1. TCPI Project Pathway: Session 8 of 8 Business Strategies Milestone #’s 18, 20, 21(specialty) 23, 25, 26 (primary care)

2. About the TCPI Milestones
22 Milestones for specialty practices
27 Milestones for primary care
Scores on each milestone determine Phase completion
For example, to complete Phase 1, as score of 3 is necessary on milestone 13 (setting an aim).
Other phases require various scores for other milestones.

3. Milestone Classes Review Scoring and Strategies for Meeting Them (numbers in parentheses indicate milestone numbers for primary care)
Each Milestone-Group Class will be held live 3 times:
Quality Improvement Strategies and Action –milestones 14, 15, 16 (19, 20, and 21) (already held- recording available)
Improvement Goals – milestones 1, 2, 3, 13 (1, 2, 3, 18)
Staff Engagement: Teamwork and Joy – milestones 6 and 19 (6 and 24)
Identifying Patient Risk and Using Best Practices – milestones 7, 11 (8, 9, 10, 16)
Streamlining Clinical and Office Work – milestone 22 (27)
Coordinated Care – milestones 8, 9, 10 (11, 12, 13, 14)
Person and Family-Centered Care – milestones 4, 5, 12, 17 (4, 5, 7, 15, 17and 22 for primary care)
Business Strategies – milestones 18, 20, 21 (23, 25, 26)

4. Today’s Objectives
Review scoring for business strategy-related milestones: 18, 20, 21 (specialty) 23, 25, 26 (primary care)
Outline strategies for meeting each of these milestones
Review relevance of milestones’ scores to phases
Provide brief overview of Alternative Payment Models
Open discussion

5. Your Transformation Workplan – Practice Plan Tab

6. Milestone 18 (#23 for primary care): Practice uses sound business practices, including budget management and ROI calculations. A score of 3 is needed to complete Phase 2

7. Strategies for Meeting Milestone 18 (# 23 for primary care)
Change Package –
Consider third party business intelligence tools
Use relations with payers to access claims data
Estimate costs of hospital and emergency department care saved through utilization reductions
Train appropriate staff on interpretation of cost and utilization information
Use available data regularly to analyze opportunities to reduce cost through improved care
Institute a fake appointment into your EHR to track how many ED visits you eliminate with enhanced access
There are several strategies to consider. After reviewing all 3 milestones for today, we’ll share some resources that can assist you meet all 3.

8. Strategies for Meeting Milestone 18 (# 23) - continued
Change Package –
Transparency with the entire team re: total cost of care
Educate staff about factors impact total cost of care
Use state professional association to collaborate with payers (American Academy of Pediatrics, American Academy of Family Practice, etc.)
Partner with the care continuum, especially small federated model
Ask staff to identify opportunities to manage cost to facilitate understanding
Know your visit costs and track and understand different components

9. Resources about ROI ROI: An Overview of Return on Investment
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Return on Investment Templates
calculator-excel-template
Return on Investment
In the simplest terms, ROI (Return on Investment), is a measure of the gain accrued from a specific investment, relative to its cost; it is the value a growth opportunity adds to your business. These website documents can you help better understand what an ROI involves and how to conduct one. The second bullet link actually includes some templates for your considered use.

10. Milestone 20 (#25 for primary care): Practice shares financial data in a transparent manner within the practice and has developed the business capabilities to use business practices and tools to analyze and document the value the organization brings to various types of alternative payment models. A score of 3 is needed to complete Phase 5

11. Strategies for Meeting Milestone 20 (#25 for primary care)
Change Package –
Conduct business fundamentals training as a lunch and learn session
Make sure budget preparation occurs at the level the costs are incurred
Share financial implications of care decisions
Share prices charged for various services
Dedicate a meeting to explaining the practice’s financial statements
From BDO document (shown in next slide):
Financial statements are a collection of reports about the medical practice’s financial results, financial condition and cash flows.
 Three Main Components:
• Balance Sheet: Shows the practice’s assets, liabilities, and equity as of a specific report date.
• Income Statement (P&L): Shows how the net income of the practice is arrived at over a stated reporting period. It includes revenues, expenses, gains, and losses.
• Cash Flow Statement: Shows the inflow and outflow of cash caused by the practice’s financial activities over a stated reporting period. It is the financial statement that shows how changes in balance sheet accounts and income affect cash and breaks the analysis down to operating, investing and financing activities.

12. Milestone #21 (specialty care) and #26 (primary care): Practice considers itself ready for migrating into an alternative-based payment arrangement. A score of 3 is needed to complete Phase 5

13. Strategies for Meeting Milestone 21 (26)
Change package –
Analyze internal costs of care by service and by population characteristics
Use external benchmarks to compare internal cost and revenue metrics, such as cost per visit and revenue per provider full time equivalent
Determine profitability by site and service

14. https://vmgma. memberclicks
The next few slides offer some resources that can assist you with all 3 of these milestones.
This is a straightforward description of the 3 main components of a financial statement: balance statement, income statement and cash flow statement

16. http://www. physicianspractice

17. MIPS Cost Measures – 10% of Total Score (https://qpp. cms
Medicare Spending Per Beneficiary (MSPB)
The Medicare Spending Per Beneficiary (MSPB) measure evaluates solo practitioners and groups on their spending efficiency and is specialty-adjusted to account for their specialty mix. Solo practitioners and groups are identified by their National Provider Identification (NPI) and Taxpayer Identification Number (TIN) combination. Specifically, the MSPB measure assesses the average spend for Medicare services performed by providers/groups per episode of care. Each episode comprises the period immediately prior to, during, and following a patient's hospital stay.
Total Per Capita Costs (TPCC)
The Total Per Capita Costs (TPCC) measure is a payment-standardized, annualized, risk-adjusted, and specialty-adjusted measure that evaluates the overall efficiency of care provided to beneficiaries attributed to solo practitioners and groups, as identified by their Medicare Taxpayer Identification Number (TIN)

19. Alternative Payment Models

22. Advanced APMs

24. CMS APM Framework