Enhanced Personal Health Care Program

Transcription

1 Enhanced Personal Health Care Program Documents included in the Recruitment Packet: Program Summary FAQ Checklist List of Program Information Form Questions Member Medical History Plus (MMH+) access form Key Contact Form 1

2 ENHANCED PERSONAL HEALTH CARE Program Summary Today s health care system is highly fragmented, is based on episodic intervention, and shows inconsistent adherence to evidence-based guidelines. The Enhanced Personal Health Care Program aims to change that by empowering Primary Care Physicians (PCPs) to engage in those comprehensive primary care functions that move us toward a coordinated, evidence-based care model and have the greatest impact on achieving the triple aim of improved quality, patient experience and affordability. Specifically, this Program will provide you with the tools and resources that allow you to do what you do best: manage all aspects of your patients care. This includes: providing meaningful and actionable information that supports proactive management of your patients, such as providing reports that identify patient-specific preventive screening needs, opportunities for generic prescription use, and when and why your patients visit the emergency room. making resources such as MMH+ available to give you up-to-date, comprehensive, clinical information regarding care provided to your patients. Access to BCBSGa support roles (as described in Section 2 of the Program Description) who are able to support your practice improvements in the areas of medical home transformation and care coordination. The Enhanced Personal Health Care Program will also move from volume to value based payment in order to reward you for improving the health of your patients and provide compensation for non-visit based clinical interventions, such as care planning, that have a positive impact on patient outcomes and cost. Ultimately, and most importantly, by providing you with the right tools, resources and financial rewards, this Program hopes to allow you to improve the health care experience of your patients by: becoming their health care champion and helping them navigate through the complex health care system. making them active participants in their health care through shared decision making. partnering with them to optimize their health. improving the affordability of health care. For a more complete description of the Program, access the Program Description available on our BCBSGa provider webpage at - BCBSGa Enhanced Personal Health Care. 2

3 ENHANCED PERSONAL HEALTH CARE PROGRAM FREQUENTLY ASKED QUESTIONS Why should I agree to be part of this Program? We believe the doctor-patient relationship is the most important in healthcare. It is essential to improving quality and outcomes and, subsequently, lowering costs. We recognize that we need to join with you and your team to provide tools and information to make it easier for you to manage and coordinate care for your patients. As the quarterback for patient care, PCPs have the unique opportunity to shape the future of health care through participation in initiatives like the Enhanced Personal Health Care Program which demonstrate the PCP and the PCP care team s ability to increase quality of care while containing costs. BCBSGa is making a significant investment in primary care to help doctors do what they do best: manage all aspects of their patients care. Although there is growing broad-based support for an Enhanced Personal Health Care model, BCBSGa understands that this shift will not just happen. Rather, it requires a concerted effort and active support from all key stakeholders in the delivery system to create an environment conducive for change. Our investment will assist you in not only meeting your current patient demand, but with meeting the goal of providing the best possible care. BCBSGa understands how this may be difficult in a fast paced environment where you do not always have access to tools, information and resources that could support your efforts. BCBSGa will help change that by making resources available that will assist you in providing the best, most comprehensive, care possible to your patients, optimizing their health, and minimizing avoidable admissions and emergency room visits that drive unnecessary costs. This investment includes: a redesign of current payment models to align financial incentives and provide compensation for important clinical interventions that occur outside of a traditional patient encounter; support for risk stratified care management through the identification of high risk patients who are in need of care delivery services; the sharing of meaningful information regarding patients that goes beyond the information captured in the primary care physicians medical record; and providing primary care physicians and their care teams with the knowledge, information and tools they need to leverage the benefits of new payment models, support services and information exchange to transform the way they deliver care. PCPs who participate in the Program will not only receive support, tools, reports and information to improve their ability to manage their patient populations, but they may also receive financial reimbursement that will help practices fund their transformation. Practices that are successful in maintaining or exceeding certain quality levels while reducing costs will also be eligible to receive a share in the associated savings. How does my compensation change under this Program? As mentioned above, PCPs in the Program are eligible to receive additional reimbursement. Compensation details are outlined in Appendix B and Appendix C of the Enhanced Personal Health Care Program Participation Attachment (the Attachment ). 3

