What to Expect in Next Year & Developing Your ACO Action Plan
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1 What to Expect in Next Year & Developing Your ACO Action Plan Welcome The webinar will start at 3:00 pm ET. It is interactive, so please make sure that you have connected via phone with your audio pin. Call in information is shown on your dashboard, right side of screen.
2 Agenda 1.Introductions 2.Housekeeping 3.Presentation 4.Q & A 5.Follow up
3 Housekeeping 1. Panelists will present for approximately 40 minutes 2. Q&As will take the remainder of the 1 hour Submit anonymous written questions using the Q/A tab (not chat) on dashboard 3. Webinar is being recorded Slides and recording will be available at
4 Today s Presenters Kris Gates, Health Endeavors Kris Gates, CEO of Health Endeavors, is the primary architect of the Health Endeavors software product suite. The primary web based software product suite includes Conflict of Interest, Contract & Entity Manager, Non Monetary Comp Tracker, Physician Hours Manager, Survey & Assess Tool and Training Center. In addition, Health Endeavors spearheaded the effort to develop software specifically for the Medicare Shared Savings Program (MSSP) ACOs, including an ACO Claims Data Center, GPRO Tool, NPI Ticker and Population Analytics. She earned her juris doctor from Creighton University School of Law with cum laude recognition. In addition to her software product development experience, Ms. Gates has provided legal services in private practice and served as corporate counsel to several large nonprofit healthcare systems, including Banner Health, Alegent Health and Norton Healthcare.
5 Kris Gates, Health Endeavors 5
6 Primary Care Only Primary Care + Specialists Primary Care + Hospital Primary Care + Hospital +Home Health Hospital Based Patient History & Demographics Geography Management Structure Past Experiences Single EMR Multiple EMRs 6
7 Best Practices + Unique Decisions =Your ACO Strategy 7
8 8
9 Initial Patient Attribution List Is the Patient Count Right? PECOS NPI Assign Primary TIN & Provider Quality Measures Accountability Financial Accountability Arms Around Population September 15,
10 Patient Population Attributed Non-Attributed Data Sharing Preferences Get Claims Data Office Encounters Mailings Medicare Telephone Encounters Office Encounters & Non-Attributed September 15,
11 TIN Add/Remove Management Add Remove Termination of Contracts Quality Measures Accountability GPRO Reporting on Quality Measures PQRS Incentive/Penalty Recruitment September 15,
12 Quality Measures Plan for each Facility/TIN/Practice How to Educate on GPRO Measures? How to Track? How to Report? How to achieve the goal benchmarks? September 15,
13 EMR Gap Analysis Monthly Gap Analysis TIN Progress (Completion) Goals EMR Captures vs. Manual Abstraction GPRO Reporting Plan Year Round 8 Week Reporting Period (January March, 2015 September 15,
14 Claims Data Individual Patient Data for TINS/Practices/Facilities Population Population Management Claims Reduction Program Facility/TIN/Practice Notifications Newly Diagnosed Admits Discharges ER Visits MRI/CT September 15,
15 Financial Analytics/Benchmarks TIN & ACO Progress Reports Quality Measures Accountability Financial Accountability Expenditures Training & Communications Providers Office Staff ACO Management Team September 15,
16 Provider Participation Staff Engagement Provider Engagement Compliance & Conflict of Interest Compliance Plan Training Annual Conflict of Interest September 15,
17 Patient Engagement Care Plans Goals Disease Group Education Discharge & Admission Notification Follow-up Care Instructions September 15,
18 CAHPS (Patient Surveys) Public Reporting Guidance Service-Payment/sharedsavingsprogram/ACO- Public-Reporting-Guidance.html September 15,
19 NPI Annual Update Provider/Supplier Annual Update September 15,
20 Get your arms around Patient Population Who is sharing data? Where are they? Use your Claims Data for GPRO! Who are they? Who is treating them? 20
21 Point of Care Notices August 2013 TOTAL ACO PATIENTS % OF POC NOTICES GIVEN # CARE MGT PATIENTS % % % % 0 Family Practice % 186 Internal Medicine % 195 Gastroenterology % % % 539 Internal Medicine 1 Neurology 1 Internal Medicine 2 Cancer Care 1 Family Practice 2 TOTAL 21
22 Get your arms around Patient Population In-Network/Out-Network Migration 22
23 Quality Measures (GPRO) Plan 33 Measures 22 GPRO September 15,
