What have we learned?

Competing demands Hard to keep all the balls in the air APM implementation, refinement, spread Bridging towards value-based pay Practice transformation Clinics face many demands Expand access for 2014 patients Hold down total cost of care Improve quality & produce data – CCO, meaningful use, ICD-10, PCPCH, APCP…

Payment Model Lessons Model should be hand in hand with payment Data/Outcomes should be clear, thoughtful, aligned This is a Partnership requiring constant refinement and trouble shooting: With Medicaid Between clinics IT and managed care Financial stability as a requirement to participate (NOT a consequence) Cascade of other financial implications: Budgeting Panel Size Provider Reimbursement

Advanced Care Model: Lessons Learned Never separate from payment Consider immensity of change Create less time pressure Plan for data collection Add ACM teams at all participating sites Co-create OPCA-ACM teams Keep learning (co-design is messy)

Early Outcomes Year 1 Year one report from OPCA and state contractor under production Model appears budget neutral per patient, per year APM reconciliations have not triggered payment to date. MCO payments appear level Clinical quality indicators appear to be holding or improving in most cases Signs of improvement in total health care utilization Access under ACA poses a challenge to transformation