ACO Forum May 13, 2021: Insights on MSSP, Quality Measures, and Membership Trends

ACO Forum May 13, 2021 7:50PM-8:45PM

AGENDA 1. 2. 2021 MSSP Overview 2021 Quality and CEHRT Requirements a) Closing ACO Care Gaps b) HCC Coding Recapture c) CEHRT Documentation 3. Chronic Care Management Updates (In-House Billing) a) 2019 2021 YTD PCP Revenue Summary b) Medi-Cal Enrollment Kickoff c) Medicare 855R 4. 2022 and Beyond Strategic Approach 5. Updates to CMS Interim Notices 6. Provider Performance and Evaluation

2021 MSSP OVERVIEW CURRENT AND FUTURE

YEAR MEMBERSHIP 2018 6,624 FCACO MEMBERSHIP 2019 11,362 2020 12,204 2021 12,476

YEAR MEMBERSHIP 2018 5,097 FCACO CCM MEMBERSHIP 2019 6,834 2020 7,169 2021 8,844

YEAR CMS FAMILY CHOICE 2018 $2,433,368 $1,216,684 YEAR TO DATE ACO SAVINGS 2019 $4,390,664 $2,195,332 2020 Fall of 2021 Fall of 2021 2021 TBD TBD

Approved for SNF 3-Day Rule Waiver SNF 3-Day Rule Waiver begins TBD SNF 3-DAY RULE WAIVER Depending on COVID-19 PHE

2021 MSSP CLOSING ACO CARE GAPS

ACO -13: Falls: Screening for Future Falls (CPT 1101F, 0-1Falls; 1100F, 2+ Falls) ACO - 14: Influenza Immunization (CPT G8482) ACO - 17: Tobacco Use: Screening and Cessation Intervention (CPT 4004F- Non-Smoking; 1036F-Current Tobacco) ACO - 18: Screening for Depression and Follow-up Plan (CPT G8431-Positive; G8510-Negative) ACO - 19: Colorectal Cancer Screening (CPT 3017F) ACO - 20: Breast Cancer Screening (CPT 3014F) ACO - 42: Statin Therapy - Treatment of Cardiovascular Disease (CPT G8598) ACO - 40: Depression Remission at Twelve Months (CPT G9509 Remission at 12 months) ACO - 27: Diabetes Hemoglobin A1c (HbA1c) Poor Control (>9%) (CPT 3046F) ACO - 28: Hypertension: Controlling High Blood Pressure (CPT G8752 -Systolic BP<140mmHg; G8754-Diastolic BP<90mmHg) QUALITY MEASURES (2021) 9

2021 MSSP HCC CODING RECAPTURE

1. See your patients at least once a year and bill the AWV! Diagnoses need to be captured through face-to-face encounters and reported annually. HCC CODING (RECAPTURE) 2. Prep for patient visits ahead of time Review ACO Care Gap report and HCC recapture report ahead of visits, so activities such as chart prep, problem list reviews can be made more effective and targeted. 3. Coding Specification Make sure that valid diagnosis codes are documented at the time of the visit, consider options as provided in our HCC tips

2021 MSSP CEHRT DOCUMENTATION

1. Please instruct staff to respond timely to ACO data support team. CEHRT DOCUMENTATION 2. Annually request a CEHRT Use letter from your EHR vendor and supply to FCACO. Audits and random by CMS.

CCM OPERATIONS OVERVIEW

CCM INCOME YEAR INCOME 2018 2020 Paid to CCM Providers $158,881.00 2021 YTD Paid to CCM Providers $64,892.35 2021 YR-to-date: Paid to CCM Providers Transition to In-house Billing* $223,773.35

CCM FACTS AND MORE # PROVIDER NAME AMOUNT TO PROVIDERS 1 PCP $38,003.48 TOP 2 PCP $24,582.24 PERFORMERS 3 PCP $15,096.89 4 PCP $13,382.80 5 PCP $12,489.75 2020 - 2021 80 providers participating. Are you missing out? 6 PCP $8,303.91 7 PCP $7,840.36 8 PCP $7,592.56 9 PCP $6,655.39 10 PCP $5,803.12

How will Family Choice ACO CCM In-house Billing Work? Patient Care Coordinators (PCCs) will continue to enroll eligible patients and create comprehensive care plans as they do daily. FC ACO will aggerate for all eligible monthly charges and bill Medicare directly. FC ACO will invoice PCP 50% of CCM allowed amount for performing monthly CCM services FC ACO will make monthly disbursements to providers along with a copy of summary of EOBs for your records. FC ACO will bill only one of the below CPT codes monthly. IN-HOUSE BILLING o 99490 o 99487 o 99489 17

Sign ACO Participation Agreement Addendum Chronic Care Management Program HOW CAN I PATRICIATE? Complete and return Medicare Enrollment Application - Reassignment of Medicare Benefits form 855R Commit to Medi-Cal enrollment 18

Three-part shared savings distribution plan 1. HCC coding recapture 2. Quality performance 3. ACO Program Participation CCM opt in CCM In-house Billing opt in ACO Hospitalist opt in PROVIDER PERFORMANCE AND EVALUATION 19

2022 AND BEYOND STRATEGIC APPROACH: UPDATES TO CMS INTERIM NOTICES DIRECT CONTRACTING PRIMARY CARE FIRST OTHER CMS MODELS

1. FCACO will remain in current MSSP track through 12/31/2021. 2021 & 2022 MSSP OVERVIEW 2. FCACO will renew ACO under MSSP Enhanced Track. Greater risk pool means bigger distribution pool paid to providers.

1. Covid 19 Public Health Emergency 1 year Extension in MSSP 1+ - 50/50 Shared Savings Rate FCACO SHARED SAVING MODELS 2. FCACO will apply for PY 2022 Direct Contracting Entity Model - Variable risk tracks up to 100% Program new applicants suspend temp.

PLEASE FILL OUT THE EVALUATION FORM AND RETURN TO FAMILY CHOICE STAFF

THANK YOU FOR ATTENDING OUR FORUM!