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Value Based Contracting Office Hours CPC+ Office Hours October 16, 2018 Section - Title

Agenda CPC+ Topics: Review CPC+ Timeline – Cindy Mattingley eCQM Reporting & Evaluation – Kim Brown RMHP Attribution Reports – Patrick Gordon Review of Total Cost Relativity – Patrick Gordon Overview of VBCRC – Cindy Mattingley RMHP Support – Cindy Mattingley Q&A   Section - Title

RMHP CPC+ Timeline Section - Title

RMHP Performance Based Incentive Eligibility “Year 1” shall mean January 1, 2017 through December 31, 2017. “Year 2” shall mean January 1, 2018 through December 31, 2018. “Year 3” shall mean January 1, 2019 through December 31, 2019. “Year 4” shall mean January 1, 2020 through December 31, 2020. “Year 5” shall mean January 1, 2021 through December 31, 2021.

Performance Based Incentive Good Standing (Monthly) Timing of RMHP Payment Base Medical Performance Based Incentive Enhancement (Monthly) Good Standing (Monthly) Quality/Cost (Annually) Reminder of how your payment is coming through to you on the enhancement and the performance payment. The year 1 performance based incentive payment is being calculated. Patrick do you have any updates on a time line of when practice will get that? Section - Title

eCQM Reporting & Evaluation

eCQM and Quarterly Assessment Timeline The 3rd Friday of the month following the quarter (April, July, October and January) RMHP CPC+ Quarter 3 Reviews to be completed Quarterly eCQMs due to RMHP eCQMs due this Friday. Quarterly feedback reports allowing meaningful comparison. Opportunity to trouble shoot reporting issues before the annual reporting requirement. Payment Period #3   Quarter 3 Performance Period Influences Section - Title

Data in the CPC+ Attribution Reports

Cost Data Total Cost of Care (TCOC) Emergency Hospital Inpatient Hospital Outpatient Hospital Pharmacy Physician Services – Primary Care Physician Services – Specialist Care All Else

CPC+ TRACK 1 RMHP ATTRIBUTION REPORT Practice Summary Tab

CPC+ TRACK 1 RMHP ATTRIBUTION REPORT Patient Summary Tab

CPC+ TRACK 2 RMHP ATTRIBUTION REPORT Practice Summary Tab

CPC+ TRACK 2 RMHP ATTRIBUTION REPORT Patient Summary Tab

Utilization Chart This section of the report will show your practices breakdown in three buckets; as a raw count for your practice on patients that have been to the ED, had an IP Admit or have had an IP Readmit. You will then get a per member count for your practice on patients that have been to the ED, had an IP Admit or have had an IP Readmit. You will then see a per 1000 members count for your practice on patients that have been to the ED, had an IP Admit or have had an IP Readmit. You will then be given the same breakdown of data for other CPC+ Track 1 or Track 2 practices that RMHP contracts with for CPC+. This allows you to compare your practice with other practices participating at the same level and gauge where you stand. You will also receive an average HCC score risk score for you practice as well as other CPC+ practices. Section - Title

Trend Data Average Risk Score Average ER Visits Average IP Visits Average IP Readmits Average Total Cost Average PMPM Cost This data is provided to practices in a run chart format and looks at your data over a 12 month period. There are three lines for each run chart. One is the ‘You’ line which is your practices raw data, not normalized All line which = all other practices in CPC+ that are participating in the same Track. You Norm = A normalized line using your risk score (HCC score).   There are run charts for the following: • Average Risk Score and Average Total Cost • ER Visits, Inpatient Visits & IP Readmissions • Average of your PMPM Cost Section - Title

Total Cost Relativity

TRACK 1 – Incentive Eligibility To remain eligible for earning the incentive payment, practices must:  Develop, embed, utilize and document processes for Empanelment, Risk Stratification and Care Management of High Risk Patients. Care management and care coordination processes are utilized for monitoring high risk patients and utilization of services such as Hospitalizations and ED use. Effective in 2019, and moving forward, practices will be evaluated using the Total Cost Relativity calculation for determining incentive payment. *Refer to your practices monthly CPC+ attribution report from RMHP for your current TCR*

TRACK 2 – Incentive Eligibility To remain eligible for earning the incentive payment, practices must:  Develop, embed, utilize and document processes for Empanelment, Risk Stratification and Care Management of High Risk Patients. Care management and care coordination processes are utilized for monitoring high risk patients and utilization of services such as Hospitalizations and ED use. Annually, practices will be evaluated using the Total Cost Relativity calculation for determining incentive payment. *Refer to your practices monthly CPC+ attribution report from RMHP for your current TCR*

TCR Outcomes – “Year 1” (CY 2017) Section - Title

TCR Outcomes – “Year 1” (CY 2017) Section - Title

Overview of the Value Based Contracting Review Committee (VBCRC)

Value Based Contracting Review Committee (VBCRC) RMHP utilizes the Value Based Contracting Review Committee for a decision making and review process to review Practice performance, make recommendations, and make payment eligibility decisions based on Practice performance in RMHP value based contracting relationships of CPC+, RAE, and Prime The 4th week of the month following the quarter (April, July, October and January) The VBCRC will review the previous quarters performance The second month following the quarter (May, August, November and February) Letters will be mailed to practices regarding their status Section - Title

RMHP CPC+ Support

We are still here for you CPC+ monthly 30 minute virtual meeting with the QIA & CI to touch base on RMHP CPC+ contractual requirements Value Based Contracting Office Hours RMHP CPC+ Newsletter Free Consultative Services

Questions?

Contacts Lori Stephenson Dale Renzi Patrick Gordon Director – Clinical Program Development and Evaluation Lori.Stephenson@rmhp.org Dale Renzi Director - Provider Network Management Dale.Renzi@rmhp.org Patrick Gordon Vice President Patrick.Gordon@rmhp.org