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WELCOME TO THE 4 Q2015 R4P MEETING November 17, 2015 AGENDA MCPIPA BUSINESS

WELCOME TO THE 4 Q2015 R4P MEETING November 17, 2015 AGENDA MCPIPA BUSINESS VOTE ON INCENTIVE DISTRIBUTION METHODOLGY BEHAVIORAL HEALTH TASK FORCE PRESENTATION ACC MEDICAID PRIME 2016 MCPIPA’S RESPONSE TO CHANGES IN HEALTHCARE IN MESA COUNTY. MCPIPA INCENTIVE PROGRAM.

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WELCOME TO THE 4 Q2015 R4P MEETING November 17, 2015 AGENDA MCPIPA BUSINESS

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  1. WELCOME TO THE 4Q2015 R4P MEETING November 17, 2015 AGENDA • MCPIPA BUSINESS • VOTE ON INCENTIVE DISTRIBUTION METHODOLGY • BEHAVIORAL HEALTH TASK FORCE PRESENTATION • ACC MEDICAID PRIME 2016 • MCPIPA’S RESPONSE TO CHANGES IN HEALTHCARE IN MESA COUNTY

  2. MCPIPA INCENTIVE PROGRAM VALUE OF R4P QUARTERLY MEETING • Meeting And Collaborating With One Another • Provides forum for updates on current events • Dollar value of 3Q2015 R4P Meeting held on August 18, 2015 based on incentive funds is: • Dollars Available $75,000.00 • Cost of Meeting $ 5,805.65 • Amount to distribute$ 69,194.35 • 147 Attendees $ 470.71

  3. HOUSEKEEPING • Did you sign in? • Remember to VOTE and sign your ballot. • Remember to complete your survey. We appreciate your responses and will share the detail with various committees including the Incentive Design Team, PIE and QVOC.

  4. PHYSICIAN DIRECTED • Board of Directors – 100% Physician • Committees – Physician directed and membership includes IPA physicians and other community stakeholders • Multi-specialty association

  5. MEET YOUR BOARD MEMBERS Primary Care Physicians Korrey Klein, MD President Family Medicine Josh Campbell, MD Vice-President, Family Medicine Stephanie Shrago, MD, Family Medicine Michael Whistler, MD, Pediatrics

  6. MEET YOUR BOARD MEMBERS Joel Dean, DO, Neurology Non-Procedural Specialists David Scott, MD, Allergy/Immunology

  7. MEET YOUR BOARD MEMBERS Charles Breaux, Jr., MD Pediatric Surgery Procedural Surgical Specialists Kirk Clifford, MD, Orthopedics

  8. MEET YOUR BOARD MEMBERS Todd Hegstrom, MD, Radiology Procedural Hospital Based

  9. MEET YOUR CHIEF MEDICAL OFFICER • Greg Reicks, DO • Member of MCPIPA since 1989 • Board Member 2004 – 2013 • Past President of Board • Select, prepare, and train future leaders of MCPIPA • Assist MCPIPA staff and President in agenda development and preparation for Board and Executive Committee Meetings • Serves as MCPIPA Representative for outside entities

  10. MCPIPA Updates • Changes to MCPIPA Staff • Welcome to New MCPIPA Members • Board Recruitment • Vote – Incentive Distribution Methodology

  11. Changes to MCPIPA Staff • Thanks to Kellie Jackson for her contributions to MCPIPA. • Good Luck in your new position at Western Orthopedics • Welcome to Donna Neste • Clinical Programs Coordinator • Coordinates activities related to development of incentive programs, education programs, physician incentive programs and data analytics

  12. Welcome to New MCPIPA Members Since August 2015 Michael (Kurt) Gordon MD Radiology George Winters, III, MD Gastroenterology

  13. Medicaid Fee Schedule Change Adjustments • “Heads up” to practices that due to changes in the Medicaid Fee Schedule from September 2014 – June 2015, RMHP is re-adjudicating claims. • RMHP sent letter to practices October 27, 2015 • Majority of adjustments are positive.

  14. BOARD ELECTIONS - 2016 • Board Positions to be Determined by Vote of the Membership in February 2016 • Pediatrics • Incumbent: Michael Whistler, MD • Primary Care • Incumbent: Josh Campbell, MD • Non-Procedural Specialty • Incumbent: Joel Dean, DO • Other nominations will be accepted. • Be involved – this is your organization!

  15. BALLOT INITIATIVE:INCENTIVE PAYMENT DISTRIBUTION METHODOLOGY THE MSA WITH RMHP EFFECTIVE JULY 1, 2015 NECESSITATES A CHANGE IN HOW THE MCPIPA INCENTIVE PROGRAMS ARE FUNDED. • Your Physician Services Agreement with the IPA states that substantial changes to the Incentive Program require a vote of the IPA membership. • The Board determined that the change in how the Incentive Program is funded requires a change in how the money is distributed. • The proposed distribution is based on a Net Pro-Rated Methodology

  16. BALLOT INITIATIVE:INCENTIVE PAYMENT DISTRIBUTION METHODOLOGY

  17. MCPIPA Incentive Program • Before and After Comparison • Before • Prior to July 1, 2015 • The incentive fund was comprised of three components

  18. MCPIPA Incentive Program • Before and After Comparison • After • The incentive fund is still comprised of three components • The dollar amount is much larger • July 1, 2015 QHN 10% R4P 10% General Incentives 80%

  19. INCENTIVE PAYMENT DISTRIBUTION METHODOLOGYEXAMPLES The $150,000 for QHN and R4P will be deducted from the total Incentive Funds each quarter prior to determining the pro-rated amount each physician is eligible to receive.

