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ACI Steering Committee

ACI Steering Committee. July 21, 2015. Today’s Agenda. Public Reporting of TCI on GetBetterMaine Update/status of Measure Alignment work Update on Primary Care Spend Findings and recommendations of Bailit Health interviews on key primary care payment definition

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ACI Steering Committee

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  1. ACI Steering Committee July 21, 2015

  2. Today’s Agenda Public Reporting of TCI on GetBetterMaine Update/status of Measure Alignment work Update on Primary Care Spend Findings and recommendations of Bailit Health interviews on key primary care payment definition CMS announcement of potential expansion of CPCI

  3. Review of recommended “payment” measure set

  4. Review of recommended “payment” measure set (continued)

  5. Review of recommended “payment” measure set (continued)

  6. Review of recommended “payment” measure set (continued)

  7. Review of recommended “monitoring” measure set

  8. Review of recommended “monitoring” measure set (continued)

  9. Primary Care Spend Calculation • Total spend used in denominator $1.02 billion (inc $290m Rx) • Of that total, primary care spend $53 million • 5.2% primary care spend • CY 14 commercial non-claims spend - $10.3 million • Current estimate = 6.2% primary care spend

  10. Findings of Current Payment Practices • All FFS based, no capitation • Most payers offer small-to-modest PMPM payments for PCMH support • Payments include quality incentives, care management and shared savings • Payers focused on ACO contracting

  11. Discern’sProposed Approach • One size does not fit all • Tier 1- Practice Investment • Initial steps and investment in improvements in cost reduction, quality improvement and system integration. • Tier 2- Practice Enhancement • Financial incentives for performance improvement, continued investment • Tier 3- Practice Integration • Transition to more advanced payment models, increased risk to providers balanced by increased integration with system

  12. Discern’s Recommendations • Define performance expectations and measures for each tier • Tier 1 – infrastructure and process • Tier 2 – clinical quality; patient engagement • Tier 3 – population clinical and cost outcomes • Define payment principles for each tier • Tier 1 – fixed payments tied to specific improvements (leverage CCM) • Tier 2 – emphasis on performance-based payment; risk for primary care outcomes • Tier 3 – population risk

  13. Recommendations

  14. Recommendations

  15. Recommendations

  16. Recommendations

  17. Recommendations

  18. Recommendations

  19. Recommendations

  20. Recommendations

  21. Implementing the Recommendations • With current variation in primary care payment models and attention on ACOs, plan sponsors, health plans and MaineCare will need to support primary care by demonstrating: • Detrimental impact of FFS on PC delivery to achieve ACO goals • Evidence of effectiveness of value-based payment models • Increased performance accountability contained in the recommended model – measurable value

  22. Implementing the Recommendations • Practice Accountability: • How to assess practice performance? • Survey to gauge performance for 8 of 9 domains (excluding Quality Improvement Results) • Third party to conduct survey

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