Introduction to the GLPTN Program. Provider Office & Physician Organization Briefing

Transcription

1 Introduction to the GLPTN Program Provider Office & Physician Organization Briefing

2 What is the GLPTN? The GLPTN is one of 29 Practice Transformation Networks (PTNs) funded under the brand new CMS Transforming Clinical Quality Initiative (TCPI). The GLPTN is a 3 state consortium made up of 32 healthcare partners in Indiana, Illinois, and Michigan. Aim: Support organizations through healthcare quality compliance, transitions to value-based care, and engaging patients to be responsible healthcare consumers. Utilize Quality Improvement Advisors (QIAs) to coach providers through the CMS Innovation Center s five phases of practice transformation. Altarum Institute is the lead organization for the State of Michigan, in partnership with McLaren Health System, the Michigan Center for Rural Health, Upper Peninsula Health Care Solutions, and Wayne State University Physician Group. The PTN program is a 4 year initiative, running from October

3 Who is eligible to participate? Exclusion Criteria Providers cannot currently be participating in: Pioneer ACO or Medicare Shared Savings Program Multi-Payer Advanced Primary Care Program (MiPCT in MI) Comprehensive Primary Care Initiative (none currently in MI) More than one CMS-funded PTN Eligibility: Primary and specialty care physicians, nurse practitioners, physician assistants, and their respective ambulatory practices Depending on setting and QI measures chosen, some Clinical Social Workers, Clinical Psychologists, or Therapists may be eligible Providers must see Medicare and/or Medicaid patients Similar to PQRS eligibility FQHC, RHCs, Health Depts., and Pediatricians are eligible even if they don t participate with PQRS

4 What s happening in Year 1? Fall 2015 Fall 2015 Spring 2016 Spring Summer 2016 Summer Fall 2016 Program Launch Enroll Providers Finalize QIA Transformation Toolkit, quality improvement interventions, and CME/MOC options Engage with enrolled practices Meet your QIA Identify Quality Improvement Goals Complete preassessment to determine current phase of transformation Begin receiving direct support from assigned QIA

5 What will TA services include? Key GLPTN Components under development: Alignment of GLPTN Quality Improvement focus areas with existing incentive and reporting programs Customized consulting support to be delivered by QIAs Quality measure specific tools, resources and best practices Tools and TA to assist practice with participation in PQRS Tools and TA to assist practice to establish a Chronic Care Management program and leverage new Medicare billing codes Workflow evaluation and coaching to improve office and clinical efficiencies Practices and procedures for optimizing EHR use for data driven quality improvement Knowledge & education resources to help providers to understand upcoming reimbursement changes (MIPS 2019) Development of a CME/MOC Part IV program on Medication Adherence Coordination with SANs to understand offerings and support available for PTN participating providers

6 What are the main GLPTN QI Measures? Medication Management Controlling High Blood Pressure Anticoagulation Therapy in Patients with Atrial Fibrillation Unnecessary Testing Advanced Diagnostic Imaging Esophageal-Gastric-Duodenoscopy (EGD) Colonoscopy Prevention Influenza Vaccination Rates Behavioral Health Depression Screening and Follow up Chronic Disease Management Diabetes Chronic Obstructive Pulmonary Disease (COPD) Congestive Heart Failure (CHF) Reducing Preventable Hospitalizations

7 What will be expected of participants? At the organization or practice level: Dedicate timely resources to the project Designate a point of contact and internal QI champion Regularly communicate with your assigned QIA Participate in the completion of an initial readiness assessment and continuous measurement and assessment of practice advancement through the phases of transformation Actively participate in transformational activities and progress through the CMS Phases of Transformation Participation in PQRS, if eligible Participation in the Value-Based Modifier Program Agree to and facilitate sharing of aggregate data on selected quality measures, to be reported quarterly

8 What are the CMS Phases of Transformation? Phases Description Sample Milestones 1. Setting Aims 2. Generating Improvements 3. Achieving Aims 4. Benchmark Status 5. Demonstrating Improvements Full leadership support Integrates planned care model Uses data to understand practice flow Acquires core population health capabilities Produces real-time reports Shares outcomes with PTN Agreements for integrated specialty care Track patients receiving outside services Optimized care team Utilizes health IT for pop. health mgmt. Obtains patient feedback Demonstrated QI measure improvement Patient risk stratification Demonstrated care coordination and patient population mgmt. using panels Provides patients with community resources Integrates advanced access Knowledge of community health status Documented substantial improvements Eligible clinicians have met Meaningful Use Detailed transformation plan Self-assessment and baseline data Train 50% of staff in QI Plan for patient engagement Capture and analyze QI metrics ID community partners Defined improvements in HIE Implements at least 3 care mgmt. strategies Care mgmt. for 50% of highest risk patients Incorporates Plan-Do-Study-Act QI cycles Reduced unnecessary tests/hospitalizations by 15% from baseline Involved patients in QI Routine, external HIE Increased rates of screenings and completed referrals Reduced unnecessary tests/hospitalizations by 25% from baseline Care mgmt. for 90% of highest risk patients Track patients receiving outside services Process to link patient to care provider Sustained improvements for 1 year Developed acumen in payment models

9 Benefits for Rural Healthcare Providers Customized one-on-one support from a Quality Improvement Advisor (QIA) to help meet your clinical quality improvement and reporting needs and assist with: Optimizing EHR use Reporting and monitoring quality improvement data Workflow optimization Using Lean and Six Sigma to improve practice operations

10 Value Proposition Rural Health Care Providers Targeted expertise and technical assistance provided to clinics/practices at no cost to help address and alleviate some of the common barriers that rural healthcare providers face.

11 Next Steps - How does enrollment work? There is no participation fee for receiving GLPTN services. CME/MOC Part IV program may also be offered at no cost. To enroll: Complete Letter of Participation and Provider Detail Spreadsheet Submit to Brittany.Henderson@altarum.org Altarum will verify eligibility of providers, with follow up communications as necessary After eligibility is verified & enrollment is complete, providers spots are secured Up to 4,000 providers will be enrolled QIAs will conduct initial visits starting in Spring 2016.

12 Contact Us Best method is to send an GLPTN website coming soon!