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MACRA Briefing:

What to Know; What to Do

Marion-Polk County Medical Society

January 12, 2017

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• Post Election Implications

• MACRA Overview

• CPC+ Program Review

• Conclusion

• Q & A

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Coni Westmoreland, MHA, MSPH Business Development & Programs Manager, Salem Health Medical Group

Coni.westmoreland@salemhealth.org

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On 3/26, the House passed H.R. 2 by 392-37 vote.

On 4/14, the Senate passed the House bill by a vote of 92-8, and the

President signed the bill.

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• MACRA exists separately from the ACA

• Unlikely to repeal MACRA due to bipartisan majority votes

• New HHS Secretary: what decisions will be made with

MACRA regulations? With CMMI?

• Repeal & Replace of ACA • Full repeal unlikely (Requires 60 Senate votes; Republicans

hold 52 seats)

• Budget reconciliation can be used to repeal parts of the

ACA with budget implications

• If repeal passes in January 2017, provisions won’t become

effective for two to three years.

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6

• Post Election Implications

• MACRA Overview

• CPC+ Program Review

• Conclusion

• Q & A

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• Final rule released on October 14, 2016

• “Pick your pace” for 2017 implementation

• Mandates CMS payment reform to value based contracts

• Consolidates current quality metric reporting

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Performance Year

Payment Year

Merit-Based Incentive

Payment System (MIPS)*

Advanced Alternative Payment Models

(APMs)

2017 2019 +/- 4% +5%

2018 2020 +/- 5% +5%

2019 2021 +/- 7% +5%

2020 2022 +/- 9%

(and beyond) +5%

(to 2024)

*Additional bonus for exceptional performers; scaling factor applies if funds

are sufficient.

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• First year billing to Medicare Part B

• Low volume threshold:

• >$30,000 in Medicare Part B charges

• Provide care for 100 or fewer Medicare Part B patients

per year

• Participation in a qualifying Advanced Alternative Payment

Model

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Advanced Alternative Payment Models

Medicare Shared Savings Program Track Two

Medicare Shared Savings Program Track Three

Next Gen ACO

Comprehensive Primary Care Plus (CPC+)

Comprehensive ESRD Care (Large Dialysis Organization

[LDO] Arrangement)

Comprehensive ESRD Care (non-LDO arrangement)

Oncology Care Model (two sided risk arrangement)

• New models being announced by CMS for 2018

• CMS re-opening CPC+ and Next Gen ACO in 2018

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• Post Election Implications

• MACRA Overview

• CPC+ Program Review

• Conclusion

• Q & A

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CPC+ and Primary Care Value Based

Payment Reform in Oregon

Presentation to the Marion – Polk County Medical Society

January 12, 2017

Dr. Jim Rickards, MD, MBA - Chief Medical Officer, Oregon Health Authority

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Overview

• OHA Coordinated Care Model - CCOs

• OHA Patient Centered Primary Care Home Program

• CMS CPCI Program

• SB231 Oregon Legislation

• CMS CPC+ Program

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OHA Coordinated Care Model – CCO’s

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OHA Patient Centered Primary Care

Home (PCPCH) Program

• 647 Clinics

• ~$240M savings first 3 years

• 4.2% reduction PP spending

• 13:1 ROI

• Existing FFS Payment Models Challenges

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CMS CPCI Program

• National CMS Comprehensive Primary Care Initiative (CPCI)

• 4 Years – ended in 2015

• 7 Regions

• 65 Oregon Clinics

• Monthly Care Management Fee + Shared Savings

• Oregon $12.8 million in Medicare Cost Savings

• Shared savings payments totaling $1 million (2015)

SB 231 Report: Primary Care Spending

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SB 231 Collaborative: Payment Reform

• “Direct greater health care resources and investments

toward supporting and facilitating health care innovation

and care improvement in primary care”

• Multi-stakeholder & Multi-payer facilitated meetings

• Monthly meetings: April to November 2016

• Membership defined in legislation, other experts added

• Supported Oregon CPC+ participation

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Comprehensive Primary Care Plus (CPC+)

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Comprehensive Primary Care Plus (CPC+)

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Comprehensive Primary Care Plus (CPC+)

• CMS national model to strengthen primary care

• Advanced Alternative Payment Model under MACRA

• CPCI program continuation & expansion

• Regional multi-payer payment reform & care transformation

• Oregon is one of 14 CPC+ regions

• Five years: 2017 to 2021

• 159 Oregon practices

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Oregon CPC+ Payers

Commercial Payers

•ATRIO Health Plans, Inc.

•CareOregon

•Moda Health Plan, Inc.

•Providence Health Plan and Providence

Health Assurance

•Tuality Health Alliance

•OHA (Fee-for-Service Medicaid)

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Coordinated Care Organizations

•AllCare Health, Inc.

•Columbia Pacific Coordinated Care Organization

•Eastern Oregon Coordinated Care Organization,

•FamilyCare Health

•HealthShare of Oregon (not a CPC+ payer, but

represented by other participating HealthShare of

Oregon payer partners)

•Jackson Care Connect

•PacificSource Central Oregon

•PacificSource Gorge

•PrimaryHealth of Josephine County

•Umpqua Health Alliance

•Western Oregon Advanced Health

•Willamette Valley Community Health

Organization

•Yamhill Community Care Organization

CPC+: Advancing Care Delivery and

Payment

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• Focus on efficient, high

quality care

• High-value utilization

• Population-based care

delivery

• Engaged patients,

caregivers, and families

• Multi-payer support

• Coordination across the

medical neighborhood and

community services

• Focus on volume

• High-cost services

• In-person encounters

• Fragmented care

• Provider burnout

• Payer segregation

• Little attention to social

determinants of health

Practice Transformation

Payment Redesign

Fee-for-Service

Primary Care

Comprehensive

Primary Care Actionable milestones to deliver high quality,

whole-person, patient-centered care

Effective use of health information

technology (HIT) and data analytics

Practice learning networks

Non-visit based care management fees

Regional shared savings opportunity

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Thank You !

Jim Rickards, MD, MBA

OHA Chief Medical Officer

james.s.rickards@dhsoha.state.or.us

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• Post Election Implications

• MACRA Overview

• CPC+ Program Review

• Conclusion

• Q & A

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• Are you eligible for exclusion?

• Select Track 1 or Track 2 pathway

• Get started. 2017 is measurement year 1.

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• Final Ruling:

https://www.congress.gov/114/plaws/publ10/PLAW-

114publ10.pdf

• CMS Overview: https://www.cms.gov/Medicare/Quality-

Initiatives-Patient-Assessment-Instruments/Value-Based-

Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-

APMs.html

• Timeline: https://www.cms.gov/Medicare/Quality-Initiatives-

Patient-Assessment-Instruments/Value-Based-

Programs/MACRA-MIPS-and-APMs/Timeline.PDF

• FAQs: https://innovation.cms.gov/Files/x/macra-faq.pdf

• Past Webinars: https://www.cms.gov/Medicare/Quality-

Initiatives-Patient-Assessment-Instruments/Value-Based-

Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-

Events.html

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• Post Election Implications

• MACRA Overview

• CPC+ Program Review

• Conclusion

• Q & A

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Moderator: Dr. Michael Rohwer, MD

Executive Director, Curandi

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Dean Andretta, CFO, WVP Health Authority

Merrin Permut, MHA, Executive Director Legacy Health Partners and Director of Care Transformation for Legacy Health

Bahaa Wanly, MHA, Chief Operating Officer and Vice President of Salem Health Medical Group

Jim Rickards, MD, MBA, OHA Chief Medical Officer

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