Opportunities on the Horizon. CCWJC/CCPN Provider Meeting Update November 2 nd, 2017

Transcription

1 Opportunities on the Horizon CCWJC/CCPN Provider Meeting Update November 2 nd, 2017

2 CCPN is physician-led and will: Increase quality and efficiency of health care Support independent, rural and/or small practices Be a high performing network o Demonstrate performance and value Secure and support value-based contracts Manage populations Be state-wide with ability to be regional Support clinicians in the Affordable Care Act o MACRA/MIPS o Quality Reporting o Practice Transformation 2 2

3 CCPN Board of Managers 3

4 Community Care Physician Network Number of Practices State-wide: 639 CCWJC: 105 Number of Clinicians 2, CCPN Website Address:

5 CCPN Participation Physician Specialties % Pediatrics 43% Family Medicine 35% Internal Medicine 15% OB/GYN 4% Practice Type/ Specialty % Pediatrics 25% FQHC 23% Family Medicine 20% Internal Medicine 14% 5

6 CCPN Practices County Designation % Urban/Suburban 49% Rural 51% Practice Size % Solo Practice 34% 5 or fewer clinicians 74% 10 or more clinicians 13% 6

7 CCPN Medicaid Enrollment Population Count % Total Medicaid 646,659 Children <21 520, % Adults 126, % ABD 98, % Duals 40, % 7

8 CCPN QI Committees and Measures CCPN Quality Assurance and Improvement Committees (QAIC) Chair: Dr. Steve Wegner Adult QAIC Pediatric QAIC Committee Chair: Dr. Terry Daniel Adult QAIC Measures Breast Cancer Screening Rate Colorectal Cancer Screening Rate Controlling High Blood Pressure Diabetes A1c Poor Control Tobacco Use: Screening and Intervention Committee Chair: Dr. Marian Earls Pediatric QAIC Measures Well Child Visits in the First 15 Months of Life Well Child Visits in the 3rd, 4th, 5 th and 6 th Years of Life Adolescent Well-Care Visit Childhood Immunization Rate Adolescent Immunization Rate Human Papillomavirus (HPV) Vaccine for Females 8 8

9 Practice-Payer Relationships NC Medicaid MCO 1 Medicaid MCO 2 MCO 3 SNPs FFS Medicare MSSP ACO MA Commercial 9

10 CCPN Supporting Practice-Payer Relationships NC Medicaid CMS MCO 1 Medicaid MCO 2 MCO 3 SNPs FFS Medicare MSSP ACO MA Commercial 10

11 Value-Based Care Changing Landscape: Movement to value-based care models = more risk assumed by provider organizations. Practices are being held to higher standards for outcomes, cost, and patient experience and the need to report on these metrics. Practices are being judged on data and it is vital that understand their data access it, analyze it, understand it, report it and improve based on it! Value = Clinical Outcomes + Patient Experience Total Cost of Care 11

12 CCPN Value Proposition Single signature for state-wide or regional coverage of the participating practices / clinicians anticipating ~ 2,500 clinicians by end of the year o Support and implement innovative payment models, p4p, etc. Delegated credentialing Practice transformation support ensuring an advanced primary care delivery system o Quality improvement and reporting CCNC has the data on Medicaid performance for each practice Benchmarking and addressing care gaps Addressing outliers & sharing best practices Provider services and supports Provider network management 12

13 Business Solutions Identified from Survey Current prioritized efforts underway to support CCPN practices and clinicians: ovaccine Purchasing oquality Reporting and EHR Support omedical and Office Supplies ohealth Insurance Benefits omalpractice Insurance o24/7 Nurse Advice Line ocredentialing 13 13

14 Opportunities for CCPN Practices Now! 14

15 CCPN Aetna Medicare Advantage Five county pilot Cumberland, Harnett, Lee, Moore, Sampson $5 pmpm for care management and provider services Base payment rate at 100% of the Medicare fee schedule Bonus potential for achieving 4-star or higher rating on 10 metrics (STAR) and the bonus is per metric higher star rating per metric increases bonus pmpm payment. Maximum total of $5.00 PMPM bonus if all 10 measures are 5 stars Additional $5.00 pmpm bonus for meeting all-or-nothing 90% annual office visit; bi-annual PCP visits for chronic disease; admits per 1000 on target; generic prescription rate 92.5% and readmission at or below 8% (risk adjusted) ~ 8 10 practices in the 5 counties and need 1,000 beneficiaries to start on 1/1/18 15

