Transforming Clinical Practice Initiative (TCPI) An Overview

Connie K. Ihde, Director of Programs & TCPIArizona Health-e Connection

November 17, 2015

o Estimated $700 Billion of “Healthcare waste” annually• $250-325 Billion in “Unwarranted use”• $75-100 Billion in “Provider inefficiency and

errors”• $25-50 Billion in “Lack of care coordination”

National Health Care Waste & Inefficiency

White Paper: “Where can $700 Billion in Waste be Cut Annually from the U.S. Healthcare System? Robert Kelley, CP, Healthcare Analytics Thomson Reuters October 2009

White Paper: “Where can $700 Billion in Waste be Cut Annually from the U.S. Healthcare System? Robert Kelley, CP, Healthcare Analytics Thomson Reuters October 2009

o Better Careo Smarter Spendingo Healthier Communities

TCPI National Goals

Overall Aims of TCPI

TCPI Focus Areas

TCPI Assistance Model

o Practice Transformation Networks (PTN) - Group practices, health care systems, and others - Serve as trusted partners to provide clinician practices with quality improvement expertise, best practices, coaching and assistance - Prepare and begin clinical and operational practice transformation

o Support and Alignment Networks (SANs) - Professional associations and others - Align their memberships, communication channels, continuing medical education credits and other work - Support the PTNs and clinician practices

PTN Award

o Provides technical assistance & peer-level support to clinicians in delivering care in a patient-centric & efficient manner

o Supports clinicians in identifying & engaging with national improvement leaders to implement and continuously refine their practices

o Allows practices to become actively engaged in the transformation

o Ensures collaboration among a broad community of practices that creates, promotes & sustains learning & improvement across the health care system

PTN Approach

o Provide “boots on the ground” support to coach, mentor & assist clinicians in developing core competencies that assist them in moving through various phases of practice transformation

o Able to collaboratively (with CMS) lead clinicians & their practices through the transformation process, achieve the initiative goals, & ensure that clinicians & their practices can maintain & sustain the activities

SAN Award

o Provides a system of national & regional professional associations & public-private partnerships that are working in practice transformation efforts

o Utilize existing & emerging tools (CME, core competency development, etc.)

SAN Approach

o Engage eligible medical professional associations, specialty societies, and other organizations that are involved in aligning programs with the aims of the initiative

o Generate evidence-based guidelines for clinical practice

o Promote measurements for improvement

o Support members and practices in work to reduce unnecessary testing & procedures

o Incorporate safety & patient and family engagement

Five Phases of TCPI

Arizona Goals

o Objective 1: 2,500 primary and specialty care providers will participate in the Practice Innovation Institute (PII) by the end of fourth project year

o Objective 2: 2,500 participating providers will achieve Phase 5 by fourth year – participation in a pay for value approach

o Objective 3: By the end of the four year project period, 90% of participating providers will enroll in a value based ‐payment program, as a result of PII’s leadership and active engagement with providers.

Goal 1: Transform the delivery of care

Arizona Goals

Goal 2: Improve outcomes while decreasing costs

o Objective 1: Achieve a 10% decrease in unnecessary testing/procedures and 12% decrease in hospital readmissions and hospitalizations

o Objective 2: Achieve 10% improvements in well child visits, adolescent well care, pediatric dental visits, breast cancer screening and diabetes care

Project Roles

Arizona Health-e Connection

o Lead Agency and Fiscal Agento Recruit Provider and Practices

• Enroll in Practice Innovation Institute• Enroll in The Network

o Strengthen EHR Integration & Meaningful Useo Develop Population Registrieso Data Collection & Reporting o CMS Point of Contact and data reporting entity

Project Roles

Mercy Care Plan

o Individual Coaching on areas including:• Performance improvement

• Population-based health improvement

• Rapid cycle change methods

• Financial and administrative efficiencies

• Care management

• Risk stratification

Project Roles

Mercy Maricopa Integrated Care

o Provides consultation in areas including:• Technical assistance and overall quality

improvement training to contracted providers

• Development of effective methods to provide integrated care

• Integration of physical and behavioral health care

Alignment

Medicaid/Medicare/CHIP Programso Optimize integrated delivery of physical & behavioral

health care services

State and Regional Initiativeso Program goals align with Arizona’s Health IT Roadmap 2.0

• Provide resource and information on tools that support health care transformation, including new payment models

• Create & Implement strategy for information sharing between behavioral & Physical health care providers

o ADHS State Health Improvement Plan• Plan has broad pubic input, measurable goals, objective

to improve quality of care and reduce costs

Recruitment Goals

Total Number of Clinicians to be enrolled: 2,500Primary Care Clinicians

• 1,775Specialty Care Clinicians

• 725Yearly Recruitment Goals:

Year 1: 2,300Year 2: 175Year 3: 25Year 4: 0

Over recruit to account for attrition

Recruitment Targets

Small Practices, Rural Areas and Medically Underservedo Arizona Primary Care Officeo Arizona Primary Care Associationo Sliding-fee Scale Clinicso Behavioral Health Provider Agencieso Arizona Medical Associationo Arizona Osteopathic Medical Associationo University of Arizona Center for Rural Healtho Phoenix Children’s Care Networko Arizona Association of Community Health Centers

o Better Careo Smarter Spendingo Healthier Communities

Questions?

www.PiiAz.org

PiiInfo@AzHeC.org

602-688-7200