Population Health ASCEND Booklet

Population HealthASCENDOutfitting for Value-Based Payments 1

Population Health To succeed under value-based payments, healthcare providers must develop population health management skills and infrastructure. Most providers, ASCEND however, are unsure how to move forward, given the need to sustain current operations. Just as Sherpa Tenzing Norgay supported Edmund Hillary in reaching Everest’s summit, PYA can guide your organization on its path forward. We are pleased to introduce Population Health Ascend, our suite of products providing critical competencies for population health management. For each product, we have designed a scope of work and project plan, secured qualified and experienced staff, and defined performance measures. We understand the climb will be different for each organization, and thus each product stands on its own. The products you select will be customized to your organization’s specific needs and circumstances. Additionally, PYA’s skilled project management team can coordinate your organization’s population health initiatives, maximizing efficiency and keeping you on schedule. What lies ahead are not obstacles, but opportunities. PYA can guide you to your summit.2

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Table of Contents Gear Up – Transitioning from Fee-For-Service Payments Organization-Wide Learning................................................................................... 9 Physician Leadership Academy............................................................................11 Ambulatory CDI....................................................................................................13 Fee-For-Service Care Management.....................................................................15 Acclimate – Building Capacity for Population Health Management MIPS Masterytm.....................................................................................................18 Network Formation and Acceleration...................................................................20 Provider Compensation Redesign........................................................................22 Alternative Payment Model Valuation...................................................................24 Forge Ahead – Achieving and Sustaining Success Under Value-Based Payments Intelligent Data Integration....................................................................................29 Provider Practice Innovation.................................................................................31 Risk-Based Contracting........................................................................................33 Why PYA?..............................................................................................................34



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GEAR UPTransitioning from Fee-For-Service Payments 1. Organization-Wide Learning 2. Physician Leadership Academy 3. Ambulatory CDI 4. Fee-For-Service Care Management 7

8 GEAR UP

Organization-Wide LearningTailored internal communication and education campaign poweredby interdisciplinary subject-matter experts.Challenges Benefits• Paradigm shift requires new • Achieve understanding and buy-in from all organizational competencies and stakeholders: front-line staff to governing tactics body• Stakeholder engagement and buy-in • Efficient investment of education spending is critical to success while avoiding costly conferences and seminars• Past experience and training do not prepare for this transition • All stakeholders can “speak the same language”• Leaders and staff lack shared understanding of key terms and • Stakeholder competency demonstrated by concepts pre- and post-testing• Do-it-yourself solutions derailed • Primed for further development of by limited time, expertise, and organizational value-based payment perspective strategy Click here for more information. 9

10 GEAR UP

Physician Leadership AcademyProven curriculum to equip, educate, and empower physicianchampions without schedule disruption.Challenges Benefits• Knowledgeable and committed • Demonstrable organizational physician leaders key to improving commitment to physician leaders quality and efficiency • Customized, non-disruptive programs• Broad-based competencies foster shared business acumen necessary for population health management • Cost-effective alternative to off-site programs• No systematic process to identify and train potential leaders Click here for more information. 11

12 GEAR UP

Ambulatory CDIFocused Clinical Documentation Improvement program toaccurately capture population risk and enhance data integrity.Challenges Benefits• Failure to appreciate impact of • Improve practice workflow to ensure diagnosis coding on risk-based accurate ICD-10 coding contracting • Ensure accurate assignment of• Increased payer denials due to poor hierarchical condition categories (HCCs) outpatient coding • Enhance position for risk-based• Inaccurate or incomplete contracting documentation yields fragmented care management • Improve revenue cycle by reducing denials • More accurate risk stratification to improve care management Click here for more information. 13

14 GEAR UP

Fee-For-Service Care ManagementStep-by-step implementation of compliant transitional and chroniccare management programs.Challenges Benefits• Managing high-risk patients key to • Generate significant new practice success under new payment models revenue• Historically, no reimbursement for • Bridge from fee-for-service to value- ambulatory care management based payments• Few providers take advantage of new • Target high-risk patients to lower total care management reimbursement cost of care due to regulatory complexity • Shore up staffing and technology• Staffing and technology challenges infrastructure required for population also hinder progress health Click here for more information. 15

A C C L I M AT E Building Capacity for Population Health Management 1. MIPS MasteryTM 2. Network Formation and Acceleration 3. Provider Compensation Redesign 4. Alternative Payment Model Valuation16