  20. BALLOT INITIATIVE:INCENTIVE PAYMENT DISTRIBUTION METHODOLOGY • QUESTIONS • DON’T FORGET TO VOTE • SEND THE BALLOTS TO THE END OF THE TABLE

  21. BEHAVIORAL HEALTH TASK FORCE • Established January 2015 • Mission: To enhance patient care through communication with Behavioral Health Providers and Primary Care Physicians. • Physician Members Deborah Stetler MD Stephanie Shrago MD Ivan Alkes MD Mary Willy MD Tonya Wren MD

  22. BEHAVIORAL HEALTH TASK FORCE PRESENTATION ABOUT MIND SPRINGS HEALTH INTAKE PROCESS • Allows Mind Springs to recommend the best range of comprehensive services for your patient • Walk -in, no appointment necessary, no referral necessary! (but referrals are appreciated…) • Available Mon-Fri 7:30 am-4:00 pm at 515 28 ¾ Rd. WHEN WILL MY PATIENT BE SEEN? • Average wait time to be seen by intake clinician: 75 minutes in last 3 months • Average number of days before first visit with clinician, after intake: 6-8 days average • Average number of intakes per month: 275 per month • Average number of clients who must return for intake because of wait time: 10 per month But my MEDICAID patient can’t do a walk-in appointment!... • Refer Medicaid to the website listing non-Mind Springs behavioral health providers - www.coloradohealthpartnerships.com

  23. BEHAVIORAL HEALTH TASK FORCE PRESENTATION • QUESTIONS • If you would like more information on Mind Springs services and intake process please indicate on your survey and Mind Springs will contact you.

  24. SIM PROGRAM • Grant awarded to Colorado • Funding in support to integrate Behavioral Health in Primary Care Practices • First Cohort – 100 practices in the state. Will be announced by year-end 2015 • Subsequent cohorts of 150 practices by year end 2018

  25. Catalog of Primary Care Advancement Opportunities – What’s In It For You?

  26. ACC MEDICAID PRIME PROGRAM • Individual practice reports are available from MCPIPA Staff • Gain On Monthly Global Payment Paid to MCPIPA Primary Care Practices Relative To Utilization • $531,391.65 or $5.30 PMPM • 100,300 Attributed Member Months

  27. ACC MEDICAID PRIME PROGRAMSHARED SAVINGS • Shared Savings Have Been Earned For Year One! • Met 4 of the 4 Targets Resulting in 100% of Potential Shared Savings • Targets • MET - Use of PAM • MET - Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up • MET - Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan • Met- Diabetes: Hemoglobin A1c Poor Control • Estimated Funds available for distribution - $1,838,139 in Spring 2016

  28. ACC MEDICAID PRIME PROGRAMSHARED SAVINGS • A primary care practice is eligible for Year One Shared Savings if the following criteria is met by 12/31/15: • Involvement in a comprehensive primary care process such as • CPCI practice with no corrective action plan from CMS • Current NCQA Level 3 PCMH Recognition • Graduate of RMHP Masters Level 2 • Eligible for Medicaid RCCO enhanced payment AND • CQM reporting: • By September 1, 2015 practice reported a baseline performance on at least 2 of the 3 quality measures • By December 31, 2015 practice establishes and reports a practice specific improvement target.

  29. ACC MEDICAID PRIME PROGRAMSHARED SAVINGS • The 8 Practices Who Did Not Participate in the Quality Measures Could Have Earned $195,975.05 Collectively • Don’t Miss Another Opportunity! - Call MCPIPA Staff to prepare for Year Two

  30. THE VALUE OF THE IPA

  31. MCPIPA’S RESPONSE TO CHANGES IN HEALTH CARE IN MESA COUNTY • Letter to IPA Physician Members from Board of Directors • MCPIPA Marketing Campaign • Alternative Payment Models • Quality Programs

  32. 2015 Incentive Reminders • 4Q2015 due January 15, 2016 • PCP – Pre-Visit Collaboration working with Specialist • Specialist – Referring physician review

  33. 2016 Incentive Measures

  34. Pre-Auth Elite Program REMINDER • Effective January 1, 2015: • Physicians who HAVE obtained Pre-Auth Elite status must recertify each year by reviewing/reading the annual updates to the appropriateness criteria on the ACR web sight. • Physicians who HAVE NOT obtained Pre-Auth Elite status must watch the video. • Once Physicians have watched the video or read the articles an attestation email must be sent to MCPIPA in order to complete your status.

  35. Pre-Auth Elite Program REMINDER TO MEET YOUR 2015 PRE-AUTH ELITE REQUIREMENTS As of November 16, 2015, 162 or 55% of MCPIPA members have met the 2015 Recertification requirement.

  36. Pre-Auth Elite Program • Go to WWW.mcpipa.org • User name and Password is mcpipadoc - lower case

  37. SAVE THE DATE February 16, 2016 • 1Q2016 R4P QUARTERLY PHYSICIANS MEETING • Share your ideas for topics • More details to come R4P MCPIPA

  38. 2016 R4P MEETINGS • Tuesday February 16, 2016 • Tuesday May 17, 2016 • Tuesday August 16, 2016 • Tuesday November 8, 2016

  39. Thank you Physicians Cooperating to Deliver High Quality Health Care to Our Community

  40. Questions?

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