4 How can I find out more information about the Program? Additional information regarding the Program is available in the Program Description, which can be accessed at the following web page location: BCBSGa Enhanced Personal Health Care Webinars are also available to provide you with a comprehensive overview of our Enhanced Personal Health Care Program. Information on Webinar dates and times can be found at the bottom of this packet. If I want to speak with someone about the Program, who should I contact? For questions regarding the Program, please contact your local network management representative. What do I need to do to become part of the Program? The enclosed Practice Enrollment Checklist details the steps that need to be followed to become part of the Program. This includes: Completing the online Program Information Form. Completing the MMH+ Access Form Completing the Key Contact Form Completing the registration of your practice with Availity Executing the BCBSGa Agreement that includes the Program Attachment Sending all executed and completed documentation to the address on the Practice Enrollment Checklist. Where do I send the information? As noted on the Practice Enrollment Checklist, send the required documents to: BCBS of Georgia Attn: Payment Innovation Director Mail Stop GAG Peachtree Rd, NE Atlanta GA Do I have to respond to the online 2Program Information Form? Yes. The Program Information Form must be completed for each practice location as part of the contracting process for the Program. This form provides us with important information about your practice which will help us understand how to best collaborate with and support your practice. Please note, however, that we only need one form completed for each location, so a practice should designate a single individual to complete the form for each practice location. In order to make it easier for you to complete the form, we ve included a list of the questions asked in the Program Information Form in these materials. We recommend that you review these questions before you or your designated practice representative access the online form to ensure that you have all the necessary information available. What can I expect after I send the required documents to BCBSGa and complete the online form? Once you send all necessary information to complete the contracting process, the following will occur: BCBSGa will send you a welcome letter and a copy of the completed Amendment. 4

5 You will also receive a separate notice to confirm when your MMH+ login is available for use. Program updates will be available via the BCBSGa provider website. These updates will include dates for informational events regarding the Program. Your practice will also begin to receive outreach from Program resources that are available to support and collaborate with you to help you achieve successful outcomes and reach program goals. These resources are described in further detail in Section 2 of the Program Description. Are there any preconditions to participation? Yes. The preconditions to participation are that the physician is participating with BCBSGa, is a Primary Care Physician, and is in good standing with BCBSGa. What is expected of me and my practice if we participate in this Program? The basic Program requirements are located in Appendix A of the Attachment, and additional obligations of the practice are outlined in Article IV of the Attachment. What can I expect from BCBSGa? As outlined in Article III of the Attachment, BCBSGa will provide additional reimbursement to participating physicians. In addition, BCBSGa will provide support for a practice s patient-centered transformation activities by making tools and resources available via the Provider Practice Toolkit, establishing new roles at BCBSGa to work directly with practices to help address transformation needs, and providing extensive reporting that will facilitate a physician s ability to manage his/her patient population. Additional BCBSGa responsibilities are outlined in the Program Description. Which physicians are eligible to participate in the Program? The physicians who are eligible to participate in the Program are participating BCBSGa physicians who are board-certified or board eligible, who are participating and in good standing with BCBSGa, and whose primary specialty is General Practice, Family Practice, Internal Medicine, Geriatrics, or Pediatrics. Are all PCP practices required to join the Program? No. The Program is an optional program. PCP practices are not required to join. Do all PCPs in our practice need to participate? Yes, the participation will be at the group level. If it is decided to participate in the Program, then all PCPs in the practice will need to participate. What happens if I do not join? Nothing. Your practice will continue to see BCBSGa patients under your existing provider agreement. Do I have to have NCQA PCMH 2011 recognition to be part of the Program? No. While having NCQA PCMH recognition is preferred because the program supports the elements of population health management, it is not a requirement for participation in the Program. 5

