INITIATING AND MAINTAINING A VALUE-BASED CARE

MODEL

Raul Vazquez, M.D. C.E.O.

1
Agenda
1. Planning Phase
2. Program Overview
3. Information Sharing
4. Informatics Integration
5. Engaging Providers

2
Accountable Care Atlas

3
4
Pre-Contract
1. Commit to pursue value-based care 5. Assess financial requirements
2. Set objectives at the board level 6. Gain access to needed capital
7. Identify and engage provider network
3. Design governance structure
9. Create legal structure for financial collaboration
4. Identify value-oriented leaders
10. Secure value-based contracts
5. Ensure multi-stakeholder input

5
Phase 1
11. Educate providers and staff
12. Build systems to track financial
performance
13. Assess current IT strategy
14. Establish quality and leadership teams
15. Align incentives with value-based
objectives
16. Identify gaps
17. Assess the needs of the covered
population
18. Organize internal data assets

6
Phase 2
19. Ensure access to care
20. Develop patient risk assessment strategy
21. Aggregate external data assets
22. Identify individual patient needs
23. Develop platforms to house and analyze
data
24. Design systems to address patient needs
25. Enable data sharing and access by care
team
26. Establish and maintain use of care guidelines
27. Design care teams
28. Establish care team protocols
29. Provide care team with data access and
support
30. Implement shared care-planning and decision
making
31. Conduct ongoing patient outreach
7
Phase 3
32. Report system and provider performance
33. Monitor performance of value-based contracts
34. Monitor and report care delivery effectiveness
35. Enable reporting and feedback

8
Value-Based Pilot
1. COMMIT TO PURSUE VALUE-BASED CARE

9
Eligible Value-Based Payment Programs

Quality Cost & Quality

only
Level 0 Level 1 VBP Level 2 VBP Level 3 VBP
(only feasible after
VBP* experience with Level
2; requires mature
PPS)
FFS with FFS with upside- FFS with risk Prospective
bonus and/or only shared sharing (upside capitation PMPM
withhold savings available available when or Bundle (with
based on when outcome outcome scores outcome-based
quality scores scores are are sufficient) component)
sufficient
(For PCMH, FFS may
be complemented
with PMPM subsidy)

10
Project Goals

1. 2. 3.
Control Cost to Obtain 12 or
Maximize Risk
Generate More Quality
Stratification
Savings Metrics

11
Potential Shared Savings Pool
The ACO will be given an annual global budget for total cost of care
◦ It is a fixed percentage of the insurance premium
◦ [medical loss ratio X number of enrolled patients]

◦ The Global budget – total dollars spent = potential shared savings pool
◦ The actual savings pool will be modified by the number of quality
metrics targets met

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Evidence Based Metrics (EBMs)

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 Higher the Quality (EBMs),
Higher the Shared Savings
MEASURES MET % SHARED SAVINGS
12-15 100%
10-11 75%
8-9 50%
6-7 25%
<6 0%
 Greater Buffalo Accountable Care Organization Inc.
5

Pilot Adjustments – Year 1

PMPY Annual Total
# of
Performan Stimulus
VBP Contractor Plan Arrangement Member Target Budget Adjusted P4R Total
Target ce Adjustme Adjustme Adjustmen
s (Baseline)
Budget Adjustme nt nt t
nt
Total Care for General
Greater Buffalo YourCare Population 7,836 $3,990.15 $4,129.81 $938,005 $0 $156,334 $1,094,339

Pilot Adjustments – Year 2

PMPY Annual Total
# of
Performan Stimulus
VBP Contractor Plan Arrangement Membe Target Budget Adjusted P4R Total
Target ce Adjustme Adjustme Adjustmen
rs (Baseline)
Budget Adjustme nt nt t
nt
Total Care for General
Greater Buffalo YourCare Population 7,836 $3,990.15 $4,149.76 $938,005 $156,334 $156,334 $1,250,673
PILOT PERFORMANCE ADD-ONS

