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Million Hearts®
Cardiovascular Disease Risk Reduction Model
Control Group Onboarding Package
Updated: March 2017
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Table of Contents 1.0 Introduction ............................................................................................................... 3
2.0 Your MH Model Orientation Webinar ......................................................................... 4
3.0 MH Model Training Requirements ............................................................................. 5
4.0 Update Your Practitioner List and Points of Contact (POCs) .................................... 6
5.0 Enrolling Beneficiaries in the MH Model .................................................................... 8
6.0 Understanding the MHM Data Registry ................................................................... 10
7.0 How and When Your Organization Will Be Paid ...................................................... 11
8.0 Using POST Portal to Assess and Improve Your Performance ............................... 13
9.0 Customer Service and Contact Information ............................................................. 15
Appendix 1: Summary of MH Model Training Events .................................................... 16
Version Description of Updates Date
1.0 First release of Onboarding Packet June 2016
2.0 Updates related to program changes and accuracy
August 2016
3.0 Post-Go-Live Updates March 2017
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Welcome to the Million Hearts® Model On behalf of the Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI), I would like to welcome you as a Control Group participant of the Million Hearts® Cardiovascular Disease Risk Reduction Model (MH Model). The Model Team is excited that you are participating in this novel and innovative program! The MH Model is one of the largest cluster randomized tests of prevention using a predictive cardiovascular risk algorithm. The rigorous program design, financial incentives, coupled with motivated and engaged leaders across the health care industry, will provide invaluable insight as we work to test new benefits for the Medicare program. Your practice was randomized to the Control Group. The MH Model team would like to stress the importance of your role as a Control Group participant. While the Control Group is not implementing the intervention, you will receive financial reimbursement for the completion of the model data reporting requirements. Your engagement and participation in the submission of data to CMS is of critical importance to the model and its success. We are excited that you have agreed to join us. Together, we will transform the way CMS pays for preventive care and improve cardiovascular health for millions of beneficiaries across the nation! We look forward to working with you. Sincerely,
Nina C. Brown-Ashford, MPH, CHES Deputy Director – Prevention and Population Health Group CMS – Innovation Center
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1.0 Introduction The content of this package explains key model policies and processes to help your organization successfully participate in the MH Model. This document offers a broad overview of your responsibilities and the support that will be provided to you as you implement the MH Model. Additional information can be found in training materials outlined in Appendix 1. You can also contact the MH Model Help Desk at any time to answer specific questions by emailing [email protected] or call 1-844-711-2664, Option 3. Please review the information contained in this document in its entirety and share with your Control Group participating organization colleagues that will be participating in the MH Model.
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2.0 Your MH Model Orientation Webinar MH Model Control Group Orientation took place in July 2016. If you were not able to
attend or were not yet part of the Model, you can find a link to the presentation content
in Appendix 1: Summary of MH Model Training Events.
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3.0 MH Model Training Requirements The MH Model “Go-Live” occurred on January 3, 2017 in January 2017 when the Million Hearts® Model Data Registry (MHM Data Registry) became available and your practice started to provisionally enroll beneficiaries. A series of training events occurred from July through December 2016, prior to model Go-Live, to prepare participants for model participation. All participants are required to complete each training to ensure they are fully prepared to participate in the MH Model. A comprehensive list of MH Model trainings, as well as event descriptions, links to event recordings, and access information can be found in Appendix 1: Summary of MH Model Training Events. Training events are targeted towards all care team members, from administrative to clinical staff. Registration and attendance for all training events is monitored by the MH Model Team.
Next Steps
Review Appendix 1: Summary of MH Model Training Events.
Identify members of your organization to attend each training event, and share relevant event information with them promptly.
Ensure that clinical team members and practice administrators attend the model’s mandatory training events.
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4.0 Update Your Practitioner List and Points of Contact (POCs) 4.1 Update Practitioner and Organization Information in MHM Data Registry After Model Go-Live, the MH Model Team migrated your practitioner list to the MHM Data Registry. From this point forward, you must update your practitioner list and your organization level data in the MHM Data Registry every 6 months. In addition, you must notify your Million Hearts® Project Officer (MHPO) 15 calendar days prior to a practitioner entering or leaving your organization. For all other changes related to participant management, you must notify your MHPO 30 calendar days before the change. Table 1 presents the organization-level and practitioner-level information that must be updated and the frequency of required updates. Your organizational information will be vetted by CMS’s Center for Program Integrity (CPI) every six months to ensure the eligibility of your organization to participate in the model is up-to-date. Table 1: Required Practitioner and Organization Updates Type of Information Information Requested Frequency of Updates
Practitioner Level Information
Practitioner NPI
Practitioner First Name
Practitioner Last Name
15 calendar days prior to a practitioner leaving or joining your organization.
