All Provider Meeting. November 29, 2017

Transcription

1 All Provider Meeting November 29,

2 Agenda Call to Order Personnel/Admin Update Contracting Update CMS ACO 2016 Comparative Results MSSP Performance Q FMH Employee Health Plan Q2 Results Johns Hopkins Advantage MD Update IT Update PCP Meeting Attendance Requirements Risk/HCC Coding Tip 2018 Meeting Schedule Wrap-Up/Adjourn Richard Gough, MD Richard Gough, MD Christian Gomes Christian Gomes Christian Gomes Christian Gomes Christian Gomes Sean Shillinger Johnson Koilpillai, MD Richard Gough, MD Richard Gough, MD Richard Gough, MD 2

3 Personnel/Admin Update 3

4 Personnel/Admin Update New FIHN Board of Managers Medicare Beneficiary Representative Lloyd Halvorson, MD New Providers/Practices in FIHN Retina Center of Western Maryland (Ophthalmology) Dara Tash, MD Gagnon Oncology (Radiation Oncology) Gregory Gagnon, MD Ashima Saini, MD Meredith Wernick, MD Mary McDonald, MD Hospice of Frederick County 4

5 Contracting Update 5

6 MSSP Reapplication Status Reapplication submitted in July to remain in Track 1 for PY2018 through PY2020 Responded to 3 rd and final Request for Information (RFI- 3) on October 26 no deficiencies Completed Step 2 of Annual Certification; awaiting Steps 3 & 4 (completed mid-december) 6

7 Additional Contracts/Agreements Cigna Collaborative Accountable Care (CAC) Presentation to FIHN made in October Program requirements and proposal under review UnitedHealthcare 7

8 CMS ACO 2016 Comparative Results 8

9 ACO_Name Track Sav_rate MinSavPerc Savings Total EarnSaveLoss QualScore Benchmark Risk Score Beneficiaries Accountable Care Coalition of Maryland Primary C % 3.44% $ 21,757, $ 10,225, % $ 18, LifeBridge Health ACO, LLC % 2.56% $ 20,157, $ 9,357, % $ 12, Frederick Integrated Healthcare Network LLC % 2.95% $ 11,021, $ 5,130, % $ 11, Maryland Collaborative Care, LLC % 0.00% $ 6,903, $ 3,787, % $ 12, AAMC Collaborative Care Network, LLC % 2.66% $ 3,601, $ % $ 9, Carroll ACO, LLC % 3.08% $ 1,804, $ % $ 10, Western Maryland Physician Network LLC % 3.91% $ 1,448, $ % $ 12, Johns Hopkins Medicine Alliance for Patients, LLC % 2.31% $ 480, $ % $ 12, Privia Quality Network, LLC % 2.13% $ (244,015.00) $ % $ 8, Bayview Physicians Group % 2.49% $ (316,798.00) $ % $ 8, Loudoun Medical Group ACO LLC % 2.96% $ (1,048,629.00) $ % $ 8, THP-Meritus ACO, LLC % 2.81% $ (2,152,620.00) $ % $ 11, Peninsula Regional Clinically Integrated Network, L % 3.02% $ (3,675,914.00) $ % $ 11, Greater Baltimore Health Alliance % 2.89% $ (7,216,370.00) $ % $ 13, MedStar Accountable Care, LLC % 0.50% $ (9,189,778.00) $ (3,675,911.00) % $ 12,

10 CMS ACO 2016 Comparative Results Local ACOs competing with FIHN did not perform as well: Privia Generated a loss in 2016 of -$244,000. Privia s quality score despite all being on one Athena EHR was 89%. Maryland Collaborative Care This is the ACO that Frederick Internal Medicine and Endocrinology (Drs Donelson and Shah(s)) participate in. They generated $6,900,000 in savings. Their quality score was 93%. 10

11 CMS ACO 2016 Comparative Results Several ACOS generated savings but did not share those dollars since it was less than the minimum savings rate required by CMS before savings are shared. Anne Arundel, Carroll, Western Maryland and Hopkins were among this group. Meritus and GBMC ACOs generated losses. They do not have to repay CMS since they are in Track 1. Peninsula Regional generated a -$3,675,914 loss in Track 1. However, they had a 100% Quality Score to be applauded! Their ACO is primarily employed but has some independents. MedStar generated a -$9,189,778 loss in Track 3, must repay $3,675, to CMS due to downside risk! 11