• To be delivered on a PMPM add on entirely to GBUACO

• Based on overall metrics
• To be initiated for the first six months assuming metrics are being met
• Subject to true up bi-annually

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STATE STIMULUS TO YOURCARE FOR THE PILOT

• Should be used to support an integral part of the operation

• Provide operational resources to the pilot
• Active assistance in member retention
• Legal, actuarial analysis
• Member support
• Outreach and satisfactions
• Problem Solving
• Quality Oversight

• YourCare commitment to this process of half of the stimulus package received by the State

17
Value Based Contracting- Taking Risk
• Year One: Target MLR 89% including 75% of the overall DOH adjustments for
patient risk, performance achievement and reporting requirements
• Adjustment used to provide for a $5 PMPM to the Primary Care MDs in support of
comprehensive care management.
• 50% of any Surplus but no Downside risk
• Predicated on Attainment of Quality Metric Score
• Care Management Fee at $275,000

• Year Two: Same MLR target and 100% of the DOH Adjustment
• $5PMPM in maintained
• 60% of the Savings but 20% of any Deficit capped at $500K.
• Predicated on Attainment of Quality Metric Score
• Care Management Fee at $275,000

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19
20
21
Information Sharing
11. EDUCATE PROVIDERS AND STAFF

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Quality Meeting
✓Directors, Management and Clinical Leads

✓ Practice Specific
▪Clinical Champion
▪Physician
▪Administrative Champion
▪Office manager
▪Key Team Members
▪Nurse
▪Senior Medical Assistant

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Informatics Integration
19. DEVELOP PLATFORMS TO HOUSE AND ANALYZE DATA
20. DESIGN SYSTEMS TO ADDRESS PATIENT NEEDS
21. ENABLE DATA SHARING AND ACCESS BY CARE TEAM

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Version 1.0
MEDENT (EHR)
Clinical Dashboards
▪ Fast access to data on daily scheduled patients
▪ Provider comparisons
▪ Monthly and yearly trending
Analytics Support

Qualmetri
Tableau Clinigence
Provides baseline data, quick EMR supplement. Monitor and
x
access for daily use Strategic planning
update EBM gaps in care

28
Tableau
Each
Organization
will receive
a specific
platform

Limited
Robust Metric
Financials
Tracking

29
Version 2.0 – Tableau
Clinigence
EMR
Data

Claims
Data HIE

Robust
Metrics
Tracking

31
Version 3.0 Clinigence
Engaging Providers
32. REPORT SYSTEM AND PROVIDER PERFORMANCE

33
Version 4.0 QMX
Cost Utilization
Provider Quality
Report
Provider Quality
Report
Provider Quality
Report
Specialist
Radiology
Evidence Based Metrics

42
26. Establish and maintain use of care guidelines
Facility Inpatient
Additional PCP Monitoring utilizing Tableau and Qualmetrix. Health Home enrollment

Facility Outpatient
Additional PCP Monitoring utilizing Tableau and Qualmetrix. Health Home enrollment

Professional Cost
One of the lower cost, initially cost may increase due to greater PCP interaction

Prescription
Start with the 6 recommended changes – change and schedule follow up as necessary , Utilize
EMR notification, Additional utilization review based on tableau and Qualmetrix

Ancillary
Highest Cost is home care, educate providers and patients on the impact of over utilization

43
 Strategy

Identify High Cost Patients Health Home Integration Follow-up PCP Visits

44
Pharmacy
Review
Meeting between MCO and
ACO clinical team to decide
on the best prescribing
practices

45
31. Conduct ongoing patient outreach
1. Offer patient incentive (if available)
2. Set a goal - Assign specific team member and incentivize
Low Performance
3. Partnership
4. Mailing
5. Automated calling
6. Perform test in office

1. Set a goal - Assign specific team member

Moderate Performance
2. Partnership
3. Automated calling
4. Perform test in office

1. Set a goal - Assign specific team member

Meet or Exceed Threshold
2. Monitor tableau

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Risk Score Optimization
6. GAIN ACCESS TO NEEDED CAPITAL

