Primary Care Alternative Payment Criteria As part of the Department of Health Care Policy & Financing’s (Department) efforts to shift providers from volume to value, the Department is developing a structure to make differential fee-for-service payments to give providers greater flexibility, reward performance while maintaining transparency and accountability, and create alignment across the delivery system. Under the proposed model, providers can earn higher reimbursement (when designated as meeting specific criteria) as they implement and achieve more advanced criteria. Movement along this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals. In developing the proposed framework, the Department cross-referenced with Departmental initiatives, such as the Comprehensive Primary Care Initiative (CPCi), Comprehensive Primary Care Plus (CPC+), Enhanced Primary Care Medical Provider (EPCMP) incentive program, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and State Innovation Model (SIM), as well as with National Committee for Quality Assurance (NCQA) standards for Medical Homes (PCMHs). Please note this is a proposed framework intended for discussion. Also note that additional work is being done to align with CPC+ Track 2 – the framework described does not apply to that methodology. Primary Care Alternative Payment Framework Payment Category Outcomes/ Care Delivery Areas of Domain Level I Level II Level III Impact 1. 24 hour phone 1. Provider 1. Asynchronous 1. Well child access Empanelment communication care 2. Primary care (75%) 2. Provider 2. Depression Access to and focus 2. Accept new Empanelment screening Continuity of 3. Extended hours patients (95%) 3. ER utilization Care 4. Same day appts 3. 24 hour EHR 4. Other access preventive screenings 1. Preventive health 1. Shared care 1. 1. Appropriate screening plan: patient asthma 2. Medication 2. E-prescribing goals medications management 2. HbA1c testing Care 3. Release of 3. Well child Management previous records care 4. Depression screening 5. SUD screening Population Population Stratification: Management Methods
Primary Care Alternative Payment Criteria As part of the Department of Health Care Policy & Financing’s (Department) efforts to shift providers from volume to value, the Department is developing a structure to make differential fee-for-service payments to give providers greater flexibility, reward performance while maintaining transparency and accountability, and create alignment across the delivery system. Under the proposed model, providers can earn higher reimbursement (when designated as meeting specific criteria) as they implement and achieve more advanced criteria. Movement along this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals. In developing the proposed framework, the Department cross-referenced with Departmental initiatives, such as the Comprehensive Primary Care Initiative (CPCi), Comprehensive Primary Care Plus (CPC+), Enhanced Primary Care Medical Provider (EPCMP) incentive program, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and State Innovation Model (SIM), as well as with National Committee for Quality Assurance (NCQA) standards for Medical Homes (PCMHs). Please note this is a proposed framework intended for discussion. Also note that additional work is being done to align with CPC+ Track 2 – the framework described does not apply to that methodology. Primary Care Alternative Payment Framework Care Delivery Domain Payment Category Outcomes/ Areas of Impact Level I Level II Level III Access to and Continuity of Care 1. 24 hour phone access 2. Primary care focus 3. Extended hours 4. Same day appts 1. Provider Empanelment (75%) 2. Accept new patients 3. 24 hour EHR access 1. Asynchronous communication 2. Provider Empanelment (95%) 1. Well child care 2. Depression screening 3. ER utilization 4. Other preventive screenings Care Management 1. Preventive health screening 2. Medication management 3. Release of previous records 1. Shared care plan: patient 2. E-prescribing 1. goals 1. Appropriate asthma medications 2. HbA1c testing 3. Well child care 4. Depression screening 5. SUD screening Population Management Population Stratification: Methods
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