J.1_MQIDTA_SOW.docx

MACRA Quality Improvement Direct Technical Assistance SOW (Quality Payment Program Small Underserved and Rural Support)

C.1. BACKGROUND

Individual and small group clinician practices, particularly those in underserved and rural areas, serve a critical role in health care delivery but have historically faced challenges adopting certified health information technology (HIT) and demonstrating improved care outcomes facilitated by its use. Effective outreach, guidance and direct technical assistance are essential components of successful HIT adoption, optimization, and engagement in delivery system reform activities. In recent years, the Department of Health and Human Services (HHS) has provided funding for direct technical assistance infrastructures to provide “boots-on-the-ground” resources for Medicare and Medicaid health care clinicians to adopt and optimize the use of HIT and that allows clinicians to succeed in improving health care delivery[footnoteRef:2]. [2: For example, the Regional Extension Centers (RECs) are working nationally with over 53,000 individual and small group clinician practices, 91% of which are live on an EHR and 75% who are demonstrating meaningful use of certified HIT. This investment has seen considerable return, as evidenced by a 2013 Government Accountability Office (GAO) report which found that Medicare clinicians working with RECs were 1.9 times more likely to receive an EHR incentive payment than those who were not working with a REC.]

The Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2)1 (MACRA) established a Direct Technical Assistance (DTA) program to help clinicians shift to a payment system focused on quality and patient outcomes. The change from a fee-for-service (FFS) Medicare payment schedule to one focused on outcomes-based payment will begin on January 1, 2019, when payment to eligible professionals will be based on their composite performance score within the Merit-Based Incentive Payment System (MIPS) program unless: 1) they are full or partial participants in an Alternative Payment Model (APM), 2)are newly enrolled in Medicare, or 3) their total claims are below the low-volume threshold as defined by the Centers for Medicare & Medicaid Services (CMS). With this change clinicians will receive all their Medicare payments based on either their participation in APM or MIPS programs. With few exceptions, professionals who do not receive a substantial portion of their revenues (defined as at least 25% in 2018-2019) from an APM will participate in the MIPS program. MACRA defines eligible clinicians as physicians, physician assistants, nurse practitioners, clinical nurse specialist, certified nurse anesthetist, and a group that includes such professionals for the first two years of MIPS and APM participants, partially qualifying APM participants, and clinicians who do not exceed the low-volume threshold are not subject to MIPS. MIPS eligible clinicians are to be rated on four performance categories: quality, resource use, clinical practice improvement activities, and advancing care information. These performance categories will be measured during a performance period and based on a series of specified measures and activities.

MACRA established a direct technical assistance program, which is referred to hereafter as the MACRA Quality Improvement Direct Technical Assistance (MQIDTA) (Quality Payment Program Small/Underserved/and Rural Support (MQIDTA (QPP-SURS))) Program, in Title I Section 101(c) (11) Technical assistance to Small Practices and Practices in Health Professional Shortage Areas. MACRA states in part, in Title I Section 101(c)(11), https://www.congress.gov/bill/114th-congress/house-bill/2/text) (“The Secretary shall enter into contracts or agreements with appropriate entities (such as quality improvement organizations, regional extension centers (as described in section 3012(c) of the Public Health Service Act), or regional health collaboratives) to offer guidance and assistance to MIPS eligible professionals in practices of 15 or fewer professionals (with priority given to such practices located in rural areas, health professional shortage areas (as designated under in section 332(a)(1)(A) of such Act), and medically underserved areas, and practices with low composite scores) with respect to— ‘‘(i) the performance categories described in clauses (i) through (iv) of paragraph (2)(A); or ‘(ii) how to transition to the implementation of and participation in an alternative payment model as described in section 1833(z)(3)(C).”

As stated in the above legislation, direct technical assistance through this program will target eligible clinicians as defined in the statute in individual or small group practices of 15 or fewer eligible clinicians, focusing on those practicing in historically under resourced areas including rural areas, health professional shortage areas (HPSA), and medically underserved areas (MUA) of greatest need. The challenges associated with HIT adoption and use for clinicians in underserved areas is well documented and the MIPS requirements will require advanced use of HIT potentially expanding the gap for clinicians’ future successful HIT use. Further, clinicians participating in MIPS or APMs may need to perform tasks while working in a team-based environment that shares longitudinal patient data across the continuum of care such as use of:

· Certified, interoperable HIT to generate e-Care Plans

· Population health tools to manage patient populations, close the referral loop, and shift patient care from disease-centric treatment to person-centric treatment

This type of practice transformation must be addressed through practice-specific operational and technical solutions, putting small and rural practices at a disadvantage and needing the most direct technical assistance and support. The desired outcome of this customized direct technical assistance program is to support individual and small group clinician practices, particularly those in underserved and rural areas, in easing the transition of Medicare payments from a FFS system to one based on performance and patient outcomes.