12 MSSP Performance Q

13 MRI events (count) FIHN MSSP Overall Dashboard FIHN MSSP Benchmark Report - produced quarterly CY15 CY16 CY 17 Q1 (rolling year) CY17 Q2 (rolling year) CY17 Q3 (rolling year) Goal (CY2016-5%, unless otherwise indicated) All ACOs Lives Attributed 11,873 10,769 10,756 10,336 10,140 11,385 COST Historical Benchmark $ 11,994 Total Expenditure per beneficiary $ 10,151 $ 10,503 $ 11,036 $ 11,326 $ 11,631 $11,574 (-3.5%) $ 10,672 UTILIZATION 30 day all cause readmissions/1000 discharges Ambulatory Sensitive Condition discharges/1000 COPD or Asthma Congestive Heart Failure Acute Composite Hospital Discharges/1000 Acute care hospital Skilled nursing facility discharges/ Skilled nursing facility days/ Emergency department visits/1000 (out patient and inpatient combined): Emergency department visits/1000 outpt Emergency department visits/1000 leading to hospitalization CT events (count)

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20 FMH Employee Health Plan Q2 Results 20

21 Overall Dashboard FIHN FMHEHP Benchmark Report CY17 Q1 CY17 Q2 Milliman Loosely Managed GOAL Attributed Lives 1,421 1,606 1,609 *** N/A ER Visits/ High Tech Imaging Tests / Diabetes Eye Exam 27% 35% 35% 35% Cost PMPM Medical $ $ $ $ Paid and Incurred 7/1/16-6/30/17 ***attribution methodology reviewed and corrected for CY17 Q3 Up to 13% savings shared 50/50. 21

22 Aetna P4P 22

23 Aetna P4P Physician Pay-for-Performance Proposal Scorecard Frederick Integrated Healthcare Network Measure Benchmark results through Dec 2016 Actual Targets through June 2018 Description Score Goal 3 Potential $ 4 Clinical Effectiveness Breast cancer screening 80.0% 82.0% $14,700 Diabetes: Hemoglobin A1c testing (NQF measure #057) 93.9% 94.5% $14,700 Diabetes: Medical attention for nephropathy (NQF measure #062) 96.1% >=95% $14,700 Diabetes: Hemoglobin A1c poor control (>9.0%) (NQF measure #059) 9.5% 10.0% $14,700 Persistent medication use with lab monitoring: Digoxin, ACE-I/ARB or Diuretic (NQF measure #2781) 92.3% 93.1% $14,700 Well child visits 3-6 years of life 96.0% >=95% $14,700 Efficiency Episode of care efficiency index 0.85 Informational Only in Year 1 Formulary compliance 99.2% 99.3% $44,098 Generic substitution 99.6% 99.7% $44,097 In-Network Lab Use 86.5% 87.8% $44, Total Potential Amount $220,489

24 Johns Hopkins Advantage MD Update 24

25 Johns Hopkins Advantage Maryland a Medicare Advantage health plan Frederick County open enrollment started on October 15!

26 What is Medicare Advantage - Part C coverage? Medicare Advantage A health plan replacement for Medicare Part A and B offered by a private insurer that contracts with CMS. Medicare beneficiaries enroll in a Medicare Advantage health plan (HMO or PPO) that may include part D prescription drug coverage. Advantage plans contain the following elements: Contracted provider network Medicare benefits Plus: vision, dental, hearing, prescription and others Fewer restrictions: no 3-day qualifying SNF stay, no homebound requirement for home health, creative expanded use of benefits (important to the emergency room providers and care management) Members have a premium, copayment/coinsurance and incentives for healthy behaviors, lower patient costs than Medicare A & B with supplement 26

27 Medicare Strategy Progression What actions will lead our community toward a healthier future and sustainable business model as the Medicare aged population grows in Frederick? Medicare is a large part of our payor mix, doubling in size Seniors shopping for value, supplemental plans expensive Advantage plans 30 % penetration in most of the country, 10% Maryland, need a close partnership with a plan ACO strategy short lived , next move? Triple Aim not achievable under the current unmanaged Medicare fee for service model Opportunity for physicians to receive value based reimbursement higher than fee for service Medicare and greater support for patients

28 Johns Hopkins Healthcare Medicare Advantage Super CIN Advanced Health Collaborative II owner health systems Other owner systems: Anne Arundel Medical Center Mercy Medical Center Frederick Regional Health System Peninsula Regional Medical Center Adventist Health System LifeBridge Health 28

29 Johns Hopkins Medicare Advantage Advanced Health Collaborative evaluated 8 Medicare Advantage Plans as partners through an extensive request for proposal, Hopkins excelled 1. Hopkins brand is meaningful to seniors 2. FRHS Agreement prohibits JH from moving volume that can be handled in Frederick 3. Provider Sponsored Johns Hopkins health plan track record, provider partnership opposed to commercial payor plans 4. Opportunity for FIHN to enter into value based alternative payment models we could not negotiate independently 5. Can still participate in other plans: currently participating with AETNA, Humana 29

