1. Rhode Island Quality Institute
4/8/2016
Rhode Island Quality Institute
Transforming Clinical Practice Initiative (TCPI)
CTC Steering Committee April 8, 2016 Jacqueline Bessette Lefebvre, Senior Clinical Practice Advisor, RI PTN Darlene Morris, Director, RI PTN
Rhode Island Quality Institute

2. Agenda RIQI Services Practice Transformation
4/8/2016
Agenda
RIQI Services
Practice Transformation
Transforming Clinical Practice Initiative
Rhode Island Quality Institute

3. RIQI’s Center for Improvement Science Services
4/8/2016
RIQI’s Center for Improvement Science Services
Health IT
CurrentCare
EHR Adoption and MU
Practice Transformation
Transforming Clinical Practice Initiative
NCQA PCMH Consultation
Rhode Island Quality Institute

4. Center for Improvement Science Services PRACTICE TRANSFORMATION
4/8/2016
Center for Improvement Science Services PRACTICE TRANSFORMATION
Rhode Island Quality Institute

5. Practice Transformation through TCPI
4/8/2016
Practice Transformation through TCPI
Transform Practice
Centers for Medicare & Medicaid Services (CMS) awarded $685M to 39 organizations to help 140,000 clinicians achieve practice transformation
High Performance
Improve health outcomes for 5 Million Medicare, Medicaid & CHIP beneficiaries
Reduce Utilization
Reduce unnecessary hospitalizations and over utilization of other services
Rhode Island Quality Institute

6. Help clinicians prepare for
4/8/2016
What Does this Mean for RI?
The Center for Medicare & Medicaid Innovation (CMMI)
Transforming Clinical Practice Initiative
(TCPI)
Support and Alignment Networks (SAN)
10 Awardees
Practice Transformation Networks (PTN)
29 Awardees
RIQI received
$8.5M to help 1500
RI-area clinicians
over 4 years
Help clinicians prepare for
success under new
payment models
It’s a unique opportunity to bring practice transformation assistance to specialists and to additional primary care physicians (≈75% specialists/25% PCPs) 6
Rhode Island Quality Institute

7. TCPI’s 5 Phases of Transformation
4/8/2016
TCPI’s 5 Phases of Transformation
Source: CMS TCPI PTN Information Webinar 2014 * 7
Rhode Island Quality Institute

8. Value Proposition – Why participate?
4/8/2016
Value Proposition – Why participate?
Business success
Prepare for and succeed under value based payments
Make your practice attractive as a potential partner/ participant in shared savings programs
Transformation support at no cost
Better patient outcomes
More joy in work
Strengthen relationships between primary care and specialist providers *
Rhode Island Quality Institute

9. Value Proposition – Local Reform Efforts
4/8/2016
Value Proposition – Local Reform Efforts
Local practice transformation and payment reform efforts
OHIC:
Care Transformation Plan
TCPI named an option, opportunity for incentives
Rhode Island HHS: 50% of Medicaid reimbursements made through alternate payment models by end of 2018
State Innovation Model (SIM): 80% of provider payments linked to value by 2018
Population based contracting:
45% covered lives (10% in downside risk)
By 2016
Payment targets:
APM: 40% by 2017, 50% by 2018
Non-FFS: 6% by 2017, 10% by 2018
Rhode Island Quality Institute

10. Value Proposition – Federal Reform Efforts
4/8/2016
Value Proposition – Federal Reform Efforts
Rhode Island Quality Institute

11. Value Proposition – Payment Reform
4/8/2016
Value Proposition – Payment Reform
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, signed into law 4/16/15)
Repeals 1997 Sustainable Growth Rate (SGR) Physician Fee Schedule (PFS) Update
Proposed rule Spring 2016
Final rule Fall 2016
Rhode Island Quality Institute

12. MACRA changes Medicare PFS payments It creates two paths:
4/8/2016
MACRA
MACRA changes Medicare PFS payments
It creates two paths:
Merit-based Incentive Payment System (MIPS)
Alternative Payment Model (APM)
It will drive the delivery of health care in the future
Reimbursement will be linked to quality and outcomes *
Rhode Island Quality Institute

13. Merit Based Incentive Payment System (MIPS)
4/8/2016
Merit Based Incentive Payment System (MIPS)
MIPs includes these components:
Meaningful Use of an EHR
Physician Quality Reporting System (PQRS)
Resource Use*
Clinical Practice
Improvement
Activities**
*CMS to develop care episode, patient condition, and patient relationships categories for accurate calculations and attributions; charges to include Parts A and B, perhaps Part D drugs if feasible
**Secretary required to specify *
Rhode Island Quality Institute

14. Merit Based Incentive Payment System (MIPS)
4/8/2016
Merit Based Incentive Payment System (MIPS)
Each MIPS component will be weighted
Clinicians will be evaluated using a scoring system from 0 to 100
Beginning 2019, based on 2017 data
Score will be used to determine and apply a MIPS payment adjustment factor
Adjustment based on performance relative to scores of your peers and be made public
Adjustment can be positive, negative or zero *
Rhode Island Quality Institute

15. Alternative Payment Model (APM)
4/8/2016
Alternative Payment Model (APM)
Requirements:
Participate in a defined APM
Meet additional criteria
Bear financial risk for more than nominal losses
Use Certified EHR
Achieve certain revenue thresholds
Definition of APM:
A Center for Medicare and Medicaid Innovation (CMMI) Model; a Medicare Shared Savings Program Accountable Care Organizations (ACO); and/or a similar CMS demonstration model
Rhode Island Quality Institute

16. Alternative Payment Model (APM)
4/8/2016
Alternative Payment Model (APM)
Payments:
Lump sum payments equal to 5% of all reimbursement for services rendered under the Medicare PFS (2019 – 2024)
Rhode Island Quality Institute

17. PFS, APM & MIPS Payments 4/8/2016 Rhode Island Quality Institute
Copyright © 2016 Deloitte Development LLC. All rights reserved
Rhode Island Quality Institute

18. 4/8/2016
Rhode Island Quality Institute

19. Value Proposition – Limited Openings
4/8/2016
Value Proposition – Limited Openings
Only 1,500 slots available, 972 already filled
RIQI mission for TCPI:
To create the conditions for unprecedented community cooperation, action, and achievement of a common goal of transformed practices that succeed under new payment models and significantly advance the Triple Aim of better health, better healthcare and lower costs statewide.
Rhode Island Quality Institute

20. Value Proposition – No Cost Services
4/8/2016
Value Proposition – No Cost Services
Technical assistance support and 1:1 coaching
Education and training
Readiness and ongoing assessments
Leadership Academy for select clinicians (15%) to train as health care leaders and inspire peers
Care coordination and care transition services
Data-driven quality improvement skill building
Practice transformation that supports specialist/primary care cooperation *
Rhode Island Quality Institute

21. Why is this important to CTC Steering?
4/8/2016
Why is this important to CTC Steering?
Key Transformation Leaders
TCPI is connecting the dots between your current transformation and payment reform
Best way to jump start primary and specialty integration
Providers are “Not Ready”
RI is experiencing a convergence of forces: all heading toward payment for value!!! Following CMS Lead
Let other providers know: specialists/primary care *
Rhode Island Quality Institute

22. Thank You CurrentCare @CurrentCare
4/8/2016
Thank You
CurrentCare @CurrentCare
Darlene Morris, Director, Center for Improvement Science –
Rhode Island Quality Institute - 50 Holden Street, Providence, Rhode Island 02908
Rhode Island Quality Institute