Rhode Island Quality Institute 4/8/2016 Rhode Island Quality Institute Transforming Clinical Practice Initiative (TCPI) CTC Steering Committee April 8, 2016 Jacqueline Bessette Lefebvre, Senior Clinical Practice Advisor, RI PTN Darlene Morris, Director, RI PTN Rhode Island Quality Institute

Agenda RIQI Services Practice Transformation 4/8/2016 Agenda RIQI Services Practice Transformation Transforming Clinical Practice Initiative Rhode Island Quality Institute

RIQI’s Center for Improvement Science Services 4/8/2016 RIQI’s Center for Improvement Science Services Health IT CurrentCare EHR Adoption and MU Practice Transformation Transforming Clinical Practice Initiative NCQA PCMH Consultation Rhode Island Quality Institute

Center for Improvement Science Services PRACTICE TRANSFORMATION 4/8/2016 Center for Improvement Science Services PRACTICE TRANSFORMATION Rhode Island Quality Institute

Practice Transformation through TCPI 4/8/2016 Practice Transformation through TCPI Transform Practice Centers for Medicare & Medicaid Services (CMS) awarded $685M to 39 organizations to help 140,000 clinicians achieve practice transformation High Performance Improve health outcomes for 5 Million Medicare, Medicaid & CHIP beneficiaries Reduce Utilization Reduce unnecessary hospitalizations and over utilization of other services Rhode Island Quality Institute

Help clinicians prepare for 4/8/2016 What Does this Mean for RI? The Center for Medicare & Medicaid Innovation (CMMI) Transforming Clinical Practice Initiative (TCPI) Support and Alignment Networks (SAN) 10 Awardees Practice Transformation Networks (PTN) 29 Awardees RIQI received $8.5M to help 1500 RI-area clinicians over 4 years Help clinicians prepare for success under new payment models It’s a unique opportunity to bring practice transformation assistance to specialists and to additional primary care physicians (≈75% specialists/25% PCPs) 6 Rhode Island Quality Institute

TCPI’s 5 Phases of Transformation 4/8/2016 TCPI’s 5 Phases of Transformation Source: CMS TCPI PTN Information Webinar 2014 * 7 Rhode Island Quality Institute

Value Proposition – Why participate? 4/8/2016 Value Proposition – Why participate? Business success Prepare for and succeed under value based payments Make your practice attractive as a potential partner/ participant in shared savings programs Transformation support at no cost Better patient outcomes More joy in work Strengthen relationships between primary care and specialist providers * Rhode Island Quality Institute

Value Proposition – Local Reform Efforts 4/8/2016 Value Proposition – Local Reform Efforts Local practice transformation and payment reform efforts OHIC: Care Transformation Plan TCPI named an option, opportunity for incentives Rhode Island HHS: 50% of Medicaid reimbursements made through alternate payment models by end of 2018 State Innovation Model (SIM): 80% of provider payments linked to value by 2018 Population based contracting: 45% covered lives (10% in downside risk) By 2016 Payment targets: APM: 40% by 2017, 50% by 2018 Non-FFS: 6% by 2017, 10% by 2018 Rhode Island Quality Institute

Value Proposition – Federal Reform Efforts 4/8/2016 Value Proposition – Federal Reform Efforts Rhode Island Quality Institute

Value Proposition – Payment Reform 4/8/2016 Value Proposition – Payment Reform Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, signed into law 4/16/15) Repeals 1997 Sustainable Growth Rate (SGR) Physician Fee Schedule (PFS) Update Proposed rule Spring 2016 Final rule Fall 2016 Rhode Island Quality Institute

MACRA changes Medicare PFS payments It creates two paths: 4/8/2016 MACRA MACRA changes Medicare PFS payments It creates two paths: Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) It will drive the delivery of health care in the future Reimbursement will be linked to quality and outcomes * Rhode Island Quality Institute

Merit Based Incentive Payment System (MIPS) 4/8/2016 Merit Based Incentive Payment System (MIPS) MIPs includes these components: Meaningful Use of an EHR Physician Quality Reporting System (PQRS) Resource Use* Clinical Practice Improvement Activities** *CMS to develop care episode, patient condition, and patient relationships categories for accurate calculations and attributions; charges to include Parts A and B, perhaps Part D drugs if feasible **Secretary required to specify * Rhode Island Quality Institute

Merit Based Incentive Payment System (MIPS) 4/8/2016 Merit Based Incentive Payment System (MIPS) Each MIPS component will be weighted Clinicians will be evaluated using a scoring system from 0 to 100 Beginning 2019, based on 2017 data Score will be used to determine and apply a MIPS payment adjustment factor Adjustment based on performance relative to scores of your peers and be made public Adjustment can be positive, negative or zero * Rhode Island Quality Institute

Alternative Payment Model (APM) 4/8/2016 Alternative Payment Model (APM) Requirements: Participate in a defined APM Meet additional criteria Bear financial risk for more than nominal losses Use Certified EHR Achieve certain revenue thresholds Definition of APM: A Center for Medicare and Medicaid Innovation (CMMI) Model; a Medicare Shared Savings Program Accountable Care Organizations (ACO); and/or a similar CMS demonstration model Rhode Island Quality Institute

Alternative Payment Model (APM) 4/8/2016 Alternative Payment Model (APM) Payments: Lump sum payments equal to 5% of all reimbursement for services rendered under the Medicare PFS (2019 – 2024) Rhode Island Quality Institute

PFS, APM & MIPS Payments 4/8/2016 Rhode Island Quality Institute Copyright © 2016 Deloitte Development LLC. All rights reserved Rhode Island Quality Institute

4/8/2016 Rhode Island Quality Institute

Value Proposition – Limited Openings 4/8/2016 Value Proposition – Limited Openings Only 1,500 slots available, 972 already filled RIQI mission for TCPI: To create the conditions for unprecedented community cooperation, action, and achievement of a common goal of transformed practices that succeed under new payment models and significantly advance the Triple Aim of better health, better healthcare and lower costs statewide. Rhode Island Quality Institute

Value Proposition – No Cost Services 4/8/2016 Value Proposition – No Cost Services Technical assistance support and 1:1 coaching Education and training Readiness and ongoing assessments Leadership Academy for select clinicians (15%) to train as health care leaders and inspire peers Care coordination and care transition services Data-driven quality improvement skill building Practice transformation that supports specialist/primary care cooperation * Rhode Island Quality Institute

Why is this important to CTC Steering? 4/8/2016 Why is this important to CTC Steering? Key Transformation Leaders TCPI is connecting the dots between your current transformation and payment reform Best way to jump start primary and specialty integration Providers are “Not Ready” RI is experiencing a convergence of forces: all heading toward payment for value!!! Following CMS Lead Let other providers know: specialists/primary care * Rhode Island Quality Institute

Thank You CurrentCare @CurrentCare 4/8/2016 Thank You CurrentCare @CurrentCare Darlene Morris, Director, Center for Improvement Science – dmorris@riqi.org Rhode Island Quality Institute - 50 Holden Street, Providence, Rhode Island 02908 www.riqi.org www.transformyourpracticeri.com www.currentcareri.com Rhode Island Quality Institute