24 ACO # Measure Title Method of Data Submission P4P Phase-in PY1 P4P Phase-in PY2 P4P Phase-in PY3 12. Medication Reconciliation 13. Falls: Screening for Future Fall Risk 14. Influenza Immunization 15. Pneumococcal Vaccination for Patients 65 Years and Older GPRO Web Interface GPRO Web Interface GPRO Web Interface GPRO Web Interface R P P R P P R P P R P P 16. Body Mass Index (BMI) Screening and Follow-Up GPRO Web Interface R P P 24
25 Quality Measures (GPRO) Plan R Report P - Perform September 15,
26 ACO # Measure Title Method of Data Submission P4P Phase-in PY1 P4P Phase-in PY2 P4P Phase-in PY3 17. Tobacco Use: Screening and Cessation Intervention GPRO Web Interface R P P 18. Screening for Clinical Depression and Follow-Up Plan GPRO Web Interface R P P 19. Colorectal Cancer Screening GPRO Web Interface R R P 20. Breast Cancer Screening GPRO Web Interface R R P 26
27 22 GPRO Measures 15 Modules 27
28 1 Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility (CARE-1) 2 Falls: Screening for Future Fall Risk (CARE-2) 3 Coronary Artery Disease (CAD) 4 Diabetes Mellitus (DM) 28
29 5 Heart Failure (HF) 6 Hypertension (HTN) 7 Ischemic Vascular Disease (IVD) 8 Preventive Care and Screening: Screening Mammography (PREV-5) 29
30 9 Preventive Care and Screening: Colorectal Cancer Screening (PREV-6) 10 Preventive Care and Screening: Influenza Immunization (PREV-7) 11 Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older (PREV-8) 12 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow- Up (PREV-9) 30
31 13 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (PREV-10) 14 Preventive Care and Screening: Screening for High Blood Pressure (PREV-11) 15 Preventive Care and Screening: Screening for Clinical Depression and Follow- Up Plan (PREV-12) 31
32 22 GPRO Measures 15 Modules 32
33 GPRO & Claims Data? Use your Claims Data for GPRO! September 15,
34 Use your claims data to flag CPT, ICD9 and G-Codes to (i) assist providers in completing Quality Measures; and (ii) locate the applicable medical record by NPI 34
35 EMR & Chart Gap Analysis Not on Chart (EMR) Can t Report September 15,
36 EMR & Chart Gap Analysis ACO Capabilities? Each TIN Capabilities September 15,
37 GPRO in 8 Weeks (January 27-March 21) Manual Chart Data Abstraction (Pull Charts) Key individual Chart Data to CMS GPRO Portal Time Consuming CMS GPRO Portal limited to 15 users Plan your registration for IACS/QNET Access (IRS Letter) Additional Staff Intensive Short Time Frame to Complete No time to review data accuracy & completeness 37
38 GPRO in 8 Weeks (January 27-March 21) Manual Chart Data Abstraction (Pull Charts) Key individual Chart Data to Excel Convert Excel to CMS XML Format XML Import to CMS GPRO Portal Time Consuming Plan your registration for IACS/QNET Access (IRS Letter) Additional Staff Intensive Limited Technology Needed for Excel Setup/XML Conversion Short Time Frame to Complete No time to review data accuracy & completeness 38
39 GPRO in 8 Weeks (January 27-March 21) Manual Chart Data Abstraction (Pull Charts) Key individual Chart Data to Electronic Reporting Tool Convert Electronic Reporting Tool Data to XML XML Import to CMS GPRO Portal Additional Staff Intensive Locate vendor for Electronic Reporting Tool Short Time Frame to Complete Limited time to review data accuracy & completeness 39
40 8 Week - Electronic Reporting Tool unlimited users central TIN data repository track completion progress daily CMS XML Data Imports to review data 40
41 GPRO in 8 Weeks (January 27-March 21) EMR Data Abstraction to XML or Excel File XML Import to CMS GPRO Portal Advanced Technology Needed Data Abstraction/XML Conversion Short Time Frame to Complete Very limited time to review data accuracy & completeness Not able to abstract all data from EMR need staging area for integration of EMR and manual abstraction 41
42 GPRO Year Round Manual Chart Data Abstraction (Pull Charts) Key individual Chart Data to Excel Review Excel Data Abstractions Time Consuming Additional Staff Intensive Difficult to review data accuracy & completeness using Excel Excel not a central repository without technology 42
43 GPRO Year Round Office Encounter - key patient data to Electronic Reporting Tool Convert Electronic Reporting Tool Data to Central Repository Locate vendor for Electronic Reporting Tool & Central Repository Allows time to review accuracy and completeness of data Central Repository Track Provider Progress 43
44 YEAR ROUND - Electronic Reporting Tool unlimited users central TIN data repository track completion progress real time data review process 44
