1. The Transforming Clinical Practice initiative (TCPi)
Colorado Practice Transformation Network:
Lead the CHANGE
Barbara Martin, RN, MSN, ACNP-BC, MPH
Program Manager, Colorado TCPi

2. Transforming Clinical Practice initiative: Practice Transformation Network (PTN)
Vision:
Provide transformation support to 140,000 clinicians to achieve the quadruple aim and improve care for millions while reducing per capita costs through reduced hospitalizations and readmissions; avoidable ED visits, and unnecessary testing
Goal:
Prepare providers for value-based compensation models
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3. What is ‘MACRA’?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015.
What does Title I of MACRA do?
Repeals the Sustainable Growth Rate (SGR) Formula
Changes the way that Medicare rewards clinicians for value over volume
Streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS)
Provides bonus payments for participation in eligible alternative payment models (APMs) 5

5. TCPi Aims Support more than 140,000 clinicians
Improve health outcomes for millions of patients
Reduce unnecessary hospitalization for 5 million patients
Generate $1 to $4 billion in savings
Sustain efficient care by reducing unnecessary tests and procedures
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6. ALLYSON

7. Eligible Clinicians PCPs and Specialists: MDs, DO’s, PA’s APN’s
(at the NPI level, not TIN level)
NOT ELIGIBLE: participating in CPCi, Medicare Shared Savings Payments (ACO)
Eligible: Evidence NOW SW; possibly SIM
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8. Colorado Practice Transformation Network
Recruit and engage 2000 clinicians for up to 4 years
Engage clinicians that have not yet participated in quality improvement initiatives
Beyond just primary care to include specialists—opportunity to think about supporting medical neighborhoods and communities
Identify measures and milestones that we will track
Improved clinical quality measures (aligned with SIM quality measures)
Improved cost/utilization measures – total population:
Hospitalizations, Readmissions, ED Visits, Reduced low back imaging
Provide the right coaching and mentoring such that 75 % of enrolled clinicians are prepared to participate in value based compensation programs by 2019
Use the existing practice transformation organization infrastructure—what is working for SIM and other initiatives—to provide this coaching and mentoring
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9. TCPi efforts intended to help clinicians in:
Specialty practices
Pediatric practices
Primary care practices
Systems of Care (FQHCs, groups planning an Alternative Payment Model (APM))
Cohorts or groups of practices that have a shared priority or plan to work together to improve care delivery
Can be a specific area of focus: Access to Specialty Care

10. Colorado PTN Methodology: Two Levels of Support for Practices
At the Practice Level:
Connect with a practice facilitator and a clinical health information advisor
Start with a practice assessment; Review current clinical, cost and utilization data
Create a plan/goals for practice
Make gradual incremental changes to practice processes and approach
Measure and report on progress
At the Learning Collaborative Level:
Virtual learning community 10/12 practices facilitated by a coach and expert faculty (the Cohort or group of practices working together)
Share ideas/struggles with other practices to provide/get help from each other
Utilize already developed/ vetted tools from national organizations
Obtain CME and MOC credit
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11. The Commitment for the practice
Identify one clinician, one staff member per practice as Select Practice Champions
Attend two face to face regional collaborative learning sessions per year
Robust conference environment
Expert faculty in plenary sessions
Peer to peer sharing in breakout sessions to exchange and learn best practices
Participation with 10 – 12 other practices to form a “learning network” and meet virtually every month for a one hour event facilitated by a practice coach
Learn, share and grow with your peers
Contribute agendas, priorities, and goals
Submission of quality measures quarterly to Colorado data hub
Baseline and periodic assessments, benchmarking on clinical data that you submit, as well as cost and utilization measures that we report to you in a collaborative, supportive environment
Work with a quality improvement coach and health information technology advisor to implement tests of change and monitor progress towards your practice quality improvement goals
Progress through a quality improvement curriculum to ensure your practice is ready and prepared for the payment reform changes that are coming
I will bring a hand out of the clinical quality measures

12. How will TCPi be organized?
Patient and Family Centered Care Design
Continuous, Data-Driven Quality Improvement
Sustainable Business Operations

13. Patient and Family Centered Care Design
Patient and family engagement
Team-based relationships
Population management
Practice as a community partner
Coordinated care delivery
Organized, evidence based care
Enhanced Access

14. Continuous, Data-Driven Quality Improvement
Engaged and Committed Leadership
Quality improvement strategy supporting a culture of quality and safety
Transparent measurement and monitoring
Optimal use of HIT

15. Sustainable Business Operations
Strategic use of practice revenue
Staff vitality and joy in work
Capability to analyze and document value
Efficiency of operation

16. TCPi resources (in general)
Support & Alignment Network (SANs):
Organizations selected to provide help to the PTNs with roadmaps, tools, “how- to” ideas to help practices
Example: American College of Physicians- ACP has tool kits developed by physicians for care coordination
American College of Radiology: RSCAN Clinical Decision Support
Practice Transformation Network (PTN)
Colorado is one of 29 PTNs
In-practice support; facilitator
Faculty support: education
Learning network support
Access to tools to help the practice from all of the SANs organizations
4 Things You Need to Know
Participation in R-SCAN is free—both for radiologists and for ordering clinicians.
A step-by-step guide leads you through the process of improving the ordering of appropriate imaging exams based on Choosing Wisely recommendations.
When you sign up to participate in R-SCAN, you’ll also gain free online access to a customized version of the ACR Select™ clinical decision support tool, which is based on the ACR Appropriateness Criteria®.
Using these tools, you can rate the appropriateness of exams ordered and create project reports.
R-SCAN participants gain free access to a customized version of the ACR Select™ clinical decision support (CDS) tool, the Web-based version of the complete ACR Appropriateness Criteria®(AC). In the near future, under the Protecting Access to Medicare Act (PAMA), CMS will require consultation of appropriate use criteria in the ordering of advanced imaging exams as a condition for reimbursement to imaging providers. For practices that already have CDS installed, R-SCAN can serve as an important first step for tracking and improving adherence with appropriate use.

17. Colorado TCPI-PTN Transformation Timeline
Set Aims; Use Data to Drive Care
Achieve progress on aims and benchmark status
Thrive as a business within value-based payment models
2016
2017
2018
2019
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18. Next Steps
For more information, sign up for a webinar or practice presentation, or apply:
Questions:
Barbara Martin

19. MACRA Goals Through MACRA, HHS aims to:
Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value.
Over time, expand the opportunities for a broad range of providers to participate in APMs.
Minimize additional reporting burdens for APM participants.
Promote understanding of each physician’s or practitioner’s status with respect to MIPS and/or APMs.
Support multi-payer initiatives and the development of APMs in Medicaid, Medicare Advantage, and other payer arrangements.