Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Welcome to Comprehensive Primary Care Plus (CPC+)

January 11, 2017

Laura Sessums, Sarah McHugh, Elisha Jewett, and Amy Gibson

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Welcome from CMS Leadership

Patrick Conway, MDCenters for Medicare & Medicaid Services (CMS)

Acting Principal Deputy Administrator and Deputy Administrator for Innovation and Quality

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

1) The CPC+ Practices

2) Perspective from CPC “Classic” Practices

3) Resources Available to You Now

4) What’s Coming Next in CPC+

5) Live Q&A

Kicking Off CPC+

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

CPC+ Practices Span 14 Regions

Rhode Island

North Hudson/Capital District (NY)

New Jersey

Greater Philadelphia (PA)

Northern Kentucky(part of Ohio region)

= Statewideregion= # of Payers= # of Clinicians= # of practices = Region comprising contiguouscounties

Hawaii

MTOR

CO

OK AR

OH

MI

TN

GreaterKansasCity

Oregon

156108715

Montana

543543

Arkansas

1826896

Kansas City

1096741

Michigan

44820022

Ohio

562256612

Rhode Island

312093

Hawaii

1032681

Colorado

20712295

Oklahoma

1746865

Tennessee

563334

Philadelphia

2199952

New York

1575933

New Jersey

43614073

INFORMATION NOT RELEASABLE TO THE PUBLIC: It must not be disseminated, distributed, or copied to persons unless they have been authorized by CMS to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Practice Selection: Current Data

47%• 782 independent

practices

• 467 rural practices

• 1057 small practices

• 1,758,982 Medicare beneficiaries served

2,894Practices

Total Number of Practices Starting in 2017

Medicare SSP* Participation

• 1354 practices in existing Medicare SSP ACOs**

Organizational Structure

1379

1515

Track 1 Track 2

Track Breakdown

*Shared Savings Program (SSP) **Accountable Care Organizations (ACOs)

INFORMATION NOT RELEASABLE TO THE PUBLIC: It must not be disseminated, distributed, or copied to persons unless they have been authorized by CMS to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Practice Selection: Regional Breakdown

Region Track 1 Track 2 Total Practices

Arkansas 84 98 182Colorado 94 113 207

Hawaii 41 62 103Kansas City 74 35 109

Michigan 258 190 448Montana 25 29 54

New Jersey 264 172 436New York 64 93 157

Ohio 192 370 562Oklahoma 78 96 174

Oregon 71 85 156Philadelphia 82 137 219Rhode Island 10 21 31

Tennessee 42 14 56INFORMATION NOT RELEASABLE TO THE PUBLIC: It must not be disseminated, distributed, or copied to persons unless they have been

authorized by CMS to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

1) The CPC+ Practices

2) Perspective from CPC “Classic” Practices

3) Resources Available to You Now

4) What’s Coming Next in CPC+

5) Live Q&A

Kicking Off CPC+

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Summit Family Physicians Inc.

Mark Frazer, MD

• Independent, physician-owned • Three Physicians, one Nurse,

and 18 dedicated Employees • 7,000 Patient Population• Summit Family was founded in

1985 in Middletown, Ohio

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Family Physicians of Greeley, PLLP

Lane MattoxQuality and Systems Manager

• Independent, physician-owned family practice

• 24 Physicians, four Physicians Assistants, and 96 Employees

• Four locations in Greeley, COand Johnstown, CO

• Primarily privately-insuredpopulation but growing inMedicare and Medicaid

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

1) The CPC+ Practices

2) Perspective from CPC “Classic” Practices

3) Resources Available to You Now

4) What’s Coming Next in CPC+

5) Live Q&A

Kicking Off CPC+

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Key Resources and Release Dates

Oct 30, 2016 Jan 6, 2017 Dec 21, 2016Jan 6, 2017

1CPC+

Participation Agreement

2CPC+ Payment Methodologies

Paper

3CPC+ Practice Composition

Policies

4Phase 1 CPC+

Implementation Guide

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Participation Agreement and Composition Policies

