ACO Forum August 25th, 2021 8:30AM-10:30AM

ACO Forum August 25th, 2021 8:30AM-10:30AM

AGENDA 1. 2022 Transition to MSSP Enhanced Overview 2. 2021 and 20221 Quality and CEHRT Requirements a) b) c) d) Annual Wellness Visit for ACO Closing ACO Care Gaps HCC Coding – Recapture 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. ACO Shared Savings Distribution Plan 5. 2022 and Beyond Strategic Approach 1. Updates to CMS Interim Notices 6. Provider Performance and Evaluation

2021 MSSP OVERVIEW CURRENT AND FUTURE

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

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

YEAR TO DATE ACO SAVINGS YEAR CMS FAMILY CHOICE 2018 2,433,36 8 1,216,684 2019 4,390,66 4 2,195,332 2020 Fall of 2021 Fall of 2021 2021 TBD TBD

Sign: ACO Participation Agreement Chronic Care Management Program PY2022 DEADLINE Inhouse-Billing Addendum ACO Hospitalists Addendum No later than 9/9/2021!!! Complete and return Medicare Enrollment Application - Reassignment of Medicare Benefits form 855R Commit to Medi-Cal enrollment 8

2021 MSSP CLOSING ACO CARE GAPS

ACO 13 - Falls: Screening for Future Falls: CPT: 1101F(0-1 falls) CPT: 1100F (2 falls or any fall w/injury) ACO 14 - Influenza Immunization : QUALITY MEASURE S (2021) CPT: G8482 (Influenza vaccine administered or previously received) ACO 17 - Tobacco Use: Screening and Cessation Intervention : CPT: 4004F (screened for tobacco use & received cessation intervention) CPT: 1036F (current tobacco non-user) ACO 18 - Screening for Depression and Follow-up Plan : CPT: G8431 (positive screen & f/u plan documented) CPT: G8510(negative screen documented, f/u plan not required ACO 19 - Colorectal Cancer Screening : CPT: 3017F (screening results documented & reviewed) ACO 20 - Breast Cancer Screening : CPT: 3014F (results documented & reviewed) ACO 42 - Statin Therapy - Treatment of Cardiovascular Disease : CPT: G9664(current statin therapy users or received a prescription for statin therapy) ACO 40 - Depression Remission at Twelve Months : ICD-10(Major Depression): F33. ICD-10(Dysthymia): F34.1 CPT: G9509(remission at 12 months) ACO 27 - Diabetes Hemoglobin A1c (HbA1c) Poor Control ( 9%): 10(Diabetes): Ell. ACO 28 - Hypertension: Controlling High Blood Pressure: BP 140mmHg) ICD- CPT: 3046F(most recent HbA1c 9.0%) CPT: G8752 (Systolic CPT: G8754 (Diastolic BP 90mmHg) 10

2021 MSSP AWV FOR ACO HCC CODING – RECAPTURE

1. See your patients at least once a year and bill the AWV! Due to Covid -19 this is Critical for 2022! 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 D O C U M E N TAT I O N 2. Annually request a CEHRT Use letter from your EHR vendor and supply to FCACO. 3. Audits are random by CMS so be prepared.

CCM OPERATIONS OVERVIEW

CCM FACTS AND MORE TOP PERFORMERS 80 providers participating . Are you missing out? # PROVIDER NAME AMOUNT TO PROVIDERS 1 PCP 147,620.04 2 PCP 92,129.68 3 PCP 62,633.00 4 PCP 57,621.86 5 PCP 54,683.74 6 PCP 49,672.22 7 PCP 41,818.30 8 PCP 39,701.69 9 PCP 21,208.29 10 PCP 19,736.55

Evaluation of Top Performers Providers PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP 2018 Shared 2018 Advanced 2018 CCM Savings Payment Model Program Total 22,459 26,952.83 1,689.58 51,101.41 15,033 11,734.21 0.00 26,767.21 6,550 41,255.44 0.00 47,805.44 7,394 19,316.62 0.00 26,710.62 11,966 0.00 234.94 12,200.94 10,981 10,978.82 729.31 22,689.13 6,263 11,991.87 538.98 18,793.85 5,830.00 11,032.51 0.00 16,862.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Providers PCP PCP PCP PCP PCP PCP Providers PCP PCP PCP PCP PCP PCP PCP PCP PCP PCP 2020 Shared 2020 Advanced 2020 CCM Savings Payment Model Program Total 0.00 0.00 36,366.19 36,366.19 0.00 0.00 26,694.52 26,694.52 0.00 0.00 0.00 0.00 0.00 0.00 6,563.18 6,563.18 0.00 0.00 14,604.63 14,604.63 0.00 0.00 158.66 158.66 0.00 0.00 36.43 36.43 0.00 0.00 4,331.55 4,331.55 0.00 0.00 5,221.73 5,221.73 0.00 0.00 0.00 0.00 PCP PCP PCP PCP 2019 Shared 2019 Advanced 2019 CCM Savings Payment Model Program Total 50,984.1 2 0.00 9,168.32 60,152.44 38,667.9 5 0.00 0.00 38,667.95 14,827.5 6 0.00 0.00 14,827.56 22,668.1 1 0.00 1,679.95 24,348.06 27,878.1 7 0.00 0.00 27,878.17 22,770.5 5 0.00 4,053.89 26,824.44 20,691.0 8 0.00 2,296.94 22,988.02 18,399.1 8 0.00 108.45 18,507.63 15,986.5 6 0.00 0.00 15,986.56 19,736.5 5 0.00 0.00 19,736.55

How will Family Choice ACO CCM In-house Billing Work? IN-HOUSE BILLING 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. o 99490 o 99487 o 99489 18

HOW CAN I PARTICIPATE ? Sign ACO Participation Agreement Addendum – Chronic Care Management Program Complete and return Medicare Enrollment Application Reassignment of Medicare Benefits form 855R Commit to Medi-Cal enrollment 19

Three-part shared savings distribution plan 1. HCC coding recapture 2. Quality performance PROVIDER PERFORMANCE AND EVALUATION SHARED SAVINGS DISTRIBUTION PLAN PY2021 3. ACO Program Participation CCM opt in CCM In-house Billing opt in ACO Hospitalist opt in FCACO will plan to distribute in next 30-45 days from receipt of payment from CMS. 20

2021 MSSP CEHRT DOCUMENTATION

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. Overlap with Primary Care First and Direct Contracting Model will not be permitted in 2022. 2. PCPs will need to select by 9/10/2021 or PCP will be terminated from ACO program and lose shared savings distribution opportunity. FCACO SHARED SAVING MODELS 3. PCF only offers minimal professional bonuses – ACO is TOTAL COST OF CARE! PCF adjusts the PBP by a factor ranging from -10% to 50% based entirely on acute hospital utilization (AHU). ACO only 75% UPSIDE!!!! 4. PCF requires additional quality reporting on all patients in practice! 5. ACO reduces additional administrative burden of PCF! Participants are subject to a program integrity screening and must submit cost, utilization, patient experience, and quality data to ensure patient safety and compliance.