New York State Department of Health

Medicaid Incentive Plans

NYS Prime PCMH (Preview)

Central New York Care Collaborative

(CNYCC)

Friday Webinar –Presented

by Karen Joncas

March 23, 2018

Welcome and Webinar Learning Objectives

Understand NYS PCMH Expectations, Criteria and Timeline

Understand Practice Transformation Technical Assistance Available

Understand changes to NYS Medicaid Incentive Plan –Current and proposed

Review CNYCC support and Partner next steps

Learning Objectives

NYS Primary Care Transformation- NYS PCMH

Delivering the Triple Aim- Heathier people, better care and individual experience and smarter spending

Reduce confusion among the various primary care model recognition programs through alignment (Programs include: DSRIP, SIM/APC, TCPI, MACRA and CPC+)

Continue to support practices in their efforts to transform to patient-centered medical homes and integration of the important pillars of the model

Align Medicaid and APC around one common (well known) practice transformation program.

Achieve NYS DOH goals that go beyond NCQA PCMH 2017Value Based payment –Accelerate transition toward quality care and new payment modelsBehavioral Health IntegrationHealth ITRobust Care CoordinationPopulation HealthImprove potential for Multi-payer supportSupports continuous practice transformation with yearly check-ins

NYS DOH PCMH Goals

NCQA PCMH 2017 addressed many of the concerns that NYS DOH had with the 2014 program which resulted in the development of NYS DOH Advanced primary care model, including annual reporting.

NCQA PCMH 2017 fell short with their core requirements so NYS PCMH moves priority items to core requirements.

As of April 1, 2018, all APC practices shift to NYS PCMH and any new NYS (not recognized) practices seeking recognition can only do so with NYS PCMH.

Developed Pathways for currently recognized practices.

Developing Transformation Timelines.

NYS DOH PCMH Goals

Transformation Timeline (April 1, 2018 Example only-Subject to change)

Recognition Starting Point

NCQA Check-in #1 NCQA Check-in #2NCQA Check-in

#3

APC

APC Gate 2 Completed 4 months 8 months 12 months

APC Gate 2 not completed

6 months 12 months 18 months

New NYS PCMH (no current recognition)

New NYS PCMH 6 months 12 months 18 months

NCQA PCMH 2014 PCMH 14 Level 3 3 months 6 months 9 months

Transformation Timeline with NCQA check-ins

Comparison of NCQA PCMH 2017 and NYS PCMH

NCQA PCMH 2017/NYS PCMH Comparison

Key Components NCQA PCMH 2017 NYS PCMHCore Standards 40 52

Requirements for Recognition

40 Core plus 25/83 Elective Credits across 5/6 competencies

52 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 of 12 new core point value. Dependent on type of practice and type of VBP contract for example.

Phases of Transformation-Replaces APC Gates

1. Commit - commit, self-assess, plan 2. Transform-develop and document PCMH capabilities 3. Succeed-Annual re-certification

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

Platform to submit validation NCQA Q Pass NCQA Q Pass

RecognitionNCQA PCMH 2017 recognition NCQA and NYS recognition as NYS PCMH

State -Funded Technical Assistance None

Support to achieve NYS PCMH recognition contingent upon 2 year participation

NYS PCMH New Core RequirementsCategory Criteria Description Points

Behavioral Health CC 09

Behavioral Health Referral Expectations: Works with Behavioral Healthcare providers

2 Elective Credits-1 Core

KM 04 Behavioral Health Screenings1 Elective Credit-1 Core

Care Management and Care Coordination

CM 03 Comprehensive Risk-Stratification Process2 Elective Credits-1 Core

CC 08Specialist Referral Expectations: Works with non-behavioral healthcare specialists

1 Elective Credit-1 Core

CM 09 Care Plan Integration1 Elective Credit-1 Core

CC 19 Patient Discharge Summaries1 Elective Credit-1 Core

KM 11

Population Needs: Identifies and addresses population-level needs based on the diversity of practice and community (demonstrate at least 2)

1 Elective Credit-1 Core

NYS PCMH New Core Requirements- (Continued)

Category Criteria Description Points

Health Information Technology

AC 08 2 Way Electronic Communication 1 Elective Credit-1 Core

AC 12 Continuity of Medical Record Information 2 Elective Credits-1 Core

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 Two-sided risk (downside)

NYS PCMH Pathways and Timeline

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

Different Pathways to NYS PCMH for NCQA PCMH recognized practices

Practices may consider different pathways depending on changes to PCMH incentive program rules.

NYS PCMH Pathways and Timeline

NYS PCMH Pathways and Timeline

Different Pathways to NYS PCMH2018 2019 2020

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

Practices expiring 2018: Enroll in "First NYS

PCMH Annual Report*" Practices expiring in

2019/2020: "First NYS PCMH Annual Report

optional."

