Medicare Shared Savings Program 2018 Performance Year Kickoff

Transcription

1 Medicare Shared Savings Program 2018 Performance Year Kickoff For Participating Accountable Care Organizations January 8, 2018 Performance-Based Payment Policy Group Medicare Shared Savings Program

2 DISCLAIMER This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes frequently so links to the source documents have been provided within this document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. Medicare Shared Savings Program 2018 Performance Year Kickoff Disclaimer 2

3 Agenda Introduction to the Medicare Shared Savings Program (Shared Savings Program) Program Lifecycle for Performance Year (PY) 2018 Systems and Access Presentation Highlights Resources Question & Answer Session Medicare Shared Savings Program 2018 Performance Year Kickoff Agenda 3

4 Introduction to the Shared Savings Program Overview Vision for ACOs Program Data Rule-Making Process Medicare Shared Savings Program 2018 Performance Year Kickoff Introduction 4

5 Overview The Medicare Shared Savings Program was established by Section 3022 of the Affordable Care Act. Eligible Medicare providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). The Shared Savings Program rewards ACOs that lower their growth in health care costs while meeting quality performance standards. ACOs can choose to participate under a Track 1 shared savings only model (onesided model), or under the Track 2 or Track 3 shared savings and losses models (two-sided models). The Medicare ACO Track 1+ Model (Track 1+ Model) is new for 2018 and offers lower levels of risk to facilitate ACOs transition to performance-based risk. The Track 1+ Model expands opportunities for clinicians to participate in Advanced Alternative Payment Models (APMs) under the Quality Payment Program. Track 3 and Track 1+ ACOs have the option to participate in the Shared Savings Program with a Skilled Nursing Facility (SNF) 3-Day Rule Waiver. Medicare Shared Savings Program 2018 Performance Year Kickoff Introduction 5

6 Vision for ACOs Promote seamless, coordinated care Put the beneficiary and family at the center of care Attend carefully to care transitions Manage resources carefully and respectfully Coordinate the beneficiary s care proactively Evaluate data to improve care and patient outcomes Innovate to achieve better health, better care, and lower costs Invest in team-based care and workforce Medicare Shared Savings Program 2018 Performance Year Kickoff Introduction 6

7 Program Data CMS makes data on Shared Savings Program ACOs publicly available through a number of resources provided on the Program Data webpage. The document Publicly Available Data Sources and ACO Performance Data Maintained by CMS includes descriptions of these data sources and links to the most recently available data. CMS will release participation data for PY 2018 on the Program Data webpage early January. Medicare Shared Savings Program 2018 Performance Year Kickoff Introduction 7

8 Rule-Making Process CMS publishes stand-alone rules for the Shared Savings Program and utilizes the annual Physician Fee Schedule to make modifications to program regulations. CMS publishes proposed rules and allows a 60-day comment period to collect stakeholder feedback before releasing final rules. The Program Statutes & Regulations webpage on the Shared Savings Program website provides a summary of these rules as well as a link to the up-to-date regulations, which can be found at the Electronic Code of Federal Regulations. The regulations were last updated with the Physician Fee Schedule that was released on November 2, Medicare Shared Savings Program 2018 Performance Year Kickoff Introduction 8

9 Program Lifecycle for Performance Year 2018 PY 2018 Preparation PY 2018 Activities PY 2018 Assessment Medicare Shared Savings Program 2018 Performance Year Kickoff Program Lifecycle 9

10 Shared Savings Program Lifecycle Preparation Performance Year Quality Reporting Period Financial Reconciliation Activities Activities Activities Activities ACO Participant List Data claims report Quality reporting Financial management Program reports Quality measure reconciliation Application cycle Public reporting audit Payments Annual Certification Marketing made/loss Compliance monitoring collected Medicare Shared Savings Program 2018 Performance Year Kickoff Program Lifecycle 10

11 Performance Year 2018 Preparation Application Cycle ACO Participant, ACO Provider/Supplier, & SNF Affiliate List Management Annual Certification Medicare Shared Savings Program 2018 Performance Year Kickoff PY 2018 Preparation 11

