The New York State Practice Transformation Network (NYSPTN)

Transcription

1 Request for Proposal New York State Practice Transformation Network Clinical Measurement Tool Issued: August 8 th, 2016 Proposals Due: August 26 th,

2 Contents No table of contents entries found. 2

3 Introduction NY State Practice Transformation Network (PTN) The New York State Practice is a collaboration designed to improve the quality of care provided to Medicare, Medicaid and CHIP beneficiaries. Practice Transformation Networks are funded by Center for Medicare and Medicaid Services (CMS) as part of the Transforming Clinical Practice Initiative to help clinical practices make the clinical and business changes needed in order to thrive in the new healthcare environment. A consortium of leading, trusted members of New York State s healthcare community have come together to apply for this CMS-funded program. NYSPTN is soliciting responses to this RFP in one phase, with very tight turnaround. Given the time sensitivity of this RFP, the NYSPTN should expect to review application and make a final decision by September 15 th, TCPI Overview The Practice Transformation Network is for primary and specialty care practices that serve Medicaid, Medicare and CHIP (Children s Health Insurance Program) patients, especially those in medically underserved, rural or health professional shortage areas. Technical Assistance (TA) subcontractors will assist them as they move through five phases of transformation in order to prepare them for shared savings programs such as Accountable Care Organizations and other value-based payment programs. Subcontractors will be supported by Support and Alignment Network (SAN) contractors formed by professional associations and others that align their memberships, communication channels, continuing medical education credits and other work to support the PTNs and clinician practices. Refer to Appendix A for detailed phases of clinical transformation. Assessment and setting of clinical aims Use of data to drive care Achieve progress through transformation resources Reach benchmarks on target measures Thrive as a business through pay for value and shared savings Goals of the NYSPTN The ultimate goal of the NYSPTN is to graduate at least 75% of participating clinicians into Accountable Care Organizations or similar shared savings or value based payment programs. The NYSPTN has proposed the following clinical, operational, and cost-reduction aims to support practices in clinical and business functions needed to succeed in shared savings models: Aim 1: Identify & Manage High Risk Patients, Keep Healthy Patients Healthy % increase: wellness visits (operational/billing, clinical) Aim 2: Quality Improvements Controlling High Blood Pressure (NQF 0018, CMS 165v1) (clinical) Diabetes HbA1C Poor Control (NQF 0059, CMS 122v2) (clinical) Aim 3: Transitions of Care reduced readmissions and unnecessary testing % increase: patients seen within 7 days post discharge (operational/billing, clinical) Aim 4: Medical Neighborhood referral optimization % increase: referrals with summary reports (CMS 50v1) The objective of the NYSPTN will deploy onsite technical assistance to support practices with the necessary in-person assistance to ensure that the TCPI aims and objectives are met throughout the program. Table 1 below links the Transformation Phases with a rubric of clinical actions that will enable clinicians to succeed in value based care and payment with clear actions and measured by key performance indicators (KPIs). These KPIs will need to be tracked for each provider participating in NYSPTN over the lifecycle of the project. 3

4 TCPI Transformation Phases The New York State Practice Table 1: PTN Transformation Phases and Clinical Activities Summary Identify & Manage High Risk Patients Quality Improvement Transitions of Care Medical Neighborhood Key Competencies Understand patient population and provide needed care Improve consistency Improve patient follow up Close the referral loop 1. Set Aims (KPIs) 2. Use Data to Drive Care - % increase: wellness visits - ED and hospital utilization - Analytics for highrisk patients - Prioritize patient recall - Know denom. BP control A1C control - CDSS - Registry - Standing orders % increase: patients seen within 7 days post discharge ADT % increase: referrals with summary reports High value referrals: specialists, hospitals, primary care 3. Achieve Progress Track and improve over time: set practice/provider-level targets, establish/refine QI protocols, optimize EHR use, engage patients 4. Achieve Benchmark Benchmark for TCPI and for PQRS, MU and value/shared savings targets 5. Business of Shared Savings Wellness Visits, Chronic Care Management PQRS, VBM, MU TOC Visits Bundled payments Shared Savings / Value Based Payment Programs 4

