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Transforming Health Care in Arkansas Through PCMH
Rhelinda McFadden, RN, CPHIMS, PCMH-CCE
Manager, Practice Transformation
AFMC Practice Transformation Team
Copyright © 2020, AFMC, Inc.
Rhelinda McFadden, RN, CPHIMS, PCMH-CCE Stacey George, MSN, APRN, PCMH-CCE Jana Ferguson, CMHPManager, Practice Transformation Supervisor, Practice Transformation jferguson@afmc.orgrmcfadden@afmc.org sgeorge@afmc.org
Marq Walker, CPHIMS Rachel Cox, RN, CMHP Aaron Buchermwalker@afmc.org rcox@afmc.org abucher@afmc.org
Arkansas’ PCMH Progress
659
769
880 900 900 900 917
123138
180192 200
210 216
0
50
100
150
200
250
0
100
200
300
400
500
600
700
800
900
1000
2014 2015 2016 2017 2018 2019 2020
PCMH Enrollment
PCP's Enrolled PCMHs Enrolled
A Quick Look Back
• 12- Activities• 4- Metrics for
Practice Support• 9- Quality Metrics
2014 / 2015
• 16- Activities• 15 Quality Metrics
2016• 14-Activities• 17 Quality Metrics• 4- Informational
Metrics
2017 / 2018
12/8/20 4
PCMH 2.0 and Beyond
2019• Activities (13)• Quality Metrics (10)• Low Performance
Core Metrics (2)• Incentive Focus
Metric (1)• Incentive Utilization
Metrics (PBIP) (2)• Informational
Metrics (4)
2020• Activities (13)• Quality Metrics (10)• Low Performance
Core Metrics (4)• Incentive Focus
Metric (1)• Incentive Utilization
Metrics (PBIP) (2)• Informational
Metrics (3)
2021 (Proposed)
• Activities (13)*• Quality Metrics (10)• Low Performance
Core Metrics (5)• Incentive Focus
Metric (1)• Incentive Utilization
Metrics (PBIP) (2)• Informational
Metrics (1)*
12/8/20 5*Anticipated
AFMC Practice Transformation
AFMC’s Practice Transformation Team has tools and resources for you and
your practice.
Practice Transformation Virtually
12/8/20 7
Since March 12, all onsite and in-person visits and meetings with practices, health care systems and agencies were suspended.
Performance Based Incentives
PBIP
Economic Care
Efficient Care
Quality of Care
12/8/20 8
Shared Performance Entity
Independent
Minimum of 1,000 attributed
beneficiaries
Single practice location
Voluntary
Minimum of 1,000 attributed
beneficiaries
Multiple practice locations
Default
Minimum of 300 attributed
beneficiaries
Practices that do not wish to
participate in a voluntary pool
Petite
Practices with less than 300
attributed beneficiaries
Practices that do not wish to
participate in a voluntary pool
Eligibility for PBIP
PBIP Eligible
Activities
Metrics
Core Metrics
2021 Anticipated Activities
12/8/20 11
2021 Anticipated Quality Metrics
12/8/20 12
New Metrics Anticipated for 2021• Antibiotic Utilization– Outpatient utilization of antibiotic prescriptions
during the measurement year• Chlamydia Screening– Percentage of women age 21 to 24 who were
identified as sexually active and who had at least one test for chlamydia during the measurement year
• Cervical Cancer Screening– Percentage of women ages 21 to 64 who were
screened for cervical cancer
12/8/20 13
2021 AnticipatedLow Performance Core Metrics
12/8/20 14
Performance Based Incentive Payments
Top 10% = $12.00Top 11 – 35% = $6.00Acute Hospitalization Utilization
Top 10% = $8.00Top 11 – 35% = $4.00Emergency Department Rates
Top 10% = $5.00Top 11 – 35% = $2.50Focus Metric Adolescent Wellness
Ways to Earn Performance Based Incentive Payments
Ways to Earn PBIP Incentive:
• Achieve 1 PBIP Metric1
• Achieve 2 PBIP Metrics2
• Achieve all 3 PBIP Metrics3
PBIP Incentive Potential:
Member Attribution
Incentive $ Amount
Attributed Months
PBIP Incentive Potential
Upcoming Reports
12/8/20 17
• December 15thPopulation Health Monthly Report
• Performance Period 2020 – Late DecemberQuarterly Report
How AFMC PCMH Practices are Performing on Infant Wellness
12/8/20 18
47% 48%
72%
67%
74% 75%
66%
2014* 2015 2016 2017 2018 2019 2020
Infant Wellness AFMC PT Average
Performance Period Target
How AFMC PCMH Practices are Performing on Child Wellness
12/8/20 19
59% 60%
69%71% 72%
78%
51%
2014* 2015 2016 2017 2018 2019 2020
Child Wellness AFMC PT Average
Performance Period Target
How AFMC PCMH Practices are Performing on Adolescent Wellness
12/8/20 20
38% 39%
46%
51%54%
61%
39%
2014* 2015 2016 2017 2018 2019 2020
Adolescent Wellness AFMC PT Average
Performance Period Target
AFMC Practice Transformation
AFMC’s Practice Transformation Team has tools and resources for you and
your practice.
As a Reminder
12/8/20 22
Attest to 6-month and 12-month activitiesAttest to 80% of HPB having two care plans
31 Dec. 2020
Begin considering who to select for HPBs for 2021
1 Jan. 2021
Attest to eCQMs for 2020 (Controlling High Blood Pressure, BMI for Children and Adolescents, HbA1c Poor Control, Tobacco Screening and Cessation Intervention, Breast Cancer Screening and Cervical Cancer Screening)
28 Feb. 2021
Questions
12/8/20 23
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