QUALITY PAYMENT PROGRAM SMALL UNDERSERVED RURAL SUPPORT (QPP SURS) WEBINARSEPTEMBER 17, 11:00 AM ET AND SEPTEMBER 19, 3:30 PM ET

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM) FOR SOLO AND SMALL GROUP PRACTICES

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

HOUSEKEEPING ANNOUNCEMENTS▸

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If you are listening to this webinar through your phone, please remember to mute your computer speakers.

You can download the slides from the file pod on your screen.

For assistance, enter your issue in the chat box.

To ask a question, enter your inquiry in the chat box.

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

POLLING QUESTIONWhat is your role?▸

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A clinician working in a practice with 15 or fewer cliniciansNon clinical staff from a practice with 15 or fewer cliniciansA clinician working in a practice with more than 15 cliniciansNon clinical staff in a practice with more than 15 cliniciansQuality Payment Program (QPP) contractorOther person helping practices prepare for MIPSOther

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

POLLING QUESTIONHow familiar are you with alternative payment models?▸

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I’m not that familiar with them and want to learn a bit more

Our practice is exploring APM options and considering joining one

Our practice is in the process of converting to a specific APM

Our practice is in an APM but reconsidering whether it’s the best option for us

Our practice is in an APM

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

POLLING QUESTIONWhat are your biggest challenges or concerns with joining an APM?

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

CMS WELCOME

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Kathleen Johnson RN, BS

Health Insurance Specialist

Centers for Medicare and Medicaid Services (CMS)

Quality Improvement and Innovation Group (QIIG)

Division of ESRD, Population and Community Health (DEPCH)

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM) 7

David Cook, Director of Transformation—QIO/Utah

Operations, ComagineHealth

Melissa Hafner, MPP Principal Research Associate, IMPAQ

International

Don Klitgaard, MD, FAAFP, CEO MedLink Advantage

Bruce Spurlock, MDPresident & CEO,Cynosure Health

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

SETTING THE STAGE▸

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Focus: Understanding what is required to participate in an APM, the potential advantages of participating in an APM, and how to know if your practice is ready.

Strategy: A panel of experts will provide practical advice on how to know if APM participation will benefit your practice and patients.

Topic Overview:

What is an APM and who can joinBenefits of joining an APMAPM optionsPractice ReadinessOther Considerations

Using the Chat Box

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

FIND YOUR LOCAL TECHNICAL ASSISTANCE ORGANIZATION FOR FREE ASSISTANCE

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Location of Practice Technical Assistance Organization

Contact Information

FL, GA, NC, SC Alliant GMCF QPPSURS@alliantquality.orgIL, IN, KY, MI, MN, OH, WI Altarum qppinfo@altarum.orgID, WA Comagine Health QPP@comagine.orgCT, MA, ME, NH, RI, VT Healthcentric Advisors NEQPPSURS@healthcentricadvisors.org

AZ, CA, HI, NM, VI HSAG HSAGQPPSupport@hsag.comDC, MD, NY, VA IPRO ny-qppsupport@atlanticquality.orgAK, MT, NV, OR, UT, WY NRHI NV, OR, UT: qpp@healthinsight.org

AK, MT, WY: QualityPaymentHelp@mpqhf.org

AL, TN QSource techassist@qsource.orgDE, NJ, PA, WV Quality Insights qpp-surs@qualityinsights.orgIA, ND, NE, SD Telligen qpp-surs@telligen.comAR, CO, KS, LA, MO, MS, OK, PR, TX

TMF QPP-SURS@tmf.org

Find your local technical assistance contractor here: https://qpp.cms.gov/about/small-underserved-rural-practices

PANELIST INTRODUCTIONS

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Introductions

Experience with APMs

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PANELIST INTRODUCTIONS

11CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

Don Klitgaard, MD, FAAFP, CEO MedLink Advantage

PANELIST INTRODUCTIONS

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David Cook, Director of Transformation – QIO/Utah Operations, Comagine Health

PANELIST INTRODUCTIONS13CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

Melissa Hafner, MPP, Principal Research Associate, IMPAQ International

QUESTION:

What is an Alternative Payment Model and who can be part of one?

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

ALTERNATIVE PAYMENT MODELS

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APMs are new approaches to paying for medical care through Medicare that incentivize quality and value.

A payment approach that provides added incentives to clinicians to provide high-quality and cost-efficient care.

Can apply to a specific condition, care episode or population.

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

ALTERNATIVE PAYMENT MODELS▸

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Goal is to reduce clinician reporting burden

Participation in an APM is at the group level

Each APM has its own requirements and schedule

Comprehensive list of APMs*

*Updated 2019 list is forthcoming

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QUESTION:

Why are some small practices joining APMs?

17CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

FINANCIAL BENEFITS

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Shared Savings – access to these revenue streams while continuing FFS or current payment model, including cost-based reimbursement

MIPS scoring advantages under MACRA – APMs/ACOs get significant MIPS scoring advantages and can maximize MACRA fee increases

5% Bonus payment/MIPS exclusion for Advanced APMs

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

IMPROVED PATIENT CARE COORDINATION▸

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Enhanced team-based care

Clinical guidelines and pathways

Processes and workflows are likely to be standardized

Data – access to claims data and risk adjustment data

Review of quality measures

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Clinical quality

Patient experience

Population management capabilities

Best practices – Gain insights from those who have experience in these models locally, regionally, and nationally

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

LEARNING OPPORTUNITIES AND SHARED RESOURCES▸

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Quality score education, QI training, improvement efforts – important in ACO work, better patient care, can give market advantages

Education on details of how ACOs and Pay for Value functions –providers, staff and administrators all need to learn about the transition to Value-Based Purchasing (VPB)

Learning Collaboratives – chance to learn alongside other leaders, providers, and practices

Networking – connect with others in similar roles with similar challenges

ACO resources: ACOs with well-financed partners, such as large hospitals, can help smaller practices by funding or supplying EHRs, quality improvement resources and care coordinators” *

*Should Your Primary Care Practice Join an ACO?, https://www.softwareadvice.com/resources/should-you-join-an-aco/

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QUESTION:

What are my APM options as a small practice?

21CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

WHICH APM IS BEST FOR YOU?

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

ADVANCED APMS▸You must meet the following criteria:

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

QUALIFYING APM PARTICIPANT▸

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APMs allow eligible clinicians to become a Qualifying APM Participant (QP).

If you’re eligible for QP status, you receive 5% APM incentive payment and are excluded from MIPS.

Three Criteria:

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You must receive at least 50% of your Medicare Part B payments OR see at least 35% of Medicare patients through an Advanced APM entity at one of your determination periods.

In addition, 75% of practices need to be using Certified EHR Technology (CEHRT) within the Advanced APM entity

Eligible Clinicians may also become a QP through the All-Payer Option, which is a combination of Medicare and non-Medicare payer arrangements such as private payers and Medicaid.

APM Lookup Tool: https://qpp.cms.gov/participation-lookup

2019 QP Methodology Fact Sheet

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

LIST OF 2019 ADVANCED APMS

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

MIPS APM

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An APM that is held to a separate scoring standard to recognize a practice or clinicians for ongoing work and efforts through an APM.

MIPS APMs work by:

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Streamlining MIPS reporting and scoring for eligible clinicians in certain APMs

Attributing APM Entity level quality performance down to MIPS Eligible Clinicians in that APM Entity

Allowing all eligible clinicians in an APM Entity to receive the same MIPS final score

Using APM-related performance

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

MIPS APM CRITERIA

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

LOW VOLUME THRESHOLD

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▸MIPS low volume threshold applies to MIPS eligible clinicians participating as part of an APM entity.

▸This means that even if a clinician or group is at or below the MIPS low volume threshold of $90,000 in covered professional services under the Medicare PFS, or furnishing covered professional services to less than or equal to 200 beneficiaries, if they participate in a MIPS APM, they will be subject to MIPS if the APM Entity exceeds the low volume threshold.

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

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Medicare Accountable Care Organization(ACO) Track 1+ Model

Medicare Shared Savings ProgramAccountable Care Organizations -Tracks 1,2, & 3

Bundled Payments for Care ImprovementAdvanced Model (BPCI Advanced)

Comprehensive ESRD Care (CEC) Model(All Arrangements)

Comprehensive Primary Care Plus (CPC+)Model

To learn more about these MIPS APMs, visit the MIPS APMs webpage on qpp.cms.gov

LIST OF 2019 MIPS APMS

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Next Generation ACO Model

Oncology Care Model (OCM –All Arrangements)

Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

Maryland Primary Care Program

Independence at Home Demonstration

QUESTION:

How do I know if my practice is ready?

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

ARE YOU READY?▸If you meet APM criteria and you are willing to:

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Look at new data – claims, utilization, risk, quality

Think about and organize around how to improve the care you provide

Collaborate with others – teach and learn together

Dedicate time/resources – especially important to identify a physician champion if at all possible!

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You don’t have to have it all together and be a highly-functional, high-performing practice up front

APM work is the pathway not the destination

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

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Foundational elements may help practices succeed regardless of whether they are ready to join an APM or if one is not available in their area.

EHR Use

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Practice uses certified EHR

Practice can report quality measures from EHR

Practice has taken steps to manage provider documentation burden

GETTING YOUR PRACTICE READY

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

▸Team-based Approach:

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Annual Wellness Visits(AWV) or Welcome toMedicare: currently providingto at least 25% of yourtraditional Medicarepopulation and (or) preparedto provide to 50% in the nextyear.

Chronic Care Management(CCM): currently have atleast 5% of your traditionalMedicare population enrolledand prepared for at least 10%in the next year.

GETTING YOUR PRACTICE READY—PRIMARY CARE

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▸High-impact population management:

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Routine screening for diabetes (including in AWV); persons with pre-diabetes referred to Medicare Diabetes Prevention Program.

Referral to Diabetes Self-Management Education programs.

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

▸Prepare to implement strategies for reducing costs while maintaining or improving quality.

