A comprehensive look at The Southern New England Practice Transformation Network (SNE-PTN), which supports implementation of person-centered, high quality, efficient, and coordinated care. SNE-PTN is funded under the Centers for Medicare & Medicaid Services’ Transforming Clinical Practices Initiative.
SNE-PTN is a complex, large-scale care transformation effort that requires a multi-faceted approach and alignment with state and national health care reform efforts. It is important to articulate the value proposition for clinicians

Konar, Valerie

Morris, Anita

Perro, Frederick (Rick)

Polakoff, David

Senesac, Pam

Steinberg, Judith

English

eScholarship@UMMS

University of Massachusetts Medical School eScholarship@UMMS Commonwealth Medicine Publications Commonwealth Medicine 2016-06-25 Paving the Way for Practice Success Under Value-Based Payments Judith Steinberg University of Massachusetts Medical School Et al. Let us know how access to this document benefits you. Follow this and additional works at: https://escholarship.umassmed.edu/commed_pubs  Part of the Health Economics Commons, Health Law and Policy Commons, Health Policy Commons, Health Services Administration Commons, and the Health Services Research Commons Repository Citation Steinberg J, Morris A, Konar V, Perro F, Senesac P, Polakoff D. (2016). Paving the Way for Practice Success Under Value-Based Payments. Commonwealth Medicine Publications. https://doi.org/10.13028/hdjj-gq06. Retrieved from https://escholarship.umassmed.edu/commed_pubs/168 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Commonwealth Medicine Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu.  RESEARCH OBJECTIVES • The Centers for Medicare & Medicaid Services (CMS) launched the Transforming Clinical Practices Initiative (TCPI) in September 2015 to engage 140,000 clinicians nationwide to support implementation of person-centered, high quality, efficient, and coordinated care, readying clinicians to be successful in value-based payment contracting.• The Southern New England Practice Transformation Network (PTN), funded under the TCPI, serves Massachusetts (MA) and Connecticut (CT) primary and specialty clinicians to achieve this aim, providing on-site quality improvement advisors for technical assistance, shared learning, transformation resource tools, access to subject matter experts, QI and change management support in optimizing performance on quality and efficiency measures.LESSONS LEARNEDThe Southern New England PTN is a complex, large-scale care transformation effort that requires: • A multi-faceted approach and alignment with state and national health care reform efforts • A focused attention to working collaboratively across multiple provider networks, independent practices and other stakeholders• Articulation of the value proposition for clinicians that captures the “What’s in it for me?”IMPLICATIONS FOR POLICY AND PRACTICE• Lessons learned will inform the further implementation of TCPI and other health care reform initiatives.DISCLOSURES & ACKNOWLEDGMENTSThe authors have no financial disclosures. Contact: Judith Steinberg, MD, MPH., Email: Judith.Steinberg@umassmed.eduSOUTHERN NEW ENGLAND PRACTICE TRANSFORMATION NETWORK OVERVIEWSOUTHERN NEW ENGLAND PTN IMPLEMENTATION STRATEGYCMS TCPI FUNDS• 29 Practice Transformation Networks (PTNs) – State and regional hubs for Technical Assistance, shared learning, practical resources for practice transformation  • 10 Support and Alignment Networks (SANs) – National Associations that support recruitment of clinicians in PTNs – Spread and institutionalize PTN learnings – Offer additional benefits to member-participants  (APA, ACP, ACEP, AMA)• National faculty and shared learning• Website as a communication hub• Data aggregation and reporting • Likely a national evaluatorVISION• Create a community of learning utilizing cross-functional teams to share best practices, align efforts and resources• Innovate and address the need to bring back the  joy in practicing medicine• Foster continuous quality improvement  for patients, families and providers• Create cost savings through efficiencies  of scale to prepare for alternative  payment models • Facilitate data-driven improvement  in clinical care, patient experience and  operational efficiency• Improve communication and  coordination in the healthcare  neighborhoodPERFORMANCE MEASURES• Diabetes: HbA1c>9%; BP <140/90mmHg• Heart Failure: Advanced care plan• Readmission rate following heart failure hospitalization • Appropriate use of medications for asthma• Use of imaging studies for lower back pain• Use of high-risk medications in the elderly• Fall risk screening • Depression screening• Hospital-wide all-cause unplanned readmission measure• Prevention quality indicator compositeVALUE PROPOSITIONACTIVITY STREAMS• Recruitment and Engagement – Collaborating with clinical partners to recruit clinician practices and build strategic partnerships• Transformation Support Intervention – Serving as a champion for continuous improvement, culture change, and person and family engagement  – Providing resources that can facilitate improved clinical practice operations• Data