programs Engagement with QIN-QIO to implement self-management training programs RHC, HIS, FQHC QI activities Regular review of practices in place on target population needs The list goes on…. © Qualis Health, 2017

Advancing Care Information Submit 4 or 5 base score measures depending Certification (2014 or 2015) Security Risk Analysis ePrescribing Patient Access Send Summary of Care Request/Accept Summary of Care Bonus credit for Reporting to Public Health Using EHR for Improvement Activities © Qualis Health, 2017

Options for MIPS Participation in 2017 Put your head in the sand and regret it later – not recommended Submit anything – 1 quality measure, 1 improvement activity, or Advancing Care Information Measure – penalty avoided Submit 90 days of data in 2017 – may get a positive adjustment and prepare for future Submit full year of data – may get a positive adjustment and maximize preparation for future

So, what do we do? Go to: https://qpp.cms.gov and see for yourself Talk to your H2N practice coach about leveraging your H2N work in preparation for MIPS Pick the “no brainer” H2N Quality measures you already have Supplement those with quality measures easily adapted from H2N Pick from Clinical Practice Improvement Activities from the list that reflect things you’re already doing or really care about © Qualis Health, 2017

It might look something like this 5 can be directly mapped from H2N data Statin therapy for preventing CVD Tobacco screening & cessation P Controlling high blood pressure P Use of ASA for ischemic vascular disease P All or none ischemic vascular disease control 5 more can be readily adapted from H2N work Tobacco Use: help quitting among adolescents P Screening for HTN and documented f/u P Improvement in blood pressure Documentation of medications in EHR Anti-platelet therapy for coronary artery disease P In October of 2016, we will publish an implementation guide – a toolkit – reflecting our experience field-testing the framework. This will include specific tools and resources practices found helpful, for example sample workflows and referral agreements. It will also include impact data and case examples from our field testing sites. The toolkit will be adopted in the Safety Net Medical Home Initiative Resource Library, joining a suite of behavioral health integration tools we published last year. All will be in the public domain and free to all to use and adapt.   © Qualis Health, 2017

Pick things you’re already doing 16 to choose from that can be met directly with H2N work Use evidence-based decision aids to support shared decision-making Use of decision support and standardized treatment protocols Tobacco use: Groups and integrated prevention & treatment interventions P Leadership engagement in regular guidance for practice improvement Integration of patient coaching practices between visits Improved practices that engage patients pre-visit Improved practices that disseminate appropriate self-management materials Implementation of formal QI methods for practice improvement P Implementation of chronic disease self-management support programs P Engagement with QIN-QIO to implement self-management training programs RHC, HIS, FQHC QI activities Regular review of practices in place on target population needs P The list goes on…. © Qualis Health, 2017

And Then…? Develop a plan to submit full year data for 2017, so you get the most out of this year of limited risk Quality metrics Clinical practice improvement activities Advancing care information Ask your coach to connect you to the regional source for technical assistance that is right for your organization © Qualis Health, 2017

The Big Picture: Quality Payment Programs It is a move away from reimbursement that rewards only volume, and toward a system that rewards for quality and value MACRA/MIPS is the first step for groups that are not part of a A-AMP MIPS is a little like quicksand, i.e. you don’t want to stand there for too long The long term strategy is to join an A-AMP, but the skills needed be an asset to an A-AMP are the skills needed to survive with MIPS

Technical Assistance for QPP © Qualis Health, 2017

Learn More Resources available at: https://qpp.cms.gov Jeff Hummel, MD, MPH e-mail: jeffh@qualishealth.org © Qualis Health, 2017