12 Application Cycle Application Overview Medicare Shared Savings Program 2018 Performance Year Kickoff Application 12

13 Application Overview What is the timeline for the annual application process? The annual application cycle typically begins with the Notice of Intent to Apply (NOIA) in May and ends with final dispositions in the fall. CMS recently approved Shared Savings Program applications for initial and renewing ACOs. CMS approved additional applications for: Track 1 ACOs requesting participation in the Track 1+ Model Track 3 and Track 1+ ACOs requesting a SNF 3-Day Rule Waiver ACOs that began a Shared Savings Program agreement period (initial or renewing) in 2016 will be eligible to renew their applications during the PY 2019 application cycle. CMS hosts various webinars throughout the year to discuss the application cycle, beginning with the Medicare Learning Network calls in the spring. Medicare Shared Savings Program 2018 Performance Year Kickoff Application 13

14 ACO Participant, ACO Provider/Supplier, & SNF Affiliate List Management 2018 Process Changes ACO Participant List ACO Provider/Supplier List SNF Affiliate List Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 14

15 2018 Process Changes CMS is updating the ACO Participant List and SNF Affiliate List change request review cycle schedule and will notify ACOs of the new schedule via the ACO Spotlight Newsletter and published guidance. CMS is planning to transition from the Health Plan Management System (HPMS) to a new management system for ACO operations this spring. More information about this change will be provided later in the presentation. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 15

16 ACO Participant List What is the ACO Participant List, and how does CMS use it? The ACO Participant List includes information about ACO participants and, in some cases, ACO providers/suppliers. CMS uses the ACO Participant List to: Assign beneficiaries to the ACO. Establish the historical benchmark. Perform financial reconciliation. Determine a sample of beneficiaries for quality reporting. Coordinate participation in CMS quality reporting initiatives based on Shared Savings Program quality reporting results. Monitor the ACO for program integrity issues. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 16

17 ACO Participant List (cont.) What are the ACO Participant List requirements? ACOs must maintain, update, and annually submit and certify the ACO Participant List before the start of any given performance year. ACOs may add, modify, and/or delete participants (via a change request in HPMS) in accordance with the ACO Participant List review schedule. ACO participants are considered participants in the program for the duration of the performance year. ACOs that terminate ACO Participant Agreements or changes ACO providers/suppliers must inform CMS within 30 days. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 17

18 ACO Provider/Supplier List What is the ACO Provider/Supplier List, and how does CMS use it? The ACO Provider/Supplier List is a list of all providers and suppliers billing through the ACO participants approved to participate in a specific ACO. In order for a provider/supplier to participate in the Shared Savings Program, they must appear on the certified ACO Provider/Supplier List. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 18

19 ACO Provider/Supplier List (cont.) What are the ACO Provider/Supplier List requirements? ACOs must certify that all ACO providers/suppliers have agreed to participate in a specific ACO during Annual Certification. ACOs that make changes to their ACO Provider/Supplier List must inform CMS within 30 days. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 19

20 SNF Affiliate List What is the SNF Affiliate List, and how does CMS use it? The SNF Affiliate List (for waiver-approved Track 3 and Track 1+ ACOs only) includes information on the SNFs that are eligible to use the SNF 3-Day Rule Waiver. UPCOMING WEBINAR January 18, 2018 SNF 3-Day Rule Waiver Webinar Details are available on the Shared Savings Program (SSP) ACO Portal Calendar of Events. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 20

21 SNF Affiliate List (cont.) What are the SNF Affiliate List requirements? ACOs may add, modify, and/or delete SNF affiliates via a change request from their SNF Affiliate List in HPMS. Changes to SNF Affiliate Lists correspond with the ACO Participant List change request schedule. Medicare Shared Savings Program 2018 Performance Year Kickoff List Management 21

22 Annual Certification Annual Certification Overview Medicare Shared Savings Program 2018 Performance Year Kickoff Annual Certification 22

23 Annual Certification Overview What is Annual Certification? On an annual basis, the Shared Savings Program requires ACOs to review, certify, and electronically sign official program documents referred to as Annual Certification. Annual Certification occurs in November/December of each year after acceptance into the Shared Savings Program as an initial or renewing applicant, and annually thereafter before the start of a new performance year. All currently participating and approved applicant ACOs (including Track 1+ Model and SNF 3-Day Rule Waiver applicants) must complete Annual Certification. Medicare Shared Savings Program 2018 Performance Year Kickoff Annual Certification 23

