Slide 1 Gulf Region Health Outreach Program Regional Care Collaborative National Models & Success Factors for Accountable Care Readiness October 23, 2015

Slide 2 Housekeeping Please type in any questions that you may have in the ‘Question’ section of the webinar dashboard (right side of screen). The presentation and session recording will be available on the wiki:

Slide 3 Introductions Julie Peskoe, Director of Health Care Capacity Building, PCDC Daniel Lowenstein, Senior Director of Public Affairs, PCDC Elena Thomas Faulkner, Senior Consultant, John Snow Inc.

Slide 4 Learning Objectives for this Webinar Update on Payment Reform: Where we’re headed Payment Reform in the Gulf States VBP arrangements for Primary Care providers Competencies Health Centers need for VBP Explain the origin and purpose of the NACHC Payment Reform Readiness Assessment Tool Review the structure of the tool

Slide 5 Value-Based Payment: Where We’re Heading Introduction of Value-Based Payments – Medicare 85% of FFS linked to quality/value by 2016, 90% by % of in alternative payment models (i.e. ACOs) by 2016, 50% by MACRA – financial rewards an penalties/APMs – Medicaid Many states adopting quality/value or aligning with Medicare Medicaid Managed care reform – Commercial (2014) 40% of in-network payments value-oriented 24% of in-network primary care payments

Slide 6 Medicare P4P goals

Slide 7 Medicare Pay for Performance

Slide 8 Preparing Providers for VBP CMS testing numerous innovation models to achieve better care for patients, better health for our communities, and lower costs through improvement for health care system HRSA incentivizing value in FQHCs Focus on building primary care capacity and readiness for value- based payment

Slide 9 FQHC Advanced Primary Care Demonstration 434 participating sites Goals: Achieve NCQA PCMH Level 3, coordinate care and manage chronic conditions Monthly care Medicare management fee

Slide 10 FQHC APCD – Gulf Region sites

Slide 11 Comprehensive Primary Care Initiative Collaboration between CMS, commercial and State health insurance plans (multi-payer) Population management fees and shared savings to participating practices for Risk-Stratified Care-Management; Access and Continuity; Care Planning; Patient/Caregiver Engagement; Care Coordination

Slide 12 Advance Payment ACO For physician–based and rural providers Receive advance on shared savings they are expected to earn

Slide 13 Pioneer ACO For healthcare organizations and providers experienced in coordinating care across care settings Goal: move rapidly from shared savings to population-based payment model

Slide 14 State Innovation Models Financial and technical support to states testing state-led, multi-payer healthcare payment and delivery models for all residents States develop State Health Innovation Plans with strategy to use all of levers available to transform healthcare delivery system through multi-payer payment reform and other state-led initiatives.

Slide 15 Transforming Clinical Practice Initiative Peer-based learning networks designed to coach, mentor and assist clinicians in developing core competencies specific to practice transformation Supports 140,000+ clinician practices in sharing, adapting and further developing comprehensive quality improvement strategies

Slide 16 Impact of VBP on Health Centers Historic underinvestment in primary care (~5% of HC spending) Challenges to the Prospective Payment System – Alternative payment methodologies (not FFS) – Payment tied to quality – Population-based and capitation payments Competition for patients – Opportunities in treating complex patient needs effectively Need for innovation partnerships/collaborations – Payers and other providers – Coordinating care, sharing data

Slide 17 Why Health Centers Are Valuable to VBP Meeting increased demand for quality primary care (Medicaid/private insurance expansion) Safety net providers 69% are Patient Centered Medical Homes 92% use Electronic Health Records Clinical and cost data reported publicly (UDS) Potential to reduce total cost of care/improve outcomes

Slide 18 HRSA Gulf State FQHC Quality Measures EHRPCMHNational Quality Leader Health Center Quality Leader Louisiana100%71%6.7%20% Alabama86% 0%7.1% Mississippi95%71%0%33% Florida95%65%2.1%41.7% National92%69%4.8%30.4% National Quality Leader: Health center exceeded national clinical benchmarks for chronic disease management, preventive care, and/or perinatal/prenatal care. Health Center Quality Leader: Health center among the top 30 percent of all health centers that achieved the best overall clinical outcomes. Source: HRSA Health Center Quality Improvement Awards FY 2015