and Measurement – Tracking and collecting quality measures and data for improved decision-making and resource allocationCREATING SYNERGIES, AVOIDING DUPLICATION• Creating a vision of statewide goals and strategic deployment  of funds to achieve goals• Discussions re: leveraging Technical Assistance resources to complement, not duplicate• Discussions on joint approach to engaging payers• New payment models• Alignment of performance measuresCenter for Health Policy and Research333 South Street, Shrewsbury, MA 01545508.856.6222  l  800.842.9375http://commed.umassmed.eduPaving the Way for Practice Success Under Value-based Payments:  Implementing the Southern New England Practice Transformation Network Judith L. Steinberg, MD, MPH Anita J. Morris, FNPBC Valerie Konar, MEd, MBA Frederick (Rick) Perro, MBA, MS Pamela Senesac, PhD, SM, RN David  Polakoff, MD, MSc© 2016 University of Massachusetts Medical SchoolPARTNERS AND COLLABORATORS1. Transform PracticeSupport more than 140,000 clinicians  in work practice transformation6. Value BasedMove clinicians through the TCPI phases to participate in incentive programs & practice models  the reward value3. Reduce UtilizationReduce unnecessary hospitalizations &  over utilization of  other services for 5M Medicare, Medicaid &  CHIP beneficiaries2. High PerformanceImprove health outcomes for 5M Medicare, Medicaid & CHIP beneficiaries5. Savings$1 - $4B in savings to the federal government over 4 years through reduced Medicare, Medicaid & CHIP expenditures4. ScaleBuild the evidence base on practice transformation so that effective solutions can be scaled, if successfulLogic FlowTCPI MODEL AIMSCliniciansBeneficiariesSystem ImpactDiscipline # of CliniciansPrimary Care 167Medical Specialties 150Surgical Specialties 91Psychiatry 52Pediatrics Specialties 41OB GYN 37Dental Medicine 27Top Disciplines by Number of CliniciansTRANSFORMATION SUPPORTQuality Improvement Advisor Assigned Practice  Readiness AssessmentPractice TransformationClinician Recruitment SNE-PTN Clinicians will:Create and coordinate local medical neighborhoodsImplement and sustain  practice transformationReduce unnecessary hospitalizationsImprove clinical  and operational measuresAchieve financial successPractice Transformation  Plan DevelopmentTransformation Toolbox:Implementation■■ Technical assistance■■ Faculty experts■■ Useful resources■■ Sharing best practices■■ Data optimization■■ Patient engagementStrengthen Connections to Community PartnersImprove coordination  across primary and  specialty care, hospitals, behavioral health and  community-based providersSucceed in  Value-Based PaymentOptimize current revenuePrepare for alternative  payment modelsOptimize Use of Health Info TechnologyCalculate and report clinical quality measuresGive clinicians actionable care gap informationFree Technical AssistanceQuality Improvement AdvisorsFaculty ExpertsProfessional Resources –  CMEs, etc.RECRUITED CLINICIANS 1105Primary Care 167Specialty 978CHALLENGES AND OPPORTUNITIESCHALLENGES OPPORTUNITIESHigh penetration of  Medicare ACOsTarget for recruitment: Network practices that remain outside of the ACO; other specialists not in ACOs — dentists, behavioralists, physical therapists, etc.TCPI does not include new payments to practices Hone the value proposition: MACRA coming soon; optimize revenues nowClinicians overwhelmed with  health care reform initiatives — can’t do one moreFocus on how TCPI can help practices achieve THEIR strategic goalsFunding levels require more  virtual transformation support Establish a trusting relationship with a QI Advisor at the outsetClinicians wary of change Value proposition: Change is coming anyway; be readyMultiple specialties require  multiple change packagesFocus on cross cutting issues: Coordination, communication, patient centeredness, performance optimizationCLINICIANS BY STATEMA 588CT 527PROGRESS TO DATECLINICIAN RECRUITMENT• CMS Change Package• Training of Quality Improvement Advisors• Practice orientation process• Practice assessment tool• Framework for Transformation Support • Data portal and manualTRANSFORMATION SUPPORT AND DATAUniversity of Massachusetts Medical School Practice Transformation Network LeadUniversity of Connecticut School of Medicine  Sub AwardeeClinical PartnersBaycare Health PartnersUMass Memorial  Health CareUConn Health CenterVA BostonCommunity Health CentersIT PartnersSMC PartnerseHealth ConnecticutMassachusetts eHealth  InstituteQIOsHealthcentric AdvisorsQualidigmIntervention PartnersMA Health Policy CommissionQualis HealthMA League of Community  Health CentersCenter for Primary Care/Harvard Medical SchoolStakeholders & CollaboratorsMA & CT Medicaid,  SIMMA & CT Depts of  Public HealthMassAHEC &  CT AHECSTUDY DESIGNA descriptive analysis of the Southern New England PTN implementation strategy and participating cliniciansPOPULATION STUDIEDClinicians and their practices enrolled  in the Southern New England PTN

Paving the Way for Practice Success Under Value-Based Payments

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Paving the Way for Practice Success Under Value-Based Payments

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