Organization Level Information
CMS Certification Number (if applicable)
Primary POC First Name
Primary POC Last Name
Primary POC Email Address
Primary POC Phone Number
Secondary POC First Name
Secondary POC Last Name
Secondary POC Email Address
Secondary POC Phone Number
Billing TIN
Additional TINs
Type II NPIs
CMS Certification Number (CCN) *if applicable
Address, City, State, and Zip Code
At least every six months after Go-Live. Updates as information changes are encouraged.
Please note that updates to your organization’s legal name, billing TIN, additional TINs, Type II NPIs, or CCNs must be approved by your MHPO. The billing TIN will be used to disburse model payments to your organization. The TINs, type 2 NPIs, and CCNs are not visible in the MHM Data Registry at Go-Live, but can be updated via your MHPO. Contact your MHPO if there are any changes to this information throughout the model to ensure that it is updated in the MHM Data Registry.
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4.2 Update Your Organization’s POCs All Million Hearts® Model communications, including documents related to Corrective Action Plan (CAP), will be documented in POST Portal and sent to the designated primary and secondary POCs for your organization via email. It is imperative that your organization has current POC information on file, as CAP and other model communications may be time sensitive. POCs were initially selected by your organization prior to randomization and may have been updated since then. POC information for your practice will be displayed in both the MHM Data Registry and POST Portal. You must update your POC information in the MHM Data Registry Administration Tab and by contacting the MH Model Help Desk. Figure 1 presents tips on choosing the best POC for your organization:
Figure 1: Overview of the POC Role
Next Steps
Make any updates to practitioner list in the MHM Data Registry Administration Tab
Make updates to POC information in the MHM Data Registry Administration tab and by contacting the MH Model Help Desk
Make updates (as needed) to your organizational identifier information through your MHPO every six months or more frequently if the information changes.
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5.0 Enrolling Beneficiaries in the MH Model 5.1 How to Enroll Beneficiaries Following Model Go-Live in January 2017, your practice is now able to provisionally enroll beneficiaries in the MH Model. The MH Model allows you to enroll beneficiaries on a continuous basis as they are seen by your participating practitioners. This approach will help reduce the likelihood that enrollment disrupts your normal practice workflow. You are encouraged to enroll beneficiaries at least once every six months. Beneficiaries must meet specific eligibility criteria in order to participate in the MH Model (see Figure 2). Please make sure that your practitioners are familiar with this criteria so they are able to identify eligible beneficiaries. Note: In addition to the listed eligibility criteria, if a beneficiary’s Systolic Blood Pressure (SBP) or Total Cholesterol (TCL) is above the range of accepted values for the MHM Data Registry (90-200 mmHg for SBP and 130-320 for TCL), the value must be controlled before the beneficiary can be enrolled in the model. If the values for these data points are below the minimum accepted value, the value can be defaulted to the lowest acceptable value in the range, and the beneficiary can be enrolled in the model. The enrollment process is described below.
1. Submitting Data to the MHM Data Registry for Beneficiary Enrollment:
Following in-person clinical visits occurring on or after January 3, 2017, submit
demographic and clinical data to provisionally enroll any beneficiary that meets
the MH Model eligibility criteria. You will submit this data via the MHM Data
Registry. It is recommended that you manually enter or bulk upload the clinical
data for each beneficiary into the MHM Data Registry every six months.
2. Validating Eligibility: On a monthly basis beneficiaries will be validated against
CMS Chronic Conditions Data Warehouse (CCW) records. In addition, every 6
months, CMS will revalidate beneficiaries, and identify any eligible beneficiary
who was seen by the practice but was not enrolled in the model. Participating
organizations will then be notified of these eligible but not enrolled beneficiaries.
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3. Aligning Beneficiaries: At the end of each six month performance period, in
addition to checking eligibility, CMS will check completed beneficiary records
against CMS claims to verify alignment – whether the beneficiary should be
aligned to your practice or another practice for the purpose of the model.
o If a beneficiary is enrolled by two practices in same reporting period,
the beneficiary will be aligned to the practice that has seen the beneficiary
more over the past two years. In the event that two participant
organizations have seen the beneficiary the same number of times, the
beneficiary will be aligned to the participant organization with the most
recent visit.
Figure 3 provides a visual overview of the beneficiary alignment process.
Figure 3: Beneficiary Alignment Diagram
5.2 Notifying Beneficiaries You are no longer required to notify your enrolled beneficiaries of their involvement in the MH Model. Please contact the MH Model Help Desk if you have any questions regarding this policy change.
