Key Insights from Research

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  • 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.
  • target.gifIn 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.

Specific accomplishments:

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.

Business Plan:

  • 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)

Survey.gifMSO Services:

  • 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

Project Management:

  • 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