APM in Primary Care

24 Pages·2015·1.57 MB·English

APM
 in
 Primary
 Care

Moving
 Away
 from
 FFS
 to
 Paying
 for
 Quality
Mindy
 Stadtlander,
 MPH

Director
 of
 Network
 and
 Clinical
 Support
Todays
 Conversation
What
 Are
 We
 Trying
 to
 Accomplish?

What
 are

YOU
 trying
 to

accomplish?
What
 Are
 We
 Trying
 to
 Accomplish?

1.  Build
 Primary
 Care
 capacity
 for
 data
 and
 quality

improvement

2.  Foster
 shared
 decision
 making
 across
 communi>es
 for

resource
 alloca>on
Primary
 Care
 Payment

Evolution

Current
 State
  Bridge
 Strategy
  Future
 State

Fee
 for
 Service

Primary
 Care

with
 expanded

Fee
 for
 Service
  Capita4on?

codes

At
 Risk
 for

Incen4ve

Quality/

Incen4ve

Payment

U4liza4on

Payment

Base
 FFS
 payment
  Base
 FFS
 payment
 structure
  Primary
 Care
 capita>on

structure
 with
 Primary
  that
 supports
 alterna>ve
 care
  with
 por>on
 of

Care
 Incen>ve
 Program
  delivery
 models
 (telephone/e-­‐ payment
 at
 risk
 for

visits,
 RN/BH
 visits,
 etc)
 with
  quality
 and
 u>liza>on

expanded
 Primary
 Care
  outcomes

Incen>ve
 Program
What
 Changes
 Can
 We
 Make?
Primary
 Care
 Incentive
 Model
 Keys

•  Co-­‐developed
 with
 major
 delivery
 system
 partners

•  Clinic-­‐chosen
 measures
 from
 a
 menu

•  Focus
 on
 improvement,
 not
 mee>ng
 benchmarks

•  Emphasis
 on
 EHR-­‐based
 quality
 measurement,
 not
 claims
 data

•  No
 central
 specifica>ons
PC
 Incentive
 Model

• 

 Report
 monthly
 on
 5
 menu
 measures

Level
 3

• 

 Receive
 measures
 and
 roster
 on
 CO
 AMributed
 Members

• 

 Improve
 3%
 on
 at
 least
 3
 measures

• 

 Report
 monthly
 on
 5
 menu
 measures

Level
 2

• 

 Receive
 measures
 and
 roster
 on
 CO
 AMributed
 Members

• 

 Improve
 3%
 on
 at
 least
 1
 measure

• 

 Report
 monthly
 on
 3
 menu
 measures

Level
 1

• 

 Receive
 measures
 and
 roster
 on
 CO
 AMributed
 Members
Participation
Current
 Results

1st
 period

 2nd
 period
  1st
 period

 2nd
 period

Year
 1
  Year
 2