VERMONT ALL PAYER MODELgmcboard.vermont.gov/sites/gmcb/files/files/meetings/presentations… ·...

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VERMONT ALL PAYER MODEL PROJECT UPDATE ELEMENTS OF THE PROPOSED TERM SHEET GMCB ANALYTICAL MODELING JANUARY 28, 2016 1

Transcript of VERMONT ALL PAYER MODELgmcboard.vermont.gov/sites/gmcb/files/files/meetings/presentations… ·...

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VERMONTALLPAYERMODELPROJECTUPDATE

ELEMENTSOFTHEPROPOSEDTERMSHEETGMCBANALYTICALMODELING

JANUARY28,2016

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Agenda

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Time AgendaItems

9:15–9:209:20–9:50

9:50–11:30

IntroducJonPartI:All-PayerModelProjectUpdate• BriefHistory• StatusofNego9a9onswithCMSPartII:ElementsoftheTermSheet

11:30–12:00 PublicComment

12:00–2:30 BREAK

2:30–3:40 PartIII:GMCBAnalyJcalModeling• UseofModeltoDate• Presenta9onofFinancialModel

4:00–5:00 PublicComment

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PartI:All-PayerModelProjectUpdate

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•  BriefHistory•  StatusofNego9a9onswithCMS

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Act 54 of 2015

TheSecretaryofAdministra8onordesigneeandtheGreenMountainCareBoardshalljointlyexploreanall-payermodel,whichmaybeachievedthroughawaiverfromtheCentersforMedicareandMedicaidServices.

-EnactedJune5,2015

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All-Payer Model

•  Anall-payermodelisanagreementbetweentheStateandtheCenterforMedicareandMedicaidServices(CMS)thatallowsVermonttoexplorenewwaysoffinancinganddeliveringhealthcare.

•  Theall-payermodelenablesthethreemainpayersofhealthcareinVermont–Medicaid,Medicare,andcommercialinsurance,topayforhealthcaredifferentlythanthroughfee-for-servicereimbursement.

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Goals of a Transformative All-Payer Model

•  Improveexperienceofcareforpa9ents•  Improveaccesstoprimary,preven9veservices

•  Rewardhighvaluecare•  Constructahighlyintegratedsystem

•  Empowerprovider-ledhealthcaredeliverychange

•  Controltherateofgrowthintotalhealthcareexpenditures•  Alignmeasuresofhealthcarequalityandefficiencyacrosshealthcaresystem

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Why Pay Differently Than Fee-for-Service?

•  Healthcarecostgrowthisnotsustainable.

•  Healthcareneedshaveevolvedsincethefee-for-servicesystemwasestablishedmorethanfi\yyearsago.

•  Morepeoplearelivingtodaywithmul9plechroniccondi9ons.•  CDCreportsthattrea9ngchroniccondi9onsaccountsfor86%of

ourhealthcarecosts.

•  Fee-for-servicereimbursementisabarrierforproviderstryingtocoordinatepa9entcareandtopromotehealth.

•  Carecoordina9onandhealthpromo9onac9vi9esarenotrewardedbyfee-for-servicecompensa9onstructure.

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Foundation for an All-Payer Model

•  Vermonthasall-payerreformsinplacetoday

–  SharedSavingsProgram(SSP)forAccountableCareOrganiza9ons(ACOs)•  MedicareoffersaSSPforACOs•  CommercialSSPStandards•  MedicaidSSPStandards

–  TheBlueprintforHealth•  Medicarepar9cipatesthroughademonstra9onwaiver•  Commercialpar9cipa9on•  Medicaidpar9cipa9on

•  Fee-For-Serviceiss9lltheunderlyingpaymentmechanisminthesemodels

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Next Generation of Accountable Care

•  ThefederalgovernmenthascreatedprogramsthatencouragetheuseofAccountableCareOrganizaJons(ACOs).

•  ThefederalNextGeneraJonACOprogramallowsACOstobepaidanall-inclusivepopula9on-basedpaymentforeachMedicarebeneficiaryacributedtotheACO.CMSwillallowACOssomeflexibilityincertainpaymentrulesinexchangeforaccep9ngthisnewtypeofpayment.

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Leveraging Federal and State Payment Reform Efforts

•  Vermont’sproposalisforallpayerstoapproachhealthcarepaymenttoACOsinacommonway.–  New,all-inclusivepopula9on-basedmodelofreimbursementrewards

healthcareprofessionalsthatareadap9ngtothechangingneedsofthepopula9on;leverageNextGenera9onmodel.