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6.0 Understanding the MHM Data Registry 6.1 Overview of the MHM Data Registry The MHM Data Registry serves as the secure data hub for your organization throughout the MH Model. Your practice will use the MHM Data Registry to:
Enter beneficiary demographic and clinical data to support enrollment, alignment of beneficiaries to your practice, and ongoing tracking of beneficiary health
Update your practice’s administrative information, including practitioner NPIs
Receive reminders and notifications about key dates for the beneficiary population management process, such as reporting periods and beneficiary annual visit dates
The MHM Data Registry contains a number of key features designed to support your participation in the model and integrate with your practice’s workflow. These features include two data upload options (manual or bulk upload). Training materials for the MHM Data Registry were distributed via email to your organization’s POCs and your participation is highly recommended to be successful throughout the lifecycle of the MH model. To access training materials, see Appendix 1 or access the Control Group Document Library at the following link: http://mhmodel-controlgroup-
documentlibrary.cms.gov/
6.2 MHM Data Registry Users Each member of your organization who intends to use the MHM Data Registry must register for their own MHM Data Registry account. Each MHM Data Registry user chooses a specific user role. The MH Model POCs for your organization must hold the MH Practice Contact (PPOC) role and will have the authority to grant other users within your organization access to the MHM Data Registry. Access to the MHM Data Registry will only be granted after standard security checks, including identity verification and user authentication, are complete. For more information on MHM Data Registry user roles and how to request MHM Data Registry access, review the MHM Data Registry User Manual and the MHM Data Registry Access Request Quick Reference Guide. Both of these resources were distributed to POCs via email in December 2016. They are also available in the MH Model Control Group Document Library at the following link: http://mhmodel-controlgroup-
documentlibrary.cms.gov/
Next Steps
Determine your organization’s ideal MHM Data Registry users in addition to your designated POCs.
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View MHM Data Registry training recordings, take the MHM Data Registry web-based training (see Appendix 1), and consult the MHM Data Registry User Manual
7.0 How and When Your Organization Will Be Paid 7.1 Payment Administration Payments will be calculated based on data submitted to CMS via the MHM Data Registry and will be administered by the CMS Office of Financial Management. Your organization should submit claims for MH Model eligible beneficiaries as you would normally; there is no MH Model specific billing code to use for visits with MH Model eligible beneficiaries. 7.2 MH Model Payment Types Your organization will receive a reporting payment for each eligible beneficiary. Further details are provided in Table 2. An example payment scenario for the Control Group is illustrated in Figure 4.
Table 2: MH Model Control Group Payment Type
Reporting Payment
Payment Amount $20 per beneficiary per year
Which Beneficiaries are Included?
All eligible beneficiaries enrolled and aligned to your organization
Frequency of Payment Annual payment will be disbursed every 6 months during Years 1-3 of the MH Model if you submit data during each 6-month performance period. If you only submit data once per year, you will be paid annually.
Practice Requirement Submit required clinical data to into MHM Data Registry for all eligible beneficiaries.
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Figure 4. Beneficiary sees a practitioner who belongs to a Control participant organization.
7.3 Payment Timing
Your organization will receive payments twice annually, about three to four months after the end of each six-month reporting period. Figure 5 below depicts when the first and second payments will initiate, based on a January 2017 go-live timeline.
Figure 5: Payment Initiation Timeline
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Next Steps
Share payment information with appropriate administrators and colleagues.
Encourage applicable staff to review the MHM Data Registry data submission process to ensure payment according to standard timelines.