24 Performance Year 2018 Activities Data Sharing Program Reports Public Reporting Ongoing Marketing Program Compliance Medicare Shared Savings Program 2018 Performance Year Kickoff PY 2018 Activities 24

25 Data Sharing Data Sharing Overview Monthly Claim and Claim Line Feed (CCLF) User Group Medicare Shared Savings Program 2018 Performance Year Kickoff Data Sharing 25

26 Data Sharing Overview Why and how does CMS share data? CMS shares CCLF data with ACOs on a monthly basis to aid in their care coordination efforts. CMS delivers CCLF data mid-month to an ACO s Managed File Transfer (MFT) mailbox, which an ACO s authorized users can access and download. What data does CMS share? For Track 1 and Track 2 ACOs, the CCLFs include data on assignable beneficiaries who had a qualifying primary care visit with the specific ACO within the previous 12 months. For Track 3 and Track 1+ ACOs, the CCLFs include data regarding beneficiaries on an ACO s current prospective assignment list. ACOs will receive a monthly beneficiary exclusion status file (BNEXC.LIST) prior to receiving their CCLFs if any beneficiaries are excluded. Medicare Shared Savings Program 2018 Performance Year Kickoff Data Sharing 26

27 Data Sharing Overview Why and how does CMS share data? CMS shares CCLF data with ACOs on a monthly basis to aid in their care coordination efforts. CMS delivers CCLF data mid-month to an ACO s Managed File Transfer (MFT) mailbox, which an ACO s authorized users can access and download. What data does CMS share? For Track 1 and Track 2 ACOs, the CCLFs include data on assignable beneficiaries who had a qualifying primary care visit with the specific ACO within the previous 12 months. For Track 3 and Track 1+ ACOs, the CCLFs include data regarding beneficiaries on an ACO s current prospective assignment list. ACOs will receive a monthly beneficiary exclusion status file (BNEXC.LIST) prior to receiving their CCLFs if any beneficiaries are excluded. Medicare Shared Savings Program 2018 Performance Year Kickoff Data Sharing 26

28 Monthly CCLF User Group The CCLF Data User Group is a forum for ACOs to engage in peer-topeer learning about accessing, interpreting and using CCLFs. The audience includes ACO project managers, data analysts, IT staff, and subject matter experts. UPCOMING WEBINAR January 10, 2018 CCLF User Group Webinar Details are available on the SSP ACO Portal Calendar of Events. CMS provides subject matter expertise through presentations and call support. The weekly ACO Spotlight Newsletter provides logistical details. User Group sessions typically occur on the first Wednesday of each month. Medicare Shared Savings Program 2018 Performance Year Kickoff Data Sharing 27

29 Program Reports Program Reports Overview Program Reports Resources Medicare Shared Savings Program 2018 Performance Year Kickoff Program Reports 28

30 Program Reports Overview Why and how does CMS share quarterly and annual data? CMS shares aggregate data with ACOs on a quarterly and annual basis for ACOs to conduct health care operations analysis. CMS generally delivers quarterly reports six to eight weeks after the end of the calendar quarter to an ACO s MFT mailbox for authorized users to access and download. CMS delivers annual reports with financial reconciliation results to an ACO s MFT mailbox for authorized users to access and download. Dynamic reporting functionality is available in the Cognos section of the SSP ACO Portal. Medicare Shared Savings Program 2018 Performance Year Kickoff Program Reports 29

31 Program Reports Overview (cont.) What data does CMS share? For Track 1 and Track 2 ACOs, CMS shares aggregate metrics on the ACO s preliminary prospectively assigned beneficiary population based on assignment run for a rolling 12 months. For Track 3 and Track 1+ ACOs, CMS shares aggregate year-todate metrics on an ACO s prospectively assigned beneficiary population. CMS also makes available certain beneficiary-identifiable information (the minimum data necessary) on the assigned beneficiary populations. Medicare Shared Savings Program 2018 Performance Year Kickoff Program Reports 30