6 Do I need an electronic health record (EHR)? No. Although an EHR is highly recommended, you are not required to have an EHR to participate in the Program. It is, however, expected that a practice utilize registry functionality either on paper or through the use of a software program in order to manage their patient population. How do I access the Enhanced Personal Health Care Reports? Primary Care Physicians will need to obtain access to Availity to access the reports. What is Availity? Availity, one of the nation s largest electronic health information networks, will be the access point to the Enhanced Personal Health Care Program. Primary Care Physicians contracted and enrolled in this Program will access, with a single sign-on. Why do I need to use Availity? The Enhanced Personal Health Care Program requires the meaningful exchange of health information. We will give you access to meaningful, actionable information about your patients who are Covered Individuals with BCBSGa. Availity is our primary means of delivering that information to you. Here are examples of the regular reports which will be made available through the Enhanced Personal Health Care Program link via Availity: Hot Spotter Report Inpatient Authorization Report Emergency Room Report Care Opportunity View Report Attribution Detail Attribution Report- Inactive/No Longer Attributed Is there a cost for Enhanced Personal Health Care contracted physicians to access Availity? No. Availity is a web-based, real-time tool that will allow contracted providers free access to their reports. How do I get started? To register for access to Availity, providers can go to Availity s website at and click on Register Now, and then follow the registration wizard. During the registration process, you will need to identify a Primary Access Administrator (PAA), who is a person who will be primarily responsible for granting and maintaining Availity access to users within your organization. The PAA must have an active Availity user account. Upon registration, the PAA will receive an from Availity with a temporary password and next steps. The PAA will log in to Availity to grant end user access and begin accessing reports. Once enrolled, shortly after your effective date, you will need to complete the second step of the Availity registration process. A link will be available on Availity called Enhanced Personal Health Care Programs ; this link is where reports related to your practice will reside. The information to complete this second step will be available in your welcome packet. 6

7 What is MMH+? Why should I use it? MMH+ is our Members Medical History Plus tool that combines our rich claims-based data with lab results from our contracted reference lab partners to create a longitudinal record giving physicians visibility to the health care services received by their patients, whether received within or outside their practice or whether prescribed by them, another physician or received by the patient on self-referral. Having access to more complete information (e.g., specialty visits, prescription medications, etc.) than what may be contained in the medical record maintained by the physician is instrumental for care coordination and management. Physicians participating in the Program are required to use the MMH+ tool as indicated in Appendix A of the Attachment. I currently use CareProfile on Availity. What is the difference between MMH+ and CareProfile? CareProfile provides very similar information as MMH+. A key difference is that MMH+ offers details on care management and utilization management activities for patients, and soon it will also include patientspecific disease management information. How will I know which patients I m responsible for managing? You will be responsible for managing your panel of patients. We will identify these patients by their selection of you as their primary care physician or, for products that do not require PCP selection, through our claims data using our attribution logic. We will provide a list of Covered Individuals that, according to our information, are part of your patient panel and included in covered products. Further details associated with this process are outlined in Section 6 of the Program Description. When will I first be paid? Reimbursement under the Program will be provided according to Appendix B of the Attachment as well as under Appendix C of the Attachment. Further details are also provided in Section 8 of the Incentive Program section of the Program Description. How will shared savings work? The practice will have the opportunity to share in the savings achieved under the Incentive Program. The amount a practice qualifies to receive is determined by the level of quality and cost-efficient utilization achieved as well as the total amount of savings calculated during the measurement period. Details regarding the Incentive Program are outlined in Section 8 of the Program Description. Is shared savings calculated at the level of each physician practice or some other basis? Cost targets and the evaluation of achieved savings are calculated at the Medical Panel level. BCBSGa will calculate the percentage of savings that you are eligible to receive at the physician group level based on how your group performs on the Program scorecard. The Program scorecard is discussed in Section 5 of the Program Description. A Medical Panel is a single physician practice or a grouping of separate practices (depending on the number of BCBSGa Covered Individuals attributed to a practice) that is used for the purpose of calculating statistically meaningful medical cost targets, shared savings, and utilization performance targets. Details regarding medical panels are outlined in Section 8 of the Program Description. 7

