Support from the CMS Innova2on Center for Rural ACOs

Transcription

1 Support from the CMS Innova2on Center for Rural ACOs Hoangmai Pham, MD, MPH Director, Seamless Care Models Group CMS Innova<on Center February 2,

2 Agenda Rural ACOs unique challenges Advance Payment Model ACO Investment Model Transforming Clinical Prac?ce Ini?a?ve 2

3 Rural ACOs face unique challenges. Limited control over constrained supply of providers Limited resources for infrastructure investments Small popula?ons rela?ve to what s needed to comfortably assume financial risk Older, sicker popula?on Physical challenges such as large distances Less access to peer support and learning 3

4 Advance Payment Model Provides par?cipants in the Shared Savings Program (SSP) with advance payments that will be recouped from the shared savings they earn Only open to ACOs entering the SSP in April 2012 or July 2012 Only open to certain types of small ACOs: 1) ACOs that do not include any inpa?ent facili?es AND have less than $50 million in total annual revenue. OR 2) ACOs in which the only inpa?ent facili?es are cri?cal access hospitals and/or Medicare low- volume rural hospitals AND have less than $80 million in total annual revenue. November 6,

5 What we learned Pre- payments do help ACOs invest in infrastructure Trend toward such support being associated with beyer financial performance Revenue caps excluded some rural ACOs with cri?cal access hospitals 5

6 ACO Investment Model The ACO Investment Model provides pre- paid shared savings to MSSP ACOs for staffing and infrastructure that supports popula?on care management, financial management or other essen?al ACO func?ons. November 6,

7 Amount of prepaid shared savings for ACOs that began MSSP in 2012 or ) An upfront, variable payment: Each ACO will receive a payment in the first month equivalent to the number of its preliminary, prospec?vely assigned beneficiaries on its most recent quarterly report mul?plied by $36. 2) A monthly payment of varying amount depending on the size of the ACO: Each ACO will receive a monthly payment equal to the same number of preliminary, prospec?vely assigned beneficiaries used to calculate the first payment above, mul?plied by $6. November 6,

8 ACO Investment Model Eligibility MSSP 2012/2013 starters To be eligible for this round of ACO Investment Model funding, applicants must: The ACO must be accepted into, par?cipate and be in good standing in the Shared Savings Program. The ACO s first performance period in the Medicare Shared Savings Program must have started in either 2012 or 2013 The ACO has completely and accurately reported quality measures to the Medicare Shared Savings Program in the most recent performance year. The ACO has a preliminary prospec?ve beneficiary assignment of 10,000 or fewer beneficiaries for the most recent quarter, as determined in accordance with the Shared Savings Program regula?ons. The ACO does not include a hospital as an ACO par?cipant or an ACO provider/supplier (as defined by the Shared Savings Program regula?ons), unless the hospital is a cri?cal access hospital (CAH) or inpa?ent prospec?ve payment system (IPPS) hospital with 100 or fewer beds. The ACO is not owned or operated in whole or in part by a health plan. The ACO did not par?cipate in the Advance Payment Model. November 6,

9 ACO Selec2on Criteria 2012/2013 MSSP starters Spend Plan Quality Acceptable Good Excep2onal Quality of Care Points (max 8 pts.) Points (max 2 pts.) Met or exceeded the median performance rate compared to all ACOs on 50% of measures 1 Met or exceeded the median performance rate compared to all ACOs on 70% of measures 2 November 6,

10 ACO Selec2on Criteria Financial Demonstrated cost efficiency gains equal to or exceeding the financial benchmark in previous performance year Higher risk and reten2on Is in or agrees to move to a two- sided risk track in the subsequent agreement period Demonstra2on of Financial Need Needs statement demonstrates excep2onal need for pre- paid shared savings Total Points Points (max 2 pts.) 2 Points (max 6 pts.) 6 Points (max 2 pts.) 2 20 November 6,

11 Amount of prepaid shared savings for ACOs that begin MSSP in ) An upfront, fixed payment: $250,000 in the first month of par?cipa?on in the Shared Savings Program. 2) An upfront, variable payment: Payment in the first month of its par?cipa?on in the Shared Savings Program equivalent to the number of its preliminary, prospec?vely assigned beneficiaries mul?plied by $36. 3) A monthly payment of varying amount depending on the size of the ACO: A monthly payment equal to the number of its preliminary, prospec?vely assigned beneficiaries mul?plied by $8, for up to 24 months or un?l it ceases par?cipa?on in the Shared Savings Program or AIM, whichever is sooner. November 6,

