CPC+ Oregon Practice

Application WebinarDavid Dorr, MD, MSRon Stock, MD, MA

We Want To Hear From You!

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Presenters

Ron Stock MD, MA

Clinical Innovation Advisor

David A. Dorr, MD, MS

Professor of General Internal Medicine/Geriatrics & Vice Chair of Clinical Informatics

Agenda1) What is CPC+?

2) Oregon CPC Experience

3) Payer Information

4) Eligibility Requirements

5) How to Apply

6) Questions

7) Questions

Congratulations Oregon!

What is CPC+?5-year model beginning January 2017Largest primary care model implementation in U.S. history 14 states and regionsUp to 5,000 practicesUp to 20,000 physiciansUp to 25 million patients

Multi-payer design15 Payers in Oregon

What are we trying to accomplish?1) Achieve the Delivery System Reform core objectives of better

care, smarter spending, and healthier people in primary care.

2) Advance care delivery and payment to allow practices to provide more comprehensive care that meets the needs of all patients, particularly those with complex needs.

3) Accommodate practices at different levels of transformation readiness through two program tracks (both offered in every region).

4) Engage multiple payers, including CCOs, to align payment, quality metrics, and care delivery in Oregon.

Program DesignTwo tracks for care delivery and paymentTrack 1: Pathway for practices ready to build the capabilities

to deliver comprehensive primary careTrack 2: Pathway for practices poised to increase the

comprehensiveness of care through enhanced Health IT, improve care of patients with complex needs, and inventory of resources and supports to meet patients’ psychosocial needs.

CPC+ Timeline to Launch

Oregon Experience: CPC Reflectionimprovement in overall PCMH-A scores from 2012-2015have a Patient Family Advisory Council for better patient engagementincrease in Risk-stratified care management PCMH-A domain from 2012-2015of Oregon practices risk stratify ≥75% of empaneled patientsof OR practices offer 24/7 access to care

35%

65%

77%

95%

100%

Oregon Experience: CPC Reflection

decrease in hospital admissions

decrease in 30-day readmissions

8%

2.4%

CPC Oregon Testimonial: Grants Pass Clinic

Founded in 1949 Independent, Multispecialty

(mostly primary care) 20 physicians 2 PAs/2 NPs About 110 employees PCPCH 3-STAR designation

Christi Siedlecki, MSN, RN, CMPEChief Executive Officer

CPC Oregon Testimonial: Physicians Medical Center

Independent

McMinnville, OR

24,047 Active Patients

15 ProvidersWilliam Koenig, DO

PediatricianYamhill County Health Officer

CPC+ Topics

1) What is going to change?

2) How will practices be paid?

3) What kind of IT support will be needed?

4) More information on payer engagement

5 Primary Care Functions

5 Primary Care Functions

Payment Methodology by Track

(PBPM) (PBPM)

Care Management Fees Determined by Risk Tier

Health IT Requirement OverviewAll Practices

By January 1st, 2017, practices will adopt a 2015 edition of a certified electronic health record technology (CEHRT)

Remote access to EHR to ensure 24/7 access to care team members with real time access to medical record

Report on electronic clinical quality measures (eCQMs) and generate quality reports at practice and panel level.

Track 2 Practices Only

Work with vendors to support the development and optimization of a set of advanced HIT functions

15 Participating Payers in Oregon1. AllCare Health, Inc.2. ATRIO Health Plans3. CareOregon4. Eastern Oregon

Coordinated Care Organization (EOCCO)

5. FamilyCare Health6. Oregon Health

Authority (Medicaid)

7. Moda Health Plan8. Pacific Source9. Primary Health of

Josephine County10. Providence Health

Plan (PHP); Providence Health Assurance (PHA)

11. Tuality Health Alliance (THA)

12. Umpqua Health13. Western Oregon

Advanced Health, LLC14. Willamette Valley

Community Health15. Yamhill County Care

Organization Inc.

Jim Rickards, MD, MBAOHA Chief Medical Officer

Practice Eligibility Requirements Primary care practices w/ ≥150 attributed Medicare FFS beneficiaries Family Medicine, Internal Medicine, Geriatric Medicine Includes MD, DO, NP, PA, CNS

Demonstrated readiness in the following areas: Care management, patient access, and quality improvement

Exclusions: Concierge Practices, Rural Health Clinics, Federally Qualified Health Centers

Note: CMS will accept up to 1,500 practices that are also participating in Shared Savings Program ACOs

A. Preliminary Questions: Region, track, eligibility, participation in other Medicare initiatives

B. Practice Structure and Ownership: Name, address, ownership type, TIN, CPC participation

C. Contact Information:Primary contact, letter of support from clinical leader, HIT contact

D. Practitioner & Staff Information: # of clinicians, Meaningful Use attestation progress and plans

E. Practice Activities: Medical Home recognition and training of future PCPs

F. Health Information Technology:EHR Certification ID, plans for purchasing EHRs

Application Topics:

Apply Online at: https://app1.innovation.cms.gov/cpcplus

G. Patient Demographics:Race/ethnicity, preferred language

H. Practice Revenue and Budget:2015 revenue, % patients by insurance type

I. Care Delivery: Drop-down options for capabilities in care plans, risk stratification, ED & hospitalization follow-up, patient access, and QI

J. Letter of Support: Also needed by parent of owner organization if practice is owned by a larger organization or person not working in the practice siteNote: Track 2 practices will also need a letter of support from their HIT vendor. Details for the letters of support can be found at the end of the application.

Application Topics Continued:

Apply Online at: https://app1.innovation.cms.gov/cpcplus

Additional questions in web-based applicationNOTE: the following are not included in Appendix B of the original RFA

1. Status and details of enrollment in any programs with a “no overlaps policy.”

2. Participation or plans to participate in an ACO3. Indication of any satellite offices of your practice4. List of TINS your practice has used to bill Medicare since

January 1, 20135. Name of clinical leader who is writing the Letter of Support

National Resources &Learning OpportunitiesMain CPC+ Website:https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus

15 upcoming CPC+ Practice Open Door Forums in August and September. Schedule and registration list: https://innovation.cms.gov/Files/x/cpcplus-practiceeventscalendar.pdf

Practice FAQs (updated frequently): https://innovation.cms.gov/Files/x/cpcplus-faqs.pdf

Questions? Email CPCplus@cms.hhs.gov or call the CPC+ Help Desk from 8:30 AM– 7:30 PM EDT at 1-844-442-2672.

Oregon Practice Application ResourcesCare Management Plus

(CMP)

Oregon Rural Practice-Based Research Network (ORPRN)

Oregon Health Care Quality Corporation (Q CORP)

Oregon Health Authority PCPCH Program

Oregon Academy of Family Physicians

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presentation

Contact InformationDr. David Dorr: dorrd@ohsu.eduDr. Ron Stock: stockr@ohsu.edu

Oregon Technical Assistance: cpcoregon@ohsu.edu