32 Program Reports Resources Where can ACOs get additional specifics on the program reports? Templates of the following reports (based on the formats for PY 2017) are currently available on the SSP ACO Portal in the Resources section: Assignment List Report, Assignment Summary Report, Expenditure/Utilization Report, and Historical Benchmark Report. The accompanying Assignment List Report and Assignment Summary Report User's Guide and Annual and Quarterly Aggregate Expenditure/Utilization Reports User s Guide provide detailed information concerning the data elements included in the referenced program reports. A Read Me file explaining the contents of the zip folder and the applicability of the reports to ACOs by track is included. CMS will update the template and user guides for 2018 prior to the release of the first quarterly reports. Medicare Shared Savings Program 2018 Performance Year Kickoff Program Reports 31

33 Public Reporting Public Reporting Overview Public Reporting Requirements Medicare Shared Savings Program 2018 Performance Year Kickoff Public Reporting 32

34 Public Reporting Overview What is public reporting, and why is it important? Each ACO must create and maintain a webpage dedicated to publicly reporting required organizational and programmatic information. Public reporting increases transparency and improves patient engagement. What are ACOs required to publicly report? ACOs must publicly report organizational information, final financial and quality results for each completed performance year, and the use of the SNF 3-Day Rule Waiver, if applicable. Medicare Shared Savings Program 2018 Performance Year Kickoff Public Reporting 33

35 Public Reporting Requirements When and how do ACOs publicly report? Twice a year, CMS creates a pre-populated public reporting template customized for each ACO using information from CMS records. ACOs receive the template near the start of every performance year and after performance year quality and financial reconciliation concludes. ACOs must verify the pre-populated information in the template, complete all remaining fields, and post the information on a webpage dedicated solely to public reporting. If an ACO s organizational information changes after posting the information from the template, it is required to update its public reporting webpage within 30 days. Medicare Shared Savings Program 2018 Performance Year Kickoff Public Reporting 34

36 Ongoing Marketing Marketing Materials Overview Marketing Requirements Marketing Toolkit Medicare Shared Savings Program 2018 Performance Year Kickoff Marketing 35

37 Marketing Materials Overview What are marketing materials and activities? Marketing materials and activities include, but are not limited to, general audience materials conducted by or on behalf of the ACO, ACO participants, and/or ACO providers/suppliers participating in an ACO when used to educate, solicit, notify, or contact Medicare beneficiaries or providers/suppliers regarding the Shared Savings Program. Examples of marketing materials may include: Brochures Webpages Advertisements Mailings Outreach events Social media Letters to beneficiaries Medicare Shared Savings Program 2018 Performance Year Kickoff Marketing 36

38 Marketing Materials Overview (cont.) Why does CMS have to approve marketing materials? ACO marketing materials are often the first exposure a beneficiary has to an ACO and to the Shared Savings Program. To ensure that beneficiaries receive accurate and clear information, CMS has created template documents and guidelines for ACOs to use. Medicare Shared Savings Program 2018 Performance Year Kickoff Marketing 37

39 Marketing Requirements What are the marketing material requirements? ACOs must submit all marketing materials to CMS for review prior to distribution except for the following: Materials that do not include information about an ACO, its ACO participants, or its ACO providers/suppliers Educational information on specific medical conditions Materials that cover beneficiary-specific billing and claims issues or other specific, individual, health-related issues Written referrals for health care items and services Template materials that have not been modified CMS makes some marketing templates available for use. ACOs cannot modify these templates other than to insert an ACO s name. Medicare Shared Savings Program 2018 Performance Year Kickoff Marketing 38

40 Marketing Toolkit What is the Marketing Toolkit? The Marketing Toolkit includes the following documents to help ACOs communicate with their attributed Medicare beneficiaries: Marketing guidelines Template materials (Poster Language, Beneficiary Information Notice, and the ACO Information Card) Supplemental materials (Beneficiary Notification Process Guidance, Front Desk Script, and Quick Reference Language Guide) Shared Savings Program fact sheets Supporting documents ACOs can find the toolkit on the SSP ACO Portal. Medicare Shared Savings Program 2018 Performance Year Kickoff Marketing 39

41 Program Compliance Compliance Plan Overview Compliance Plan Requirements Program Compliance Overview Consequences of Noncompliance Medicare Shared Savings Program 2018 Performance Year Kickoff Program Compliance 40

