Care Transformation Collaborative of Rhode Island Supporting the Implementation of Comprehensive Primary Care Plus (CPC+) Advancing Primary Care in Rhode Island August 2016

Benefits of Participation in CTC-RI Additional payer participation (PMPM) in CTC-RI (e.g. Medicaid Managed Care) Supports data collection, reporting and utilization for performance measurement Provides hands-on practice facilitation – Practice facilitators provide on- site transformation coaching Partnering in Best Practice Quality Improvement opportunity Assistance with NCQA PCMH recognition Preparation for sustainability payments under OHIC Monthly, quarterly, and annual learning collaborative meetings

CTC Payment and Delivery Model Payment for Value Infrastructure payments for care management and becoming a patient centered medical home Incentive payments for quality, customer experience and utilization Alignment with the Office of Health Insurance, CPC+ and MACRA Incentives Delivery System Improvements Access and Continuity Care Management Care Coordination Patient and Family Engagement Data Driven Population Health Management Practice as a patient centered medical home

CPC+ Implementation in RI Pathway for practices not participating in an ACO Accepted in CPC+ Track 1 CPC+ payer partners provide additional support through CTC Three year common contract (includes alignment with OHIC requirements for PCMH sustainability payments) Practices align with an ACO value- based contact in year 4 and 5 Pathway for practices participating in an ACO Accepted in CPC+ Track 1 or 2 Participate in commercial ACO shared savings contracts ACOs direct support for practice level transformation An opportunity for clinicians meeting the statutory thresholds to be considered as meeting Advanced Alternative Payment Model requirements. For 2019-2024, qualifying clinicians would be excluded from Merit Based Incentive Payment System (MIPS) requirements and quality for a 5% APM incentive payment.

Participation in CPC+/CTC-RI Per member per month infrastructure payments Readiness for upcoming federal and state primary care alternative payment models. A "voice at the table" with primary care providers and health plans working together to improve care at lower costs For 2019-2024 clinicians, meeting statutory thresholds would be excluded from Merit Based Incentive Payment System (MIPS) requirement and quality for 5% APM incentive payment. CPC+ qualifies as an Advanced Alternative Payment Model

Additional information CTC+: https://innovation.cms.gov/initiatives/Comprehensive-Primary- Care-Plus For any additional questions, please contact Care Transformation Collaborative: Care Transformation Collaborative of RI ctcri@umassmed.edu ctc-ri.org 401-528-3271

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Additional Slides for Reference Only

CTC Practices Reduce In-Pt Admissions CTC practices also demonstrated inpatient savings for Fiscal Year 2015. Practices have shown less inpatient hospitalizations than the comparison group, translating to significant cost savings shown below. Since 2012, we have tracked the number of inpatient hospitalizations attributed to our practices, organized in three cohorts. Compared to non-CTC practices, all three cohorts March 2012-June 2015 have greater reduction rates of patient hospital admissions (from all causes) than the comparison group. CTC Savings $21,231,824 Total Program costs (15-16) $15,754,793 Net Savings $5,477,031

Quality Data

CAHPS Data CTC Survey Results Compared with National Comparison CTC Practices are generally on par with national benchmarks, but do better in adult behavioral care coordination and less well on office staff.