Central New York Care Collaborative (CNYCC)

Transcription

1 Central New York Care Collaborative (CNYCC) NYS PCMH Collaborative April 18, 2018

2 Welcome and Introductions

3 Learning Objectives Understand NYS PCMH Expectations, Pathways Understand Practice Transformation Technical Assistance Available Understand changes to NYS Medicaid Incentive Plan Current and proposed Review Annual Reporting documentation and 12 new Core Criteria Review CNYCC support including Health Literacy training Partner recommended next steps Partner sharing for meeting NYS PCMH requirements

4 Comparison of NCQA PCMH 2017 and NYS PCMH

5 NYS PCMH As of April 1, 2018: Any new (not previously recognized ) practices will need to pursue NYS PCMH NCQA PCMH 2017 not available to NYS practices All APC practices will shift to NYS PCMH No requirement to seek NYS PCMH ahead of your current expiration date Consider pursuing ahead of expiration due to available funding and future incentive opportunities Begin planning for NYS PCMH well ahead of your recognition expiration. Practices will have 18 months or less to achieve recognition depending on your current status..

6 NCQA PCMH 2017/NYS PCMH Comparison Key Components NCQA PCMH 2017 NYS PCMH Core Standards core criteria- 40 original plus 12 specific elective criteria moved to core; Additional elective credits required from any of the 6 competencies. Number dependent on what is needed to meet 25 additional points in conjunction with value Requirements for Recognition 40 Core plus 25/83 Elective Credits across 5/6 competencies of 12 new core point value. Dependent on type of practice and type of VBP contract for example. 1. Commit - commit, selfassess, plan 2. Transform-develop and document PCMH capabilities Phases of Transformation- Replaces APC Gates 3. Succeed-Annual recertification Platform to submit validation NCQA Q Pass NCQA Q Pass Recognition NCQA PCMH 2017 recognition 1. Commit-Same plus a commitment to adopt VBP 2. Transform- develop and document PCMH Capabilities including 12 additional electives as core 3. Succeed- Annual re-certification NCQA and NYS recognition as NYS PCMH State -Funded Technical Assistance None Support to achieve NYS PCMH recognition through February 2020

7 NYS PCMH New Core Requirements Category Criteria Description Points Behavioral Health CC 09 KM 04 CM 03 Behavioral Health Referral Expectations: Works with Behavioral Healthcare providers Behavioral Health Screenings Comprehensive Risk-Stratification Process 2 Elective Credits-1 Core 1 Elective Credit-1 Core 2 Elective Credits-1 Core Care Management and Care Coordination CC 08 CM 09 CC 19 Specialist Referral Expectations: Works with nonbehavioral healthcare specialists Care Plan Integration Patient Discharge Summaries 1 Elective Credit-1 Core 1 Elective Credit-1 Core 1 Elective Credit-1 Core KM 11 Population Needs: Identifies and addresses population-level needs based on the diversity of 1 Elective Credit-1 practice and community (demonstrate at least 2) Core

8 NYS PCMH New Core Requirements- (Continued) Category Criteria Description Points AC 08 2 Way Electronic Communication 1 Elective Credit-1 Core AC 12 Continuity of Medical Record Information 2 Elective Credits-1 Core Health Information Technology CC 21 External Electronic Exchange of Information: Demonstrates electronic exchange of information with external entities, agencies and registries 3 Elective Credits- 1 CORE (RHIO), 1 Potential Elective Credit ( Immunization Registry), 1 Potential Elective Credit (Summary of Care). TC 05 Certified EHR System 2 Elective Credits-1 Core Value-Based Contracts QI 19 Value-Based Contract Agreement (s) Up to 2 Elective Credits- 1 Core (upside) OR, 2 Core Credits for Twosided risk (downside)

9 NYS DOH Support for Practice Transformation

10 NYS DOH Support for Practice Transformation Covers all NCQA PCMH Recognition Pricing costs regardless of the number of clinicians (for up to three NCQA check-ins) Use the appropriate code in Q PASS to have the State pay NCQA fees. GNYDOC except for APC practices (See your TA) Contracting with a TA Vendor will provide support for transformation and submission, including preparation for NCQA check-ins, where applicable. TA Services could include gap analyses, work plan development, staff training, development and review of required documentation, etc. Review their model with each TA you are considering. Funding for Recognition pricing submission fees and technical assistance expires no later than February 2020.

