TCPI Project Pathway: Session 8 of 8 Business Strategies Milestone #’s 18, 20, 21(specialty) 23, 25, 26 (primary care)

About the TCPI Milestones 22 Milestones for specialty practices 27 Milestones for primary care Scores on each milestone determine Phase completion For example, to complete Phase 1, as score of 3 is necessary on milestone 13 (setting an aim). Other phases require various scores for other milestones.

Milestone Classes Review Scoring and Strategies for Meeting Them (numbers in parentheses indicate milestone numbers for primary care) Each Milestone-Group Class will be held live 3 times: Quality Improvement Strategies and Action –milestones 14, 15, 16 (19, 20, and 21) (already held- recording available) Improvement Goals – milestones 1, 2, 3, 13 (1, 2, 3, 18) Staff Engagement: Teamwork and Joy – milestones 6 and 19 (6 and 24) Identifying Patient Risk and Using Best Practices – milestones 7, 11 (8, 9, 10, 16) Streamlining Clinical and Office Work – milestone 22 (27) Coordinated Care – milestones 8, 9, 10 (11, 12, 13, 14) Person and Family-Centered Care – milestones 4, 5, 12, 17 (4, 5, 7, 15, 17and 22 for primary care) Business Strategies – milestones 18, 20, 21 (23, 25, 26)

Today’s Objectives Review scoring for business strategy-related milestones: 18, 20, 21 (specialty) 23, 25, 26 (primary care) Outline strategies for meeting each of these milestones Review relevance of milestones’ scores to phases Provide brief overview of Alternative Payment Models Open discussion

Your Transformation Workplan – Practice Plan Tab

Milestone 18 (#23 for primary care): Practice uses sound business practices, including budget management and ROI calculations. A score of 3 is needed to complete Phase 2

Strategies for Meeting Milestone 18 (# 23 for primary care) Change Package – 3.1.1 Consider third party business intelligence tools Use relations with payers to access claims data Estimate costs of hospital and emergency department care saved through utilization reductions Train appropriate staff on interpretation of cost and utilization information Use available data regularly to analyze opportunities to reduce cost through improved care Institute a fake appointment into your EHR to track how many ED visits you eliminate with enhanced access There are several strategies to consider. After reviewing all 3 milestones for today, we’ll share some resources that can assist you meet all 3.

Strategies for Meeting Milestone 18 (# 23) - continued Change Package – 3.1.1 Transparency with the entire team re: total cost of care Educate staff about factors impact total cost of care Use state professional association to collaborate with payers (American Academy of Pediatrics, American Academy of Family Practice, etc.) Partner with the care continuum, especially small federated model Ask staff to identify opportunities to manage cost to facilitate understanding Know your visit costs and track and understand different components

Resources about ROI ROI: An Overview of Return on Investment https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=15 &cad=rja&uact=8&ved=2ahUKEwj5uqbL-sndAhVHG6wKHWc- B0QQFjAOegQIAhAB&url=https%3A%2F%2Fbondstreet.com%2Fblog%2Fr oi%2F&usg=AOvVaw0rP4inS5ZyEzgEv7pzvKxq Return on Investment Templates https://www.eloquens.com/category/finance/return-on-investment-roi- calculator-excel-template Return on Investment https://www.business-case-analysis.com/return-on-investment.html In the simplest terms, ROI (Return on Investment), is a measure of the gain accrued from a specific investment, relative to its cost; it is the value a growth opportunity adds to your business. These website documents can you help better understand what an ROI involves and how to conduct one. The second bullet link actually includes some templates for your considered use.

Milestone 20 (#25 for primary care): Practice shares financial data in a transparent manner within the practice and has developed the business capabilities to use business practices and tools to analyze and document the value the organization brings to various types of alternative payment models. A score of 3 is needed to complete Phase 5

Strategies for Meeting Milestone 20 (#25 for primary care) Change Package – 3.3.3 Conduct business fundamentals training as a lunch and learn session Make sure budget preparation occurs at the level the costs are incurred Share financial implications of care decisions Share prices charged for various services Dedicate a meeting to explaining the practice’s financial statements From BDO document (shown in next slide): Financial statements are a collection of reports about the medical practice’s financial results, financial condition and cash flows.  Three Main Components: • Balance Sheet: Shows the practice’s assets, liabilities, and equity as of a specific report date. • Income Statement (P&L): Shows how the net income of the practice is arrived at over a stated reporting period. It includes revenues, expenses, gains, and losses. • Cash Flow Statement: Shows the inflow and outflow of cash caused by the practice’s financial activities over a stated reporting period. It is the financial statement that shows how changes in balance sheet accounts and income affect cash and breaks the analysis down to operating, investing and financing activities.

Milestone #21 (specialty care) and #26 (primary care): Practice considers itself ready for migrating into an alternative-based payment arrangement. A score of 3 is needed to complete Phase 5

Strategies for Meeting Milestone 21 (26) Change package – 3.3.4 Analyze internal costs of care by service and by population characteristics Use external benchmarks to compare internal cost and revenue metrics, such as cost per visit and revenue per provider full time equivalent Determine profitability by site and service

https://vmgma. memberclicks https://vmgma.memberclicks.net/assets/2017_Spring_Conference/medical%20practice%20finances_vmgma%20spring%20conference_final.pdf The next few slides offer some resources that can assist you with all 3 of these milestones. This is a straightforward description of the 3 main components of a financial statement: balance statement, income statement and cash flow statement

http://www.hcpro.com/content/35756.PDF

http://www. physicianspractice http://www.physicianspractice.com/compliance/five-financial-ratios-know-about-your-practice

MIPS Cost Measures – 10% of Total Score (https://qpp. cms Medicare Spending Per Beneficiary (MSPB) The Medicare Spending Per Beneficiary (MSPB) measure evaluates solo practitioners and groups on their spending efficiency and is specialty-adjusted to account for their specialty mix. Solo practitioners and groups are identified by their National Provider Identification (NPI) and Taxpayer Identification Number (TIN) combination. Specifically, the MSPB measure assesses the average spend for Medicare services performed by providers/groups per episode of care. Each episode comprises the period immediately prior to, during, and following a patient's hospital stay. Total Per Capita Costs (TPCC) The Total Per Capita Costs (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall efficiency of care provided to beneficiaries attributed to solo practitioners and groups, as identified by their Medicare Taxpayer Identification Number (TIN)

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Cost-Performance-Category-Fact-Sheet.pdf

Alternative Payment Models https://qpp.cms.gov/apms/overview

Advanced APMs

CMS APM Framework