Value Based Contracting Office Hours Regional Accountable Entity November 20, 2018

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Agenda Patient Dismissal Policy – Nicole Konkoly Attribution and Patient Choice Forms – Nicole Konkoly Key Performance Indicators (KPIs) – Patrick Gordon Care Compacts – Chelsea Watkins Truven Data Analytics Portal – Nicole Konkoly RAE and the Medicaid APM – Nicole Konkoly and Chelsea Watkins VBCRC & Verification Updates – Lori Stephenson   

Patient Dismissal Policy– Nicole Konkoly

Patient Dismissal Policy As part of our contract requirements and transition into Phase II of the ACC initiative, we have updated our Patient Dismissal Policy.  This policy is compliant with our RAE contract requirements & replaces previous versions.  Please contact Nicole Konkoly or your Regional Provider Relations Representative with questions.  

Patient Dismissal Policy   Section - Title

Attribution & Patient Choice Forms – Nicole Konkoly

RAE Attribution Panel Analysis Reports / Meetings with HCPF available Missing Member Analysis Reports available from HCPF Panel limits: how to set them / check them Geo-assignment: re-balancing project in process PCMP to PCMP Re-attribution – coming soon!

Patient Choice Forms For RAE only Members, an attribution form is not needed, since the State determines attribution. RAE only Members can change their attributed Primary Care Medical Provider (PCMP) by calling Health First Colorado Enrollment at 888-367-6557. For RAE Prime members, RMHP’s Patient Choice Form can still be used as it always has been.

Key Performance Indicators (KPIs) – Patrick Gordon

ACC (Accountable Care Collaborative): Key Performance Indicators Measure Name Description Target Behavioral Health Engagement % of members receiving at least one BH service (primary care or capitated BH benefit) 1-5% improvement = 75% 5% or more = 100% Dental Visits % of members who received professional dental services (medical or dental claims) Well Visits % of members who received a well visit Prenatal Engagement % of members who received a prenatal visit during pregnancy Emergency Department Visits Number of ED visits per-thousand members per-year (PKPY) risk adjusted Health Neighborhood (1) % of Primary Care-Specialty Care Compacts 50% of PCMP network has 2+ executed care compacts (at least 1 BH) Health Neighborhood (2) Percentage of outpatient visits with a specialist who had a referring PCMP

RAE Behavioral Health Incentive Measures RAE BH Measure Description Target Engagement in Outpatient SUD Treatment % of members with 2 or more outpatient services for a primary dx of SUD within 30 days of first episode of SUD TBD Hospital Follow-up for Mental Health % of member discharges from an inpatient hospital stay for mental health to the community or a 24-hour treatment facility who were seen on an outpatient basis by a MH provider within 7 days ED Follow up for SUD % of member discharges for an ED for treatment of SUD to the community or a 24-hour treatment facility who were seen on an outpatient basis by BH provider within 7 days Depression Screen Follow Up % of members engaged in mental health services within 30 days of screening positive for depression within primary care BH Screening or Assessment for foster children % of foster care children who received a BH screening or assessment within 30 days of ACC enrollment

Tiered payment & incentive rates Paid State for claims-based attribution only (+$2 pmpm paid for auto assigned / “geo attributed” members) Section - Title

Care Compacts – Chelsea Watkins

November KPI Focus: Care Compacts Quarter 1 State KPI Submission 71 Care Compacts / 198 PCMPs = 35.8% Where are we? As of November 2018, collected 225 care compacts from 79 unique PCMPs – not all meet the criteria Improvement Opportunities: Practice Information includes phone numbers, addresses, etc. Mechanisms for renewal Not meeting the intent of the care compact (MOUs, template) Defining service line transitions of care (i.e. primary care to primary care with dental health)  Each webinar we are going to focus on KPIs that you can take immediate action on. This webinar, we are going to focus on the care compact KPI. This KPI success is directly impacted by the work that each practice does. For Quarter 1 (July-October 2018), RMHP submitted a care compact report to the State. This Q1 goal was: at least 25% Primary Care Medical Practices (PCMPs) must have at least one care compact. As you can see on the screen, 71 care compacts met the KPI criteria for an acceptable care compact out of 198 PCMP sites. Therefore, Region 1 had 35.8% which exceeds the goal for Q1. As many of you experienced via the RAE verification process, care compacts were collected. In fact, we collected 225 care compacts from 79 different or unique practices. BUT, not all that was submitted meets the criteria. As we reviewed each care compact, we saw several themes that need to be improved upon. This includes: Practice Information includes phone numbers, addresses, etc. Mechanisms for renewal. Not meeting the intent of the care compact (MOUs, template). We received several facility agreement, cost agreements, etc. which do not meet the intent of care compacts. Defining service line transitions of care (i.e. primary care to primary care with dental health). For example, if a PCP had a care compact with an FQHC, is it for ALL service lines? BH? DH? Etc. Section - Title

November KPI Focus: Care Compacts The Medical Neighborhood KPI goal: Meaningful and thorough care compacts Focus on appropriate referrals Communicate more effectively across the medical neighborhood to improve health outcomes What’s next? RAE KPI Goals: By December 31, 2019 at least 50% Primary Care Medical Practices (PCMPs) must have at least one care compact. By March 30, 2019 at least 75% of PCMPs must have at least one care compact. By June 30, 2019, at least 50% of the PCMPs must have at least two care compacts and one of those must be with a behavioral health entity. With that said, this is the overall intent of the care compact KPI: Meaningful and thorough care compacts Focus on appropriate referrals Communicate more effectively across the medical neighborhood to improve health outcomes On the slide are Q2-Q4 goals for Region 1. The call to action is if you have already created care compacts, make sure they meet the criteria on Page 30 of the RAE Orientation Guide and be sure to have at least one with a Behavioral Health Entity. If you do not have any care compacts, please start working on these. This will help ensure the success of this KPI for our Region which in turn is money back into your practices. Section - Title

