Massachusetts League of Community Health Centers

Transcription

1 Massachusetts League of Community Health Centers ACO RFR Q & A October 24, 2016 HEALTH MANAGEMENT ASSOCIATES

2 Agenda Time Line Model Comparison Readiness for Value-Based Payments 2

3 A Time Frame for Many Activities Implementing the plans means conducting a series of procurements Pilot ACOs have been selected Full ACO RFR released due January 12, 2017 MassHealth also planning a regional procurement of Certified Community Partners (CPs) MCO contracts will be re-bid after the ACO process, consistent with the ACO plan ACO RFR Released 9/29/16 ACO Pilot Launch December 2016 ACO Selection May 2017 MCO Selection June 2017 Member Notice Nov 2017 Services begin MCO RFR Released Nov 16 CP Certification Process Feb 2017 TCOC targets and rates Summer 2017 Model C Contracts July 2017 Dec 18, 2017 Source: 3

4 The ACO Models (1) Accountable Care Partnership Plan ("A") Primary Care ACO ("B") MCO-Administered ACO ("C") Structure Exclusive relationship between a group of PCPs and one MCO Direct contact with Mass Health for exclusive group of PCPs Exclusive group of PCPs who contract with multiple MCOs Membership Requirements 20,000 10,000 5,000 Payment Capitation (monthly subject to risk corridor) TCOC based on population and anticipated costs Capitation to MCO; MCO assess TCOC performance and make/receive payments Risk Structure Risk for savings and/or losses beyond capitation rate Shared savings/losses through TCOC and quality ACO accountable to MCO for shared savings/losses Network Defined by ACO with MassHealth approval (not geographically bound) MassHealth and MBHP network (ACO may designate preferred providers) MCO network Health Management Associates 4 Source:

5 The ACO Models (2) Accountable Care Partnership Plan ("A") Primary Care ACO ("B") MCO-Adminstered ACO ("C") Governance Certification At least one consumer or consumer advocate (voting) Majority of governing board seats must be held by providers Providers must represent diverse provider types (BH, LTSS, Specialists) Board must have a Patient and Family Advisory Committee and a Quality Committee Must maintain HPC ACO Certification Must meet MH MCO requirements, including HMO licensure Solvency and Financial Requirements Same as MCO including operating reserves Maintain a repayment mechanism (performance bond, line of credit, or escrow account) Negotiated with MCO (not specified by EOHHS) Health Management Associates 5 Source:

6 Care Delivery and Management Responsibilities Look very much like PCMH care management requirements CLAS Access to care including social services Wellness initiatives Collaboration and coordination with CPs for BH care and LTSS HEALTH MANAGEMENT ASSOCIATES 6 Source:

7 Quality Performance and Measurement Quality performance is a gate for shared savings Quality domains: o Prevention and Wellness o Chronic Disease Management o Behavioral Health/Substance Abuse o Long Term Services and Supports o Integration o Avoidable Utilization HEALTH MANAGEMENT ASSOCIATES 7 Source:

8 DSRIP Allocation # of Members Attributed to ACO PMPM Amount Based on: # of ACOs ACOs safety net category (% of revenue generated from MH/uninsured members) Chosen risk model Health Management Associates 8 Source:

9 DSRIP Funds: Acceptable Uses ACO Startup/Ongoing Support (decreases over 5 years) Support for Flexible Services (held constant through the 5-year DSRIP period) Transitional Funding for Certain Safety Net Hospitals (CMMI/EOHHS negotiations) Initiatives to Improve the Availability and Use of Accessible Medical and Diagnostic Equipment for People with Disabilities HEALTH MANAGEMENT ASSOCIATES 9 Source:

10 Member Choice and Attribution Will be Challenging MEMBER ENROLLMENT CHOICES Model A MCO/ACO (new) Model B ACO (new) Managed Care Plan (old) Including a Model C ACO (new) The PCC Plan (old) The idea is that Members will have information to make enrollment decisions based on what is most important o PCPs, key specialists or facilities This happens during an open enrollment period (October December 2017) o o Customer Service will need data to enable these informed choices (So will MCOs and PCPs and specialists and hospitals and ACOs and CHCs) What will happen with Members that do not make a choice? o o o Auto-assignment in MCOs (members who don t make an active choice) is a meaningful percentage of members Probably these members will be attributed based on available data Based on PCPRI issues with attribution, this could be a seriously difficult process 10

11 Health Policy Commission ACO Standards For the first year of the ACO certification program, ACOs must comply with three categories of certification criteria. Mandatory Criteria Market and Patient Protections Reporting Only Criteria Legal and Governance Structure Risk Stratification and Population Specific Interventions Cross Continuum Network: Access to BH & LTSS providers Participation in MassHealth APMs PCMH Adoption Rate Risk-bearing provider organizations certificate or waiver from DOI Material Change Notices filing attestation Compliance with state and federal Anti-trust laws Compliance with Office of Patient Protection guidelines (patient protection) Quality and financial performance reporting Provides palliative care and end-of-life planning Care Coordination Peer Support Adherence to evidence-based guidelines APM adoption for primary care Analytic Capability Consumer Price Transparency Transparent process for flow of payment to providers Patient and Family Experience Community Health ACO assess population demographics and preferences EHR Interoperability Commitment SOURCE: HPC Care Delivery and Payment Transformation Committee 11

12 Community Partners are a Required Network Partner for ACOs SOURCE: MH Payment and Care Delivery Transformation: Strategic Design Workgroup, 1/28/16 12

13 Final ACO Strategic Considerations Are these clinical or financial partnerships? Long-term financial stability and shorter-term DSRIP financing Governance considerations Whose market share is it now? 13

14 VBP Readiness Assessment Tool Purpose is to provide primary care and behavioral health providers with actionable information on their readiness to succeed under value-based payment and to identify critical gaps to address Includes questions on systems, tools, and capacity across multiple dimensions Designed by HMA and CohnReznick in partnership with the DC Primary Care Association 14

15 Tool Overview Four sections: Section I: Organization Section II: Partnerships Section III: Care Delivery and Health Information Technology/Health Information Exchange Section IV: Financial and Operations Section V: Concerns Total of 88 questions, excluding subquestions Takes a team about 4 hours to complete 15

16 How Best to Use the Assessment Encourage that you have a team take the assessment Opportunity to explore topics together and agree on status of each readiness element Reduces likelihood of answers being based on single person s perceptions 16

17 Online Format A unique link for an organization is generated and ed after terms and conditions accepted and payment made This link will automatically save your progress allowing your organization to pause and continue as needed. All questions require a response to ensure the tool captures the most complete picture of your organization. An address is provided on every page for any technical or content questions that arise. 17

18 Format Answer format is generally no/partial/yes Not asking for any documentation In a few instances, we ask you to provide staffing FTEs Every page has space to put comments (optional) Please include question number to which you are referring Definitions for select items are contained in footnotes for reference 18

19 Online Output Shortly after completion, a Readiness Report will be generated and ed If participating in a cohort, you will also get a Cohort Readiness Report once the other providers complete the assessment. This report will follow the same template as the individual report, but in addition to individual results, it will compare your responses for each questions with the aggregate responses of the cohort. 19

20 Questions and Discussion HEALTH MANAGEMENT ASSOCIATES 20