30 All JH plans include coverage for hearing, vision and dental and prescription drugs. Plus Plan includes hearing aids, glasses and fitness coverage Fee-for-Service Medicare Medicare Part A,B + Supplement Plan Premium <$350> + $1500 deductible Deductible + 20% coinsurance $330 $670 inpt copay No vision, hearing, dental or prescription drug coverage included, must purchase Part D Rx

31 Product Mix : Frederick County PPO Plus PPO Basic Product Mix 20% 45% FRHS Corporate Goal Achieve at least 80% (240) of Hopkins goal for Frederick Co. HMO 35% Total PPO Plus PPO Core HMO 2018 Distribution 100% 45% 35% 20% 2018 Enrollment

32 Advantage MD Marketing FRHS will not be part of pre-heat TV buy since it is prior to our Oct 15 eligibility.

33 FRHS Marketing Support External Audience Well Aware magazine October issue (100K HH) Article in FMH Select newsletter November issue (1100 members) Radio Spot on 4 local stations 10/15-12/7 Social Media and Media Relations 10/15-12/7 Internal Audience Mailing to eligible MHP patients 10/15 Social Media 10/15-12/7 #FMH s about AEP and educational seminars Messages to our Auxiliary about AEP and educational seminars ( s, flyers, Stethoscope letter)

34 Community Outreach Educational Seminars/Enrollment Events FMH Crestwood 10/25 11/3 FMH Classrooms 11/9 Mt. Airy Health and Wellness Pavilion 11/15 12/1 Frederick Community Health Fair 10/28 (Enrollment table) Advantage MD Sales Force run these events. Utilizes sales team and call center. Each hospital/ health system was asked to provide a location for two or more seminars.

35 Steps to Support Plan Success Support co-branded marketing practice affiliation letters Training - provider toolkit, practice orientations - December Quality STAR rating and Risk Score - PCP $500 payment incentive 2018 is a key year for plan growth prior to Kaiser s entry into the market in Members tend to stay with the plan they select long term. Encourage Seniors to evaluate this plan in their menu of options for 2018!

36 Maryland Primary Care Program The State is scheduling regional meetings to introduce providers and practices to the Maryland Primary Care Program present general program design information Care Transformation Organizations care management, data tools and informatics, practice transformation, etc. preview the Request for Application, planned CRISP engagement, and other key areas Western Region meeting December 4 th, 2017 Meritus Medical Center 3-6pm 36

37 IT Update 37

38 ACI Attestation Timeline FIHN contacts practices to encourage them to schedule Security Risk Analysis and share ACI dashboard data from EHR Thru 12/29/17 FIHN communicates with practices to ensure understanding of ACI requirements and EHR workflows Thru 12/29/17 FIHN collects ACI data from ACO participants 1/2/18 3/31/18 Practices submit ACI to CMS with the assistance of Sean Shillinger. We can help maximize the collective score. This is important! 3/31/18 Please do not hire a vendor to do your ACI reporting! 38

39 Example of a Successful ACI Attestation Process ACI requires a specific, auditable trail of evidence Yearly Security Risk Analysis is REQUIRED Monitoring throughout the year ensures success Create an Audit Binder FIHN will want to review your documentation and ensure integrity of paper trail in preparation of CMS audit ensures success of all ACO members 39

40 Practice Name Meets all ACI requirements Security Risk Analysis Completed ACI Report Provided Meets ACI Required Minimum Monocacy Health Partners Yes Yes Yes 100 CARDIOVASCULAR SPECIALISTS OF FREDERICK Yes Yes Yes 100 FREDERICK GASTROENTEROLOGY ASSOC Yes Yes Yes 100 SIBTE A KAZMI MD LLC Yes Yes Yes 100 DAVID W KOSSOFF MD PA Yes Yes Yes 100 WILLIAM H. JOHNSON, M.D., P.A,- Kidney Center of Frederick & Hagerstown Yes Yes Yes 100 Frederick Medical and Pulmonary Associates Yes Yes Yes 97 GAFFAR A SYED, MD, PA- Internal Medicine and Primary Care Yes Yes Yes 91 Ravi Yalamanchili, MD, P.A. Yes Yes Yes 88 X'cel Primary Care Yes Yes Yes 82 Primary Medical Services, PC - Dr. Zaidi Yes Yes Yes 81 Syed Haque, MD Yes Yes Yes 81 Comprehensive Neurology Services Yes Yes Yes 77 Maryland Vision Center, PA (Sunil Thadani) Yes Yes Yes 61 Estimated Points to date /100 40