5 Objective of this RFP Clinical Measurement Tool Overview Through this RFP, NYSPTN seeks qualified cloud-based technical solution with the systematic capability to store, capture aggregate, report and present KPI clinical measures. These clinical measures will be reported by primary and specialty care practices from across New York State using various different Electronic Health Record tools. Data will be collected from providers on all KPIs and operational measures through this KPI capture tool and will be the master source of data collection to track over 5,000 clinicians. As detailed below, the Clinical Measurement Tool will support clinical practices participating in the PTN with the following: NYSPTN Clinical Database Used to securely collect, store, parse, aggregate, and present the Key Performance Indicators and data specific to the NYSPTN goals. NYSPTN Participant User Licenses (User License) User licenses to Clinical Database that will be assigned to the NYSPTN staff and administrators, providers, and other subcontractors to the NYSPTN. NYSPTN Core Modules (Core Modules) Through the Clinical Measurement Tool, deliver a set of modules that are required to successfully meet the reporting requirements of the NYSPTN TCPI program, such as: electronic version of the CMS Practice Assessment Tool (PAT), document upload, and link to external curriculum web links. Automated KPI Data Integration Provide NYSPTN with services related to automatically populating the NYSPTN KPI data into the Clinical Measurement Tool. This eliminates the need for providers to manually enter their KPI data. Third-Party Integration Services Provide third-party data integration to the Clinical Measurement Tool to simplify any manual entry processes. Physician Quality Reporting System (PQRS) and Qualified Clinical Data Registry (QCDR) Licenses Provide PQRS and QCDR licenses to be included in the User License to enable the participating providers of the NYSPTN to submit their PQRS and QCDR data using the Clinical Measurement Tool Feature Table 2: NYSPTN Clinical Measurement Tool Requirements Feature Description Clinical Measurement Core Modules (base capabilities) User Registration Manual Entry of KPI Data from program users Support reporting Link to Curriculum This feature would allow practice users to navigate to their required NYSPTN curriculum from the portal site. The portal would provide an external link to the AMA, ACP, or HealthcareCommunities sites where the curriculum is provided. Document Upload This feature would allow for the upload of files and documents requested as evidence for KPIs, provider enrollment updates, etc. User Oriented Dashboards To provide all portal users the capabilities to see how practices under their management are performing, dashboards shall be provided at several levels of detail, including; Individual practice level dashboards for practice users. o This may also include physician level detail. Multiple practice view for practice managers that are associated with multiple practices within an organization. This should include aggregated practice data, and individual practice and provider detail. Multiple practice view for NYSPTN TA s that are associated with multiple practices within an organization. This should include aggregated practice data, and individual practice and provider detail. The dashboards rendered should be appropriate to the user type, and the practices affiliations associated with that user. Automated KPI Aggregation (no PHI) For this feature, the practice EHR and billing data would be made available to a practice user through an automated ETL process of 5