16 CCPN Gateway D-SNP (Dual Eligible Special Needs Plan) Currently in 41 counties in NC ~ 1,500 enrolled beneficiaries Want CCPN /CCNC support in DSNP practices in the 41 counties (includes Wake and Johnston counties) Payment for closing gaps in care chart reviews, office visits/physical exams Provision of provider services, physician relations, practice support and care management ($15 - $28 pmpm, depending on scope of services and enrollee acuity) Shared savings on incremental enrollees up to 50% with a 3% decrease in medical loss ratio (MLR) Targeted increase in STAR ratings (up to 2% bonus of 50/50 risk revenue) Bonus payments for Medicare Gap Closure 16

17 CCPN EverMed Direct Primary Care (DPC) Not insurance, DPC provides a PMPM for primary care services Employers incentivize their employees to choose DPC (e.g. no copays, pharmacy discounts) Marketing to small and large self-insured companies in NC o Projected life pool through season in NC ~ 200, ,000 Due to our statewide coverage, CCPN will be the exclusive network for EverMed in NC Works with independent clinics to offer a great way to improve patient care while also improving revenue Flexibility for practices to control whether they are accepting patients - can toggle whether you want to be selected at any given time CCPN can also participate in other DPC programs 17

18 EverMed DPC, cont. EverMed DPC provides: o A new, healthy stream of patients o Consistent practice revenue o Minimal administration o National and regional employer patient pools o Simple roster management An academic review of DPC claims data showed: o 25% lower outpatient utilization o 48% fewer ER visits o 41% fewer hospital admission 18

19 EverMed DPC: Clinic Revenue Clinic Revenue per PMPM Tier Individual $60 Individual + 1 $125 Family up to 4 $180 Additional $33 Members <2 yrs of age $40 Rider Plans Sample Practice Revenue at 200 Patient subscriptions Clinic Revenue Per Plan Plan Ratio 19 Clinic Revenue Per Month Annual Clinic Revenue Individual $60 42% $5,043 $60,518 Individual + 1 $125 12% $2,952 $35,419 Family $180 27% $9,864 $118,372 Additional Member $33 19% $1,239 $14,863 Total Revenue 100% $19,095 $229,171

20 EverMed DPC: Covered Primary Care Services Primary Care Visits Urgent Care Visits Preventive Care Annual Wellness Exams Well Child Exams/Sports Physicals Telemedicine EKG PPD (TB Test) Injection Fees (med may not be covered) Immunizations (med may not be covered) Skin Lesion Removal/Destruction Flu Shot Ear Irrigation Nebulizer Treatments Liquid Nitrogen Procedures Urinalysis Blood Glucose Urine Pregnancy Test Lipid Profile HgbA1c Rapid Strep Test Alcohol and Substance Abuse Screening 20

21 EverMed DPC: Current Opportunity 21

22 Potential EverMed Lives in CCWJC Network Name County # of Prospective Employers # of Prospective Employees # of Prospective Employees & Dependents (Bellybuttons = employees X 3) COMMUNITY CARE OF WAKE AND JOHNSTON COUNTIES Johnston 6 4,618 13,854 Wake 50 19,187 57,561 COMMUNITY CARE OF WAKE AND JOHNSTON COUNTIES Total 56 23,805 71,415 22

23 EverMed DPC: Relative Value Units (RVU) What would the impact of EverMed DPC be on your practice? o Conversion factor per RVU (on average): 28% higher than commercial contracts o RVUs are a measure of value used in Medicare reimbursement formula for physician services o Average utilization rate: 24% o Time spent chasing reimbursement dollars: 0 23

24 Group Purchasing Organizations (GPO) Offer cost-effective alternative to purchasing vaccines at catalogue price through contractual purchasing and volume discounts Contract either with Merck and Sanofi or GSK Member practices agree to purchase vaccines from either Merck and Sanofi or GSK 24

25 CCPN has partnered with 2 GPOs Atlantic Health Partners Vaccine Connect Contracts with Merck and Sanofi Contracts with GSK 25

26 Both GPOs offer significant cost savings 26

27 Atlantic Health Partners Physician buying group affiliated with Merck and Sanofi plus Pfizer s Trumenba Already working with over 600 CCPN member practices All CCPN practices will receive rebates at the highest tier, between 1.5% and 1.7% 27

28 Vaccine Connect GSK-affiliated buying group, owned and operated by independent primary care physicians and administrators Offers 3 portfolio options: o Full Portfolio o Adult/Adolescent Only o Bexsero Only (meningococcal B) Eligible for semi-annual rebates between 1% and 1.75% o If the practice spends at least $10,000 in vaccines during 6 month rebate period 28

29 Regional CCPN Meetings Starting in January 2018, CCPN will work with networks to hold regional meetings for clinicians and practice managers Share new opportunities, services and contracts Share best practices Report on quality metrics Increase communication and transparency CCWJC will participate by hosting more details to come 29

30 communitycarephysiciannetwork.com