Practices expiring 2018: NYS PCMH Annual Reporting

Practices expiring in 2019/2020: "First NYS PCMH

Annual Report optional."

Practices expired in 2018/2019: NYS PCMH

Annual Reporting Practices expiring 2020: Enroll in "First NYS PCMH

Annual Report*"

APC Practices Enroll in NYS PCMH Achieve NYS PCMH Recognition

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.

NYS DOH Support for Practice Transformation

Covers all NCQA PCMH Recognition Pricing costs regardless of the number of clinicians (NYS and NCQA will be issuing a discount code soon)

Note: If you have already paid the (initial) recognition fee, there will be no reimbursements either from NYS or from NCQA.

Contracting with a TA Vendor will provide support for transformation and submission, including preparation for NCQA check-ins.

TA Services could include staff training, Q Pass Enrollment, development and review of required documentation, uploading documentation, etc.

Funding (available through the SIM grant) expires February 2020 and is contingent on at least 2 year participation.

NYS DOH Support for Practice Transformation

NYS DOH Technical Support Vendors-Region 6

NYS will provide technical assistance through vendors for up to 18 months, depending on

your practice’s current recognition status

Region 6: Onondaga and Cayuga Counties

Common Ground Health (CGH)

• Contact – Bill Brien, 585-224-3149 williambrien@flhsa.org

• Contact – Sue Swift, 585-224-3144 susanswift@flhsa.org

Island Peer Review Organization (IPRO)

• Contact – Thomas Lemme, 516-209-5284 tlemme@ipro.org

• Contact – Susan Hollander, 516-209-5241 shollander@ipro.org

https://www.health.ny.gov/technology/innovation_plan_initiative/ta_contact_info.htm#region_1

NYS DOH Technical Support Vendors-Region 7

NYS will provide technical assistance through vendors for up to 18 months , depending on

your practice’s current recognition status

Region 7: Oswego, Madison, Oneida and Lewis Counties

Adirondack Health Institute (AHI)

• Contact – Mary McLaughlin, 518-480-0111 ext. 413 mmclaughlin@ahihealth.org

• Contact – Thomas Melville, 518-480-0111 ext. 423 tmelville@ahihealth.org

Capital District Physicians Health Plan (CDPHP)

• Contact – Vincent Speenburgh, 518-641-4194 Vincent.Speenburgh@cdphp.com

• Contact – Michael Courtney, 518-641-3494 Michael.Courtney@cdphp.com

https://www.health.ny.gov/technology/innovation_plan_initiative/ta_contact_info.htm#region_1

NYS Medicaid PCMH Incentive Changes

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 2018-2019 and 2019-2020.

NYS DOH conducting a current push on commercial payers to support continuing transformation

Medicaid PCMH Incentive Changes: Background

Medicaid PCMH Incentive Changes

NYS PCMH Medicaid Incentives

PCMH Incentive (PCMH Standard Year and LevelThrough April 30,

2018May-June 2018

MMC PMPM (2014 Level 2) $3.00 0

MMC PMPM (2014 Level 3, APC* or 2017) $7.50 $2.00

FFS claim add-on Professional (2014 Level 2) $20.50 0

FFS claim add-on Institutional (2014 Level 2) $23.25 0FFS 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.

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 MedicaidManaged Care (MMC) and Fee-for-Service (FFS) PCMH incentive be tied to bothPCMH recognition and VBP contracting.

Proposal components include:Providers have at minimum PCMH recognition at NCQA PCMH 2014 Level 3Providers have a Medicaid VBP contract at Level 1 or higher with at least one MMC

PlanThe FFS incentive will be tied to VBP contracting for those providers who

participate in both FFS and MMC.

Medicaid PCMH Incentive from July 2018 Onward

CNYCC Support for NYS PCMH and Next

Steps

Proposed components include:

NYS PCMH Learning Collaborative for interested partners- Wednesday April 18th

Continued support through training opportunities, such as Value Based Payment

Ongoing workforce efforts to support primary care

Population Health Management platform – IBM Watson

CNYCC Support for NYS PCMH

Review NYS PCMH Standards and Guidelines once published, regardless of whetheryou are currently recognized or when your recognition expires.

APC practices will continue to work with their technical advisors and will switch toNYS PCMH at April 1, 2018.

NCQA PCMH 2014 Recognized practices should continue all PCMH initiatives begunas part of your recognition, including population outreach, patient satisfaction andquality monitoring.

Consider contracting with a technical advisor for NYS PCMH assistance.

For NYS PCMH each recognized practice site must have a clinical and business lead.

Consider your organization’s time-line for achieving NYS PCMH.

Continue your efforts toward value-based payment contracts to maximizeincentives.

Partner next steps

Questions & Answers