6 Automated KPI Population (PHI stored) Group PQRS Reporting Individual PQRS Reporting PQRS Reporting through Qualified Clinical Data Registry (QCDR) the data into the portal. In this case, the ETL process would not transfer any PHI from the practice site to the clinical measurement tool platform. When this feature is available, the practice EHR and Billing data would be made available to a practice user through an automated ETL process of the data into the portal. In this case, the ETL process would transfer PHI from the practice site to the portal environment. It may or may not be persistently stored. This feature would include PQRS group reporting for the PTN KPIs through a qualified PQRS registry. It may also permit other PQRS measure to be managed through the portal. This feature would include individual PQRS reporting for the PTN KPIs through a qualified PQRS registry. It may also permit other PQRS measure to be managed through the portal. Provide PQRS and QCDR licenses to be included in the User License to enable the participating providers of the NYSPTN to submit their PQRS and QCDR data using the Clinical Measurement Tool Users and User Requirements and Design Considerations This section identifies and describes the different types of users that are anticipated to interact with a NYSPTN clinical measurement tool in some meaningful capacity. This list includes primary end-users, as well as users that administrate and maintain the portal for the NYSPTN program. For each user type, some general design requirements considerations are provided. User Type User Description Design Requirements and Considerations Practice Physician User Practice Manager User This user is a physician at a participating practice that will use a NYSPTN clinical measurement tool to manage their assigned KPI data for their patients. This user is a senior practice manager or practice/site administrator who would use a NYSPTN clinical measurement tool to report performance for all patients at a practice or practice site, for all providers. 6 An individual physician may participate from multiple practices and practice sites May register and manage their physician profile through clinical measurement portal. May enter KPI data into portal manually. May manage imported clinical data for their patients for KPI reporting through the portal. May be a PQRS or MU reporting physician. Dashboard this user would likely want to see a dashboard that shows personal performance, practice and/or site performance, performance against peers at practice, performance against peer by geography (region, state, national) May be interested in accessing PTN curriculum through a NYSPTN clinical measurement tool. A practice manager user may manage multiple practice sites, or there may be individual site managers. May register and manage their practice, site, and provider profile(s) through KPI portal. May enter KPI data for all practice or site data into portal manually. May manage imported clinical data for all practice or site patients for KPI reporting through the portal. Dashboard this user would likely want to see a dashboard that shows practice and/or site performance, performance by provider at practice (where available), performance against peers by geography (region, state, national)

7 Practice Data User This user is a physician or staff person at a participating practice or practice site whom is not participating as a physician or as practice manager, but is interested in gathering and/or view data and reports about the PTN program. May be interested in accessing PTN curriculum through a NYSPTN clinical measurement tool. May be interested in completing Practice Assessment Tool through portal. Dashboard this user would likely want to see a dashboard that shows practice and/or site performance, performance by provider at practice (where available), performance against peers by geography (region, state, national) Practice IT User NYSPTN TA User NYSPTN Support User NYSPTN Data User NYSPTN Database Administrator This user is a practice or practice site employee or vendor who manages practice information technology, including networking, EHRs and billing systems. A Transformation Agent (TA) is a NYSPTN agent that works with practices to enroll them, and guide them through the NYSTPN program lifecycle. The TA is the primary contact to the NYSPTN for a practice. This user is a NYSPTN core staff person that would be responsible for providing technical assistance to the TAs and/or practice users, for questions and issues encountered with the NYSPTN clinical measurement tool This user is a NYSPTN core staff person who is responsible for data quality, data management, analysis, and reporting of all NYSPTN data, including practice and practice site data. This user is a NYSPTN core staff person responsible for development, management, and integration of the NYSPTN KPI databases. This user would be responsible for developing queries to aggregate clinical data, or extract data for quality and KPI reporting. This user would support any web interfaces and protocols including; firewalls, network routers, VPN, SSH, RDP, and SFTP configurations. This user would support practice users in achieving their program milestones through enrollment to program graduation. Will require access to multiple practices and physicians under their management. Will require ability to manage data associated with their practices. View dashboards for aggregate of all practices, and drill down to individual practices and provider level detail. This user would need ability to manage all TA and Practice user accounts Requires ability to view usage logs. Will require ability to create user accounts for other users (passwords cannot be known by this user) This user would require access to raw and aggregated clinical measure/kpi data for reporting purposes. This user would require database level r/w/d access to all program data collected and stored for the clinical measure tool. This user would require database level r/w/d access to all program data collected and stored for the clinical measure tool Hosting and Security Requirements The responding vendor shall propose their primary recommendation inclusive of technical specifications for hosting with resultant costs for implementation and support. If the vendor is supportive of NYeC providing hosting (facility, racks, power, AC, physical security and so forth), NYeC would be interested in knowing this to discuss in further detail. Please provide in addition an outline of the vendors HIPAA and Data Security Policies and Recommendations. Reporting Requirements Data collected from use of the clinical measurement tool will be aggregated, validated and normalized by the vendor. NYSPTN will need to use this data to provide data reports on practices monthly and quarterly back to the practices to enable them to benchmark their improvement with similar practices. Additionally, the clinical measure platform must enable NYSPTN to generate comprehensive program status reports for CMS and partners. 7