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MIPS MasteryTMCutting through regulatory complexity to move the needle on MIPSperformance measures.Challenges Benefits• New Medicare quality payment • Practical understanding of complex program fundamentally alters regulatory scheme physician reimbursement • Evaluation of current performance• Physician payment based on through the lens of MIPS standards composite performance score (CPS) • Customized work plan to enhance• CPS impacts physician reputation each CPS component with payers, providers, and patients • Evaluate alternative payment model• Budget neutrality means winners and participation losers Click here for more information.18

19A C C L I M AT E

Network Formation and AccelerationDesign, implementation, and optimization of clinically integratednetworks.Challenges Benefits • Critical to build consensus among • Ensure compliance with clinical integration providers standards using proprietary Network Gap Analysis • Need to create workable governance structure • Engage in meaningful operational planning • Design work plans to reduce total cost of • Need to craft fair and compliant participant agreements care • Quantify and pursue gainsharing • Identify incentives necessary to create sustainable change opportunities • Successfully implement evidence-based • Meet demand for short- and long- term ROI clinical protocols • Realize financial success Click here for more information.20

21A C C L I M AT E

Provider Compensation RedesignAligning incentives for teams delivering value-based care. Challenges Benefits • Current productivity-based • Facilitate communication and compensation plans inconsistent decision making regarding with value-based payments compensation • Highly sensitive conversations necessitate third-party involvement • Identify workable value-based • Need to build consensus around new compensation model models • Critical importance of aligning • Build trust through transparent incentives processes to calculate compensation Click here for more information. • Coach physicians on behavior changes to maximize payments22 • Ongoing monitoring to ensure intended outcomes

23A C C L I M AT E

Alternative Payment Model ValuationFair market value and commercial reasonableness assessments ofprovider network revenue distributions.Challenges Benefits• Network payments to physicians • Confidence in compliance of planned must comply with fraud and abuse network revenue distributions laws and IRS rules • Appropriately designed plans• Limited regulatory guidance incentivize desired behavior change• Minimal market data on which to rely necessary to achieve organizational• Need to properly incentivize population health goals physician behavior Click here for more information.24

25A C C L I M AT E

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FORGE AHEADAchieving and Sustaining Success Under Value-Based Payments 1. Intelligent Data Integration 2. Provider Practice Innovation 3. Risk-Based Contracting 27

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Intelligent Data IntegrationTranslating disparate data into meaningful business intelligence todrive performance improvement.Challenges Benefits• IT solution fatigue and “buzzword • Define data intelligence game plan overload” • Demonstrate immediate and• False promise of interoperability for quantifiable ROI disparate data sources • Deliver customized application for• Mistaking data gathering for data data intelligence intelligence • Design tailored predictive analytics• Fear of data breach and misuse for risk stratification• Failure to launch • Align disparate data sources • Leverage external data • Capture and validate free-form text Click here for more information. 29

30 FORGE AHEAD

Provider Practice InnovationTransforming physician practices to achieve better patient care,improved outcomes, and smarter spending.Challenges Benefits• Growing demand for full-risk primary • Purposefully position primary care care payments providers to lead population health• Increasing provider and consumer • Pursue direct contracting dissatisfaction with eight-minute opportunities office visit • Enhance physician recruitment and• Poor patient engagement in healthy retention lifestyles and behaviors • Improve patient engagement,• Physician burnout threatens access satisfaction, and adherence to care • Smarter spending on shared value proposition for all stakeholders Click here for more information. 31

32 FORGE AHEAD

Risk-Based ContractingPositioning for success under pay-for-performance, shared savings,bundled payments, and full-risk contracts.Challenges Benefits• Payers aggressively pursuing risk- • Improve quality performance and based arrangements patient care reputation• Unprepared providers need transition • Generate potential ancillary revenue strategy to assume risk or cost avoidance• Lack of understanding of key • Enhance clinical documentation and business terms impacting risk-based treatment plans contracting • Scale population health activities• Unable to quantify upside and across multiple risk-based contracts downside risk Click here for more information. 33

Why PYA? Experienced. We have served the healthcare industry for more than three decades. Trusted. We have more than 200 long-term clients, the majority of which have been with us for more than 10 years. Privately Held. We answer to our clients, not third party investors. Highest Standards. We are organized as an accounting firm, adhering to the American Institute of CPAs’ Professional Standards. Multi-Disciplinary. Our team includes doctors, nurses, hospital administrators, practice managers, data scientists, compliance and reimbursement experts, health plan executives, accountants, appraisers, auditors, lawyers, policy analysts, and performance improvement specialists. Thought Leadership. We publish and speak frequently on cutting-edge industry developments and trends. C ustomized Engagements. No “minimum contract” requirements; no obligation to use specific IT solution.34

Contact Marty Brown [email protected] David McMillan [email protected] Martie Ross [email protected](800) 270-9629 35

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