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  • Comprehensive Primary Care: Our Success Story

    March 2, 2016

    Tamra Lavengood, RN, BSN, MSN CPC Coordinator and Clinical Performance Coordinator

    Centura Health Physician Group, Centura Health Will McConnell, PhD, MBA, MS VP Operations and Outreach Strategy

    Mercy Regional Medical Center, Centura Health

  • Introductions

    Tamra Lavengood, RN, BSN, MSN, CPNP, CCNS Clinical Performance Coordinator for Centura Health Physician Group in Colorado Coordinator for the Comprehensive Primary Care Initiative for Mercy Family Medicine in Durango, Colorado Will McConnell, PhD, MBA, MS VP Operations and Outreach Strategy for Mercy Regional Medical Center in Durango, ColoradoWill McConnell, PhD, MBA, MS • VP Operations and Outreach Strategy • Mercy Regional Medical Center

  • Conflict of Interest

    Tamra Lavengood, RN, BSN, MSN Will McConnell, PhD, MBA, MS Have no real or apparent conflicts of interest to report

  • Learning Objectives Objectives: • Identify four qualitative and four quantitative elements used to determine an

    individual's health risk • Construct an adaptation of a paper or electronic risk stratification tool using

    the Mercy Adult Risk Stratification Tool (MARST) • Adapt a methodology for emergency department (ED) and hospital follow

    up • Influence electronic health record (EHR) vendors to adapt a risk

    stratification methodology that assesses the whole person • Influence the current healthcare environment to prepare for population

    health management

  • Agenda

    • The Beginnings – What is the CPC Initiative? – Why did Mercy Family Medicine choose to participate? – Barriers

    • Our Comprehensive Primary Care Initiative Story

    – Task Force – 9 milestones, key elements

    • Empanelment • Risk stratification

    – Mercy Adult Risk Stratification Tool (MARST) development • Care Management vs. Care Coordination • ED and hospital follow-up

    • Outcomes and lessons learned

  • Benefits Realized for the Value of Health IT STEPSTM VALUE CATEGORIES Treatment/Clinical: Care Management for high-risk patients identified by risk stratification looking at the whole person; ED and hospital follow-up care management; and care management to include behavioral health integration Savings: Realized by decreased Per Member Per Month (PMPM) expenses for Medicare population due to decreased ED utilization, hospital admissions for any cause and hospital admissions for Ambulatory Care Sensitive Conditions (ACSC)

    http://www.himss.org/ValueSuite

  • What is the Comprehensive Primary Care Initiative?

    Four-year multi-payer initiative designed to strengthen primary care Population-based care management fees and shared savings opportunities to participating primary care practices to support the provision of a core set of five “Comprehensive” primary care functions.

    – 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

    https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/

    https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/

  • What is the Comprehensive Primary Care Initiative?

    Demographics – 474 practice sites – 2,200 practitioners – 2.7 million active patients – 38 public and private payers – 335,000 Medicare beneficiaries

    Purpose

    – Improved care – Better health for populations – Lower costs – Inform future Medicare and Medicaid policy https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative

    https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/

  • What is the Comprehensive Primary Care Initiative?

    Payment Model

    – Participating primary care practices receive two forms of financial support on behalf of their fee-for-service (FFS) Medicare beneficiaries:

    • A monthly non-visit based care management fee

    • The opportunity to share in any net savings to the Medicare program

    https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative

    https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative https://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative

  • Why did Mercy Family Medicine Choose to Participate? • Value-based purchasing was getting a lot of attention

    – We needed to identify viable payment models and prepare for the future

    • Cost neutral solution • Alignment with PCMH status • Great group of clinicians and staff • Huge potential within CPC • Timing was right

  • Barriers to get the Comprehensive Primary Care Initiative started

    • One more thing to do

    – Do we have the bandwidth? • Moving into uncertain territory with CPC • A lot of additional reporting and process work would be needed • No real quantifiable risk stratification tools in the beginning • Practice was recently acquired

  • Comprehensive Primary Care Initiative: Our Story

    • Center for Medicare and Medicaid had a great idea! • Privileged to be a part of initiative • Started with a Task Force

  • Comprehensive Primary Care: 9 Milestones

    1. Budget 2. Care management for high-risk patients 3. Access and continuity 4. Patient experience 5. Quality improvement 6. Care coordination across the medical neighborhood 7. Shared decision making 8. Participation in learning collaboratives 9. Health Information Technology

  • Comprehensive Primary Care Initiative: Our Story

    CMS selected key elements that aligned with Patient Centered Medical Home elements Milestone 2: Empanelment; Risk Stratification; Care Management; Behavioral Health Integration

  • Comprehensive Primary Care Initiative: Our Story

    Empanelment • End of 2012 = 79% • End of 2015 = 99.9% • Four Cut Method (1) • Care Teams

    (1) Panel Size: How Many Patients Can One doctor Have?, Mark Murray, MD,MPA, Mike Davies, MD, Barbara Boushon, RN,Fam Pract Manag. 2007 Apr; 14(4):44-51

  • Comprehensive Primary Care Initiative: Our Story

    Risk Stratification • All 500 clinics asked to develop their own risk stratification

    methodology • Mercy Family Medicine reviewed tools from:

    – California Quality Collaborative – AAFP Risk Stratification Tool – Telluride Medical Center in Colorado (another CPC practice)

  • Risk Stratification in CPC Practices

    Comprehensive Primary Care practices risk stratify their patients by: • Clinical intuition: 71% • Practice developed clinical algorithm: 61% • Published clinical algorithm: 40% • Claims: 24% • EHR methodology: 19%

    Practices were able to select more than one method

  • Comprehensive Primary Care Initiative Our Story

    Developed our own Mercy Adult Risk Stratification Tool (MARST) and the Mercy Pediatric Risk Stratification Tool (MPRST) Critical to have not only Objective elements but Subjective elements as well

  • HIT Needed for Risk Stratification • Using the system we had • Our risk stratification elements flow exactly like our EHR

  • Mercy Adult Risk Strat