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Value Based Contracting Office Hours

Value Based Contracting Office Hours. RAE Prime Office Hours. December 18, 2018. What questions do you have regarding RMHP Prime?. Agenda. Prime Topics: Year 3 Performance & Payment – Patrick Gordon Year 3 Practice Performance Review – Patrick Gordon

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Value Based Contracting Office Hours

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  1. Value Based Contracting Office Hours RAE Prime Office Hours December 18, 2018

  2. What questions do you have regarding RMHP Prime?

  3. Agenda Prime Topics: Year 3 Performance & Payment – Patrick Gordon Year 3 Practice Performance Review – Patrick Gordon Year 4 Incentive Pool Estimate – Patrick Gordon Closing out Year 4 - Lori Stephenson Year 5 MLR Metrics and Value Based Performance Payment Criteria – Lori Stephenson Year 6 Strategy – Patrick Gordon

  4. Key Timeline – Prime *Contingent upon overall plan performance on total cost and quality

  5. Year 3 (SFY 2016-17)Performance & Payment Discussion

  6. Year 3 – Incentive Payment Outcomes

  7. Year 3 – Incentive Payment Outcomes

  8. Year 4 (SFY 17-18) – Practice Performance Review

  9. Practice Performance – Foresight Family Physicians

  10. Practice Performance – Grand Valley PC

  11. Practice Performance – Marillac Health

  12. Practice Performance – Mountain Family

  13. Practice Performance – Primary Care Partners

  14. Practice Performance – River Valley

  15. Practice Performance – St. Mary’s Family

  16. Practice Performance – Western Valley

  17. Year 4 – Incentive Pool Estimate Estimate only Subject to change.

  18. Closing out Year 4 – CQM Reporting and PAM/CfA

  19. Year 4 Shared Savings Criteria Review Clinical Quality Measures (CQM) – All Prime participating practices will be required to report on ALL measures. ADULT PRACTICES: All 3 measures are reported to RMHP via SPLITby 1/31/2019. • NQF 0059: Diabetes Hemoglobin A1c Poor Control (>9.0%) • NQF 0418: Depression Screening and Follow up • NQF 0421: Adult BMI Screening and Follow up PEDIATRIC PRACTICES: Both measures are reported to RMHP via SPLIT by 1/31/2019. • NQF 0418: Depression Screening and Follow Up • NQF 0024: Childhood BMI Screening with Nutrition and Physical Activity Counseling Patient Activation Measure/Coaching for Activation (PAM/CfA) Utilization – Practices to continue demonstrating ongoing utilization of the PAM and CfA tools on a subset of their attributed Prime population. Further, practices will perform a re-assessment on all previously screened patients that are at a PAM Level 1 or Level 2 by 12/31/2018

  20. Year 4 Required Annual CQM Reporting All RMHP Prime practices will be given access to the SPLIT tool by December 2018. Practices MUST report the required Prime CQMs into SPLIT to remain eligible for value-based performance payment (“PBIB”) Annual CQM Reporting due 1/31/2019 for performance year 2018 (1/1/18-12/31/18) FINAL SPLIT TRAINING: January 11th at 12:00pm – Register at: https://zoom.us/meeting/register/56e6948acb5fb45a34538d7d4481ef37

  21. Year 5 MLR Metric & Value-Based Performance Payment Criteria

  22. Year 5 MLR Metrics/Targets for RMHP • NQF 0418/CMS 2 • NQF 0059/CMS 122 • SUD ER Utilization • Patient Activation Measure • Patient Activation Measure Depression Screening and Follow-Up = 64% HgbA1c Poor Control > 9.0 = 23.5% Emergency Room Utilization for Substance Use Disorder = 25.10 per 1,000 per year Levels 1, 2, & 3 Re-assessment = 41% Roadmap Report

  23. Year 5 - Aligning MLR Metrics and Value-Based Performance Measures *Aligning your internal practice targets with the RMHP MLR Targets creates a greater potential for the overall Prime region to meet the established MLR metrics*

  24. Year 5 Value-Based Performance Payment Criteria Quarterly submission to RMHP and annual submission to SPLIT via EHR on the following eCQMs: • NQF 0059 = Diabetes Hemoglobin A1c poor control • NCF 0418 = Screening for Depression and Follow-up plan • NQF 0004 = Initiation and Engagement of Alcohol and other drug dependence treatment PAM Re-assessment of Level 1, 2 and 3 Risk adjusted attribution

  25. Year 6 Prime Program Expectations

  26. Year 6 Program Expectations Prime Year 6 (2020) • Continuous evolution of value-based performance payment (“PBIB”) criteria • Alignment with RAE tiering

  27. Questions?

  28. Contact Lori Stephenson Director of Clinical Program Development and Evaluation lori.stephenson@rmhp.org Patrick Gordon Vice President patrick.gordon@rmhp.org Nicole Konkoly RAE Network Relations Manager Nicole.konkoly@rmhp.org

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