The Transforming Clinical Practice initiative (TCPi) Colorado Practice Transformation Network: Lead the CHANGE Barbara Martin, RN, MSN, ACNP-BC, MPH Program Manager, Colorado TCPi

Transforming Clinical Practice initiative: Practice Transformation Network (PTN) Vision: Provide transformation support to 140,000 clinicians to achieve the quadruple aim and improve care for millions while reducing per capita costs through reduced hospitalizations and readmissions; avoidable ED visits, and unnecessary testing Goal: Prepare providers for value-based compensation models ALLYSON

What is ‘MACRA’? The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015. What does Title I of MACRA do? Repeals the Sustainable Growth Rate (SGR) Formula Changes the way that Medicare rewards clinicians for value over volume Streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS) Provides bonus payments for participation in eligible alternative payment models (APMs) 5

TCPi Aims Support more than 140,000 clinicians Improve health outcomes for millions of patients Reduce unnecessary hospitalization for 5 million patients Generate $1 to $4 billion in savings Sustain efficient care by reducing unnecessary tests and procedures ALLYSON

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Eligible Clinicians PCPs and Specialists: MDs, DO’s, PA’s APN’s (at the NPI level, not TIN level) NOT ELIGIBLE: participating in CPCi, Medicare Shared Savings Payments (ACO) Eligible: Evidence NOW SW; possibly SIM ALLYSON

Colorado Practice Transformation Network Recruit and engage 2000 clinicians for up to 4 years Engage clinicians that have not yet participated in quality improvement initiatives Beyond just primary care to include specialists—opportunity to think about supporting medical neighborhoods and communities Identify measures and milestones that we will track Improved clinical quality measures (aligned with SIM quality measures) Improved cost/utilization measures – total population: Hospitalizations, Readmissions, ED Visits, Reduced low back imaging Provide the right coaching and mentoring such that 75 % of enrolled clinicians are prepared to participate in value based compensation programs by 2019 Use the existing practice transformation organization infrastructure—what is working for SIM and other initiatives—to provide this coaching and mentoring ALLYSON

TCPi efforts intended to help clinicians in: Specialty practices Pediatric practices Primary care practices Systems of Care (FQHCs, groups planning an Alternative Payment Model (APM)) Cohorts or groups of practices that have a shared priority or plan to work together to improve care delivery Can be a specific area of focus: Access to Specialty Care

Colorado PTN Methodology: Two Levels of Support for Practices At the Practice Level: Connect with a practice facilitator and a clinical health information advisor Start with a practice assessment; Review current clinical, cost and utilization data Create a plan/goals for practice Make gradual incremental changes to practice processes and approach Measure and report on progress At the Learning Collaborative Level: Virtual learning community 10/12 practices facilitated by a coach and expert faculty (the Cohort or group of practices working together) Share ideas/struggles with other practices to provide/get help from each other Utilize already developed/ vetted tools from national organizations Obtain CME and MOC credit ALLYSON

The Commitment for the practice Identify one clinician, one staff member per practice as Select Practice Champions Attend two face to face regional collaborative learning sessions per year Robust conference environment Expert faculty in plenary sessions Peer to peer sharing in breakout sessions to exchange and learn best practices Participation with 10 – 12 other practices to form a “learning network” and meet virtually every month for a one hour event facilitated by a practice coach Learn, share and grow with your peers Contribute agendas, priorities, and goals Submission of quality measures quarterly to Colorado data hub Baseline and periodic assessments, benchmarking on clinical data that you submit, as well as cost and utilization measures that we report to you in a collaborative, supportive environment Work with a quality improvement coach and health information technology advisor to implement tests of change and monitor progress towards your practice quality improvement goals Progress through a quality improvement curriculum to ensure your practice is ready and prepared for the payment reform changes that are coming I will bring a hand out of the clinical quality measures

How will TCPi be organized? Patient and Family Centered Care Design Continuous, Data-Driven Quality Improvement Sustainable Business Operations

Patient and Family Centered Care Design Patient and family engagement Team-based relationships Population management Practice as a community partner Coordinated care delivery Organized, evidence based care Enhanced Access

Continuous, Data-Driven Quality Improvement Engaged and Committed Leadership Quality improvement strategy supporting a culture of quality and safety Transparent measurement and monitoring Optimal use of HIT

Sustainable Business Operations Strategic use of practice revenue Staff vitality and joy in work Capability to analyze and document value Efficiency of operation

TCPi resources (in general) Support & Alignment Network (SANs): Organizations selected to provide help to the PTNs with roadmaps, tools, “how- to” ideas to help practices Example: American College of Physicians- ACP has tool kits developed by physicians for care coordination American College of Radiology: RSCAN Clinical Decision Support Practice Transformation Network (PTN) Colorado is one of 29 PTNs In-practice support; facilitator Faculty support: education Learning network support Access to tools to help the practice from all of the SANs organizations 4 Things You Need to Know Participation in R-SCAN is free—both for radiologists and for ordering clinicians. A step-by-step guide leads you through the process of improving the ordering of appropriate imaging exams based on Choosing Wisely recommendations. When you sign up to participate in R-SCAN, you’ll also gain free online access to a customized version of the ACR Select™ clinical decision support tool, which is based on the ACR Appropriateness Criteria®. Using these tools, you can rate the appropriateness of exams ordered and create project reports. R-SCAN participants gain free access to a customized version of the ACR Select™ clinical decision support (CDS) tool, the Web-based version of the complete ACR Appropriateness Criteria®(AC). In the near future, under the Protecting Access to Medicare Act (PAMA), CMS will require consultation of appropriate use criteria in the ordering of advanced imaging exams as a condition for reimbursement to imaging providers. For practices that already have CDS installed, R-SCAN can serve as an important first step for tracking and improving adherence with appropriate use.

Colorado TCPI-PTN Transformation Timeline Set Aims; Use Data to Drive Care Achieve progress on aims and benchmark status Thrive as a business within value-based payment models 2016 2017 2018 2019 ALLYSON

Next Steps For more information, sign up for a webinar or practice presentation, or apply: www.colorado.gov/healthinnovation/tcpi Questions: Barbara Martin 773-412-4999 Barbara.martin@state.co.us

MACRA Goals Through MACRA, HHS aims to: Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value. Over time, expand the opportunities for a broad range of providers to participate in APMs. Minimize additional reporting burdens for APM participants. Promote understanding of each physician’s or practitioner’s status with respect to MIPS and/or APMs. Support multi-payer initiatives and the development of APMs in Medicaid, Medicare Advantage, and other payer arrangements.