12 ACO Investment Model Eligibility MSSP 2016 starters The ACO must be accepted into and agree to enter the Shared Savings Program in The ACO has a preliminary prospec?ve beneficiary alignment of 10,000 or fewer beneficiaries, as determined in accordance with the MSSP program regula?ons. The ACO does not include a hospital as an ACO par?cipant or an ACO provider/supplier (as defined by the MSSP regula?ons), unless the hospital is a cri?cal access hospital (CAH) or inpa?ent prospec?ve payment system (IPPS) hospital with 100 or fewer beds The ACO is not owned or operated in whole or in part by a health plan. November 6,

13 ACO Selec2on Criteria 2016 MSSP starters Spend Plan Quality Geographic Penetra2on Higher risk Demonstra2on of Financial Need Rural Loca2on Points (max 8 pts.) Points (max 4 pts.) Points (max 2 pts.) Points (max 2 pts.) Points (max 4 pts.) % of provider delivery sites in either: 1. nonmetropolitan coun2es, or 2. in areas with RUCA codes 4-10 in metropolitan coun2es Total Points November 6,

14 Applying to AIM The applica?on period for ACOs that started in 2014 or will start in 2016 will open in the summer of 2015.

15 Context for Transforming Clinical Prac2ce Passage of the Affordable Care Act in 2010 renewed efforts to improve our health care system Efforts have been guided by focus on beder health, beder health care, and lower costs through quality improvement Clinicians want to improve care for their pa?ents and posi?on their prac?ces to thrive in a pay- for- value system Increasing accountabili?es from care delivery reform programs (e.g., Medicare Shared Savings Program) About 16% (~185,000) of clinicians are currently par?cipa?ng in CMS advanced care delivery models With Innova?on Center support, successful clinical prac?ce leaders can support their peers with direct technical assistance to help them transform their prac?ces 15

16 Prac2ce Transforma2on in Ac2on Transforming Clinical PracDce would employ a three- prong approach to nadonal technical assistance. This technical assistance would enable large- scale transformadon of more than 150,000 clinicians pracdces to deliver beder care and result in beder health outcomes at lower costs. 16

17 Transforming Clinical Prac2ce Goals 17

18 Transforming Clinical Prac2ce Ini2a2ve Phases of Transforma2on 18

19 Who Might Be a Prac2ce Transforma2on Network (PTN)? Health Systems Regional Extension Centers Quality Improvement Organiza?ons Primary Care and/or Specialty Care Prac?ces Small/Rural/Medically Underserved Prac?ces And more! Support and Alignment Network (SAN)? Medical Associa?ons Specialty Boards Professional Socie?es Founda?ons State Organiza?ons Pa?ent and Consumer Advocacy Organiza?ons University Consor?ums And more! 19 Any enddes with exisdng federal contracts, grants, or cooperadve agreements would need to sadsfy both conflict of interest and duplicadon of effort specificadons.

20 Key Accountabili2es of Prac2ce Transforma2on Networks Pursue and achieve the quan2ta2ve AIMS of the ini2a2ve Recruit clinicians/prac?ces and build strategic partnerships Lead prac?ces in con?nuous improvement and culture change Facilitate improved clinical prac?ce management U?lize quality measures and data for improvement 20

21 Key Accountabili2es of Support & Alignment Networks Pursue and achieve the quan2ta2ve AIMS of the ini2a2ve. Align Their Mul?ple Programs and Drivers with Aims & Ac?vi?es of TCPI Ini?a?ve: Board Cer?fica?on Maintenance of Cer?fica?on Registries Journals, NewsleYers, Messaging to Members Professional Standards & Requirements Con?nuing Medical Educa?on Annual Mee?ngs Awards Programs Help Recruit Members Into Ini?a?ve and Sustain Their Ac?ve Engagement Over 4 Years Support Prac?ces with Pa?ent & Family Engagement 21

22 Important Transforming Clinical Prac2ce Ini2a2ve Web Links Transforming Clinical Prac?ce Ini?a?ve Website: hyp://innova?on.cms.gov/ini?a?ves/transforming- Clinical- Prac?ces/ Prac?ce Transforma?on Network hyp://innova?on.cms.gov/files/x/tcpi- FOA- PTN.pdf Support and Alignment Network hyp://innova?on.cms.gov/files/x/tcpi- FOA- SAN.pdf You can general ques?ons to: or Acquisi?on Ques?ons: 22