–  Allpayersgivedoctorsandotherhealthcareprofessionalstheflexibilitytheyneedtoleadhealthcaredeliverychange.

•  Healthcareproviders’par9cipa9oninACOsisvoluntary;theACOmustbeacrac9vetoprovidersandofferanalterna9vehealthcaredeliverymodelthatisappealingenoughtojoin.

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Status of Negotiation with CMS

•  GMCBandAOAhavejointlyexploredanall-payermodelthroughdialogueandnego9a9onwithCMS.

•  Theresultofthisdialogue,andconsulta9onwithstakeholdersandconsultants,isatermsheetproposedbytheStateofVermonttoCMS–  Proposedtermsheetdescribesthebasicpolicyframeworkthatwould

allowVermont’shealthcareproviders,payers,andthegovernmenttooperateanall-payermodel.

–  Theproposedtermsheetdoesnotbindthestateorfederalgovernments.

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Next Steps

•  PublicPar9cipa9onandComment–  Thetermsheetisavailabletothepublicthroughdistribu9ontothe

mediaandpos9ngontheAgencyofAdministra9onandGreenMountainCareBoard’swebsites.

–  ThetermsheethasbeendistributedtoLegislators.–  TheGreenMountainCareBoardwillholdopen,publicmee9ngsto

discussandevaluatethetermsheet.

–  Aformalpubliccommentperiodonthetermsheetwillbeini9atedbytheGreenMountainCareBoard.

–  TheAgencyofAdministra9onwillacceptpubliccommentsathcp://hcr.vermont.gov/home.

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Next Steps

•  AssessandEvaluateAll-PayerModelProposal–  Takingallpointsofviewintoconsidera9on,theGreenMountainCare

BoardandtheAgencyofAdministra9onmustindependentlyassessthepoten9aloftheall-payermodeltobuildasystemthatofferstherightincen9vesandrewardsprovidersfordeliveringonthepromiseofintegrated,coordinated,highqualitycare.

–  Attheconclusionofthisevalua9on,theGreenMountainCareBoardandtheAgencyofAdministra9onwilldeterminewhetherandhowtheall-payermodelproposalshouldbeadjustedtoreflectstakeholderinput.

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Next Steps

•  Basedonevalua9onoftermsheet,–  Con9nuenego9a9onswithCMSonAll-PayerModel

–  IfVermontdecidesthefinalagreementisnotbecerthantoday’ssystem,itcanendthenego9a9onwithCMS.

–  Similarly,ifCMSisnotsa9sfiedthattheoverallproposalmeetsitspolicyandfinancialgoals,itcandeclinetoenterintotheagreement.

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Steps Toward an Improved Vermont Health Care System

DevelopAll-PayerModelandFinancialTargets

CreateStandardsforAccountableCareOrganiza9onProgram

ExerciseGMCBRateandRegulatoryAuthority

AcainQualityImprovementandCostControl

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PartII:ElementsoftheTermSheet

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Vermont’s Proposed Term Sheet

•  Thetermsheetincludesallofthebasiclegal,policy,andenforcementprovisionsthatwouldbeinaModelAgreement.

•  Insomecases,termsrefertoappendiceswhichwillhavegreatertechnicaldetailortoprocessesthatwilloccurduring2016.

Term

1. LegalAuthority2. PerformancePeriod3. MedicareBeneficiaryProtec9ons4. MedicareBasicPaymentWaivers5. MedicareInnova9onWaivers6. InfrastructurePaymentWaivers7. FraudandAbuseWaivers8. RequestforAddi9onalWaivers9. Revoca9onofWaivers10. All-PayerRateSenngSystem11. ProviderPar9cipa9oninAlterna9vePayment12. RegulatedServices13. FinancialTargets14. QualityMonitoringandRepor9ng15. DataSharing16. AllPayerModelEvalua9on17. Modifica9on18. Termina9onandCorrec9veAc9onTriggers

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Term #1: Legal Authority

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Medicareauthority,throughtheInnovaJonCenter(CMMI):SecJon1115(A)oftheSocialSecurityAct

MedicaidauthorityaddressesexisJngMedicaidlawsinrelaJontothemodel.•  SpecifiesthatVermontwillensurethatthestate-federalagreementsinplace(intheformofstateplans

or1115demonstra9onwaivers)willbemodifiedtoaccommodatetheall-payermodel.

