Physician Organization of Michigan ACO. Presented by Jeni Hughes Oakland Southfield Physicians, PC

Transcription

1 Physician Organization of Michigan ACO Presented by Jeni Hughes Oakland Southfield Physicians, PC 1

2 Topics To Cover Background Principles & Structure Quality Measure Requirements & Support Population Management Tools & Focus Future Path for POM ACO Questions 2

3 ACO Background Multiple Shared Savings Models Participation requirements PCPs may participate in only ONE Each TIN/NPI combination under which a primary care physician bills must be exclusive to one ACO only Physician ACO participation entails Move from current Medicare Shared Savings Program (MSSP) model to Advanced Payment Model (APM) Annual automatic renewal 60 day contract term notice provision 3

4 POM ACO Principles & Structure Current participating physician organizations Huron Valley Physicians Association Integrated Health Associates MidMichigan Health Collaborative Care Organization Oakland Southfield Physicians Olympia Medical Services Physicians Organization of Western Michigan United Physicians UM Faculty Group Practice Wexford PHO Visit to learn more 4

5 POM ACO Principles & Structure Visit to learn more 5

6 6 Quality Measure Requirements Patient/Caregiver Experience Care Coordination/Patient Safety Documentation of Current Medications in the Medical Record Fall Risk Preventive Health Influenza Pneumonia BMI Screening and Follow-up Tobacco Use Screening Depression Screening and Follow-up Breast Cancer Screening Colorectal Cancer Screening High Blood Pressure Screening Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

7 Quality Measure Requirements At-Risk Population Depression Remission Diabetes Composite Hemoglobin A1c Eye Exam Hypertension: Controlling Blood Pressure Ischemic Vascular Disease: Use of Aspirin or Another Antithrombotic Congestive Heart Failure: Beta-Blocker for LVSD Coronary Artery Disease: ACE Inhibitor or ARB Therapy 7

8 8 Quality Measure Requirements On-demand quality measure documentation and reporting video available at

9 9 Quality Measure Requirements On-demand information and education available at

10 Population Management Tool OSP POM ACO Aligned Beneficiary Report Monthly aligned beneficiary roster publication Promote physician efforts in routine care management Facilitate PQRS quality measure capture efforts 10

11 Population Management Focus OSP POM ACO Leadership Directives Clinical priorities Utilization drivers Promote annual wellness visits Engage geographically diverse care community 11

12 Future Path & Beyond CMS regulatory changes impact POM ACO Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) Merit-based Incentive Payment Systems (MIPS) Advance Payment Model (APM) [risk-based ACOs] POM ACO MSSP Track 1 non-risk ACO Not APM eligible unless CMS permits Track 1 MSSP qualify 2017 will be a MIPS mandated reporting year MIPS-based reporting year means we are measured as one POM ACO 12

13 Future Path Quality Reporting (GPRO) [50%] Advancing Care Information (ACI) [30%] Cost or Shared Savings [0%] ACO MIPS Score Clinical Performance Improvement Activity (CPIA) [20%]

14 Future Path & Beyond POM ACO Board of Managers summary All ACO participants have their MIPS scores averaged to create ACO MIPS score applied to all participants TINs participating in ACO earn full CPIA credit rather than granting 50% of the available points TINs MUST submit their own information to CMS for Advancing Care Information (ACI) scoring TINs submit at least 90-days of data for the for 2017 (OSP target is submit for full year) MU Stage 3 required by 2018 to maximize the ACI score 14

15 Questions For more information contact: Oakland Southfield Physicians at Jeni Hughes 15