45 GPRO Year Round EMR Data Abstraction to acceptable vendor file format Import EMR Data to Electronic Reporting Tool Convert Electronic Reporting Tool Data to Central Repository Locate vendor for Electronic Reporting Tool & Central Repository Allows time to review accuracy and completeness of data Central Repository Track Provider Progress Achieve Performance Year Round 45
46 YEAR ROUND - Electronic Reporting Tool unlimited users central TIN data repository track completion progress real time data review 46
47 YEAR ROUND - GPRO & Claims Data? Remember - Use your Claims Data for GPRO! September 15,
48 Use your claims data to flag CPT, ICD9 and G-Codes to (i) assist providers in completing Quality Measures; and (ii) locate the applicable medical record by NPI 48
49 Get Claims Data Get & Use Claims Data September 15,
50 How you GET IT 50
51 51
52 Get your arms around Patient Population Who is sharing data? Where are they? Use your Claims Data for GPRO! Who are they? Who is treating them? 52
53 Determine initial method to collect patient preferences to submit via MFT Portal in XML Format: Mail Encounters How will you electronically (initial and changes) process print documents? Office Encounters How will you electronically (initial and changes) process office encounters? Medicare Encounters How will you electronically process the information communicated by the patient to Medicare? (initial and changes)
54 54
55 Covers the following topics: Overview Required Testing of the MFT XML Transfer Process Accountable Care Organization (ACO) to ACO-Operating Store (ACO-OS) Beneficiary Data Sharing Request File ACO to ACO-OS Beneficiary Data Sharing Preferences File ACO-OS to ACO Monthly Beneficiary Data Sharing Status File ACO-OS to ACO Error File 55
56 Declining to Share Personal Health Information (Y/N and Mechanism of obtaining Preference) (Y/N) Y Beneficiary notified and has not declined sharing claims data N Beneficiary notified and does not agree to sharing claims data (Signed form to decline) Mechanism R = Response to 30 day letter N = No response to 30 day letter O = Decision via Office Visit
57 Data Sharing Preferences File 1 st file option) upload (text Check for Errors in MFT Portal download the CMS response file (5 minutes or less) (text file option) Data Sharing Request File 2 nd upload (text file option) Check for Errors in MFT Portal download the CMS response file (5 minutes or less) (text file option)
58 In your download look for Response Code: Must be 00 to be success. 00 Success 5 System Exception 10 Record level ICD validation failed 11 Record count does not match trailer 12 Header record missing/invalid 13 Trailer record missing/invalid
59 Use the templates provided by CMS and create an XML file to populate with the required patient information and data sharing preferences noted above.
60 Header Month, Year File Creation Date ACO Program HICAN (validate all patient data against attribution list) First Name Middle Name (leave blank if unknown) Last Name DOB Gender ACO ID Encounter Date Data Sharing Preference (Y/N) Substance Abuse Preference (Y/N) Beneficiary Data Sharing Mechanism (R/N/O) Substance Abuse Sharing Mechanism (R/N/O) Trailer Month/Year File Creation Date Record Count (needs to match the number of patients you submitted or rejected)
61 Header Month, Year File Creation Date ACO Program HICAN (validate all patient data against attribution list) First Name Middle Name (leave blank if unknown) Last Name DOB Gender ACO ID Encounter Date Data Sharing Request (Y/N) Trailer Month/Year File Creation Date Record Count (needs to match the number of patients you submitted or rejected)
62
63 63
64 (ext. 200) 64
65 Questions? Submit anonymous written questions using the Q/A tab (not chat) on dashboard If you did not have a chance to ask a question today or have new questions, please send to info@naacos.com.
66 Speaker Kris Gates
67 Upcoming Next webinar in series for new 2014 ACOs on February 4: Getting Your Arms around the Attributed Population Speaker: Kris Gates 2014 Spring Conference: April in Baltimore Register now! Slides and recording of today s webinar will be posted on our website, by tomorrow. Check back to our website for future webinar series and conference information
68 Thank You! Thank you for attending today s webinar! Consider joining NAACOS The ACO and Business Partner applications can be found at
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