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
Agenda
 RIQI Services
 Practice Transformation
o Transforming Clinical Practice Initiative
2
RIQI’s Center for Improvement Science Services
Health IT
3
Practice
Transformation
CurrentCare
Transforming
Clinical Practice
Initiative
EHR Adoption
and MU
NCQA PCMH
Consultation
Center for Improvement Science Services
PRACTICE TRANSFORMATION
4
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
5
What Does this Mean for RI?
The Center for
Medicare & Medicaid
Innovation (CMMI)
Transforming Clinical
Practice Initiative
(TCPI)
Support and
Alignment Networks
(SAN)
Practice
Transformation
Networks (PTN)
10 Awardees
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
TCPI’s 5 Phases of Transformation
Source: CMS TCPI PTN Information Webinar 2014
*
7
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
•
•
•
•
8
Transformation support at no cost
Better patient outcomes
More joy in work
Strengthen relationships between primary
care and specialist providers
*
Value Proposition – Local Reform Efforts
Local practice transformation and payment reform efforts
OHIC:
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
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
9
Value Proposition – Federal Reform Efforts
10
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
11
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
12
*
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**
13
*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
*
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
14
*
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
15
Alternative Payment Model (APM)
• Payments:
– Lump sum payments equal to 5% of
all reimbursement for services
rendered under the Medicare PFS
(2019 – 2024)
16
PFS, APM & MIPS Payments
Copyright © 2016 Deloitte Development LLC. All rights reserved
17
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.
19
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
20
*
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
21
*
Thank You
CurrentCare
@CurrentCare
Darlene Morris, Director, Center for Improvement Science – [email protected]
Rhode Island Quality Institute - 50 Holden Street, Providence, Rhode Island 02908
www.riqi.org
www.transformyourpracticeri.com
www.currentcareri.com
22