- The Practice Options Initiative (POI) supports all three
2015-2017 PAMED strategic goals.
- In 2015, the Department of Health & Human Services announced two new goals for value-based payment and alternative practice models (APMs) in Medicare. By the end of 2016, 30% of fee-for service (FFS) Medicare payments will be tied to quality or value through APMs and 50% by the end of 2018. Second, 85% of FFS Medicare payments will be tied to quality or value and 90% by the end of 2018.
In announcing their $12 billion contract with Medicaid Managed Care plans, Pennsylvania Medicaid indicated a 30% target for payments to providers be based on value received or outcomes, rather than the quantity of services provided.
- Pennsylvania has hired Catalyst for Payment Reform to suggest targets for commercial health plan provider payments through population-based payment models and episode-based payment models.
- In a recent survey, Deloitte-Touche found that just 50% of non-pediatric physicians have heard of the Medicare Access & CHIP Reauthorization Act. Medicare reporting requirements, which commence in 2017 and a push toward Advanced Payment Models mandated by the Act, will likely drive payment and delivery reform efforts across all payers.
Listed below are recent accomplishments driving the ultimate creation of the Business Plans as PMSCO moves forward with planning and design efforts for the MSO and CIN.
- Refined financial model and assumptions for both the CIN and MSO
- Drafted the MSO business plan and developed design decisions for input from the PMSCO Board and Project Steering Committee
Population Health Vendor RFP:
- Evaluated responses to the August population health RFI and narrowed recommended vendors to receive the RFP
- Issued RFPs and developed recommended prioritization based on responses
- Developed critical path and timing for vendor selection process (for multiple vendors)
- Surveyed PAMED physicians to understand desired services both in the near-term and longer-term
- Prioritized services based on the survey and identified additional potential vendors to consider
- Began work to develop insurance services packages for physicians
- Drafted detailed workplan for Design and Implementation of MSO and CIN and identified key activities and milestones
- Set up project management processes and cadence, including status reporting, risk and issue identification and resolution, communications process, and team charters
CIN and MSO Structure:
- Obtained approval to retain PMSCO as legal entity to offer MSO services
- Engaged marketing vendor, Pavone Marketing, to rename and rebrand offerings
- Initiated pricing and packaging discussions, including evaluation of equity vs. reduced participation fee and preferential pricing for members
- Approved funds flow and monitoring triggers for release of endowment dollars