8 The reporting requirements for NYSPTN includes both defined standard monthly reports, as well as ad hoc reporting. To ensure reporting can be performed accurately, and in a timely matter, the following design considerations are required: o All aggregate and raw stored data will be made available in a straight forwardly designed relational database schema. Preferably Microsoft SQL Server 2012, though more recent releases may be supported. o NYSPTN Data User and Database Administrator users must be given secure access to all stored program data. o Systems user access (Salesforce / Alteryx) may be required as well. o Scripting support for scheduled reporting may be required. Clinical KPI Overview NYSPTN is requesting a secure, cloud-based technology system reporting on clinical, operational and financial KPIs. The selected KPIs are measures enrolled practices currently capture. The Meaningful Use (MU) related KPIs selected (KPIs 2, 3, 6) are captured by MUcertified EHRs. Billing codes that will be used for KPIs 1, 10, 11 are also currently tracked by all electronic Practice Management Systems. The NYSPTN will use claims data to evaluate the other goals, cost savings of reducing unnecessary testing and total cost savings. Table 3 provides an overview and definition of the NYSPTN s improvement areas that will be uses to track the effectiveness and report on the progress of the program. Table 3: KPI Details Clinical Outcomes NYSPTN KPI # KPI Description Measure Details 12-month Goal (Change from baseline) 1 KPI 1: Increase in billing for wellness visits Diagnosis code V70.0; Initial Annual Wellness Visit G0438; Subsequent Annual Wellness Visit G KPI 2: Controlling high BP NQF 0018, CMS 165v3 4% (24,000 patients) 3 KPI 3: Diabetes: A1C poor control 4 KPI 4: Clinician PQRS enrollment and reporting NQF 0059, CMS 122v3 4% (9000 patients) Clinicians enrolled in PQRS and reporting data to CMS 4 Year Goal (Change from baseline) 200% 300% 100% within a year for selected small practices 100% of eligible clinicians at practice 10% (60,000 patients) 20% increase over 24- month project with 150 small practices 10% (60,000 patients) 5% improvement over 24- month project with 150 small practices 100% of eligible physicians at practice 5 KPI 5: Maintain or improve MU MU attestation 75% 90% Cost Savings & Care Mgmt Measures 6 KPI 6: Tobacco use screening and cessation intervention 7 KPI 7: 24/7 access policy documented 8 KPI 8: Potentially Preventable ED Visit Reduction 9 KPI 9: Cost Savings from Potentially Preventable ED Visit Reduction 10 KPI 10: Increase in billings for chronic care management (CCM) services NQF 0028, CMS 138v3 10% (48,000 interventions) Provider has a documented policy for patients to obtain consultation 24/7 Decline in number of potentially preventable ED visits. Cost savings realized from reduction in potentially preventable ED visits ICD9: At least 2 chronic conditions, CPT % (144,000 Interventions) 10% 20% 0.3% 2% $ 4,639,800 $ 37,118,400 25% 100% 8