November KPI Focus: Care Compacts Care Compact Criteria: Page 30 of the RAE Orientation Guide Events: TBD Resources/Submission of Care Compact(s): Contact your QIA or the following RMHP PT staff Katie Voller (Katie.voller@rmhp.org) Mary Beckner (Mary.Beckner@rmhp.org) Chelsea Watkins (Chelsea.Watkins@rmhp.org) Page 30 of the Orientation Guide has the criteria for the care compacts. RMHP is planning on hosting care compact events, please be looking for further information from the RAE newsletters, these webinars, and your RMHP QIAs. If you are working with RMHP in a Practice Transformation program, please contact your QIA for further support and questions. If you are not working with RMHP, please contact one of the people listed on the slide for support. Section - Title

Truven Data Analytics Portal – Nicole Konkoly

Data Analytics Portal HCPF has contracted with IBM Watson Health (formerly Truven) to host the Data Analytics Portal (DAP) This data analytics tool for Primary Care Medical Providers (PCMPs) and Regional Accountable Entities (RAEs) includes population and performance information. The portal allows for drill downs and drill ups, data exports, and provider-level comparisons. Contact Nicole Konkoly for an access request form or to check the status of your request. https://www.colorado.gov/pacific/hcpf/health-first-colorado-data-analytics-portal-dap

RAE and the Medicaid APM – Nicole Konkoly & Chelsea Watkins

HCPF Alternative Payment Model (APM) The Department will award “credit” in the APM model for PCMPs that are in good standing with SIM and/or CPC+ and that are certified or recognized as a PCMH practice. October 2018 – PCMP eligibility letters were sent to practices. PCMPs with more than $30,000 in paid claims (at the PCMP billing ID level) for procedure codes in the PC APM benefit package AND are not participating in SIM/CPC+ are eligible November/December 2018 - PCMPs who are eligible should receive claims based measure reports from the State November/December 2018 – PCMPs will be sent a measure selection survey for CY 2019. Once measures selected, practices will not be able to change them If you are CPC+ and/or SIM, you may or may not receive the survey. If you do receive the survey, select which program you are in and the survey will end immediately. Section - Title

RAE Roles in the HCPF APM December 2018 - Support PCMPs in the selection of appropriate structural and performance APM measures Enrolled in a RMHP PT Program? QIA/CI will assist Not enrolled in a RMHP PT Program? Chelsea Watkins will reach out CY 2019 – Practices should be monitoring and improving upon the measures selected. July 1, 2020 – CY 2019 performance will be reflected in the FFS Adjustment for the APM Code Set.

Chelsea Watkins – RMHP Clinical Informaticist Chelsea.Watkins@rmhp.org Questions? Chelsea Watkins – RMHP Clinical Informaticist Chelsea.Watkins@rmhp.org Nicole Konkoly – RAE Network Relations Manager Nicole.Konkoly@rmhp.org Talk about RMHP roles in each of these Section - Title

Value Based Contracting Review Committee & Verification Updates – Lori Stephenson Section - Title

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

Ongoing Demonstration Criteria In order to stay in Attested Tier, practice must demonstrate ALL of the following:  Achieve ≥80% on appropriate assessment o Tier 4 Assessment – none o Tier 3 Assessment – semi-annually o Tier 2 Assessment – quarterly o Tier 1 Assessment – quarterly  Achieve Medicaid APM scoring thresholds o Tier 4 – Medicaid APM score of 0-25% o Tier 3 – Medicaid APM score of 26-50% o Tier 2 – Medicaid APM score of 51-75% o Tier 1 – Medicaid APM score of 76-100%  Submit 6 CQMs quarterly AND annually meet or exceed the 70th percentile CMS benchmarks (January 2019 reporting is baseline based on 2018 performance) o Tier 4 – none o Tier 3 – 2/6 eCQMs must meet or exceed the 70th percentile of the current CMS benchmarks o Tier 2 – 4/6 eCQMs must meet or exceed the 70th percentile of the current CMS benchmarks o Tier 1 – 6/6 eCQMs must meet or exceed the 70th percentile of the current CMS benchmarks  Be open to Medicaid o Tier 4 – Not open to new Medicaid. o Tier 3 – Limited, intermittent availability for new Medicaid patients o Tier 2 – Open with equitable panel management processes and tools applied in order to maintain current Medicaid attribution numbers (at a minimum). Attach processes and tools. o Tier 1 – Open to new Medicaid Section - Title

Questions?

Contact Nicole Konkoly Meg Taylor Dale Renzi Patrick Gordon RAE Network Relations Manager Nicole.konkoly@rmhp.org Meg Taylor RAE Program Officer Meg.taylor@rmhp.org Dale Renzi Director Provider Network Management Dale.Renzi@rmhp.org Patrick Gordon Vice President Patrick.gordon@rmhp.org Lori Stephenson Director of Clinical Program Development and Evaluation Lori.stephenson@rmhp.org