Transcription
Introduction to the Maryland PrimaryCare Program (MDPCP) for CareTransformation OrganizationsChrista SpeicherBonnie Gewanter1
Introduction to the Maryland Primary Care Program (MDPCP) for CareTransformation Organizations (CTOs) What Care Management Staff will the CTO Deploy? What Services Does a CTO Provide?Agenda Payments to CTOs (care management fee [CMF] and performance-basedincentive payment [PBIP]) Resources for Practices to Meet Care Transformation Requirements Opportunities for Learning, Collaboration, and Support Overview of Driver Diagram and Change Package Using Data to Drive Learning Application Process What Happens Next? Questions2
Introductionto theMDPCP forCTOs Strengthening primary care is critical to promoting healthand reducing overall health care costs in Maryland. CMS is offering primary care practices in the state ofMaryland an opportunity to participate in the MDPCP. Participants in the MDPCP are expected to transform theway they deliver primary care in order to providecomprehensive care management and patient-centeredcare. CMS will support primary care practices’ transformationefforts by offering care coordination and performancebased payments to Participant Practices in the MDPCP.CTOs3
This program begins on January 1, 2019, and runsthrough December 31, 2026.Introductionto theMDPCP forCTOs CMS is accepting applications from CTOs. A CTO may provide additional support to participatingpractices by hiring and managing an interdisciplinarycare management team that will furnish an array ofcare coordination services. The CTO may be the applicant organization itself ormay be the organization that owns and operates theCTO.CTOs4
Introductionto theMDPCP forCTOs,continuedCTOs are an important element of the MDPCP,as they give practices of all sizes access tothe types of specialized care management staffand processes that can make a difference forbeneficiaries with chronic conditions.CTOs5
What CareManagementStaff WillCTOsDeploy?CTOs will hire, manage, and deploy care managementstaff that would be hard for many practices to deployindependently. These may include: Pharmacist services Health and nutrition counseling services Behavioral health specialists Social services Support from health educators and CommunityHealth Workers (CHWs)6
CTOs will help practices by providing the five services,below, which are necessary to meet the caretransformation requirements:Whatservices doesa CTOprovide?1. Care Coordination Services2. Support for Care Transitions3. Standardized Beneficiary Screening4. Data Tools and Informatics5. Practice Transformation Assistance7
Paymentsto CTOs The CTO will receive a percentage of thecare management fee (CMF) for eachpractice that has signed up with the CTO. CMS will pay the CMF directly to the CTO. CMS offers two options for payment.8
CTO will receive 50% of the CMF paymentCTOPaymentOption 1 Remaining 50% of the CMF will be paid tothe partner Participant Practice CTO will provide each partner ParticipantPractice with at least one Lead CareManager for every 1000 attributed MedicareFee-For-Service (FFS) beneficiaries9
CTOPaymentOption 1,continuedLead Care Manager is defined as an individual whois fully dedicated to care management functions ofthe Participant Practice under the MDPCP. Must be a full-time employee (FTE) of the CTO Works with practice-based practitioners who haveprimary responsibility for care management of allbeneficiaries attributed to the practiceThe CTO may provide additional care managers asnecessary to fulfill specialized care managementneeds that the practice may have.10
CTO will receive 30% of the CMFCTOPaymentOption 2 70% of the CMF payment will be paid tothe partner Participant Practice. Under Option 2, the partner ParticipantPractice has its own Lead Care Manager forevery 1000 attributed Medicare FFSbeneficiaries, so the CTO does not need todeploy a Lead Care Manager to the practice.11
CTOPaymentOption 2,continued CTO will provide the practice with accessto an interdisciplinary care managementteam. The CTO’s interdisciplinary care managementteam will supplement the Lead Care Manager,who is employed by the practice.12
Payments toCTOs-PBIP The CTOs will also receive a performancebased incentive payment (PBIP) that is a perbeneficiary per month (PBPM) payment. The PBIP will be based on utilization andquality measures of all practices with whom aCTO partners.13
Opportunitiesfor Learning,Collaboration,and SupportCTOs in MDPCP will have access to learning communitysupport, to facilitate shared learning. Features include: Change Package and Getting Started with the MDPCP Curriculum with CTO-specific learning opportunities In-Person and Virtual Learning Sessions Outreach and support from learning faculty Newsletters, Spotlight articles, and FAQs MDPCP Connect: a web-based platform for MDPCPstakeholders to share ideas, resources, and strategies forpractice transformation.14
MDPCPDriverDiagramIllustrates how all componentsof the MDPCP work togetherto support practices’ delivery ofprimary careOrganizes framework forlearning and transformationwithin the MDPCPShows, at the center, the focusfor the diagram: Beneficiariesand Caregivers15
MDPCPDriverDiagram16
ChangePackage Organizes change concepts and tactics to supportimplementation of primary care functions and otherdrivers Is a key tool to support practice transformation Builds on experience from CPC, CPC , and other primarycare transformation efforts18
ChangePackage,continuedNote: this is a snapshot ofwhat the actual ChangePackage will look like18
Using Datato DriveLearning,ComingSoon .Wewant tohear fromyou!Needs Assessment Survey Provides information about practice and CTO prioritiesand capabilities Allows CMS to tailor learning events and opportunities tobest support practice transformationLearning Event Feedback Opportunities to provide feedback at the end of learningevents Opportunities to provide feedback on MDPCP Connect19
The RFA application will be completed viaan online portal.ApplicationProcess How to Apply Applicants register for an account on the portalhome page:https://app1.innovation.cms.gov/mdpcp. Applicants receive a follow-up email containinginstructions for completing the registration processand accessing the application. Applicants are able to log in viathe portal and start a new application online.20
All application questions must be answered.ApplicationProcess Applications must include appropriate lettersof recommendation. Applicants must indicate geographic servicearea and the maximum number of practicesyou can support.22
ApplicationProcess –CTOselection CMS will review applications and announcethe selected participants after the RFA periodcloses. CMS will base CTO selection on: CTO’s demonstration of its ability tosupport Participant Practices in meetingthe care transformation requirementsCTO22
Application period for CTOs will openin early June, 2018, and will close 6 weekslater.WhatHappensNext? CMS will announce CTO selections in Augustof 2018 Practices will begin applying to the MDPCP inAugust of 2018 More information and welcome materials willbe provided to participants prior to programstart date23
Email us at: MarylandModel@cms.hhs.gov Contact the MDPCP Help Desk at: 1-844-711-CMMI ,option #7Questions? Find information on the MDPCP cm/ Access the “Request for Applications” a.pdf?24
an online portal. Applicants register for an account on the portal home page: https://app1.innovation.cms.gov/mdpcp. Applicants receive a follow-up email containing instructions for completing the registration process and accessing the application. Applicants are able to log in via the portal and start a new application online. 20