42 Compliance Plan Overview What is a compliance plan and why is it important? ACOs must maintain a compliance plan that adheres to Shared Savings Program requirements. A compliance plan is a written document that establishes an organization s commitment to adhere to health care regulations and is usually signed off on, implemented, and overseen by a governing body and shared with all employees. A compliance plan: Sets the first line of defense to help maintain proper oversight of the organization and sets the tone of the organization and its business practices. Provides an organization s protection against fraud, waste, and abuse and program noncompliance. Incorporates the five requirements presented on the next slide. ACOs should develop effective internal controls that promote adherence to applicable federal and state law and program requirements. Medicare Shared Savings Program 2018 Performance Year Kickoff Program Compliance 41

43 Compliance Plan Requirements The Shared Savings Program requirements for an ACO s compliance plan include: A designated compliance official who does not provide legal counsel to the ACO and reports directly to an ACO's governing body. Mechanisms for identifying and addressing compliance problems related to an ACO's operations and performance. A method for individuals to anonymously report suspected problems related to an ACO to the compliance official. Compliance training for an ACO, ACO participants, and providers/suppliers. A requirement for an ACO to report probable violations of law to an appropriate law enforcement agency. Medicare Shared Savings Program 2018 Performance Year Kickoff Program Compliance 42

44 Program Compliance Overview Examples of CMS-monitored ACO activity: Governing body Maintaining 5,000 assigned beneficiaries throughout the agreement period Quality reporting Compliance plan Medicare enrollment of ACO participants and SNF affiliates Data breaches Public reporting Various data elements Program integrity Medicare Shared Savings Program 2018 Performance Year Kickoff Program Compliance 43

45 Consequences of Noncompliance The consequences of program noncompliance include: Warning letters Corrective action plans Special monitoring plans Termination from the program Medicare Shared Savings Program 2018 Performance Year Kickoff Program Compliance 44

46 Performance Year 2018 Assessment Quality Measurement, Reporting, & Performance Financial Reconciliation Medicare Shared Savings Program 2018 Performance Year Kickoff PY 2018 Assessment 45

47 Quality Measurement, Reporting, & Performance Quality Measurement Quality Reporting Methods & Timeline Quality Performance Standard Medicare Shared Savings Program 2018 Performance Year Kickoff Quality 46

48 Quality Measurement What is the purpose of quality measurement in the program? To promote care of chronic illness; prevent high-prevalence conditions; and increase patient safety, patient and caregiver engagement, and care coordination To align with other quality reporting and incentive programs such as the Quality Payment Program To conduct critical program operations, including: Establishing ACO quality performance benchmarks Assessing ACO performance Rewarding ACOs Improving ACO quality performance Medicare Shared Savings Program 2018 Performance Year Kickoff Quality 47

49 Quality Reporting Methods & Timeline How are measures collected? Patient survey (CAHPS for ACOs) Claims Advancing Care Information CMS Web Interface UPCOMING WEBINAR First Quarter 2018 Quality Measurement Kickoff for 2018 Starters Webinar Details are available on the SSP ACO Portal Calendar of Events. When does quality reporting occur? The quality reporting window typically spans January March of any given year. For example, 2018 quality reporting will begin in January of ACOs must have their system access accounts set up before quality reporting begins every January. Medicare Shared Savings Program 2018 Performance Year Kickoff Quality 48

50 Quality Performance Standard What is the quality performance standard? Pay-for-Reporting or Pay-for-Performance: Pay-for-Reporting (PY1) Pay-for-Performance (PY2, 3, and beyond) To be eligible to share in savings, if earned, the ACO must: Completely and accurately report all quality measures. This qualifies the ACO to share in the maximum available sharing rate for payment. Completely and accurately report all quality measures and meet minimum attainment on at least one quality measure in each domain. ACOs must meet the quality performance standard in order to be eligible to share in any savings earned and to stay in good standing with the program. Medicare Shared Savings Program 2018 Performance Year Kickoff Quality 49

51 Financial Reconciliation Financial Reconciliation Overview Medicare Shared Savings Program 2018 Performance Year Kickoff Financial Reconciliation 50