9 11 KPI 11: Increase in billing for transition care management (TCM) services 12 KPI 12: Cost savings from Unplanned hospital readmission Within 30 Days 13 KPI 13: Reduction in Unplanned Hospital Readmissions Within 30 Days CPT 99496, CPT % 100% NCQA HEDIS Plan All-Cause Readmission within 30 days NCQA HEDIS Plan All-Cause Readmission with 30 days $8,000,000 $160,000, % (806 visits) 2% (16,111 visits) Example KPI: Increase in Billing for Wellness Visits The objective of this measure is to calculate the increase in billing for annual wellness visits among Medicare patients by using the following data sources: Data Source Name Code system/measure Steward Code/National Standard Measure Known Data Sources Data Source Description ICD, CPT ICD 9 V70.0/ ICD 10 Z00 AND CPT G0438 or CPT G0439 EHR, EPM Selection Criteria: Baseline: Any period of at least 3 months of data, preferably 9 months, prior to October 1, 2015 Updates: Quarterly reports for prior reporting period There are two data element for this KPI: Numerator & Denominator as detailed below: Numerator: Total number of Medicare visits billed during the measurement period. Denominator: Total number of active Medicare beneficiaries during the measurement period Exclusions: Patients that are within the first 12 months of their Medicare Part B coverage period. This measure can be calculated as follows: Performance rate is to be calculated using formula: ( Numerator Value Denominator Value Exclusion ) Project Timeline Timeline: Phase Timeframe RFP Issued August 8 th, 2016 Proposals Due August 26 th, 2016 Anticipated Contract Start Date September 15 th, 2016 Contracting Execution October 14 th, 2016 Anticipated Go-Live January 1 st, 2017 Submission Details - August 26, 2016 To be considered to participate as a Clinical Measurement Tool vendor for the NYSPTN, qualified and interested organizations please respond in writing to the information requests below by August 26, 2016 at 5PM EST. These responses will be considered non-binding expressions of intent, and interest in the NYSPTN. Please response package to: info@nysptn.org. The subject line of all communications must include your company name and the label NYSPTN Clinical Measurement Tool. 9

10 NYSPTN reserves the right to amend or cancel this RFP at any time prior to a signed contract with the vendor. NYSPTN is not responsible for any costs incurred by a vendor in the preparation of a response to this RFP Proposal Guidelines Vendors responding to this RFP must respond to ALL items contained in the five sections below. The proposal contents must include: 1. Cover Letter and Company Overview (1-page limit) a brief overview of the vendor s organization and contact information to direct future inquiries regarding the proposal. The cover letter must be signed by an officer authorized to bind the vendor to the terms of the proposal. 2. Company Background, Relevant Experience & References (5-page limit) The vendor should provide an overview of its company, relevant experience in this space, and provide appropriate references for this project. 3. RFP Scope Statement (8-page limit) the vendor must respond to each component in the project purpose and scope of this RFP. 4. Provide Development Timeline (1-page limit) Identify the key tasks, milestones, and project deliverables within the timeline. The project must be planned to be completed by January 1st, Any assumptions used in developing the timeline should be identified in this section. If there are specific tasks that NYSPTN will be responsible for, they should be identified clearly within the timeline. 5. Pricing (1-page limit) please provide pricing based on services, deliverables, and milestones as aligned with the proposed timeline. Budget Response In order to support the NYSPTN application, all vendor responses must include a budget summary that correlates to the number of clinicians targets for the life of the remaining program, assumed to be January 1, 2017 through April 30, All costs and fees must be clearly described in each proposal. Proposal Evaluation Criteria NYSPTN will evaluate all proposals based on the following criteria. To ensure consideration for this Request for Proposal, your proposal should be complete and address all of the following criteria: Overall proposal suitability: proposed solution(s) must meet the scope and needs included herein and be presented in a clear and organized manner Organizational Experience: Bidders will be evaluated on their experience as it pertains to the scope of this project Previous work: Bidders will be evaluated on examples of their work pertaining to data analytics as well as client testimonials and references Value and cost: Bidders will be evaluated on the cost of their solution(s) based on the work to be performed in accordance with the scope of this project Technical expertise and experience: Bidders must provide descriptions and documentation of staff technical expertise and experience 10

11 11 The New York State Practice