1. Pushing Ahead of Technology for CPCi and PCMH When Providers are Struggling to Catch Up Bryan L. Goddard, M.D. CapitalCare Medical Group Albany, N.Y. December 5, 2014

2. Disclosures None

3. CapitalCare Medical Group, Albany, N.Y. 120 Providers 600+ Staff 7 Medical and Pediatric Sub-Specialties 21 Primary Care Sites – FP, Peds, IM

4. Where CPCi fit into our overall PCMH strategy 2009 PCMH Pilot Sponsored by HMO Facilitated by TransforMED 2011 Expansion to Six Roll Out sites Facilitated by TransforMED 2012 Activation of Allscripts Enterprise ½ from Mysis ½ from Paper CPCi enrollment begins 2013 Hire Quality Team Expansion to six more sites One Recert Enhanced Primary Care Payments starts 2014 Last Five Sites Six Recerts

5. Recruitment for CPCi Application 6/15-7/21/2012 NY market created by CMS – Included the Taconic Collaborative and the CDPHP demo Site requirements EMR capability – Preference to MU-1 success Participating insurers >60% of visits PCMH recognition or comparable QI history Representative of population for whole market

6. Opportunity CPCi provided CCMG Advanced EHR functionality –Reporting & QI tools Create Case Management capacity Engage the local payers in new model Primary Goal: “Triple Aim”: –Improving Patient Experience –Improving Quality –Reducing Overall Cost

7. Building Technical Capabilities to Achieve Program Goals Program Year 1 TouchWorksAnalytics MU-1 Package MU-1 EHR Reporting PkgStim Reports Program Year 1 TouchWorksAnalytics MU-1 Package MU-1 EHR Reporting PkgStim Reports Program Year 2 Clinical Quality Solutions – Reporting & POS Prompts Follow My Health – Patient Portal MU-2 Upgrade & Report Package – Stimulus Certified Reports Program Year 2 Clinical Quality Solutions – Reporting & POS Prompts Follow My Health – Patient Portal MU-2 Upgrade & Report Package – Stimulus Certified Reports Program Year 3 Raising the Bar Measure Process Outcome Improvement Program Year 3 Raising the Bar Measure Process Outcome Improvement Program Year 4 Report on Process Outcome Improvements Program Year 4 Report on Process Outcome Improvements

8. CPCi Milestones NOT Supported Risk Stratification Placed in Vitals(!) Use Data to Drive Improvement Required CQS Self-Management Plan Format limitations required paper process Data elements come from too many parts of record Shared Decision Making Too many options – none supported by vendor! Vendor now partnering with niche content provider Workflow will take time/commitment Presentation to Vendor – August 2014 Vendor very interested in collaborating Open source requirement

9. Regulatory changes that have required additional attention Portal Has required a lot of work! Additional functionality needed – not necessarily what is being developed!! Connecting the community IT connectivity is just the beginning! Electronic Prescribing of Controlled Substances NYS’s mandate will make us early adopters of EPCS ICD-10 Transitioning Requires significant upgrade to PMS Reports need to be rewritten

10. Important Changes that Matter Optimize Team-Based Care Medicare Annual Assessment – Regardless of Insurance! Previsit planner Rooming staff Providers Complex Chronic Care Coordination – All staff should count! Transition of Care Workflow Notification of hospital discharge Timely document completion Changing culture – hospitalists, consultants, patients, & medical homes!

11. Next Step Research for New Payment Model Involve the vendors! And content vendors!!!! Ability to swap if initial content vendor “fails.” Support vendor “collaboratives” May need to exclude practices using other vendors Support neighborhood “collaboratives”Research hypotheses need vendor support Don’t test what hasn’t been generally built! Workflow matters

12. Involve the vendors! Recruit vendors willing to enable what you want to test. Prioritize practices with technology that should support reporting on the research question Hold the vendor accountable for workflow to enable data integrity Recruit content vendors and require interoperability Niche vendors will be more willing to create robust tools Impossible to identify which will be sustainable before time has allowed the market to vote. Practices that select failed niched vendors will want to swap out functionality with minimal impact on other workflows.

13. Support Vendor “Collaboratives” If it works for practices... Interoperability will be enhanced if vendors can share what they want from content vendors If practices with the same vendor... Although it was interesting to see what was possible with others, we often “couldn’t get there from here”

14. Support Medical Neighborhood “Collaboratives” Although PCMHs may know our roles... We can’t partner alone. Hospitals give us what is easy for them... We got notification of discharges until we called for discharge summaries! Subspecialist don’t yet know the language!The vendors have a lot of bugs to work out!!!

15. Proof of PCMH should not depend on unproven technology Tests of generalizability of the model require use of generally available technology! Develop new technologies without calling the viability of the model into question!!!

16. Workflow matters! It was true in paper...Vendors start with yes...

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