Participation Agreement

• Legal agreement and reference for all CPC+ policy

• Summary Guide available that highlights key sections

• Most relevant now:– General CPC+ Practice

Requirements, Page 11– Agreements with

Practitioners, Page 12– Payment, Page 17– Use of CPC+ Payments,

Page 22

Composition Policies

• Practitioner Roster changes: how to add/withdraw practitioners

• Changing a Practice Tax Identification Number (TIN)

• Workflow for all composition change requests

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Payment Methodology Paper

Care Management Fee

Performance-Based Incentive Payment

Underlying Payment Structure

Track 1

$15 average $ 2.50 opportunity Standard fee-for-service (FFS)

Paid prospectively on a quarterly basis

Paid prospectively on an annual basis; must meet quality and utilization metrics to keep incentive payment

Regular Medicare FFS claims payment

Track 2

$28 average; including $100 to support patients with complex needs

$4.00 opportunity

Reduced FFS with prospective*Comprehensive Primary Care Payment* (CPCP)

Paid prospectively on a quarterly basis

Paid prospectively on an annual basis; must meet quality and utilization metrics to keep incentive payment

CPCP paid prospectively on a quarterly basis; Medicare FFS claim is submitted normally but paid at a reduced rate

On-demand webinar series available in February

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Phase I Implementation Guide: Getting Started with CPC+

Steps to Access and Use the CPC+ Practice Portal

Choose Your Electronic Clinical Quality Measures (eCQMs)

Plan for your CPC+ care delivery redesign

Health IT

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

CPC+ Practice Portal

Actions you need to take:• Get CPC+ Practice Portal Access• Update Practice Information• Add and Withdraw Practitioners

Practice Portal and CPC+ Connect Webinar Jan 25th

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Selecting eCQMs for CPC+

Practices must select and report 9 of the 14 measures from the CPC+ eCQM measure set for the 2017 Performance Period

• At least two of the three outcome measures, AND• At least two of the four complex care measures, AND• Five of the remaining 10 measures

Practices are strongly encouraged to obtain the technology and necessary configuration for the ability to report all 14 measures; however, practices are only required to report nine measures

Practices are required to engage in quality improvement efforts focused on at least three of the eCQMs they selected for the 2017 performance period

Practices should have selected their eCQMs by January 1, 2017

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Reporting eCQMs for CPC+

• Practices should:– Understand how performance is calculated for all measures selected– Ensure the measures are calculated correctly in the electronic health record (HER)

• Reporting eCQMs - All data elements for the eCQMs, including numerator, denominator, exclusions and exceptions (if applicable), and performance rates must be submitted in order to meet the requirements.

– For measures with multiple data elements, all elements must be reported (e.g., two performance rates or two numerators)

• CPC+ Quality and Health IT Overview on-demand webinar now available

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Care delivery requirements

Incremental steps to achieve requirements

Track 2 requirements only

Care Delivery Roadmap Example: Access and Continuity

Care Delivery webinar Jan 19th

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Key Health IT Requirements

All CPC+ practices must use certified EHR technology and Certified Health IT to perform specific functions throughout all 5 CPC+ performance periods.

All CPC+ Practices are strongly encouraged to contact their Health IT vendor immediately to ensure that they will be able to meet these requirements.

By January 1, 2017 By January 1, 2018 By January 1, 2019

Track 1 and 2 Track 1 and 2 Track 2 Only

CPC+ Health IT and Reporting Requirements by Performance Period

• Maintain 2014 or 2015 Edition Health IT certification criteria

• Ensure Health IT is capable of reporting CPC+ eCQMs at the Practice Site level

• Adopt or maintain 2015 Edition Health IT certification criteria

• Ensure eCQM Practice Site Report is made using Health IT meeting 2015 Edition (c)(4) criterion, filtered by Practice Site & TIN/NPI

• Adopt 2015 Edition Health IT certification criteria for Care Plan criterion

• Adopt 2015 Edition Health IT certification criteria for Social, Behavioral and Psychological Data criterion

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Health IT Checklist: Tracks 1 and 2

Review the Health IT requirements for your track at https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus

Talk with your Health IT vendor(s) to ensure that your practice will meet all CPC+ requirements

If you are planning to switch EHRs, you must notify CMS in the CPC+ Practice Portal. CPC+ Support will then follow up with the practice directly. Contact your current and new Health IT vendors immediately to plan for the switch and ensure you remain eligible for CPC+.