11 NYS DOH Technical Support Vendors-Region 6 NYS will provide technical assistance through vendors, timeframe, depending on your practice s current recognition status Region 6: Onondaga and Cayuga Counties Common Ground Health (CGH) Contact Bill Brien, williambrien@flhsa.org Contact Sue Swift, susanswift@flhsa.org Island Peer Review Organization (IPRO) Contact Thomas Lemme, tlemme@ipro.org Contact Susan Hollander, shollander@ipro.org

12 NYS DOH Technical Support Vendors-Region 7 NYS will provide technical assistance through vendors timeframe, depending on your practice s current recognition status Region 7: Oswego, Madison, Oneida and Lewis Counties Adirondack Health Institute (AHI) Contact Mary McLaughlin, ext. 413 mmclaughlin@ahihealth.org Contact Jolene Munger, ext. 421 jmunger@ahihealth.org Capital District Physicians Health Plan (CDPHP) Contact Vincent Speenburgh, Vincent.Speenburgh@cdphp.com Contact Michael Courtney, Michael.Courtney@cdphp.com

13 NYS DOH Technical Support Vendors-Other This technical advisor worked with one partner in the PPS to achieve APC Gate 2 and will continue work towards NYS PCMH. For technical advisors outside of your region, the State has an established process including approval from the regional vendors. The Healthcare Association of New York State (HANYS) Contact Lindsay Milchteim, lmilchte@hanys.org; Contact Nicole Harmon, nharmon@hanys.org

14 NYS PCMH Pathways and Timeline

15 NYS PCMH Pathways and Timeline As of April 1, 2018: All NYS practices will need to pursue NYS PCMH For previously recognized practices, begin planning for NYS PCMH well ahead of your recognition expiration. Practices will have availability of 18 months or less technical assistance to achieve recognition depending on where you are in the process. Review NCQA Pathways for NYS PCMH depending on your current status.

16 NYS PCMH Support andtimeline Current Recognition Level Stage of NCQA Process Timeline for NYS PCMH NCQA support TA Support PCMH Level 3 Succeed (Annual reporting with new NYS PCMH criteria in 1st year.) up to 6 months Representative only Available for up to 6 months PCMH Level 1 or 2 Transform (Accelerated renewal) up to 12 months Representative and 3 check-ins Available for up to 12 months APC Gate 2 Commit up to 12 months APC Less than Gate 2 or Unrecognized Commit up to 18 months Representative and 3 check-ins Representative and 3 check-ins Available for up to 12 months Available for up to 18 months

17 NYS PCMH Pathways and Timeline Different Pathways to NYS PCMH New Practices Enroll in NYS PCMH Achieve NYS PCMH Recognition NYS PCMH Annual Reporting NCQA PCMH 2014 Level 1, 2 Enroll in NYS PCMH Accelerated Renewal Achieve NYS PCMH Recognition/NYS PCMH Annual Reporting NYS PCMH Annual Reporting NCQA PCMH 2014 Level 3 APC Practices Practices expiring 2018: Enroll in "First NYS PCMH Annual Report*" Practices expiring in 2019/2020: "First NYS PCMH Annual Report optional." Enroll in NYS PCMH Practices expiring 2018: NYS PCMH Annual Reporting Practices expiring in 2019/2020: "First NYS PCMH Annual Report optional." Achieve NYS PCMH Recognition Practices expired in 2018/2019: NYS PCMH Annual Reporting Practices expiring 2020: Enroll in "First NYS PCMH Annual Report*" NYS PCMH Annual Reporting *For practices that are currently NCQA PCMH 2014 Level 3 recognized, the "First NYS PCMH annual report" will include evaluation of NCQA annual reporting requirements for the year and the 12 elective criteria required by New York State.

