Value Based Contracting Office Hours RAE Prime Office Hours December 18, 2018 Section - Title

What questions do you have regarding RMHP Prime?

Agenda Prime Topics: Year 3 Performance & Payment – Patrick Gordon Year 3 Practice Performance Review – Patrick Gordon Year 4 Incentive Pool Estimate – Patrick Gordon Closing out Year 4 - Lori Stephenson Year 5 MLR Metrics and Value Based Performance Payment Criteria – Lori Stephenson Year 6 Strategy – Patrick Gordon     Section - Title

Key Timeline – Prime Now CY 2017 “Year 3” Shared Savings Distribution Practice Performance Period Underway January 2019 CY 2019 “Year 5” Practice Performance Period Starts July 2019 New Prime Agreements & Tiered Participation Structure August 2019 Shared Savings Distribution* January 2020 CY 2020 “Year 6” Practice Performance Period Starts *Contingent upon overall plan performance on total cost and quality

Year 3 (SFY 2016-17) Performance & Payment Discussion Section - Title

Year 3 – Incentive Payment Outcomes This is paid RMHP dollars for incurred months, not reflecting Medicare Part A or encounter equivalent info. It is only for the attributed months, not those prior to attribution. Nothing offline has been counted. Based on % of members only Amount to Pay Total Shared Savings Pool: $850,000 Total to be distributed to CMHCs: $283,330 Total to be distributed to PCMPs: $566,670 Prime Practice Avg Risk Score Payment Multiplier #1 for Risk Score Global Caps Paid Global Cap PMPM Total Claim Costs Claim PMPM Claim + Cap PMPM Cost Normalized on Risk Score Payment Multiplier #2 for TCR Shared Savings Multiplier #1 = 75% #2 = 25% Attributed Member Months % of Total Attribution Unadjusted Portion of Pool Adjusted Final Payment Impact of TCR Adjustment Dr Lu Family Medicine Prof LLC 2.4547 1.1129 $9,556 $31.75 $186,470 $619.50 $651.25 $585.19 0.9067 1.06134 301 0.21% $1,211 $1,287 $76 Etcheverry, Aurelio 2.0268 0.9189 $6,716 $28.82 $131,927 $566.21 $595.03 $647.56 0.7902 0.88671 233 0.17% $937 $832 -$105 Foresight Family Practice 2.4136 1.0942 $252,548 $31.46 $3,400,876 $423.68 $455.14 $415.94 1.2229 1.12641 8,027 5.70% $32,287 $36,432 $4,145 Grand Junction Family Medicine PC 1.9990 0.9063 $55,111 $28.64 $622,855 $323.73 $352.37 $388.81 1.2736 0.99812 1,924 1.37% $7,739 $7,738 -$1 Gunnison Valley Family Physicians 1.2738 0.5775 $74,892 $20.57 $1,230,352 $337.92 $358.49 $620.74 0.8403 0.64321 3,641 2.58% $14,645 $9,436 -$5,209 Juniper Family Medicine PLLC 2.1221 0.9621 $74,898 $29.48 $930,455 $366.18 $395.65 $411.23 1.2317 1.02951 2,541 1.80% $10,221 $10,541 $320 Marillac Clinic 2.2632 1.0261 $1,565,436 $70.78 $15,380,619 $695.42 $766.20 $746.73 0.6049 0.92078 22,117 15.70% $88,961 $82,057 -$6,904 MidValley Family 2.2638 1.0263 $15,734 $26.40 $229,894 $385.73 $412.13 $401.55 1.2498 1.08219 596 0.42% $2,397 $2,599 $202 Mindy Miller MD PC 2.4746 1.1219 $27,344 $32.98 $417,082 $503.11 $536.10 $477.84 1.1073 1.11826 829 0.59% $3,334 $3,735 $401 Mountain Medical Center 1.3732 0.6226 $4,315 $25.23 $97,393 $569.55 $594.78 $955.35 0.2151 0.52072 171 0.12% $688 $359 -$329 Ouray Family Medicine $30,674 $31.59 $534,161 $550.11 $581.70 $566.78 0.9411 1.00502 971 0.69% $3,906 $3,932 $26 Peach Valley Family Medical Center 2.1430 0.9716 $68,853 $29.63 $843,015 $362.74 $392.37 $403.84 1.2455 1.04007 2,324 1.65% $9,348 $9,739 $391 Peak Family Medicine 2.1636 0.9809 $147,606 $30.78 $2,487,873 $518.85 $549.63 $560.32 0.9532 0.97398 4,795 3.40% $19,287 $18,818 -$469 Pediatric Associates 4.0294 1.8268 $25,805 $43.89 $723,186 $1,229.91 $1,273.79 $697.27 0.6973 1.54446 588 $2,365 $3,659 $1,294 Peterson, Linda M 1.9084 0.8652 $9,017 $28.99 $197,716 $635.74 $664.74 $768.27 0.5646 0.79008 311 0.22% $1,251 $990 -$261 Primary Care Partners 2.0615 0.9346 $1,207,236 $29.07 $16,620,356 $400.20 $429.27 $459.31 1.1419 0.98643 41,530 29.48% $167,046 $165,066 -$1,980 River Valley Family Health Centers 1.7446 0.7910 $749,760 $96.00 $3,950,742 $505.86 $601.86 $760.93 0.5784 0.73781 7,810 5.54% $31,414 $23,218 -$8,196 Roaring Fork Family Practice 1.3678 0.6201 $65,583 $21.11 $1,092,679 $351.80 $372.91 $601.34 0.8765 0.68423 3,106 2.20% $12,493 $8,563 -$3,930 San Juan Family Medicine 2.2025 0.9985 $117,322 $31.08 $1,856,446 $491.77 $522.85 $523.62 1.0217 1.00433 3,775 2.68% $15,184 $15,276 $92 SMH Family Medicine 2.8363 1.2859 $600,397 $34.33 $10,790,824 $617.04 $651.37 $506.55 1.0536 1.22782 17,488 12.41% $70,342 $86,518 $16,176 Uncompahgre Medical Center 1.7714 0.8031 $0 $0.00 $483,485 $547.55 $681.77 0.7262 0.78390 883 0.63% $3,552 $2,789 -$763 Western Medical Associates 2.1205 0.9614 $157,312 $2,436,296 $456.49 $485.97 $505.49 1.0556 0.98494 5,337 3.79% $21,467 $21,181 -$286 Western Valley Family Practice 2.3991 1.0877 $363,401 $31.37 $5,132,447 $443.06 $474.43 $436.18 1.1851 1.11205 11,584 8.22% $46,594 $51,905 $5,311 Total 2.2057 1.0000 $5,629,516 $39.96 $69,777,149 $495.29 $535.25 1.00000 140,882 100.00%

