Transforming Clinical Practice Initiative (TCPI) An Overview Connie K Transforming Clinical Practice Initiative (TCPI) An Overview Connie K. Ihde, Director of Programs & TCPI Arizona Health-e Connection November 17, 2015

National Health Care Waste & Inefficiency Estimated $700 Billion of “Healthcare waste” annually $250-325 Billion in “Unwarranted use” $75-100 Billion in “Provider inefficiency and errors” $25-50 Billion in “Lack of care coordination” White Paper: “Where can $700 Billion in Waste be Cut Annually from the U.S. Healthcare System? Robert Kelley, CP, Healthcare Analytics Thomson Reuters October 2009

White Paper: “Where can $700 Billion in Waste be Cut Annually from the U.S. Healthcare System? Robert Kelley, CP, Healthcare Analytics Thomson Reuters October 2009

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TCPI National Goals

Overall Aims of TCPI

TCPI Focus Areas

TCPI Assistance Model Practice Transformation Networks (PTN) - Group practices, health care systems, and others - Serve as trusted partners to provide clinician practices with quality improvement expertise, best practices, coaching and assistance - Prepare and begin clinical and operational practice transformation Support and Alignment Networks (SANs) - Professional associations and others - Align their memberships, communication channels, continuing medical education credits and other work - Support the PTNs and clinician practices

PTN Award Provides technical assistance & peer-level support to clinicians in delivering care in a patient-centric & efficient manner Supports clinicians in identifying & engaging with national improvement leaders to implement and continuously refine their practices Allows practices to become actively engaged in the transformation Ensures collaboration among a broad community of practices that creates, promotes & sustains learning & improvement across the health care system

PTN Approach Provide “boots on the ground” support to coach, mentor & assist clinicians in developing core competencies that assist them in moving through various phases of practice transformation Able to collaboratively (with CMS) lead clinicians & their practices through the transformation process, achieve the initiative goals, & ensure that clinicians & their practices can maintain & sustain the activities

SAN Award Provides a system of national & regional professional associations & public-private partnerships that are working in practice transformation efforts Utilize existing & emerging tools (CME, core competency development, etc.)

SAN Approach Engage eligible medical professional associations, specialty societies, and other organizations that are involved in aligning programs with the aims of the initiative Generate evidence-based guidelines for clinical practice Promote measurements for improvement Support members and practices in work to reduce unnecessary testing & procedures Incorporate safety & patient and family engagement

Five Phases of TCPI

Arizona Goals Goal 1: Transform the delivery of care Objective 1: 2,500 primary and specialty care providers will participate in the Practice Innovation Institute (PII) by the end of fourth project year Objective 2: 2,500 participating providers will achieve Phase 5 by fourth year – participation in a pay for value approach Objective 3: By the end of the four year project period, 90% of participating providers will enroll in a value‐based payment program, as a result of PII’s leadership and active engagement with providers.

Arizona Goals Goal 2: Improve outcomes while decreasing costs Objective 1: Achieve a 10% decrease in unnecessary testing/procedures and 12% decrease in hospital readmissions and hospitalizations Objective 2: Achieve 10% improvements in well child visits, adolescent well care, pediatric dental visits, breast cancer screening and diabetes care

Project Roles Arizona Health-e Connection Lead Agency and Fiscal Agent Recruit Provider and Practices Enroll in Practice Innovation Institute Enroll in The Network Strengthen EHR Integration & Meaningful Use Develop Population Registries Data Collection & Reporting CMS Point of Contact and data reporting entity

Project Roles Mercy Care Plan Individual Coaching on areas including: Performance improvement Population-based health improvement Rapid cycle change methods Financial and administrative efficiencies Care management Risk stratification

Project Roles Mercy Maricopa Integrated Care Provides consultation in areas including: Technical assistance and overall quality improvement training to contracted providers Development of effective methods to provide integrated care Integration of physical and behavioral health care

Alignment Medicaid/Medicare/CHIP Programs Optimize integrated delivery of physical & behavioral health care services State and Regional Initiatives Program goals align with Arizona’s Health IT Roadmap 2.0 Provide resource and information on tools that support health care transformation, including new payment models Create & Implement strategy for information sharing between behavioral & Physical health care providers ADHS State Health Improvement Plan Plan has broad pubic input, measurable goals, objective to improve quality of care and reduce costs

Recruitment Goals Total Number of Clinicians to be enrolled: 2,500 Primary Care Clinicians 1,775 Specialty Care Clinicians 725 Yearly Recruitment Goals: Year 1: 2,300 Year 2: 175 Year 3: 25 Year 4: 0 Over recruit to account for attrition

Recruitment Targets Small Practices, Rural Areas and Medically Underserved Arizona Primary Care Office Arizona Primary Care Association Sliding-fee Scale Clinics Behavioral Health Provider Agencies Arizona Medical Association Arizona Osteopathic Medical Association University of Arizona Center for Rural Health Phoenix Children’s Care Network Arizona Association of Community Health Centers

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Questions? www.PiiAz.org PiiInfo@AzHeC.org 602-688-7200