Maryland Primary Care Program American College of Physicians

Maryland Primary Care Program American College of Physicians- Maryland Chapter Howard Haft, MD, MMM, CPE, FACPE Program Management Office

Background & Overview Remember the “Why” • Provide the best quality health for the “Population” served • Shift from an ever increasing volume demand to rewards for value based care • Avoid unnecessary emergency department and hospital visits • Provide evidence for the essential role of Primary Care in improving health and reducing cost “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win. ” - JFK Rice Univ. 1962 2

Past, Present and Future (1950 annual per capita cost for healthcare $100 Life Expectancy 68. 2 years) 3

Background & Overview US Ranks 39 th Healthiest Nation 4

19 th Down from 18 th 5

Background & Overview Per Capita Health Care Spending – US Has No Peer 6

Background & Overview US Life Expectancy Lowest in World Among Peers 7

Present Disease Burden is Higher in the US than in Comparable Countries 8

Past Ratios of Primary Care to Specialists 9

Addressing the Issues: Total Cost of Care Model Contract TCOC Model Agreement Signed on July 9, 2018! 10

Hospitals Lead-Since 1977, Maryland operated an all-payer, hospital rate setting system Volume 11 Value

Total Cost of Care Model Components “Under this Model, CMS and the State will test whether State-wide health care delivery transformation, in Hospital conjunction with Care Population-Based Redesign Payments, improves programs population health and care outcomes for individuals, while controlling the growth of Medicare Total Cost of Care” 12 • Reduce Medicare expenditures by an annual run rate of $300 m by 2023 Population Health Improvement credits Improved Health for Marylanders Maryland Primary Care Program • Innovate hospital/provider partnerships Hospital Population based revenue • Gain credit for improving overall population health • Build a strong effective primary care delivery system, inclusive of medical, behavioral and social needs

Background & Overview So- Why Primary Care? • International Experience supports role • US Experience- recent data • Single largest provider category • Low relative healthcare spend (~5%) • Low cost venue for care • Best place to invest to avoid unnecessary hospital and ED visits • Offset to burnout of Physicians 13

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Background & Overview Recent US Experience in Primary Care Policy Increasing primary care investment Source: Baum et al. Health Affairs, February 2019 15

Background & Overview More Primary Care Increases Life Expectancy 16 JAMA, Basu, Feb 2019

Care Delivery Redesign Maryland Primary Care Responds with Advanced Primary Care Five advanced primary care functions: Planned Care for Health Outcomes Access & Continuity Expanded Access Advanced HIT Beneficiary & Caregiver Experience Care Management Risk Stratified Care Management Transitional Care Management Comprehensiveness & Coordination 17 Behavioral Health and SDo. H Medication Management

Program Requirements 2020 Metrics electronic Clinical Quality Measures (e. CQM) include: • Outcome Measures – Diabetes and Hypertension Control (NQF 0018 & 0059) Patient Satisfaction • Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) – survey of practice patients (NQF 0005) Utilization • Emergency department visits and Hospitalizations per 1, 000 attributed beneficiaries (HEDIS) 18 Current metrics as of 2019 – May be updated for 2020

Incentives Payment Incentives in the MDPCP Practices – Track 1/Track 2 Care Management Fee • $6 -$100 Per Beneficiary, Per Month (PBPM) Ø Tiered payments based on acuity/risk tier of patients in practice including $50/$100 to support patients with complex needs, dementia, and behavioral health diagnoses • Timing: Paid prospectively on a quarterly basis, not subject to repayment 19 Performance-Based Incentive Payment Underlying Payment Structure • Up to a $2. 50/$4. 00 PBPM payment opportunity • Track 1: Standard FFS • Must meet quality and utilization metrics to keep incentive payment • Track 2: Partial prepayment of historical E&M volume with 10% bonus • Timing: Paid prospectively on an annual basis, subject to repayment if benchmarks are not met MSSP ACO practices do not receive the Performance-Based Incentive Payment Potential for additional bonuses via AAPM Status under MACRA Law • Timing: ØTrack 1: FFS; Track 2: prospective

Supports for Practices Care Transformation Organization (CTO) On request – assisting the practice in meeting care transformation requirements Services Provided to Practice: Care Coordination Services Support for Care Transitions CTO Data Analytics and Informatics Standardized Screening Practice 20 Assistance with meeting Care Transformation Requirements Examples of personnel: Care Managers Pharmacists LCSWs Community Health Workers

Supports for Practices Existing CRISP HIT Services for Practices Maryland Prescription Drug Monitoring Program Monitor the prescribing and dispensing of drugs that contain controlled dangerous substances Encounter Notification Service (ENS) Be notified in real time about patient visits to the hospital Query Portal Search for your patients’ prior hospital and medication records Direct Secure Messaging Use secure email instead of fax/phone for referrals and other care coordination 21

Program Management Office 22

Supports for Practices MDPCP Learning System • Practice Coaches- State and CTOs • Webinars • Office Hours • Online Manuals • Collaborative Communities • Newsletter • Connect Site • 3 Annual Face-to-Face Meetings • Quarterly Reporting 23

MDPCP – 476 Practices currently PARTICIPANTS 2019 2020 Providers in MDPCP 1, 500+ 1, 916+ FFS Beneficiaries Attributed 220, 000 300, 000+ Marylanders Served 2, 000 – 3, 000* 2, 700, 000 – 3, 800, 000* * The Annals of Family Medicine, 2012 http: //www. annfammed. org/content/10/5/396. full 24

MDPCP Status Program Year 1 Total Payments Program Year 1 • Total investment for Practices & CTOs in Program Year 1 = $67 M • Average amount to practices = ~$176, 000* *Includes payments to Track 1 & 2 Practices and CTOs 25

Past, Present and Future 26

Thank you! Updates and More Information: https: //health. maryland. gov/MDPCP Questions: email mdh. pcmodel@Maryland. gov 27