Vermontauthority,acJngthroughGMCB,addressesthreeregulatoryfuncJons:•  AuthoritytoenterintotheagreementwithCMMI

•  GMCBhasauthorityto“[o]verseethedevelopmentandimplementa9on,andevaluatetheeffec9veness,ofhealthcarepaymentanddeliverysystemreformsdesignedtocontroltherateofgrowthinhealthcarecostsandmaintainhealthcarequalityinVermont.”18V.S.A.§9375(b)(1)

•  Authoritytosetratesforprovidersandrequirepayerstocomplywiththoserates•  GMCBhasauthorityto“setreasonableratesforhealthcareprofessionals,healthcareprovider

bargaininggroupscreatedpursuanttosec9on9409ofthis9tle,manufacturersofprescribedproducts,medicalsupplycompanies,andothercompaniesprovidinghealthservicesorhealthsuppliesbasedonmethodologiespursuanttosec9on9375ofthis9tle,inordertohaveaconsistentreimbursementamountacceptedbythesepersons.”18V.S.A.§9376(b)(1).

•  AuthoritytoregulateanACOandothercomponentsofthehealthcaresystem•  Referstotheauthori9escitedaboveandGMCBauthoritytosethospitalbudgets,regulateinsurance

ratechanges,andregulatecapitalexpendituresofhealthcarefacili9es.

StatementsaffirmingtheauthorityofMedicare,Medicaid,andVermont(throughtheGMCB)toenterintotheAll-PayerModelagreement

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Term #2: Performance Period

•  Five-yearperformanceperiodfrom2017to2021

•  Uponsigningamodelagreement,Vermontentersan“opera9onalcapacitybuilding”periodun9limplementa9ononJanuary1,2017

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Setsthe9meframeforimplemen9ngtheall-payermodel

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Term #3: Medicare Beneficiary Protections

•  ThistermstatestheprinciplethataccesstocareandprovidersforMedicarebeneficiarieswillnotbelimited–  Medicarebeneficiarieswillhavefullfreedomofchoiceofproviders–  Allexis9ngbeneficiaryrightsandprotec9ons(likeappealrights)will

beprotected

–  Medicareundertheall-payermodelwillincludeallthesameservicesandcoverageasoriginalMedicare

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Provisionstoenshrineallexis9ngprotec9onsforMedicarebeneficiariesinVermontundertheall-payermodel

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Term #4: Medicare Basic Payment Waivers

•  BasicpaymentwaiversrelatetolawsthatgovernratessetforMedicareregulatedservices–  Currentlythissec9ondocumentsthelawsthatcreatetheinpa9ent

prospec9vepaymentsystem(IPPS)andtheoutpa9entprospec9vepaymentsystem(OPPS)forhospitals.

–  Ul9matelyanagreementwouldneedtoincludethelawsthatgovernreimbursementforallregulatedservices,includingphysicianservices,homehealthservicesandothers.

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ThetermSheetcontains4separatetypesofwaiversofMedicarelaws

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Term #5: Medicare Innovation Waivers

•  MedicareinnovaJonwaiversremoverestric9onsonservicesorauthorizeexpandedservicesforbeneficiaries–  Eliminaterequirementfora3-dayhospitalstaybeforeadmissiontoa

nursinghome

–  Authorizetelehealthservicesforallbeneficiaries–  Enablehomevisitswithoutphysiciansupervisiontoallowother

licensedclinicians

•  LanguageallowsVermonttoseekaddi9onalwaiversunderconsidera9ontoenhanceMedicareservices–  ExpandingNursePrac99onerscopeofprac9cerules–  Enhancingtheavailabilityofhomecareandhospiceservices

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ThetermSheetcontains4separatetypesofwaiversofMedicarelaws

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Term #6: Infrastructure Payment Waivers

•  InfrastructurepaymentwaiversallowMedicaretopar9cipatefullyintheBlueprintforHealth–  Con9nua9onofCHTpayments–  ExpansionofSASHpayments

•  ThistermalsoincludeswaiversnecessarytosupporttheHub&SpokeProgram–  Paymentformedica9on-assistedtherapiesatspecialtyopioid

treatmentcenters

–  Infrastructuresupportfor“Hubs”

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ThetermSheetcontains4separatetypesofwaiversofMedicarelaws