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Improve coordination and communications with primary care.

Identify strategies for unnecessary costs, duplicated tests, low value services through improved coordination.

Work with primary care providers to promote appropriate, high-quality referrals.

Assess/improve patient education and engagement.

GETTING YOUR PRACTICE READY—SPECIALTIES

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QUESTION:We are interested and considering applying, what else should we consider?

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CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

CHOOSING AN APM

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▸ Consider which APM is best for your practice

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Do you meet the minimum criteria: https://qpp.cms.gov/apms/overview

Review the APMs in your region here: https://innovation.cms.gov

Look at size and scope of APMs:

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Number of Practices in the APM/ACO: how many practices are enrolled?

Number of lives covered: how many beneficiaries are covered?

Location covered: are these locations an option for you?

Focus area: primary care or specialty?

Maturity: how long have they been operating?

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

OTHER CONSIDERATIONS

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Cost

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Know the cost to join, upfront costs, cost of technology

Consider what participation might do to improve revenue, therefore offsetting or overshadowing any costs

Consider what new opportunities participation can bring

Time/Staff/Resources

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Know your responsibilities to perform in the APM/ACO

Decide if this time/work will benefit your practice in tangible ways

Know the reporting requirements

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

OTHER CONSIDERATIONS

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▸ Risk

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Is there downside risk? If so, is it acceptable?

Know the clinician risk for not meeting quality and cost requirements

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

HOW TO APPLY

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Each APM has it’s own application and unique requirements

Most ACOs operate on a calendar year basis, with sign-up for the next year occurring sometime between June-September, depending on the payer.

For a complete list of 2019 APMs as of November 2018: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/113/2018%20Comprehensive%20List%20of%20APMs.pdf

CONSIDERATIONS FOR JOINING AN ALTERNATIVE PAYMENT MODEL (APM)

PRACTICAL TIPS

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Talk to APM participants and learn about their experiences

Understand the risks

Understand your options

Manage new processes

Look at your quality and cost metrics

Reach out to your colleagues

APM lookup tool: https://qpp.cms.gov/participation-lookup

QUESTION:

If I still need help, where can I go?

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FREE RESOURCES FOR ASSISTANCE FROM CMS▸

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QPP website: https://qpp.cms.gov/--includes information tailored for the needs of small practicesContact the Quality Payment Program at: QPP@cms.hhs.gov or call 1-866-288-8292Support and Available resources for Small, Underserved, and Rural Practices: https://qualitypaymentprogram.cms.gov/about/small-underserved-rural-practicesSmall Underserved Rural Support Technical Assistance Organizations (see list on slide 9) Contact information is available at: https://qpp.cms.gov/about/small-underserved-rural-practices Available websites of each Technical Assistance Organization Types of help: needs assessments, webinars, technical support, links to peers you can talk with,

assistance getting signed up to report through an approved channel that meets your practice’s needs

Resource Library2019 MIPS Participation and Eligibility Fact Sheet

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FREE RESOURCES FOR ASSISTANCE FROM CMS▸

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QPP Participation Status Tool

APM pages of the Quality Payment Program website

2019 QP Methodology Factsheet

2019 MIPS APM User Guide

Connect to an Organization: APM Entity

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WRAP-UP ACTIVITIES▸

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Links to Q&A documents, transcripts, and recordings of the event are available here: www.qppsurs.com

October: How to Transform Your Practice Workflow to Succeed in MIPS: Advice for Solo and Small Group Practices

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Tuesday, October 15, 2019, 3:30 p.m. – 4:30 p.m. ET

Thursday, October 17, 2019 11:00 a.m. – 12:00 p.m. ET

Please provide feedback on this event: Feedback Form

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REFERENCESSlide decks created by event panelists also provided information reflected in this presentation. The input from project panelists is gratefully acknowledged.

Other documents on the https://qpp.cms.gov/ and https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html website provide additional detail about the MIPS program.

Comagine Readiness Checklists, To Join or Join ACO

Alternative Payment Models and Risk Readiness; An In-Depth Analysis of the CMS “Pathways to Succes” Final Rule, HealthPOINTCompass PTN TCPI Learning Community, Don Klitgaard, MD, FAAFP

Disclaimer: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes periodically so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.

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APPENDIX: ACRONYMSAPM – Alternative Payment ModelACO – Accountable Care Organization CERT—Certified EHR TechnologyCMS – Centers for Medicare & Medicaid ServicesFFS- Fee for ServiceMIPS – Merit-based Incentives Payment SystemPCMH— Patient Centered Medical HomePCP— Primary Care ProviderPI— Promoting Interoperability PFS-Physician Fee ScheduleIA – Improvement ActivitiesEHR – Electronic Health Records

QCDR—Qualified Clinical Data RegistryQPP – Quality Payment ProgramQRDA – Quality Reporting Data ArchitectureQRUR— Quality and Resource Use ReportsSURS - Small Underserved Rural Support TIN—Tax Identification NumberQI-Quality ImprovementQP- Qualifying APM ParticipantVBP- Value-Based Purchasing

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