41 Practice Name Security Risk Analysis Completed ACI Report Provided Meets ACI Required Measures Estimated Points to date /100 *If Security Risk Analysis Completed Scheduled to meet all requirements MIDDLETOWN VALLEY FAMILY MEDICINE, P.A. Scheduled-11/30 Yes No 99 Not meeting use of CEHRT requirements on ACI Report, Security Risk Met Branislav S Romanic MD LLC Yes Yes No 0 MARK X COYNE MD Yes Yes No 0 DR JULIE JURD PC- Progressive Podiatry Yes Yes No 0 Sajjad Aziz, MD Yes Yes No 0 SHERMAN KAHAN, MD, PA (Cardiology Associates) Yes Yes No 0 41

42 Practice Name Security Risk Analysis Completed ACI Report Provided Meets ACI Required Minimum Estimated Points to date /100 Completed Security Risk Analysis, no ACI report provided CYNTHIA J. MOORMAN, M.D., P.A.- Urology Consultants of Maryland Yes No No 0 FORIS SURGICAL GROUP LLP Yes No No 0 FREDERICK KIDNEY CARE ASSOCIATES LLC Yes No No 0 FREDERICK UROLOGY ASSOCIATES Yes No No 0 INTERNAL MEDICINE SPECIALISTS OF FREDERICK- Dr. Tyra Kane Yes No No 0 IRFAN HASSEN MD Yes No No 0 MANN & HENRY PODIATRY SERVICES, LLC- Atlantic Foot & Ankle Specialists Yes No No 0 McKenna Surgical Yes No No 0 MID-MARYLAND EAR NOSE & THROAT SPECIALISTS, P.A. Yes No No 0 Tracey A. Culbertson, MD Yes No No 0 Awaiting Security Risk Analysis completion, no ACI report provided DR DIANE FORD - Jen John, Inc. Self- awaiting No No 0 FREDERICK ONCOLOGY HEMATOLOGY ASSOCIATES, P.C. Self- awaiting No No 0 Pending exemption or hospital-based reporting CRITICAL CARE ASSOCIATES, LLC* No* No No 0 DRS REID AHMADIAN AND THOMPSON PA* No* No No 0 ANUSHA BELANI MD No No No 0 Estimated aggregate ACI Score: 73.1/100 42

43 CMS Web Interface ACO Quality Reporting Timeline FIHN provides Remote Access User Account Form to practice(s) 11/15/17 12/15/17 Practices provide completed forms back to FIHN and create EHR access 11/20/17 12/29/17 FIHN and Primaris (CMS Web Interface Vendor) confirm EHR access with each practice 11/20/17 12/29/17 Patient Lists and Measures Required received from CMS 1/2/18 FIHN and Primaris complete abstraction 1/2/18 3/16/18 FIHN submits Final Results to CMS 3/16/18 43

44 Annual ACO Quality Reporting EHR Minimum Access Requirements Completion of the Remote Access Form and created abstractor EHR user accounts within 30 days of FIHN original request Remote Access to the EHR using SecureLink (preferred), RDP, web-based URL, or some other agreed-upon tool Access granted to BAA authorized 3rdparty abstractors as requested Unique access for all requested abstractors; with individual logins and passwords Daily and weekend access to EHR throughout GPRO abstraction process; dedicated computer if applicable, left on without sleep settings; at least 2 designated contacts at practice (who can respond as access problems arise) Read-only access preferred when made possible by the vendor 44

45 Annual ACO Quality Reporting EHR Minimum Access Requirements (cont d) Abstractors need the ability to view all of the following scanned, abstracted, codified, and office entered/generated items in the chart: 45

46 CRISP HIT Supports for Practices Data Exchange Support Programs (DESP) This program will provide funds directly to practices who want to connect with CRISP. The payments are fixed amounts, which the practice can use to offset connectivity costs. In return, the practice will provide and maintain data feeds to CRISP. Requirement: CEHRT Funding Milestone 1 $3,000 + Milestone 2a $4,000 OR Milestone 2a+2b $7,000 Total = up to $10,000 46

47 CRISP HIT Services for Practices Maryland Prescription Drug Monitoring Program Monitor the prescribing and dispensing of drugs that contain controlled dangerous substances Encounter Notification Service (ENS) Be notified in real time about patient visits to the hospital Query Portal Search for your patients prior hospital and medication records Direct Secure Messaging Use secure instead of fax/phone for referrals and other care coordination 47