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Term #7: Fraud and Abuse Waivers

•  Fraudandabusewaiversprotectproviderspar9cipa9nginanACO–  Thesearethesamewaiversgrantedtopar9cipantsinMedicare’s

exis9ngACOprograms–authorizereferralsandsharingofsavingsacrossproviders

–  Fivecategoriesofwaivers–  ACOPre-Par9cipa9onWaiver

–  ACOPar9cipa9onWaiver

–  SharedSavingWaiver

–  CompliancewithPhysicianSelf-ReferralWaiver–  Pa9entIncen9vesWaiver

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Thetermsheetcontains4separatetypesofwaiversofMedicarelaws

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Term #8: Request for Additional Waivers

•  Addi9onalwaiversmaybesubmicedbyVermontalongwithara9onaleforthewaiveratany9me–  ThesearegrantedonlyifCMSagrees–  IfCMSdeniesarequestandVermontdeterminesthatthewaiveris

necessarytoachievethegoalsofthemodelagreement,Vermontmayterminatetheagreement

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SpecifieshowVermontmayrequestaddi9onalwaiverstocarryouttheall-payermodel

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Term #9: Revocation of Waivers

•  CMSmayrevokewaiversorterminatetheagreementifVermontdoesnotcomplywithcondi9onsassociatedwiththewaiver.–  Anywaivercondi9onswillbemadeexplicitinthefinalmodel

agreement

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AuthorizesCMStorevokewaiversorterminatetheagreement

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Term #10: All-Payer Rate Setting System

•  Vermontwillmaintainanallpayerratesenngsystemforallregulatedservices

•  Medicarerateswillbeestablishedinoneoftwoways–  ThroughanACO-basedreimbursementmethod

–  UsingtheMedicarefeescheduleasareference

•  LanguagecontemplatesVermontandCMSworkingtogethertodesignaclaimsprocessingandpaymentapproachforACOservicesandpaymentsthatconformstoVermont’splanandCMSopera9onalrequirements

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Describesingeneraltermstheopera9onoftheall-payersystem

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Term #11: Provider Participation in Alternative Payment Models

Beginningin2019,anewfederallaw–theMedicareAccessandCHIPReauthorizaJonActof2015(MACRA)–willgovernMedicarephysicianpayments•  MACRAcreatesanewframeworkforexis9ngqualityrepor9ngprogramsand

encouragesphysicianstopar9cipateinalterna9vepaymentmodels

•  Alterna9vepaymentmodelsincludeACOs,pa9ent-Centeredmedicalhomes,andbundledpaymentmodels

•  Providerswhoqualifycanreceiveincen9vepaymentsunderMACRA

ThetermsheetspecifiesthatprovidersparJcipaJngintheACOinVermont’sall-payermodelwillqualifyfortheMACRAincenJvepayments

•  Willreceivelumpsumbonuspaymentsof5%ofaphysician’stotalMedicarepayments

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StatesthatVermontwillu9lizeanACOmodelundertheall-payermodel

EnsuresthatVermontwillbenefitfromanewMedicarephysicianpaymentlawthatencouragesproviderstopar9cipateinalterna9vepaymentmodels

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Inessence,RegulatedServicesarethosecoveredbytheModelAgreement

•  InMaryland,themodelagreementonlyregulateshospitalpayments.InVermont,regulatedservicesaremoreexpansive

•  DerivedfromcurrentfederalandstateSSPs

•  ForMedicare:PartsAandBServices

•  ForMedicaidandCommercial:TheclosestanaloguetothoseMedicareservices

•  Definedbycategoriesofservice

RegulatedRevenuecanbedifferentfromtheservicesforwhichtheACOisatrisk.

•  TermsheetindicatesaninterestinpursuingpharmacyasanACO-coveredservice

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RegulatedServices:SpendingcategoriessubjecttotheallpayerceilingandfromwhichMedicaresavingsarederived

Term #12: Regulated Services

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All Payer Baseline

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Medicare Services Parts A-B = 87.7% Part D = 12.3%

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Commercial Services Covered = 71.4% Non-covered = 28.6%

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Medicaid Services Covered = 34.3% Non-covered = 65.7%

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Regulated Services in Relation to the Overall Delivery System

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ThegoalofalloftheworkVermontisdoingandwilldoistocreateanintegratedsystem.Vermontiscommifedtopaymentanddeliveryreformacrossallservices,whetherinsideoroutsideoftheall-payermodel.