8 Will these medical panels be formed only for the purpose of administering the shared savings or will they serve other purposes? The medical panels will be formed for the purpose of administering the Incentive Program; however, they will also be used to facilitate learning and collaboration across physician groups regarding the delivery of patient centered care. Are there quality standards that physicians and their teams need to meet? Yes. The Program scorecard is comprised of 29 clinical quality measures and 3 utilization measures. These measures are used to establish a minimum level of performance and to encourage improvement through sharing of information and will also serve as the basis for Incentive Program savings calculations. The scorecard also allows for credit to be earned if a group has NCQA Patient Centered Medical Home (PCMH) recognition; however, NCQA recognition is not required under Program and there is no penalty to groups that do not have such recognition. Please refer to Section 5 of the Program Description, for a complete list of the quality measures. In summary: Clinical quality measures for the Program are grouped into two categories: (1) acute and chronic care management and (2) preventive care. These measures cover care for both adult and pediatric populations. Nationally standardized specifications are used to construct the quality measures in conjunction with Plan data. Utilization measures focus on appropriate emergency room (ER) utilization, management of ambulatory-sensitive care conditions as measured by hospital admissions, and generic dispensing rates for a select set of drug classifications. As with the clinical metrics, administrative data are used to construct the utilization measures. Performance on the selected Program clinical quality and utilization measures will be reported to the practice on a quarterly basis. The assessment of performance to define the proportion of shared savings that the practice earns will be conducted annually. Performance will be calculated for each measure and then results will be rolled into three categorical scores for: Acute and Chronic Care Management Preventive Care Utilization Optional NCQA PCMH recognition The categorical scores will be based on performance relative to different tiers of performance thresholds. Better performance will generate a better score. For example, meeting or exceeding the regional 50 th percentile of performance will score better than meeting or exceeding the regional 30 th percentile. I m participating in a quality incentive program right now. How will this impact my payout? For practices participating in the Program, the Program is intended to replace any existing provider quality incentive program that you or your practice currently participates in with BCBSGa. Your current quality incentive program related rates will stay in effect until the effective date of your practice s participation in the Program. The value of your current quality incentive program payout may either be folded into the Program reimbursement, or will continue until the current payout period is complete. 8