52 Financial Reconciliation Overview What is the goal of financial reconciliation and when does it occur? ACOs are rewarded when they are able to lower growth in Medicare Parts A and B fee-for-service costs (relative to their unique target) while, at the same time, meeting quality performance standards. UPCOMING WEBINAR First Quarter 2018 Financial Overview Webinar Details are available on the SSP ACO Portal Calendar of Events. Performance year financial reconciliation occurs annually after the quality performance has been assessed. Any earned shared savings payments or incurred losses are adjudicated in the fall following the performance year. Medicare Shared Savings Program 2018 Performance Year Kickoff Financial Reconciliation 51

53 Systems & Access CMS Systems Access Health Plan Management System (HPMS) SSP ACO Portal Quality Payment Program Portal New ACO Management System Learning Systems for Accountable Care Organizations Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 52

54 CMS Systems Access System Access Guidance HPMS SSP ACO Portal MFT Mailbox Quality Payment Program Portal New ACO Management System Enterprise User Administration (EUA) Enterprise Identity Management (EIDM) CMS User ID Process webpage Recertification & Password Process webpage ACO EIDM Account and Role Setup (available on the SSP ACO Portal) Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 53

55 HPMS HPMS modules SSP ACO Agreement Management Contact Data Page SSP ACO Application Submission SSP ACO Application Tracking SSP ACO Participant List Management SSP ACO SNF Affiliate List Management SSP ACO Electronic Signature Management SSP ACO Marketing SSP ACO Reports Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 54

56 SSP ACO Portal The SSP ACO Portal provides announcements, an events calendar, resources, and reports. How to access the SSP ACO Portal: Go to On the right side of the page, under CMS Secure Portal, click Login to CMS Secure Portal. Review Terms and Conditions and click I Accept. On the Welcome to CMS Enterprise Portal page, enter your CMS User ID and password and click Log In. On the top left side of the screen, scroll over the yellow box and click ACO/SSP2 >> ACO MSSP Reports. The Announcements section will appear. Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 55

57 Quality Payment Program Portal ACOs will use the Quality Payment Program Portal to enter and submit quality data for PY 2017 through the CMS Web Interface. The Quality Payment Program Portal is accessible through the Quality Payment Program website. Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 56

58 New ACO Management System CMS is in the process of implementing a new ACO Management System to expand and replace HPMS in The aim is to develop a more user-friendly and customized system that automates processes to expedite reviews. The following tentative dates are related to the system s phased implementation in 2018: HPMS will continue to be in use and fully functional for ACOs through mid-march CMS expects to transition to the new ACO Management System in early April ACOs should refer to the ACO Spotlight Newsletter and other program guidance in the upcoming months for more information (e.g., training webinars, black-out dates, etc.). Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 57

59 Facilitates shared learning among ACOs and provides opportunities for networking. Designed to help ACOs share information about opportunities for improvement, new practices, ways to actively measure progress, and strategies for improving quality and lowering costs. CORE FUNCTIONS OF THE LEARNING SYSTEMS Drive model success Use data for improvement Give tools to capture innovation & support performance Provide technical assistance Support learning communities Measure performance toward model aim Assess & provide feedback Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 58

60 Resource Topical webinars In Person Learning Collaboratives (IPLCs) ACO Toolkit Description Topic-specific webinars in which representatives from ACOs participating in Medicare ACO initiatives share tips and best practices Brings together ACOs in each CMS region to exchange ideas and information; there is no registration fee to attend Compiles resources from the CMS-sponsored ACO learning systems (such as webinars, case studies, and in-person meetings) to help ACOs identify new insights and potential peers These resources, transcripts, and summary documents are available on the SSP ACO Portal. Medicare Shared Savings Program 2018 Performance Year Kickoff Systems & Access 59

61 Presentation Highlights Key Points to Remember Upcoming Program Information Medicare Shared Savings Program 2018 Performance Year Kickoff Highlights 60

62 Key Points to Remember Wait to publicly announce your acceptance into the Shared Savings Program until CMS advises to do so via the ACO Spotlight Newsletter. Keep CMS User ID and passwords current. Keep your contact information in HPMS updated. Check the SSP ACO Portal frequently for program materials. Read the ACO Spotlight Newsletter. Reach out to your ACO coordinator with any questions. Medicare Shared Savings Program 2018 Performance Year Kickoff Highlights 61

