Cross Walk: OHIC Patient Centered Medical Home Expectations for Care Transformation

8/19/16 Cross Walk: OHIC Patient Centered Medical Home Expectations for Care Transformation Collaborative Inc. (CTC-RI) Practices

The RI Office of the Health Insurance Commissioner (OHIC) primary care practice transformation initiative aims to strengthen primary care and financially assist practices with their PCMH operations. OHIC has recently provided primary care practices with a Frequently Asked Questions (FAQ) document to assist primary care practices with understanding the expectations and details associated with the OHIC primary care practice transformation initiative (http://www.ohic.ri.gov/documents/2016-Final-Signed-PCMH-FAQ-07112016.pdf . Requirements vary based on the evolution of the OHIC program, and the primary care practice experience. CTC-RI has outlined below the expectations for primary care practices that are participating in the CTC-RI program. For OHIC payment, practices must meet Rhode Island’s definition of PCMH; Cost Management Strategies Self-Assessment can be submitted to OHIC website: http://www.ohic.ri.gov/ohic-reformandpolicy-pcmhinfo.php CTC Practice Cost Management Strategy Survey CTC/OHIC Sustainability Payment First submission Performance Improvement Measure First Notes Developmental Completion Requirements timing linked to bridge submission Contract Stage and/or OHIC linked to as of 7/1/2016 sustainability performance/ funding baseline Advanced Practices must complete the Cost CTC contract payment and  10/15/16 Practices must submit to OHIC via the  10/1 10/15/16 submission Collaborative Management Strategies Self MAPCP ends 12/31/16; OHIC OHIC website the quality 5/16 used for baseline and -Assessment on the OHIC website Eligibility for OHIC sustainability Sustainability performance measures annually performance evaluation. annually. payment starts 1/1/17 based on 10/15 for Q3 performance (based on 80% completion of previous year of data (e.g. requirements in 10/15/16 10/1/2015-9/30/2016) survey. Finished PY 2 Practices must complete the Cost CTC contract payment and  10/15/16 Practices must submit to OHIC via the  10/1 10/15/16 submission 6/30/2016, CTC Management Strategies Self MAPCP ends 12/31/16; OHIC OHIC website the quality 5/16 used for baseline and contract ended -Assessment on the OHIC website Eligibility for OHIC sustainability Sustainability performance measures annually performance evaluation. annually starting 10/15/16. payment starts 1/1/17 based on 10/15 for Q3 performance (based on 80% completion of previous year of data (e.g. requirements in 10/15/16 10/1/2015-9/30/2016) survey. One time only bridge payment per health plan (7/1/16-12/31/16) PY 2 Practices must complete the Cost CTC guaranteed funding through  10/15/16 Practices must submit to OHIC via the  10/1 10/15/16 submission CTC contract Management Strategies Self 6/30/2017 regardless of OHIC OHIC website the quality 5/16 used for baseline and ends 6/30/17 -Assessment on the OHIC website 10/15/2016 submission. OHIC Sustainability performance measures annually performance evaluation. annually starting 10/15/16. sustainability funding 7/1/2017- funding 7/1/1 10/15 for Q3 performance (based on 12/31/2017 if 80% of  10/1/17 previous year of data (e.g. requirements are met by OHIC 10/1/2015-9/30/2016) 10/15/2016.. Sustainability 8/19/16

CTC Cost Management Strategy Survey CTC/OHIC Sustainability Payment First submission Performance Improvement Measure First Notes Developmental Completion Requirements timing linked to bridge submission Contract Stage and/or OHIC linked to as of 7/1/16 sustainability performance funding baseline PY 1 Practices must complete the Cost CTC guaranteed funding through  10/15/17 Practices must submit to OHIC via the  10/1 10/15/16 submission CTC contract Management Strategies Self 6/30/2018 regardless of OHIC OHIC website the quality 5/16 used for baseline ends 6/30/18 -Assessment on the OHIC website 10/15/2016 and 10/15/2017 sustainability performance measures annually 10/15/17 submission annually starting 10/15/15. submissions. OHIC sustainability funding 10/15 for Q3 performance (based on used for performance funding 7/1/2018-12/31/2018 if  10/15/18 previous year of data (e.g. evaluation. 80% of requirements are met by OHIC 10/1/2015-9/30/2016) 10/15/2017. Sustainability

Transition Practices must complete the Cost CTC guaranteed funding through  10/15/18 Practices must submit to OHIC via the  10/15/17 10/15/17 submission (Adult) Management Strategies Self 6/30/19 regardless of OHIC OHIC website the quality used for baseline CTC contract -Assessment on the OHIC website 10/15/2016, 10/15/2017 and sustainability performance measures annually 10/15/18 submission ends 6/30/19 annually starting 10/15/16. 10/15/2018 submissions. OHIC funding 10/15 for Q3 performance (based on used for performance funding 7/1/2019-12/31/2019 if  10/15/19 previous year of data (e.g. evaluation 80% of requirements are met by OHIC 10/1/2015-9/30/2016) 10/15/2018. OHIC sustainability Sustainability payment starts 1/1/20 and will continue as long as the requirements are met.. PCMH Kids Practices must complete the Cost CTC guaranteed funding through  10/15/18 Practices must submit to OHIC via the  10/15/16 10/15/16 submission Practices Management Strategies Self 12/31/2018 regardless of OHIC website the quality used for baseline CTC contract -Assessment on the OHIC website 10/15/2016 and 10/15/2017 performance measures annually 10/15/17 submission ends 12/31/18 annually starting 10/15/16 . submissions. OHIC sustainability 10/15 for Q3 performance (based on used for performance payment starts 1/1/19 if 80% of previous year of data (e.g. evaluation. requirements are met in 10/1/2015-9/30/2016) 10/15/18 submission. 1 Performance Improvement Requirements: Internal Medicine and family practices: 2017 Recognition: Improve by 3% points on 2 of 3 of the following measures: diabetes HbA1c control, blood pressure control and tobacco use assessment and counseling measures relative to the performance one or two years prior or achieve the national 66th percentile benchmark (or RI benchmark if the national benchmark is not available ) 2018 Recognition: Improve by 3% points on 3 of the 5: HbA1c blood pressure control, tobacco use assessment and counseling, adult BMI assessment, screening for clinical depression measures relative to performance one or two years prior or achieve the national 66th percentile benchmark (or a RI benchmark if a national benchmark is not available 8/19/16 2 Performance Improvement Requirement: Pediatric practices: 2017 Recognition: Improve by 3 % points on 2 of the 4 measures relative to performance one or two years prior or achieve the national 66th percentile benchmark (or a RI benchmark if a national benchmark is not available). 2018 Recognition: Same as 2017