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Comprehensive Primary Care Initiative _CPCi_

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					        Innovation Grant:
               CMMI
      Comprehensive Primary
       Care Initiative (CPCi)

              presented to
      HFMA Southwestern Ohio Chapter




Will Groneman
Executive Vice President System Development
TriHealth
Comprehensive Primary Care Initiative (CPCi)

 What is it?
    4-year pilot program from CMS Innovation Center – CMMI
    Authorized under the Accountable Care Act
    Funding for 330,750 Medicare and Medicaid beneficiaries




                                   2
Comprehensive Primary Care Initiative (CPCi)

 What is it?
    4-year pilot program from CMS Innovation Center – CMMI
    Authorized under the Accountable Care Act
    Funding for 330,750 Medicare and Medicaid beneficiaries
    Designed to accomplish the “triple aim” at the community level
    Aligns multiple payers in a community around common goals




                                     3
Comprehensive Primary Care Initiative (CPCi)

 What is it?
    4-year pilot program from CMS Innovation Center – CMMI
    Authorized under the Accountable Care Act
    Funding for 330,750 Medicare and Medicaid beneficiaries
    Designed to accomplish the “triple aim” at the community level
    Aligns multiple payers in a community around common goals
    Aimed at Primary Care Physicians
    Builds on the “Medical Home” concept
    Holds PCP practices accountable for the total cost of care
    Solicitation issued in late September 2011


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Comprehensive Primary Care Initiative (CPCi)

  CMS’ Framework for Comprehensive Primary Care

     Risk stratified care management


     Access and continuity


     Planned care for chronic conditions and preventive care


     Patient and caregiver engagement


     Coordination of care across the medical neighborhood



                                  5
Four Basic Steps in the Process
  1. Select communities to participate
     Number of commercial plans willing to participate
     Support of state Medicaid
     Community infrastructure and history of collaboration
     Seven Communities were selected
           Arkansas
           Colorado
           New Jersey
           Oregon
           New York Capital District-Hudson Valley Region
           Greater Tulsa Region
           Cincinnati-Dayton-Northern Kentucky Region
     Community selection completed April 2012

                                     6
Four Basic Steps in the Process

    1. Select Communities to participate (April 2012)
    2. Align payers who are willing to commit to:
        Payment above normal Fee-for-Service (e.g. pmpm)
             CMS pmt will be risk adjusted and will average $20 pmpm
        Provide gainsharing opportunities in years 2-3-4
        Common set of metrics for cost, quality, service
             Using 18 of the 33 ACO measures as a starting point
        Providing aggregate member level cost/utilization data
        Signing a Letter of Intent with CMS
        Cincinnati had 10 payers commit to participate
             Includes Aetna, Anthem, Humana, Medicaid, MMO, United
        Payers signed non-binding LOIs in June 2012


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Four Basic Steps in the Process

    1. Select Communities to participate
    2. Align payers
    3. Select PCP Practice Locations
        Practice = physical office location
        75 practices per market to be selected
        Screening Criteria:
            150 FFS Medicare patients
            Physicians have attested to Meaningful Use
        Qualitative Criteria:
            >60% of patients are covered by participating payer
            Demonstration of readiness to transform
                  PCMH Recognized
            Commitment to transformational activities
        Practices to be selected August 2012

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Year 1 Commitments Required by CMS
    Complete an annual budget
    Implement risk stratification methodology for all patients

    Attest to 24/7 patient access to a nurse or practitioner with
     access to the patient’s EHR
    Establish baseline for patient satisfaction using CG-CAHPs

    Demonstrate care coordination for the medical neighborhood
     and c omply with at least one of the following:
         Notification of ED visit in a timely fashion
         Med reconciliation completed with 72 hours of hospital discharge
         Exchange of clinical information at the time of admission and at discharge
         Exchange of clinical information between PCP-specialists

    Participate in quarterly market based learning collaborative


                                         9
Four Basic Steps in the Process

    1. Select Communities to participate
    2. Align payers
    3. Select PCP Practice Locations
    4. “Negotiate” with practices and start program
        No negotiations with CMS
        Expect limited negotiation with plans
            Will need to conform with their LOI commitments
            Will plans cover TriHealth PCMH sites not selected?
            Not clear if “ASO” employers will participate
        Go-live November 1, 2012
            13 months from solicitation to go-live



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CPCi v. Accountable Care Organization

  Focus is on Patient Centered Medical Home (PCMH) as
   the foundation for managing care
    ACO not as prescriptive as to care management strategy

  Provides new funding for infrastructure
      Focused on adult PCP sites
      For systems: only funds part of the PCP base
      For independents: provides funding to sustain independence

  Requires participating competitors to cooperate in
   sharing best practices
      Goal is to demonstrate impact at the community level
      Monthly meetings of practices


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CPCi v. Accountable Care Organization
  Requires commercial plans/Medicaid support
     Must provide additional pmpm funding
     Patient attribution updated quarterly
     Must commit to a common “menu” of cost/quality measures to be
      used for gainsharing program
     Must provide monthly claims/utilization data
        Still defining level of detail
     Monthly multi-stakeholder meetings
     ASO customers must agree to participate

  Does not require gainsharing/full risk on day 1
      Year 1 used to build capabilities and establish data baselines
      Gainsharing in years 2-3-4 still undefined


                                          12
CPCi Challenges

  Attribution requires 24 months of claims experience
     What happens when a commercial enrollee switches plans

  Many “Key Success Factors” still undefined
       Attribution methodology
       Cost/utilization data specificity
       Gainsharing methodology
       Severity adjustment methodology

  CMS’ agenda does not always support community
   existing initiatives
     Public Reporting through the Health Collaborative


                                    13
CPCi Challenges

        Self Insured Employers must agree to participate
          ASO provider cannot commit without their consent

        Threats to health system goal of creating a system
         brand for their PCP network
          TH has 34 PCP practice locations
             30 NCQA Recognized Level 3 PCMH sites
             19 Sites have been selected by CMS to participate
             Funding only applies to 19 sites
             How to fund remaining 15 sites?
             Can we get performance data for non CPCi sites even if we are
              not part of a payer’s P4P program?



                                      14
CPCi Challenges

        Common community agenda still a challenge
          19 Common Quality/Measures Selected
             CMS priorities
             Medicare Advantage “star” program measures
             Medicaid plans’ payment incentives
             Commercial payers’ national quality/cost agendas




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    Questions?

        16

				
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