63 Upcoming Program Information ACOs must make their public reporting information available no later than 30 days after receiving the template from CMS. ACOs should attend the CCLF User Group Webinar on January 10, SNF 3-Day Rule Wavier-approved ACOs should attend the webinar on January 18, In the first quarter of 2018 ACOs can expect to receive: Monthly CCLFs Preliminary Historical Benchmark Report, including Assignment Summary Reports and Expenditure/Utilization Reports Medicare Shared Savings Program 2018 Performance Year Kickoff Highlights 62

64 Resources Track 1+ Model Drivers (ACO Perspective) Contact Information ACO Spotlight Newsletter Shared Savings Program Website CMS Coordinator Shared Savings Program Mailbox Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 63

65 Track 1+ Model Drivers (ACO Perspective) AIM Primary Drivers Secondary Drivers Change Concepts Better care, better health, & lower cost for ACO beneficiaries Physician engagement & buy-in Analytics infrastructure Physician adaptability Value-Based Payment/ shared savings concept Risk stratification population health prospective beneficiary assignment Increased physician-beneficiary engagement Decision making in how ACO networks are created Physician education & acceptance of Value-Based Payment Vendors for analytics Big data processing Analytics software Create a more gradual pathway to take on performance-based risk Financial infrastructure Beneficiary engagement/ care coordination infrastructure Low risk for savings/losses improvement benchmarks advanced Alternative Payment Model options SNF 3-Day Rule Waiver Care transition program Patient-centered services Clinician incentives Vendor costs ACO startup costs for care coordination SNF care coordination Case mgt; post discharge coordination Patient education Behavioral health access Medication adherence Transportation Predicting high-risk patients Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 64

66 Contact Information Contact Information Be sure to specify your ACO ID (Axxxx) in the subject line or text of the Type of Inquiry All program and policy inquiries from Shared Savings Program ACOs All program-related inquiries from external parties (i.e., non-acos) All technical inquiries related to HPMS that do not involve password resets All inquiries related to user issues with accessing HPMS Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 65

67 Contact Information (cont.) Contact Information Quality Payment Program Service Center: Phone: Phone: ACO Information Center: Phone: (select Option 2) TTY/TDD ; Type of Inquiry All inquiries related to quality reporting, the Meritbased Incentive Payment System (MIPS), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and APMs All inquiries related to technical assistance, comments, or questions on the CAHPS for ACOs survey All inquiries related to password resets for your four-character CMS User ID All technical inquiries related to MFT, CCLFs, and the SSP ACO Portal Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 66

68 ACO Spotlight Newsletter Key Points Published weekly Includes announcements for: Important program information Upcoming deadlines Upcoming webinars SSP ACO Portal updates Recipients: Contacts listed in HPMS ACO Spotlight Newsletter Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 67

69 Shared Savings Program Website The Shared Savings Program website is a one-stop shop for general, program-related information, which is organized by audience and subject matter. Webpages include: Application types and timeline Program data Statutes and regulations Guidance and specifications Audience-specific pages for ACOs, ACO providers/suppliers, and beneficiaries Shared Savings Program website home page Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 68

70 CMS Coordinator Role of CMS coordinator CMS assigns a CMS coordinator to each ACO to assist the ACO with meeting program objectives. Along with the weekly ACO Spotlight Newsletter, HPMS, the SSP ACO Portal, and frequent webinars, the CMS coordinator serves as a resource to ACOs. How to identify in HPMS HPMS path: ACO Management >> SSP ACO Agreement Management >> View Basic Agreement Data Regularly scheduled meetings Expect coordinators to contact ACOs in late December/early January to schedule recurring meetings. Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 69

71 Shared Savings Program Mailbox Submit program and policy inquiries to: Include the following in the ACO ID in the subject line or text of the Medicare Shared Savings Program 2018 Performance Year Kickoff Resources 70

72 QUESTION & ANSWER SESSION Medicare Shared Savings Program 2018 Performance Year Kickoff Question & Answer 71

73 Acronyms in this Presentation ACO: Accountable Care Organization APM: Alternative Payment Model CCLF: Claim and Claim Line Feed CMS: Centers for Medicare & Medicaid Services EIDM: Enterprise Identity Management EUA: Enterprise User Administration FFS: fee-for-service HPMS: Health Plan Management System MACRA: Medicare Access and CHIP Reauthorization Act of 2015 MFT: Managed File Transfer Medicare Shared Savings Program 2018 Performance Year Kickoff Acronyms 72