18 NYS Medicaid PCMH Incentive Changes

19 Medicaid PCMH Incentive Changes: Background Rate of PCMH incentives need to be adjusted due to: Fiscal constraints of the Medicaid Global Spending Cap DSRIP success has increased participation in PCMH programs Due to a payment lag from DOH for this incentive, changes must be made prior to July 2018 for State Fiscal year and NYS DOH conducting a current push on commercial payers to support continuing transformation

20 Medicaid PCMH Incentive Changes NYS PCMH Medicaid Incentives Through April 30, PCMH Incentive (PCMH Standard Year and Level 2018 May-June 2018 MMC PMPM (2014 Level 2) $ MMC PMPM (2014 Level 3, APC* or 2017) $7.50 $2.00 FFS claim add-on Professional (2014 Level 2) $ FFS claim add-on Institutional (2014 Level 2) $ FFS claim add-on Professional (2014 Level 3, APC* or 2017**) $29.00 $29.00 FFS claim add-on Institutional (2014 Level 3, APC* or 2017**) $25.25 $25.25 *NYS Medicaid is planning to add APC providers, who are Gates 2 and 3 certified, into the PCMH incentive program once federal approval is obtained. ** Starting April 1, 2018, the NCQA "NYS PCMH" model will take the place of PCMH 2017 in New York.

21 Medicaid PCMH Incentive from July 2018 Onward 2018/2019 Budget: In development (Additional guidance will be published once the final policy is published) *Effective July 1, 2018 the Department of Health is proposing that Medicaid Managed Care (MMC) and Fee-for-Service (FFS) PCMH incentive be tied to both PCMH recognition and VBP contracting. Proposal components include: Providers have at minimum PCMH recognition at NCQA PCMH 2014 Level 3 Providers have a Medicaid VBP contract at Level 1 or higher with at least one MMC Plan The FFS incentive will be tied to VBP contracting for those providers who participate in both FFS and MMC.

22 CNYCC Support for NYS PCMH and Next Steps

23 CNYCC Support for NYS PCMH Proposed components include: NYS PCMH Learning Collaborative for interested partners-tbd Purpose: Share best practices- Agenda to be determined by partners Continued support through training opportunities, such as Value Based Payment Ongoing workforce efforts to support primary care Population Health Management platform IBM Watson Health Literacy training and screening implementation support

24 CNYCC Support for Health Literacy/Cultural Competency Training Cultural Competency and Health Literacy 101 Future trainings planned on teach back methods etc. Performance Activity Funding Support-Due 6/30/18 PA 133 Provide "Intro to Cultural Competency/Health Literacy (CCHL)" training to at least 75% of all staff by June 30, PA 93 Adopt and implement an evidence-based health literacy screening tool Health Literacy Screening Tools- CNYCC Clinical Governance approved

25 Cultural Competency & Health Literacy 101 Course CCHL 101 course provides general awareness and identify ways partner organizations (and their employees) can deliver more culturally competent and health literate services min video presentation and a post-test questionnaire Provided to partners via CNYCC s LMS, HWapps (login required): Define and describe cultural competency. Define and describe health literacy. Recognize the potential consequences of limited understanding of cultural diversity and impact of low literacy. Identify appropriate resources to address cultural, linguistic, and health literacy gaps.

26 Health Literacy Screening Tools CNYCC provided health literacy screening tools that partners can use and implement: Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF) Short Assessment of Health Literacy - English and Spanish (SAHL-E&S) Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) Pfizer s Newest Vital Sign in English & Spanish Short Test of Functional Health Literacy in Adults (STOFHLA) Screening Tools Review webinar: by CNYCC CMO Dr. Joseph Maldonado Resources for building a Health Literate organization Agency for Healthcare Research and Quality Alliance for Health

27 Partner Recommended next steps Review NYS PCMH Standards and Guidelines, Annual reporting requirements and pathways regardless of whether you are currently recognized or when your recognition expires. APC practices will continue to work with their technical advisors on NYS PCMH. Continue all PCMH initiatives begun as part of your recognition, including population outreach, patient satisfaction and quality monitoring. Consider contracting with a technical advisor for NYS PCMH assistance. Each recognized practice site should have a clinical and business lead. Consider your organization s time-line for achieving NYS PCMH. Consider work with the RHIO to identify ways to share care plans across settings. Continue your efforts toward value-based payment contracts to maximize incentives.

28 Questions & Answers