Year 3 – Incentive Payment Outcomes

Year 4 (SFY 17-18) – Practice Performance Review

Practice Performance – Foresight Family Physicians

Practice Performance – Grand Valley PC

Practice Performance – Marillac Health

Practice Performance – Mountain Family

Practice Performance – Primary Care Partners

Practice Performance – River Valley

Practice Performance – St. Mary’s Family

Practice Performance – Western Valley

Year 4 – Incentive Pool Estimate Total Revenue $186,451,371 HIT $0 Risk Corridor Recoup $483,327 Revised Revenue for MLR $186,934,698 Total Medical $162,163,339 Additional Medical   Total Expense Actual MLR 86.7% Target MLR 85.0% MLR Recoup Total Revenue $189,409,119 Operating $22,394,781 Total Medical $165,812,647 Additional Benefit Costs $690,828 HIT Tax $0 Risk Corridor Recoup -$483,327 MLR Recoup Total Expense $188,414,929 Shared Savings Pool $994,190 RMHP Share $99,419 Provider Share $894,771 Estimate only Subject to change.

Closing out Year 4 – CQM Reporting and PAM/CfA

Year 4 Shared Savings Criteria Review Clinical Quality Measures (CQM) – All Prime participating practices will be required to report on ALL measures. ADULT PRACTICES: All 3 measures are reported to RMHP via SPLIT by 1/31/2019. NQF 0059: Diabetes Hemoglobin A1c Poor Control (>9.0%) NQF 0418: Depression Screening and Follow up NQF 0421: Adult BMI Screening and Follow up PEDIATRIC PRACTICES: Both measures are reported to RMHP via SPLIT by 1/31/2019. NQF 0418: Depression Screening and Follow Up NQF 0024: Childhood BMI Screening with Nutrition and Physical Activity Counseling Patient Activation Measure/Coaching for Activation (PAM/CfA) Utilization – Practices to continue demonstrating ongoing utilization of the PAM and CfA tools on a subset of their attributed Prime population. Further, practices will perform a re-assessment on all previously screened patients that are at a PAM Level 1 or Level 2 by 12/31/2018 Practices were NOT required to set performance targets with RMHP. Practices should work to sustain processes that support continuous data driven improvement on the measures listed on this slide. PAM/CfA: Any re-assessment done prior to 2018 is counted RMHP to monitor continued utilization of CfA via monthly reports. Please ensure all PAM surveys are entered into Flourish as soon as possible. RMHP to begin drafting final practice and program level reports the 1st of January. Section - Title