9 What is the ACP Practice Advisor? The American College of Physicians (ACP) Practice Advisor is a web-based application created by the ACP to support Primary Care Physicians and their practices in working on Enhanced Personal Health Care transformation. With a modular framework that aligns with the 2011 NCQA PCMH Recognition Program, the ACP Practice Advisor provides the Primary Care Physician and team with the opportunities for unlimited practice self-assessments and access to a resource library of over 800 entries. Use of the ACP Practice Advisor is not required in order to participate in BCBSGa Enhanced Personal Health Care Program, however the belief is held that ACP Practice Advisor use will favorably impact both the learning and transformation activity curve. The Practice Advisor online tool is a means of providing a self-assessment to practices of all sizes. ACP Practice Advisor includes multiple components that can assist your pursuit of practice improvement, including PCMH recognition. The ACP Practice Advisor s self-assessment tool is called the Practice Biopsy. Each member of your team can complete all or some of the biopsies. Designated staff (Practice Administrator) will be able to see the results of the work and identify areas for possible improvement. In addition, ACP Practice Advisor provides a virtual bookshelf of useful resources that can be filtered to help you quickly find what you need. It provides exposure to a community of users that can provide support to each other throughout their practice improvement journey. The license to use the ACP Practice Advisor is full subsidized by BCBSGa. What is the purpose of ACP Practice Advisor? ACP Practice Advisor was created to help practices of all sizes: Engage in practice improvement Pursue PCMH recognition/certification. Prepare for purchasing/implementing an EHR (good workflow is an essential prerequisite for EHR implementation and ACP Practice Advisor can help with this) Build a new practice from the ground up. In the program description I see that there is a reference to the CPC, what is CPC? Is BCBSGa participating? CPC is an effort by the Centers for Medicare and Medicaid Services ( CMS ) to align multiple payers around select physician practices in specific geographic areas for the purpose of transforming payment and practice redesign. Currently, the BCBSGa markets with participating physicians in the CPC initiative are Colorado (statewide), New York (Mid-Hudson and Capital District region), and Ohio (including the Cincinnati/Dayton region and 4 northern counties in Kentucky). Our practice includes specialists and Primary Care Physicians. Will specialists have the opportunity to participate? We believe primary care practitioners are the foundation of the health care system. For that reason, we designed our program to empower primary care providers to manage the overall health of their patients. That said, under our program in most cases we contract at the organizational level. Any organization, including hospitals, multi-specialty groups or ACOs that include Primary Care Physicians are eligible to participate in our program. 9

10 A core premise of a patient-centered care model is collaboration and coordination between Primary Care Physicians, specialists and other providers involved in the treatment plan of the individual patient. For these reasons, we encourage Primary Care Physicians even those who practice within a group or organization that includes specialists to develop a compact regarding how they will work together with the specialists in their medical neighborhoods. This agreement should describe the ways both Primary Care Physicians and their colleagues in other specialties will support a proactive and coordinated care model and share information in support of that model. In some cases we may not be aware that a medical group comprised of Primary Care Physicians also includes specialist. If you are a Primary Care Physician who practices as part of a larger organization that includes specialists please make sure that we are aware so that we can work with you in a way that allows you to best take advantage of your existing relationships. ENHANCED PERSONAL HEALTH CARE PROGRAM MEDICAL PANELS Formation of Medical Panels As stated in the frequently asked questions section of this packet, Medical Panels can be composed of an individual physician practice or a group of practices. A list of all physician practices selected to participate in the Program is available via the following link BCBSGa Enhanced Personal Health Care. Each Medical Panel must be comprised of practices that collectively reach a statistically significant Attributed Member population. Once the Medical Panel assignments are complete, this information will be available on the secure provider portal. You will have an opportunity to review and submit preference information regarding your Medical Panel assignment at that time. If you are satisfied with your assigned Medical Panel, or you do not submit your preference to us within the timeline indicated on the BCBSGa provider portal, you will remain in your assigned Medical Panel for the duration of the Measurement Period. BCBSGa will make best efforts to consider all preferences submitted in a timely manner; however, we cannot guarantee that all preferences will be accommodated. BCBSGa reserves the right to make all final determinations on Medical Panel formation. General Parameters for Medical Panels Provided below are general parameters related to the formation of Medical Panels under the Program. Specifically, the qualifying thresholds related to Attributed Member populations covered by the Medical Panel will vary to address market-specific variations and needs. The thresholds below are for an example market. 10 A single physician group with more than 7,500 commercial Attributed Members will form its own Medical Panel. Physician groups with Attributed Member populations less than 7,500, but more than the minimum level set by BCBSGa, may form Medical Panels with other participating physician groups. Prior to the start of the Measurement Period, assigned Medical Panels will be posted on our provider portal. Each Medical Panel that is comprised of multiple practices must exceed the 7,500 minimum number of Attributed Members. If a physician group would like to change the assigned Medical Panel to another Medical Panel, a form will be available prior to the Measurement Period to identify

