APM in Primary Care PDF
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APM in Primary Care Moving Away from FFS to Paying for Quality Mindy Stadtlander, MPH Director of Network and Clinical Support Todays Conversation What Are We Trying to Accomplish? What are YOU trying to accomplish? What Are We Trying to Accomplish? 1. Build Primary Care capacity for data and quality improvement 2. Foster shared decision making across communi>es for resource alloca>on Primary Care Payment Evolution Current State Bridge Strategy Future State Fee for Service Primary Care with expanded Fee for Service Capita4on? codes At Risk for Incen4ve Quality/ Incen4ve Payment U4liza4on Payment Base FFS payment Base FFS payment structure Primary Care capita>on structure with Primary that supports alterna>ve care with por>on of Care Incen>ve Program delivery models (telephone/e-‐ payment at risk for visits, RN/BH visits, etc) with quality and u>liza>on expanded Primary Care outcomes Incen>ve Program What Changes Can We Make? Primary Care Incentive Model Keys • Co-‐developed with major delivery system partners • Clinic-‐chosen measures from a menu • Focus on improvement, not mee>ng benchmarks • Emphasis on EHR-‐based quality measurement, not claims data • No central specifica>ons PC Incentive Model • Report monthly on 5 menu measures Level 3 • Receive measures and roster on CO AMributed Members • Improve 3% on at least 3 measures • Report monthly on 5 menu measures Level 2 • Receive measures and roster on CO AMributed Members • Improve 3% on at least 1 measure • Report monthly on 3 menu measures Level 1 • Receive measures and roster on CO AMributed Members Participation Current Results 1st period 2nd period 1st period 2nd period Year 1 Year 2
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