1. PRACTICE MANAGER MEETING Wednesday Jan. 10th 2018 Noon – 1:00PM
Instructions to join the meeting remotely:
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Phone in for the audio portion of the conference:
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MEETING HANDOUTS:

2. Alternative Payment Methodology
Primary Care
Alternative Payment Methodology
Delivery System Reform Team
8/23/17

3. APM Goal Payments for Volume
Payments for Value
Provide sustainable, appropriate funding for primary care that rewards high value, high quality care.
Sustainable investment that rewards performance and creates delivery system alignment
Payments for Volume
Provide sustainable, appropriate funding for primary care that rewards high value, high quality care.

4. Alternative Payment Methodology How does it work?
Achieve Points
Enhanced Payment

5. APM Code Set
Identified common primary care codes from a variety of sources
Delphi panel from the University of Colorado Hospital reviewed and modified code set to represent primary care

6. Who Participates?
Primary Care Medical Practices that contract with the Accountable Care Collaborative
Primary Care Medical Practices that contract with the Accountable Care Collaborative

7. Excluded Federally Qualified Health Centers (have a different APM)
Exclusions:
Federally Qualified Health Centers (have a different APM)
Rural Health Centers
The Department is working on defining a minimum threshold in paid practitioner claims for procedure codes in the PC APM benefit package. PCMPs below the threshold will be excluded from the APM.
Federally Qualified Health Centers (have a different APM)
PCMPs below the defined minimum threshold
Rural Health Centers

8. Does This Impact Me? How will I know?
How will I know? Web portal or list to the RCCOs.
How will I know?

9. Attribution Accountable Care Collaborative
Determining which clients practices will be measured on
ACC Phase II methodology
Care
Collaborative
Determining which client’s practices will be measured
Phase II Methodology

10. Performance and Structural Measures
Self -Reported Structural Measures
Claims -Based Clinical Performance Measures
eCQM - Reported Clinical Performance Measures
Self- Reported Structural Measures
30 choices
Continuous Quality Improvement
Team Based Care
Access
Care Management
Care Coordination
Providing Self- Management Support
Claims Based Clinical Performance Measures
16 adult and 13 pediatric choices
Behavioral Health
Chronic Care Management
Cost Containment
Preventive Services
eCQM Reported Clinical Performance Measures
10 adult and 4 pediatric choices
16 adult &
13 pediatric
choices
10 adult &
4 pediatric
choices
30 choices

11. Close the Gap

12. Score to FFS Enhancements
Scores will translate into the following FFS rate enhancements:

14. Tools, Resources, and Practice Supports
RAE support
PMPM
Practice transformation assistance
Data to measure improvement
Download the Primary Care Alternative Payment Model Survival Guide
Resources are available at Primary Care Payment Reform

15. Survival Guide

16. Structural Measure Example
Measure Description
Documentation
Requirements
Possible Points
Measure Name
SIM/CPC+/PCMH

17. Performance Measure Example
Definition
Denominator
Numerator
Denominator Exclusions
Numerator Codes
Exclusion Codes
Numerator Exclusions
Measure Steward

18. eCQM Measure Example CMS Measure ID Version Numerator Exclusions
Controlling High Blood Pressure
Version
Numerator Exclusions
NQF Number
Measure Description
Denominator Exceptions
Initial Pat. Population
Measure Steward
Domain
Denominator Statement
Previous Version
Denominator Exclusions
Improvement Notation
Guidance
Numerator Statement

19. Goals Measure Name Measure Type HCPF Goal
Adolescent Immunizations Combo 1
Claims
83.00%
Adolescent Well Visits
80.00%
Adult BMI Assessment
claims, eCQM
90.00%
Alcohol Use: Screening & Brief Counseling
eCQM
Report*
Appropriate Testing for Children with Pharyngitis
82.00%
Breast Cancer Screening
66.00%
Childhood Immunizations Combo 7
62.00%
Chlamydia Screening
Colorectal Cancer Screening
60.00%
Controlling High Blood Pressure
70.00%
Depression Remission at 12 months
Diabetes: A1c Test During Measurement Year
92.00%
Diabetes: Eye Exam
Diabetes: Foot Exam
Diabetes: HbA1c >9 (Poor Control) (INVERTED)
36.00%
Diabetes: Nephropathy Screening
93.00%
ED Utilization (per 1000)
Initation and Engagement of Alcohol and Other Drug Dependence Treatment
43.00%
Maternal Depression Screening
Medication Management for People with Persistent Asthma
50.00%
Prenatal and  Post Partum Care
68.00%
88.00%
Readmissions
Screening for Clinical Depression & Follow-up Plan
Suicide Risk Assessment for MDD
80%
Tobacco Use: Screening and Cessation Intervention
Total Cost of Care
reduce 2%
Use of Imaging Studies for Low Back Pain
Well Child Visits 15 months (6 visits)
Well Child Visits 3-6 years
Weight Assessment,  Counseling for Nutrition &  Physical Activity for children/adolescents
78.00%
71.00%
64.00%
Measure Name
Measure Type
HCPF
Goal
Adolescent Immunization Combo 1
Claims
83.00%
Adolescent Well Visit
80.00%
Adult BMI Assessment
Claims, eCQM
90.00%

20. Model Demonstration

21. Measure Selection
Strategy for selecting measures (from survival guide)
What would be a good strategy for selecting metrics?
(1) What are you working on for other payers?
(2) What are you working on for yourself?
(3) What are the needs of the population you serve?
(4) Where can you realistically make change?
What are you working on for other payers?
What are you working on for yourself?
What are the needs of the population you serve?
Where can you realistically make change?

22. How Am I Doing?
Feedback

23. Baseline Period and Performance Measure Period

24. What to Do and When? 1. 2. 3. Choose measures by December 1st, 2017
Department guidance on process to report measures coming in late summer/early fall
Information posted on Department website
Submission of measure selection begins December 1, 2017
Department guidance coming in late summer/early fall
Check CO.gov/HCPF for information

25. Where to get Information?
All information will be posted on the Department’s website
Check the website for new information and updates.
APM Website

26. Questions or Concerns?

27. Delivery System Reform Team
Contact Information
Delivery System Reform Team

28. Thank You!