Year 4 Required Annual CQM Reporting All RMHP Prime practices will be given access to the SPLIT tool by December 2018. Practices MUST report the required Prime CQMs into SPLIT to remain eligible for value-based performance payment (“PBIB”) Annual CQM Reporting due 1/31/2019 for performance year 2018 (1/1/18-12/31/18) FINAL SPLIT TRAINING: January 11th at 12:00pm – Register at: https://zoom.us/meeting/register/56e6948acb5fb45a34538d7d4481ef37 ADULT REQUIRED MEASURES PEDS REQUIRED MEASURES Diabetes A1c Poor Control Depression Screening & Follow Up Childhood BMI, Nutrition & Physical Activity Counseling Adult BMI Screening & Follow Up OPTIONAL MEASURE FOR ADULT AND PEDIATRIC PRACTICES Initiation and Engagement of Alcohol & Other Drug Dependence Treatment Section - Title

Year 5 MLR Metric & Value-Based Performance Payment Criteria

Year 5 MLR Metrics/Targets for RMHP Depression Screening and Follow-Up = 64% NQF 0418/CMS 2 HgbA1c Poor Control > 9.0 = 23.5% NQF 0059/CMS 122 Emergency Room Utilization for Substance Use Disorder = 25.10 per 1,000 per year SUD ER Utilization What has changed? Year 4 to Year 5 CQM Diabetes Hemoglobin A1c measure replacing HEDIS CDC measure Performance focus on Prime practices participating in SIM, and Advancing the number of Prime practices reporting Diabetes A1c Poor Control Step toward moving to CQMs as opposed to HEDIS Step toward measure alignment across programs Performance Targets Depression Screening and Follow Up: Increase of about 9% PAM: Expanded re-assessment criteria to include Levels 1, 2 and 3. Also, increase target by 11%. Patient Activation Measure Levels 1, 2, & 3 Re-assessment = 41% Patient Activation Measure Roadmap Report Section - Title

Align your Internal Practice Targets Year 5 - Aligning MLR Metrics and Value-Based Performance Measures MLR/Value-Based Performance Measures RMHP MLR Targets Align your Internal Practice Targets Depression Screening and Follow Up 64% Diabetes HgbA1c Poor Control 23.5% ED Utilization for Substance Use Disorder 25.10/1000 per year Report NQF 0004/CMS 137 PAM Re-Assessment 41% *Aligning your internal practice targets with the RMHP MLR Targets creates a greater potential for the overall Prime region to meet the established MLR metrics* Section - Title

Year 5 Value-Based Performance Payment Criteria Quarterly submission to RMHP and annual submission to SPLIT via EHR on the following eCQMs: NQF 0059 = Diabetes Hemoglobin A1c poor control NCF 0418 = Screening for Depression and Follow-up plan NQF 0004 = Initiation and Engagement of Alcohol and other drug dependence treatment PAM Re-assessment of Level 1, 2 and 3 Risk adjusted attribution Note:  These measures can also be a part of the 6 measures required for the RAE Tiering if practices choose.  We will not require meeting a target but will provide feedback reports that emphasize the plan targets as benchmarks for the measures. CQM Reporting – Required New CQM: Initiation & Engagement of Alcohol and Other Drug Dependence Treatment (link to MLR metric – not identical but processes overlap) Reporting is required for all practices (2 for Pediatric Practices), (3 for Adult Practices) Required Annual Reporting All RMHP Prime practices will be given access to the SPLIT tool by December 2018. Training webinars will be held in November, December and January. RMHP Prime practices MUST report Prime CQMs into SPLIT to remain eligible for value-based performance payment (“PBIB”) Year 4 and Year 5 requirement Required Quarterly Reporting Due the 3rd Friday of the month following the end of the quarter. Links emailed out 3 weeks in advance. Quarterly feedback reports allowing meaningful comparison Opportunity to trouble shoot reporting issues before the annual SPLIT reporting requirement. Opportunity to trouble shoot performance issues before program deadline PAM & CfA - Required Utilization with Continued focus on re-assessment to include Level 3 Required – all Patients previously assessed at Level 1, Level 2 or Level 3 are re-assessed by 12/31/2019 RMHP to monitor monthly for re-assessments and ongoing growth of utilization of both PAM and CFA Section - Title

Year 6 Prime Program Expectations

Year 6 Program Expectations Prime Year 6 (2020) Continuous evolution of value-based performance payment (“PBIB”) criteria Alignment with RAE tiering

Questions?

Contact Lori Stephenson Patrick Gordon Nicole Konkoly Director of Clinical Program Development and Evaluation lori.stephenson@rmhp.org Patrick Gordon Vice President patrick.gordon@rmhp.org Nicole Konkoly RAE Network Relations Manager Nicole.konkoly@rmhp.org Section - Title