8.0 Using POST Portal to Assess and Improve Your Performance You will use the POST Portal to get up-to-date information about your organization’s performance and to communicate with your assigned MHPO regarding any CAPs for your organization. Only your organization’s designated POCs have access to POST. 8.1 Performance Data Captured in POST Portal The POST Portal shows information on your organization’s enrolled beneficiaries and model payments made to your organization. Beneficiary information captured in POST Portal includes the following:
Total beneficiaries currently enrolled in the model
% accuracy between model-eligible beneficiaries for which claims were submitted and reported on in the MHM Data Registry
Number of eligible beneficiaries not yet enrolled in model as of the last year of model participation
Number of beneficiaries updated in last performance year
Number of beneficiaries determined ineligible and for which exclusion criteria Payments-related information captured in POST Portal includes the following:
Total payments disbursed
Last reporting period’s payment
Total recoupment 8.2 Corrective Action Plans If your organization is not compliant with the Model Participation Agreement (MPA) or program integrity, CMS will notify you via e-mail and request you upload your corrective action plan (CAP) into POST Portal. Your CAP must outline the actions your organization will take within a CMS-specified time period to ensure that all deficiencies will be corrected. There are several situations when your organization may be placed on a CAP. These include, but are not limited to, the following:
Changing how your practice implements the Model without amending the MPA
Failure to notify CMS at least 30 calendar days prior to changes regarding: organization name; POCs; practitioner names, service site name, or NPI; Organization TIN; Merger/acquisition of participating organization; cessation of practice operations; or departure/inclusion of any practitioner
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Failure to notify CMS within 15 calendar days of: departure or exclusion of any model beneficiary; participant’s entrance into proceedings related to bankruptcy; participant or any practitioner being under investigation or being sanctioned by the Government or any licensing authority
Non-compliance with CMS audit
Unapproved use of model information, including public communications
Inadequate privacy and security safeguards for all model-related information that identifies beneficiaries
Failure to submit at least 90% of model-eligible beneficiaries for which claims were submitted during a given reporting period
Failure to update clinical data for at least 95% of eligible, enrolled beneficiaries each year
No documentation of at least two annual follow-up interactions with each high-risk beneficiary annually
Failure to engage beneficiary in shared decision making and document it in electronic health records (EHR)
8.3 Accessing the POST Portal Only your organization’s designated POCs have access to POST portal. To access the POST Portal, go to https://app.innovation.cms.gov/mhcvd and enter your username and password. If you forget your POST Portal username or password, the SalesForce Help Desk team will be able to restore your access. You can contact the SalesForce Help Desk by phone or email: Phone: 1-888-734-6433, option 5 Email: [email protected]
Next Steps
After the first reporting period, check your organization’s performance indicators as desired.
If your organization has been notified of a model deficiency, communicate with your MHPO regarding a CAP.
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9.0 Customer Service and Contact Information
9.1 MH Model Help Desk We encourage you to call the MH Model Help Desk for any questions related to the MH Model. Our customer service representatives would be happy to assist you during our regular business hours (Monday through Friday, 8:30 am to 7:30 pm EDT). Contact information is listed below.
Phone: 1-844-711-2664, option 3
Email: [email protected] 9.2 Emails from the MH Model Team Emails from the MH Model Team to participants will be sent from a general CMS distribution email address: [email protected]. To make sure you do not miss any important communications, please add this email address to your safe list. As the general distribution address is unable to receive emails, you should continue to send emails to the MH Model Team at [email protected]. Project officers will contact participant POCs through the MH Model Help Desk or by email via the MH Model email address. Participants may contact their project officer by emailing [email protected] and stating they would like to speak with their project officer. 9.3 POST Portal Access Questions If you have questions about the POST Portal, please contact the SalesForce Help Desk at the contact information below: Phone: 1-888-734-6433, option 5 Email: [email protected]
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Appendix 1: Summary of MH Model Training Events Below is an overview of each training event including an event summary, who is expected to attend and the format of the event..
Table 3: MH Model Training Activities
Training Activity Format Event Summary Attendees Link to Content
Orientation
Live Webinar
Learn more about the MH Model’s technology platforms, policies and payment processes and meet your fellow intervention group participants.
Recommended for both Clinical team and Practice administrators
https://engage.vevent.com/rt/cms2~070716pm
Introduction to the MHM Data Registry for Control Group
Live Webinar
Learn about the MHM Data Registry including what it is, what its major components are, and how you are expected to use it.
Mandatory: Practice Administrators Optional: Clinical team
https://engage.vevent.com/rt/cms2~101116
Understanding Beneficiary Enrollment and Alignment
Video
Learn how to enroll beneficiaries into the model and view a demonstration of how to input beneficiary data into the MHM Data Registry.
Mandatory: Practice Administrators Optional: Clinical team
https://www.youtube.com/watch?v=KNfpnuTIbwA&feature=youtu.be
Using the MHM Data Registry in Practice
Web-based Training Module
Practice how to access and use the MHM Data Registry by completing this interactive, online training.
Mandatory: Practice Administrators Optional: Clinical team
http://mhmregistrywbt-control.cms.gov/
Training Review and Q&A session
Live Webinar
Join the Model Team for a review of key tools and model requirements before Go-Live, with an opportunity to ask questions about any previous training topics.
Optional: Clinical team and Practice administrators
https://engage.vevent.com/rt/cms2~120816pm
Supplemental guides, question and answer documents, and other useful materials can be found in the Control Group Document Library at the following URL: http://mhmodel-
controlgroup-documentlibrary.cms.gov/