• CPC+ Quality and Health IT Overview on-demand webinar now available

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

1) The CPC+ Practices

2) Perspective from CPC “Classic” Practices

3) Resources Available to You Now

4) What’s Coming Next in CPC+

5) Live Q&A

Kicking Off CPC+

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

CPC+ Practice Participants’ Checklist

If not already complete, select your eCQMs and work with your EHR vendors to ensure those measures are tracked

Inform your patients about your participation in CPC+

Complete the Baseline Assessment by January 18

Update your calendar with upcoming CPC+ webinars

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

What CPC+ Means for your Patients

As part of your practice’s participation in CPC+, you are required to notify Medicare FFS beneficiaries attributed to your practice of:

1. Your practice’s participation in CPC+2. Medicare’s intention to share personally identifiable information from

Medicare claims with your practice

It is important for you to convey to your patients that their Medicare benefits are not changing, they can visit any doctor or hospital they choose, and there is not any additional cost sharing for CPC+.

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Baseline Learning Assessment

Assessment distributed on Jan 5, 2017

Each CPC+ practice should only submit one assessment for each unique CPC+ Practice ID

Baseline Learning Assessment should be completed by January 18, 2017

CPC+ Support is available from 8:00 am to 1:00 am ETat Toll-Free Number:1-888-372-3280 and CPCPlus@telligen.com

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Many Opportunities for Learning, Collaboration, and Support

Web-based platform for CPC+ stakeholders to share ideas, resources, and strategies for practice transformation.

National Learning Community• Cross-region collaboration• Live and on-demand learning opportunities: action

groups, webinars, affinity groups, office hours• Durable written products: Implementation Guide,

newsletters, FAQs, case studies/spotlights• Annual Stakeholder Meeting

Regional Learning Communities• Virtual and in-person learning sessions• Outreach to and support for practices• Clinical and administrative leadership engagement• Payer engagement• Alignment with regional reform

Learning Communities

CPC+ Connect will be available to all participants on Jan 26

Practice Portal and CPC+ Connect Webinar Jan 25th

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Save the Date: Upcoming CPC+ Events

Check the CPC+ Community’s Weekly Update for registration details as they become available

Open Office Hour sessions will be on last Thursday of every month at 4:00 pm ET; additional office hours may be added as needed

Webinar Topics Target Date Overview of Care Delivery Model January 19, 2017 @ 4:00 pm ET

Practice Portal and CPC+ Connect January 25, 2017 @ 4:00 pm ET

Care Management February 2, 2017 @ 4:00 pm ET

Optimal Use of Health IT February 8, 2017 @ 4:00 pm ET

Comprehensiveness and Coordination February 16, 2017 @ 4:00 pm ET

Planned Care andPopulation Health March 2, 2017 @ 4:00 pm ET

Requirements, Reporting, and Monitoring March 8, 2017 @ 4:00 pm ET

Patient and Caregiver Engagement March 16, 2017 @ 4:00 pm ET

Continuous Improvement DrivenBy Data March 22, 2017 @ 4:00 pm ET

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Montana

Oregon

HawaiiOklahoma

Kansas City Michigan

X ??X ??X ??

Ohio

New Jersey

Arkansas

Rhode Island

Philadelphia

New York

Roger Adams

Colorado

Johnathan Yao

Gabrielle Schechter

Julie Johnson / Motisola

RoweSarah McHugh

RebeccaBirnbach

RebeccaBirnbach

Andrea Harmon

Ben Lauing

Roger Adams Tennessee

LisaMacDonald

Lisa Bari

Roger Adams

SonjaMadera

Contact Us

CPC+ Support is available from (8:00 am to 1:00 am ET, at Toll-Free Number:1-888-372-3280 and CPCPlus@telligen.com

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Kicking Off CPC+

1) The CPC+ Practices

2) Perspective from CPC “Classic” Practices

3) Resources Available to You Now

4) What’s Coming Next in CPC+

5) Live Q&A

Additional Questions?

Contact CPC+ Support atCPCPlus@telligen.com or 1-888-372-3280

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Comprehensive Primary Care Plus Center for Medicare & Medicaid Innovation

Thank you

We appreciate your feedback on this learning event. Please take a minute to complete our survey.

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