Underthislanguage,VermontmayphaseinaddiJonalservicesintotheregulatedenvironmentandincludemorehealthcarespendingover9mebasedonmutualagreementwithCMMI/CMS

Vermontcandefineapathwayforassessingreadinesstoconsiderinclusionoftheseservicesintheall-payermodel.Vermontwillevaluate

•  Payerandproviderreadiness

•  Healthinforma9oninfrastructure

•  Evalua9onreadiness•  Federalreadiness

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Term #13: Financial Targets: All-Payer Ceiling

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•  All-PayerCeiling:adefinedupperlimitonpercapitaspendinggrowth

•  All-PayerTarget:adefinedtargetforpercapitaspendinggrowtho  TheAll-PayerTargetisVermont’sgoalforspendinggrowth

o  TheAll-PayerCeilingisVermont’sobliga9onundertheModelAgreement

Measure Growth

15-YearEconomicGrowth(GrossStateProduct)

3.3%

All-PayerTarget 3.5%

All-PayerCeiling 4.3%

FailuretomeetceilingorMedicaresavingsisa“triggeringevent”–canleadtoa“correcJveacJonplan”

–  Requiresawricenresponseandanactualplan

–  Couldincludeprogramma9cchanges,modelchanges,orrateadjustments

–  Termsheetspellsoutwhatcons9tutesa“triggeringevent”

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Term #13: Financial Targets: Medicare Savings

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•  MedicareSavings–minimumsavingsrequiredundertheagreement•  Separatelycalculatedandbenchmarkedtona9onalpercapitagrowth

•  BenchmarkFloor–proposesafloortoguardagainstlowna9onalMedicaregrowth

Savingsarecalculatedoverthe5-yeartermoftheagreement•  Thisprovidesconsiderableflexibility,butplacesemphasisonstrongperformancein

theearlyyearsoftheagreement

Thebenchmarkfloorisanovelideathatcouldbeverycontroversial•  CMSunderstandsVermont’sconcernsandwilltrytoaddressthem

•  ToguardagainstbeingputinadeficitinYear1•  TorecognizethatVermontisaverylow-coststate

MedicareSavingsTarget 0.2%belowna9onalpercapitagrowth

BenchmarkFloorPerformanceYear1:3.5%

PerformanceYears2-5:2.0%

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Medicare Savings with an Aging Population

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ThetermsheetaddressesthechallengethatVermontfacesbyhavingalargershareof85+yearoldMedicareenrolleesthanthenaJonalaverage.•  Contemplatesanage-adjustedMedicaresavingscalcula9ontoadjustforrela9ve

differencesbetweenthena9onalandVermontpopula9on

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Term #14: Quality Monitoring and Reporting

POPULATIONHEALTH•  Establishedgoalsandpopula9onhealth

measureswillallowthestateandCMStomonitorprogressonthehealthofthepopula9oninpriorityareas

1.  Increasingaccesstoprimarycare

2.  Reducingtheprevalenceofandimprovingthemanagementofchronicdiseases

3.  Addressingthesubstanceabuseepidemic

•  Statewidemeasureswillbecollectedusingstatewidetools(BRFSS,surveillancedata,deathdata)

ALL-PAYERMODELQUALITYTARGETS•  Establishedtargetswillmeasureclinical

interven9onsthatleadtohealthimprovementsrelatedtothepopula9onhealthpriorityareas

•  Thesemeasuresarecurrentlycollectedandreflectprovenclinicalinterven9ons

•  Establishingqualitytargetsdirectlyrelatedtopopula9onhealthgoalswillensurethattheclinicaldeliverysystemisalignedwithstatepriori9es

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VermontisproposingtoestablishpopulaJonhealthgoalsandmeasurestobemonitoredandwillsetall-payermodelqualitytargetsrelatedtothosegoalsBothsetsofmeasureswillbeestablishedtogetherwithCMMIbyJune1,2016

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All-Payer Model Quality Framework