47
Risk Score Optimization
▪Evaluate ICD 10 Coding
▪Rehabilitate clinician ICD 10
skills
▪Leverage EHR default features
▪Implement best practices

48
Raul Vazquez, M.D. C.E.O.
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MVP Health Care and Support of
Primary Care Transformation
Engaging providers to revamp care delivery

March 21, 2018

Cupid Gascon, MD
Vice President, Clinical Transformation
©2017 MVP Health Care, Inc.
©2018
 Practice transformation is a journey that requires true
partnerships with aligning incentives
MVP is working to evolve the relationships between payers and
providers. MVP supports transformation through:
• Providing accurate patient attribution
• Offering data and analysis to support Quality Improvement
• Making available transparent financial data
• Data distribution and exchange
• Collaborating with providers on Care Management activities
• Engagement with provider and community partners

“Great things are done by a series of small things brought

together.“ – Vincent Van Gogh

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Transformation
“It is not the strongest of the species that survives, nor the most
intelligent, but the one most responsive to change.” – Charles Darwin

©2017 MVP Health Care, Inc.

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Primary Care Transformation is the frontier of the changing healthcare
environment
Primary care practice transformation and delivery are essential to achieving the Quadruple Aim

Improve Patient
Experience

Improve
Decrease
Provider
Cost
Experience

Health of the
Population

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 MVP interfaces with Primary Care providers across multiple
functional units in order to support transformation

Population Health
Management
Specialists (PHMS)

Retail Outreach

Quality Leads

Value Based
Arrangements

Provider
Relations

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 Value based care contracts are not transformative, but
rather provide a conduit to transforming care delivery

• MVP has a significant history of supporting value based programs

• Supported early forays into PCMH
• One of seven pilot regions for CPCi/CPC+ national program

• Types of Value based arrangements across current network

• Quality incentive
• Shared savings
• Shared risk
• Capitated primary care

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Attribution
“Accountability breeds response-ability.”
- Stephen R. Covey

©2017 MVP Health Care, Inc.

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 Attribution supports transformation by allowing the
provider to understand their patient panel

• Power in knowing the patients who comprise your panel

– Risk identification
– Population health management
• Reviewing member rosters offer an opportunity to empanel:
– HMO members without a recent visit
– EPO/PPO members who are non-utilizers/low utilizers

MVP provides monthly rosters to all VBP partners as well as

other large primary care practices

©2017 MVP Health Care, Inc.

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Quality Improvement
"Quality is not an act, it is a habit.“ - Aristotle

©2017 MVP Health Care, Inc.

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 A focus on Quality Improvement shifts the
conversation from “how am I doing” to “how can I
do better?”
MVP provides reports and in-person support to review Quality
Metrics and construct paths for improvement
• Gaps in Care Reports
– All patients with at least one gap
– All product lines
• Quality Leads/PHMS office visits
– Quality Metric tip sheets
– Share best-practice
• MVP Utilization reports
– Inpatient/ER reports
– Standard Reporting Packing

©2017 MVP Health Care, Inc.

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Finance
“Knowledge is a weapon. I intend to be formidably armed.”
― Terry Goodkind

©2017 MVP Health Care, Inc.

©2018 61
 Financial data provides guardrails in ensuring
appropriate utilization of services and efficient care

Providers engaged with MVP in a value-based agreement receive

quarterly financial reports
• Over 50 sub-categories offer insight into utilization and inform
clinical decisions
• High-cost patient report

Pharmacy initiative to provide clinically equivalent low-cost drug

alternatives

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Data Distribution and Exchange
“Data, I think, is one of the most powerful mechanisms for telling stories. I
take a huge pile of data and I try to get it to tell stories.” – Steven Levitt,