11 this preference. Practices will have a window of time to submit such preferences. After this preference time period is complete. BCBSGa will make final Medical Panel decisions, and the final list will be shown on the provider portal. When multiple physician groups make up a Medical Panel, quality performance will be evaluated at the physician group level and utilization performance will be calculated at the Medical Panel level to determine the Shared Savings Percentage. If one provider group represents a Medical Panel, both quality and utilization performance would be calculated at the single group/panel level. While a single Shared Savings Percentage will be calculated for you, regardless of line of business, the Savings Pool calculations can vary between commercial, Medicare, and Medicaid membership. For commercial membership, such financial reconciliations will always take place at the Medical Panel level. For Medicare and Medicaid, however, calculations will only take place at the Medical Panel level if the total Attributed Members exceed minimum thresholds established for these lines of business. If the number of Attributed Members by line of business is below certain thresholds set by BCBSGa, then the MCTs may be set at the county, region or state level. 11

12 BCBSGa Enhanced Personal Health Care Program Practice Enrollment Checklist Practice Name Please be sure you have completed the following key steps, and return this form with the required documents listed below. Note: Your practice effective date for this Program is dependent on the completion of ALL items in the below checklist. Check when COMPLETED 1. Online Program Information Form was completed for each practice location. Link to the online form: 2. Please see enclosed instructions regarding the completion of the online form as well as the list of questions you will be required to answer online. 2. Completed the MMH+ Access Form. 3. Complete the key contact form 4. Complete the registration of your practice within Availity 5. Execute the Agreement 6. Returned the ORIGINAL executed documents (Amendment, preference form and MMH+ Access Request Process form) to Terry Welch, BCBS of Georgia,Mail Stop GAG , 3350 Peachtree Road, NE, Atlanta GA by January 27, Preference Form and MMH+ can be ed to 7. Completed preference form (Optional). 12

13 We recommend you keep a COPY of these documents for your records. BCBSGa Enhanced Personal Health Care Program Instructions for completion of the Online Form As noted, the online Program Information Form provides us with important information about your practice which will help us understand how to best collaborate with and support your practice. Unfortunately, we cannot accept paper submissions. The form must be completed online to enable us to capture your information in our data base. We will need one form completed for each practice location. So, for example, if your practice has 4 practice locations or offices, you will need to complete a separate form for each location and the responses provided should be specific to that location. For instance, for questions about the number of physicians or nurse practitioners in the practice your answer should be limited to the number of physicians or nurse practitioners who practice at the specific location that is the subject of that form. Note, however, that we only need one form per each practice location. Each physician in the practice does not need to complete the form. Therefore, you should designate one person for each practice location to complete the form. Program Information Form Questions to be completed online Below is the list of the questions found on the Provider Information Form that must be completed online to participate in the Program. Please review the list of questions below so you will be prepared to answer them once you access the form at the link below. NOTE: This form must be completed online. We will not accept responses on paper. Link to the Program Information Form: Program Information Practice Name* 2. Your Name* 3. Your Role/Title 4. Practice{Physical} Address* 5. Practice State* 6. Practice County* 7. Practice Zip Code* 8. Practice Address* a. Provide the PC2 point of contact address to get communications, registrations, and other information to the appropriate individual. 9. Practice Phone Number* xxx-xxx-xxxx 10. Practice 9 digit Tax ID Number (TIN)*

