Comprehensive Primary Care Plus - Greenway Health€¦ · 1 © Greenway Health, LLC. All rights...

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Comprehensive Primary Care Plus

David Heller

Industry & Government Affairs Manager


Agenda

• CPC+ and policy

• The CPC+ program

• CPC+ and MACRA


Poll question

Have you participated in other value-based programs before? (choose all that apply)

a) Yes (PCMH)

b) Yes (PQRS, MU)

c) Yes (ACO)

d) No


CPC+ AND POLICY


HEALTHCARE EXPENDITURES AS PERCENTAGE OF GDPThis growth in costs is unsustainable for payers and patients alike


WHERE THOSE DOLLARS GOHospital care, the most expensive type of healthcare, accounts for over 30% of all healthcare expenditures


WHO BUYS IT?Public payers account for 40% of all healthcare, and when they ring the bell others follow


STRATEGIES THAT LOWER UTILIZATION

Wellness & preventative

visits

Chronic conditions

management

Transparency across the healthcare continuum

Shift heatlhcare spend to lower priced

markets

Offsetting the dramatic rise in price for post-acute care and controlling it’s variance will bend the curve

Post-acute costs uncontrolled

Managing utilization in the last year of life is key to controlling Medicare costs

End of life is expensive


CPC+ PROGRAM


Four Drivers of Care

COMPREHENSIVE PRIMARY CARE PLUS (CPC+)

Comprehensive care Use of enhanced, accountable

payment

Continuous improvement driven by data

Optimal use of HIT


1

2

3

Care Management FeePer beneficiary per month infrastructure investments that must be spent on staffing

Quality and utilization incentivePaid upfront per beneficiary per month. Must be repaid to CMS if metrics not met.

Comprehnsive Primary Care PaymentSimilar to population based payments, FFS reduced and paid to CPC+ upfront monthly

Payment structure


11 I


What makes Track 2 different


• CPCP payments only for Track 2• Higher Care Management Fee and

Quality Incentive payments

HIT Vendor Letter of Support • Emphasis on

behavioral and social health

• Focus on complex patients


CPC+ and technology

• Risk stratification (patient and practice levels)

• Practice Level eCQM reporting

• Psychosocial data

• Care coordination

• Controlling costs (particularly for Track 2)

• Data feedback loops with CMS and private payers


How Greenway Health supports CPC+

• Track 1 and Track 2

• Vendor Letter of Support

• MOU with CMS

• Technology and services stack


CPC+ PRODUCT SUMMARY

Platform Health IT Solutions

Prime Suite Prime Suite Greenway Patient Greenway Community

Intergy Intergy EHR Intergy Practice Analytics Greenway Patient Greenway Community

Success EHS SuccessEHS SuccessEHS Patient Portal Greenway Community

Greenway Health’s platform is uniquely positioned to support your practices participation in CPC+



Product Track 1 Track 2

Greenway EHRs 2015 Edition CEHRT, risk assignment and stratification, care team and/or preferred provider assignment

2015 Edition CEHRT, flag patients with complex conditions, customizable care plans, capture social, behavioral and psychological data

Greenway Exchange

2015 Edition CEHRT 2015 Edition CEHRT, Clinical connectivity for transitions and coordination of care

Greenway Patient/Link

2015 Edition CEHRT; providing patients with expanded access

2015 Edition CEHRT, Patient engagement, expanded access, patient experience surveys, non-visit based care activities

Majority of HIT requirements in line with ongoing plans for 2015 CEHRT; will partner with practices to build out remaining functionality



Product Track 1 Track 2

Greenway Community Care team assignment and risk assignment/stratification

Advanced capabilities around managing care of high-risk, chronic disease patients, visibility into performance, care plans, connectivity for data exchange

Analytics 2015 Edition CEHRT; practice level eCQMreporting

2015 Edition CEHRT, additional eCQMs, CPC QRDA to support electronic submission

Majority of HIT requirements in line with ongoing plans for 2015 CEHRT; will partner with practices to build out remaining functionality


CPC+ AND MACRA


MACRA TIMELINE

2019201820172016

• Final performance period for MU/PQRS/VBM

• Payment year for 2014 performance period

MACRA activities

• Payment year MU/PQRS/VBM (2015 performance)

• Final payment year for MU/PQRS/VBM (2016 performance)

• First MIPS performance period

• May select either 8 Modified Stage 2 objectives or 6 Stage 3 objectives

• Second performance period for MIPS

• Stage 3 only & 2015 CEHRT required

• Feedback report from CMS due in July

• March 31: QCDR/EHR attestation submission deadline for 2017 performance

• Payment year for 2017 MIPS performance period

• Performance period for 2021

• “ACI” objectives –same as Stage 3 with different thresholds

Sunsetactivities


Only for CMMI Medical Homes with 50 or fewer Eligible Clinicians

THE MEDICAL HOME MODEL

Or

General definition

Quality incentive or PMPM at risk

2017: 2.5% 2018: 3%

2019: 4% 2020: 5%

RISK


Qualifying Participants

WHO’S IN THE APM TRACK?

201720152024+20232022202120202019

Payments

25%

Patients

20%

Payments

50%

2019-2020

• Medicare APMs only

2021+•Include private payers

Payments

75%

Patients Patients

35% 50%


Financial Rewards

IMPACT TO PROVIDERS

20242026+202020182016

5% Lump Sum

Bonus


Poll question

Would you like to be contacted by a Greenway Health sales representative about CPC+?

a) Population health

b) Care coordination services

c) Patient engagement

Date post:	20-Jul-2020
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