74 Acronyms in this Presentation MIPS: Merit-based Incentive Payment System NOIA: Notice of Intent to Apply PY: performance year SNF: Skilled Nursing Facility SSP: Shared Savings Program Medicare Shared Savings Program 2018 Performance Year Kickoff Acronyms 73

75 Appendix: Topic-Specific Resources Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 74

76 Annual Certification Resources Resource Description/Location Annual Certification: Includes information and guidance on the ESM module in HPMS ESM Module HPMS. It can be found at HPMS Homepage >> SSP ACO User Guide Electronic Signature Management Module >> PY 2018 >> ESM User Manuals >> Open >> Shared Savings Program Annual Certification The HPMS ESM User Guide.pdf CMS User ID Process webpage For additional guidance about obtaining and maintaining a CMS User ID Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 75

77 Data Sharing Resources Resource CCLF Information Packet Description Provides file structure, relationships, layouts, and definitions ACO-OS Data Exchange Governs data exchanges and communication paths User s Guide Managed File Transfer (MFT) User Guide CCLF User Group Recordings Appendix A and B of the ACO and ACO-OS Data Exchange User s Guide Monthly user group presentation recordings for ACOs to share knowledge and present lessons learned These resources are available on the SSP ACO Portal. Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 76

78 Public Reporting Resources Resource Example 2017 Public Reporting Template Description Preview of the pre-populated public reporting template for ACOs. ACOs will receive a template, pre-populated with ACO-specific information from CMS, near the start of every performance year and shortly after performance year quality and financial reconciliation concludes. This resource is available on the SSP ACO Portal. For questions about the public reporting requirements, contact CMS by SharedSavingsProgram@cms.hhs.gov Include your ACO ID and Public Reporting in the subject line Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 77

79 Marketing Resources Resource Marketing Toolkit Description Documents to help ACOs communicate with their attributed Medicare beneficiaries that include: marketing guidelines, template materials (Poster Language, Beneficiary Information Notice, and the ACO Information Card), supplemental materials (Beneficiary Notification Process Guidance, Front Desk Script and Quick Reference Language Guide), Shared Savings Program fact sheets, and supporting documents This resource is available on the SSP ACO Portal. Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 78

80 Quality and Performance Resources Resource Program Guidance & Specifications webpage Description Provides access to the quality measure benchmarks, narrative specifications, and measure information forms. These documents are currently being updated and will be available soon. For assistance with user access to CMS systems, contact CMS by Specify your ACO ID in the subject line or text of the . For inquiries related to MIPS, APMs, MACRA, quality measures and quality reporting for 2017 and future years, CMS Web Interface, and EIDM: Quality Payment Program Service Center Phone: Hours: M-F, 8 a.m. 8 p.m. ET. Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 79

81 ACO Participant List and SNF Affiliate List Resources Resource ACO Participant List Requirements ACO Participant List and Participant Agreement Guidance HPMS SSP ACO Participant List Management Module User Guide Skilled Nursing Facility 3-Day Rule Waiver Guidance HPMS SSP ACO SNF Affiliate List Management Quick Reference Guide 2018 Application Reference Manual Description 42 CFR , , , , Guidance document for clarification of the ACO Participant List and Participant Agreements Instructions for access: HPMS >> ACO Participant List Module >> ACO Participant List User Manual Guidance document for clarification of SNF 3-Day Rule Waiver for Track 3 and Track 1+ ACOs, if applicable Instructions for access: HPMS >> SNF Affiliate List Management Module >> ACO SNF Affiliate Quick Reference Guide Reference manual for ACO applicants applying during Calendar Year 2017 for PY 2018 Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 80

82 Compliance Plan Resources Resource Office of Inspector General (OIG) industry best practices for compliance programs OIG Compliance Education Materials Description HHS OIG guidance for best practices for compliance program and plans. Resources to help health care providers, practitioners, and suppliers understand health care fraud and abuse laws and the consequences of violating them. Materials can also provide ideas for ways to cultivate a culture of compliance within your own health care organization. Specific program compliance questions can be sent to SharedSavingsProgram@cms.hhs.gov. Medicare Shared Savings Program 2018 Performance Year Kickoff Appendix 81