14 Organization Type* 12. Payment Name * a. The Payment Name reflects the name of the entity that should receive any program related reimbursement. 13. Payment Address* a. This could be the physical of EFT address. 14. Payment TIN* a. This reflects the TIN of the entity that should receive any program related reimbursement. 15. Group Practice Name* a. List the Group name you would like listed on the reports and remittance advices you receive. Clinician Information 16. Number of Primary Care Providers in practice at the practice location.* 17. For each Primary Care Provider in the Practice, please provider First Name, Last Name and NPI in the following format: Example David Smith, Please be sure to include the comma separating the name and NPI. 18. Number of Nurse Practitioners and/or Physician Assistants that do not have their own Patient Panel at the practice location.* 19. How many nurses and medical assistants in the practice at the location?* Facility Privileges 20. Number of facilities to which the practice clinicians have admitting privileges.* 21. List the facilities to which the practice clinicians have admitting privileges.* Patient Services 22. On a daily basis, what is the average number of patients seen per PCP at the location?* 23. On a daily basis, what is the average number of patients seen by the providers other than the MD s, DO s, or Advanced Practice Nurses with Independent Practice Privileges?* 24. In addition to the Physician Assistants, Nurse Practitioners, Licensed Practical and Registered Nurses, Medical Assistants, and PCPs, what other roles exist in your practice at the location?* 25. What are your general office hours at the location?* 26. What after hour services does your practice provide at the location? 27. What services are available via telephone to your patients at the location?* 28. What services are available via the internet to your patients at the location?* 29. Is the practice accepting new patients at this location?* 30. Patients call for appointments for a variety of reasons: well visits, rechecks, on-going reoccurring conditions, and ill visits. When a patient calls in for an ill visit, on average, when is the next available appointment time at this location?* 31. What type of patients make up your practice at this location?* 32. Which population makes up the greatest percentage of your practice at the location?*

15 Electronic Health Record (EHR) 33. Do you have an Electronic Health Record at the location?* 34. If not, does the practice plan on getting an Electronic Health Record?* 35. When does the practice location plan on getting the Electronic Health Record?* Registry 36. What population health registry are you currently using?* Meaningful Use 37. Has your practice achieved meaningful use Stage 1 NCQA criteria with the CMS EMR Incentive Program?* 38. What Electronic Health Record is used?* 39. Which version of the Electronic Health Record is being used?* NCQA PCMH Recognition 40. Has the practice location achieved NCQA PCMH recognition?* 41. For practice locations that have not achieved NCQA recognition, does the practice location intend to seek NCQA PCMH recognition at the level 1,2,or 3 recognition level?* 42. If applicable, which level of NCQA PCMH recognition does the practice intend to seek?* 43. If applicable, when does the practice intend to seek NCQA PCMH recognition?* 44. If yes, what level of recognition has been achieved at the location?* 45. Does the practice intend to seek a higher level of NCQA PCMH recognition?* 46. When does the practice intend to seek higher NCQA PCMH recognition?* 47. When does the current NCQA PCMH recognition expire?* 48. Are you a member of a Health Information Exchange (HIE)?* Provider Feedback 49. A programmatic expectation is to have a Care Coordinator who will interact with your Clinical Liaison related to managing high risk members. Have you identified a Care Coordinator?* 50. Is there an area in which you would like to focus for transformation?* 51. Are you interested in utilizing ACP Practice Advisor, a web based tool from the American College of Physicians that supports transformation and achievement of NCQA PCMH recognition. Note: The survey questions may vary slightly over time as BCBSGa is continually working to improve the content for the purposes of this Program. 15

16 BCBSGa MMH+ Access Form BCBSGa s MMH+ system provides Covered Individual-based personal health information to clinicians via the internet. MMH+ provides a picture of the services patients may have received outside of the primary care practice. This information provides a better history of utilization which can then be utilized by the primary care team to develop data informed comprehensive care plans with their patients. Please fill out the information form below and it to GA_PrimaryCareProgram@bcbsga.com. An MMH+ Access Grid will be ed to you. The MMH+ Access Grid indicates all individuals in your practice who should have access to clinical information regarding BCBSGa patients via MMH+. Practice Name Practice TIN Practice Name Practice Person who will fill out access form for MMH+ of person who will be filling out the form Phone number of person filling out the form 16

17 BCBSGa Key Contact Form Please provide the key contact(s) within your practice(s) so that we may begin discussions to identify roles for the transformation process. Establishing roles within your practice to facilitate practice transformation is essential to forming a collaborative team. Name(s) Title Phone Number Individual Address 17