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 Actionable and timely data allows for practices to be
informed and agile
• Transparently sharing data with providers offers insight on
performance and opportunities for correction or improvement
• MVP recognizes that practices have various capabilities to receive
and analyze data
– Advanced providers/systems receive raw data
– Emerging practices receive analyzed data as they do not have
the IT resources
• Reports are regularly distributed with in-person follow up

Linking Clinical and Financial Data is the Key to Real Quality and
Cost Outcomes

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 Actionable and timely data allows for practices to be
informed and agile

Monthly claims extracts Monthly eligibility extracts

Member rosters Care Management

Coordination data
Utilization Reports
Gaps-in-Care
Standard Reporting
Package

Patient Risk Detail

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Care Management
“Unity is strength ... when there is teamwork and collaboration, wonderful
things can be achieved.”
- Mattie Stepanek

©2017 MVP Health Care, Inc.

©2018 66
 Care Management functions are vital in transforming
practices

MVP provides direct-to-patient Care Management

• Acute care
• Chronic care
• Transitions of care

MVP supports providers by providing data

• Population health
• High-cost/utilizers
• Risk Identification and stratification
• Resource utilization
• Pharmacy risk factors

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 Care Management functions are vital in transforming
practices

MVP recognizes that collaboration with practices result in the

greatest impact
MVP has developed module to support practices in highly effective
care management processes
• Reduce redundancy
• Share best practices
• Exchange data to improve coordination

Additionally, MVP provides financial support to practices in order

to fund care management services

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Engagement
"Coming together is a beginning, staying together is progress, and
working together is success." – Henry Ford

©2017 MVP Health Care, Inc.

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 MVP seeks to engage with providers to enable transformation

PHMS

Contract
Management

Retail
Provider Reps
Outreach

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 Aligning with the provider improves provider
experience and benefits the patient

MVP meets with provider partners on a regular basis

• Population Health Management Specialist
• Provider Reps
– Policy interpretation
– Remedy claims issues
• Governance meetings with providers in VBP
– Cross-functional teams provide insight and align incentives
• Retail outreach
– MVP employee located in office
• Prevent lapses in insurance
• Pre-visit planning

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 Provider Relations representatives collaborate with
practices and provide Focus Visits and Dashboard
Reports
Schedule a Provider Focus Visit
Detailed review of the MVP Provider
Portal
Policies and procedures
Provider Dashboard Report

What is the Provider Dashboard Report?

Comprehensive view of claims
submissions, rejections, denials and
interactions with MVP provider call center

Enables open communication and

collaboration

Ability to identify and address areas of

concern

Improve efficiency, reduce costs,

improve provider satisfaction
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 Population Health Management Specialists (PHMS)

Proactively Address Risks

Collaborative Relationships
with Providers

Improve Quality and Reduce

Costs

Support Transition to Value

Based Care

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Collaboration with Performing Provider
Systems
“Alone we can do so little; together we can do so much.” – Helen Keller

©2017 MVP Health Care, Inc.

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 MVP has engaged with PPS partners across New
York State

MVP is working with PPSs to:

– Deploy provider education modules on topics such as:
• Value Based Payment
• Quality Improvement
• Risk Stratification of patients
• Coding and Risk Adjustment
– CBO Collaboration
– Collaboration on DSRIP performance metrics

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DSRIP Project and MVP Initiative Alignment Work Group: Long Term
Engagement Strategy
DSRIP Project and Initiative Alignment Work Group

MVP and PPS staff in this work group are responsible for identifying opportunities for
aligning PPS-selected DSRIP projects and MVP’s initiatives to create synergy and mutual
support.

One of the most impactful

areas for alignment is:

3.a.i Integration of
Primary Care and
Behavioral Health Services

All of the PPSs in MVP

service areas selected this
project

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 Identified MVP Initiatives Aligning with PPS-Selected
DSRIP Projects
Behavioral Health Case
Management

Back Care Program

Asthma Action Plan

Little Foot Prints Program

MVP Heart Failure Program

Diabetes Care Program

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Thank you!
Contact: Cupid Gascon, MD
cgascon@MVPHealthcare.com

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