48 Notification of Intent to Change EHR Vendor FIHN requests adequate notification from practices of their intent to change EHR vendors facilitating timely abstraction of quality measures requirement FIHN is a participant in the decision FIHN is a participant in the setup/design process Change at the start of the calendar year is preferable Access to prior system is required by CMS for at least 7 years 48

49 PCP Meeting Attendance Requirements 49

50 PCP Meeting Attendance Requirements FIHN Board of Managers approved new annual PCP meeting attendance requirements During the course of the calendar year, PCPs must attend: 1 All Provider meeting 1 PCP POD meeting 1 additional meeting of the PCPs choice All Provider or PCP POD Total of 3 meetings required annually All Provider and PCP POD offer more schedule flexibility in selecting which meetings to attend (8 opportunities) Very important and PCP-specific information covered in PCP POD meetings helpful for FIHN performance 50

51 50% Savings Payor FIHN Shared Savings Distribution Methodology 80% 50% Savings to FIHN 20% FRHS Administrative Services Fee (At Risk) Shared Savings to Network Providers $ FIHN Infrastructure Cost repayment, Administrative Services Fee CIN costs covered include: 50% 25% 25% PCPs Specialists Hospital IT Systems and Analysts Medical Director, Operations Dir. Legal/Compliance/Consulting Quality and Service Reporting Budgeting/Finance Contracting Facilitating timely extraction of quality measures (required to receive any payment) (40%) Citizenship Attending meetings 3 total 1 All Provider 1 PCP Pod 1 of either (60%) Attribution total number of attributed patients Facilitating reporting of quality measures or transition to PCP (required to receive any payment) (40%) Citizenship Attending meetings 2/4 All Provider (60%) Number of unique patient encounters Tiered weight by specialty (100 / 75 / 25) Quality/Utilization Transitions, Inpatient and ED Care Management Benchmarks: MSSP ACO ratings, Milliman or AHRQ/other

52 Risk/HCC Coding Tip: HCC 21 Protein-Calorie Malnutrition 52

53 Protein-Calorie Malnutrition Protein-Calorie Malnutrition is an HCC (Hierarchical Condition Category) that can increase your overall risk score when coded appropriately (HCC 21; RAF ~0.731) Look for a low BMI (generally BMI <18; unintended weight loss of >10%), especially in the following disease states: Cancer Liver Disease (includes alcoholic) Chronic Kidney Disease Drug Abuse May be acute or chronic (>3 months); can be influenced by various social or environmental factors 53

54 Protein-Calorie Malnutrition Must identify 2 or more of the following: Insufficient energy intake Weight loss Loss of muscle mass Loss of subcutaneous fat Localized or generalized fluid accumulation that may sometimes mask weight loss Diminished functional status as measured by hand grip strength 54

55 Protein-Calorie Malnutrition The diagnosis is often made in conjunction with a dietary consult to confirm the diagnosis and assess the degree of the nutritional deficit (severe vs. non-severe). ICD-10 codes for Protein-Calorie Malnutrition include: E44.1 E44.0 E43 Mild Moderate Severe 55

56 Medicare Patients with BMI > 40 Recorded and no diagnosis of Morbid Obesity (%) NextGen Practice Name 1/1/17-8/27/17 Center for Breast Care 93% 33% Frederick Urology Specialists 86% 58% Immediate Care 86% 64% MHP Endocrine & Thyroid 1% 0% MHP Internal Medicine Associates 23% 8% MHP Sleep Medicine 5% 0% MHP Pain & Supportive Care 50% 0% MHP CARE Clinic -- 75% Orthopaedic Specialists 55% 48% Parkview Medical Group 26% 12% Surgical Specialists 35% 0% Union Bridge 32% 0% Middletown Valley Family Medicine 73% 60% Frederick Gastroenterology Associates 37% 6% Cardiovascular Specialists of Frederick 34% 13% Frederick Internal Medicine & Endocrinology Services 36% 7% 8/28/17-11/26/17 Sibte Kazmi 56 57% 46% Great Improvement! *2017 NextGen Data All Providers have opportunity!

57 2018 Meeting Schedule 57

58 2018 Meeting Schedule All Provider FMH Classrooms 1 & 2 February 21, 2018 (PM) May 9, 2018 (AM) August 22, 2018 (PM) November 14, 2018 (AM) PCP POD Crestwood 6pm-8pm January 25, 2018 April 5, 2018 July 26, 2018 October 25,

59 2018 Meeting Schedule Super User POD Crestwood 12pm-1:30pm March 21, 2018 June 20, 2018 September 19, 2018 November 14,

60 Wrap-Up/Adjourn 60