Slide 19 Recent Evidence of Health Center Value 1 UC Irvine – 10%-30% lower Medicare costs than physician offices and outpatient clinics 1 Chicago Center for Diabetes Translation Research – 24% Lower Medicaid costs than non-health center settings: 23% lower Primary Care, 14% lower Rx, 11% lower ER, 27% lower Inpatient JSI Medi-Cal (California Medicaid) study. Non-FQHC patients – Twice as likely as FQHC patients to have an inpatient stay – 2.62 times as likely of 30-day readmissions – 1.27 times as likely to have an ED visit Idaho commercial payer study – FQHCs 21% more cost effective compared to peers 1 “Are Health Centers Cost Effective?” A Review of Recent Research on Health Center Cost of Care HRSA/BPHC Webinar Thursday, July 23, 2015

Slide 20 Payment Reform for Health Centers Getting Ready

Slide 21 Value Based Payment (VBP) Continuum of methodologies transitioning from FFS to full capitation. Payments for specific activities, services, or procedures that are not traditionally reimbursable, such as care coordination or PCMH Pay-for-performance programs Shared savings but with no risk when savings are not realized Partial risk - upside and limited downside Partial capitation – limited categories of service included in capitation Full Capitation – for a specified population over a specific time period

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Slide 23 Primary Care Provider Capabilities Required for VBP Understand your data and costs Have the ability to exchange and use data Truly patient centered medical homes Coordinate care and managing costs across the continuum Quality Improvement Engage patients Risk Stratification of patients Comfort with transparency

Slide 24 RCC Survey Results

Slide 25 To What extent has your health center begun to prepare for Value-Based Payment (VBP)? Not started Not sure where to start In process Have a plan to address VBP readiness Have begun to assess readiness Other

Slide 26 What are the most challenging aspects of payment reform readiness for your health center? Quality Assurance40% HIT20% Payer Contracting20% Finance 60% Clinical Services 20% Staff Training 50% Relationships with hospitals and other providers20% Leadership20%

Slide 27 NACHC Payment Reform Readiness Assessment Tool Elena Thomas Faulkner, Senior Consultant, JSI

Slide 28 This Part of the Call Will:  Explain the origin and purpose of the NACHC Payment Reform Readiness Assessment Tool  Review the structure of the tool

Slide 29 NACHC Payment Reform Primer  Help health centers understand the role of payment reform in achieving the Triple Aim  Identify core capacities health centers need to participate successfully in payment reform

Slide 30 Readiness Assessment Tool Objectives  Involve key staff in assessing payment reform readiness  Identify four areas of competency required for successful participation in payment reform  Differentiate between three levels of readiness for payment reform The NACHC Payment Reform Readiness Assessment Tool was supported by Grant/Cooperative Agreement Number U30CS16089 from the Health Resources and Services Administration, Bureau of Primary Health Care (HRSA/BPHC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA/BPHC.

Slide 31 Competency Areas: four domains key to payment reform readiness Assessment Elements: readiness elements for each competency area with descriptive statements to assist health centers identify their level of readiness. Rating Elements: Tool Structure

Slide 32 Four Competency Areas

Slide 33 Organizational Leadership and Partnership Development

Slide 34 Change Management and Service Delivery Transformation

Slide 35 Robust Use of Data and Information

Slide 36 Financial and Operational Analysis, Management and Strategy

Slide 37 Lets look at an example from the first domain

Slide 38 Organizational Leadership and Partnership Development

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Slide 41 Note:  There is no “right answer” or expected readiness level.  Answering openly and frankly will allow your health center to identify useful next steps or questions.

Slide 42 Find a PDF copy at: NACHC is developing an on-line tool for release toward end of year

Slide 43 Questions?

Slide 44 PCDC Contact information Dan Lowenstein, Senior Director of Public Affairs PCDC - Primary Care Development Corporation 45 Broadway, 5th Floor New York, NY T: (212)