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PopulaJonHealth

Measures

All-PayerWaiverQuality

MeasuresACOQualityMeasures

ProviderQualityMeasures

CMMI GMCB

GMCB ACO

ACO Providers

ReporJngandMonitoringMeasures•  Necessaryoverallprioritymeasuresforrepor9ng

successofthemodel•  MayoverlapwithACOandprovider-specific

qualitymeasures•  DerivedfromStatePriorityGoals•  Repor9ngcategories:ACO,non-ACO

SetGoalsandMonitor

CMMI VDH/GMCBPrevalenceandAccessMeasuresforStatePriorityGoals1.  Increasingaccesstoprimarycare2.  Reducingtheprevalenceofandimprovingthe

managementofchronicdiseases3.  Addressingthesubstanceabuseepidemic

SetTargetsforAll-PayerModelAgreement

AdjustACOPayments

AdjustProviderPayments

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Term #15: Data Sharing

•  Vermontsuppliesall-payerclaimsfromVHCURESonaquarterlybasis

•  CMSwillacceptdatarequestsfromVermonttofurtherthepurposesofthemodel,andwillapprove,denyormodifywithin30daysofanyrequest,subjecttoprivacyandsecuritylaws

•  ProposesthatCMSwillsharewithVermontdatanecessarytodetermineproviderperformance,andauthorizesVermonttodisclosesuchperformancedata

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Describesexpecta9onsaboutdatasharingandtheprocessfordatarequests

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Term #16: All-Payer Model Evaluation

•  CMSwillevaluatethemodelinaccordancewithSec9on1115(a)(b)(4)–  Thisisasubstan9alevalua9onandwillcompareVermonttona9onal

Medicareandtootherstates

•  VermontwillsubmitanannualreporttoCMSconcerningitsperformanceonthefinancialandqualityrequirementsofthemodelagreement–  Thiswillincludeperformanceontheall-payerceiling,and

performanceonqualitymeasuresestablishedunderTerm#14.

•  Containstechnicallanguageaboutmaintenanceofrecords

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DescribeseffortsbyVermontandCMStoevaluatetheimplementa9onoftheall-payermodel

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Term #17: Modification

•  Bothpar9esmayamendtheagreementatany9mebymutualconsent

•  CMSmayamendtheagreementforgoodcauseorifnecessarytocomplywithfederalorstatelaworregula9on–  CMSprovides30daysno9ce

–  IfVermontdisagreeswiththemodifica9on,orcannotadoptitbecauseitiscontrarytostatelaw,CMSorthestatemayterminatetheagreement

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Specifiestheprocessforeitherpartytosuggestamendmentstothemodelagreement

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Term #18: Termination and Corrective Action Triggers

•  Enforcementofthemodelisdrivenbytheoccurrenceofspecified“triggeringevents”

•  AmaterialbreachoftheModelAgreement•  Adetermina9onbyCMSthatVermonthasnotproducedagreed-uponMedicare

savingsfor2consecu9vePerformanceYears•  Adetermina9onbyCMSthatVermonthasexceededtheall-payerpercapitagrowth

ceilingby1.0percentagepointormorefor2consecu9vePerformanceYears•  Adetermina9onbyCMSthatthequalityofcareprovidedtoMedicare,Medicaidor

CHIPbeneficiarieshasdeteriorated•  Adetermina9onbyCMSthattheStateand/orACOhavetakenac9onsthat

compromisetheintegrityoftheModelortheMedicaretrustfunds

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Specifiestheprocessfortermina9onofthemodelagreement

Describestheenforcementoftheagreement,intheformofcorrec9veac9onplansbasedondefinedtriggeringevents

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Term #18: Termination and Corrective Action Triggers (continued)

•  Ifatriggeringeventoccurs,CMSprovidesawarningno9cewithin6monthsoftheendofaperformanceyear

•  Vermonthas90daystorespondtotheno9ce,andwithin90daysofitsresponseCMScanrequireVermonttoproduceacorrec9veac9onplan(CAP)

•  Vermonthas1yeartosuccessfullyimplementtheCAP

•  IftheCAPisnotimplemented,CMScanrescindpartoftheagreementorterminateit

•  Ingeneral,thestatemayterminatetheagreementforanyreasonwith180dayswricenno9ce

•  Upontermina9on,Vermonthas2yearstotransi9onbacktothena9onalMedicareprogram

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PartIII:GMCBAnalyJcalModeling

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The GMCB All-Payer Analytical Model

1.UseoftheModeltoInformtheNegoJaJons

2.PresentaJonoftheModel• All-PayerSummaryProjec9ons• RegulatedRevenue• CategoriesofService• Representa9veUsesoftheModel• Projec9onModel• TheModelasaToolforGMCB

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