Overall, CMS aims to achieve the following with MACRA Implementation:

· Offer multiple pathways with varying levels of risk and reward for clinicians to tie more of their payments to value

· Expand the opportunities for a broad range of clinicians to participate in APMs

· Minimize additional reporting burdens for eligible clinicians

· Promote understanding of each “Clinicians” status with respect to MIPS and/or APMs

· Support multi-payer initiatives and the development of APMs in Medicaid, Medicare Advantage, and other payer arrangements

C.2. CONTRACT PURPOSE

The purpose of this contract is to provide direct technical assistance and support services tailored to clinician needs to ensure successful participation of MIPS eligible clinicians during the transition of Medicare payments from a FFS system to one based on performance and patient outcomes. CMS anticipates provision of technical assistance resourcing for all eligible clinicians meeting the target population requirements of the geographically defined areas across the country. The contractor will identify, assess, and enroll clinicians into the program. Additionally, the contractor will assist with implementation of a quality improvement program, provide customized direct technical assistance tailored to clinician needs, and enable Peer-to-Peer Learning.

Technical Assistance is defined as clinician outreach, education, practice readiness, practice facilitation, HIT optimization, practice workflow redesign, change management, strategic planning, assisting with full transition to APM, and enabling partnerships with local stakeholders. Through additional contract support, outcomes based measures of customized direct technical assistance will be identified, collected and reported to HHS leadership on a frequent and ongoing basis.

Stakeholders include Quality Improvement Organizations (QIOs), Quality Improvement Networks (QINs), Regional Extension Centers (RECs) as well as State, Local and Regional associations and government. Other identified stakeholders include medical societies or associations and governing boards who support under-resourced individual and/or small group practices who predominately serve Medicare beneficiaries.

C.3 STATEMENT OF WORK – QUALITY PAYMENT PROGRAM SMALL UNDERSERVED AND RURAL SUPPORT

Independently, and not as an agent of the Government, the contractor and its subcontractors shall furnish all necessary services, qualified personnel, material, equipment and facilities not otherwise provided by the government as needed to perform the work requirements specified in the detailed task section below.

The MQIDTA (QPP-SURS) contractor must provide customized direct technical assistance tailored to clinician needs in their geographic service areas to successfully transition Medicare payments from a FFS environment to a performance and patient outcome based system for participating MIPS eligible clinicians. See SOW Requirements for further details

C.3.1 Program Overview The Direct Technical Assistance Program is designed to help clinicians to comply with MIPS eligibility requirements and to improve the quality of care through technical support of eligible clinicians. Upon award, MQIDTA (QPP-SURS) contractors will create networks with an existing infrastructure to provide customized direct technical assistance and support to MIPS eligible clinicians within small group or individual practices, particularly those historically under resourced, including rural areas, health professional shortage areas (HPSA), and medically underserved areas (MUA) of greatest need, or individual and small group practices not fully participating in Alternative Payment Models (APMs) as defined by the QPP

Program Aims for Targeted Populations (as listed above)

· Provide customized technical assistance to all eligible clinicians across the United States.

· Provide a positive customer service experience to clinicians participating in the MIPS/APM programs.

Definitions for the MQIDTA (QPP-SURS) program are as follows:

· Direct Technical Assistance is the active process by which the contractor will assist clinicians with enrolling into the MIPS program by customizing the approach to meet needs and to assist clinicians with transitioning into APMs appropriately. The customized direct technical assistance may include, but is not limited to, the following:

· Understanding MIPs expectations, timelines

· How to read MIPS report

· Creating MIPS-score improvement plan

· Clinicians Outreach and Education

· Evaluation and Assessment of Practice Readiness

· Practice Facilitation

· Evaluation and Assessment of HIT Optimization

· Implementation Practice Workflow Redesign

· Change Management

· Strategic Planning

· Ensuring clinician satisfaction with the process

· Small practices – those practices that contain 15 or fewer professionals

· Health professional shortage area - HPSAs are defined to include 1) urban and rural geographic areas, 2) population groups, and 3) facilities with shortages of health professionals. Resource (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html?redirect=/hpsapsaphysicianbonuses/)

· Medically underserved areas (MUA) - A region that has a relative or absolute deficiency of health care resources–e.g., hospital beds, equipment and/or medical personnel.

· Rural – Includes clinicians in counties designated as micropolitan or non-Core Based Statistical Areas (CBSAs), using HRSA’s 2014-2015 Area Health Resource File (http://datawarehouse.hrsa.gov/data/datadownload/ahrfdownload.aspx)

The MQIDTA (QPP-SURS) contractors’ approach will focus on a targeted number of clinical practices and set of clinicians that meet the criterion of the targeted populations. MQIDTA (QPP-SURS) contractors will focus efforts on providing efficient and customized assistance at the level of clinician need for clinicians within the following categories:

(1) Individual and small practice clinicians

(2) Clinicians located in primary care HPSAs

(3) Clinicians in practices located in rural counties

(4) Clinicians serving large underserved populations

(5) Clinicians with the greatest need of technical assistance

These categories are not mutually exclusive; clinicians who fall in more than one of these categories should be prioritized in the provision of customized direct technical assistance. MQIDTA (QPP-SURS) contractor’s technical assistance will include Peer-to-Peer learning through collaboration and engagement with Learning and Action Networks (LANs).

Successful MQIDTA (QPP-SURS) contractors will be those that provide customized assistance to meet the needs of clinicians that fall into these categories in the successful transition into APMs and/or success in MIPS performance categories at the greatest value to the government, and those contractors that commit to and meet quantifiable outcomes. These outcomes must be aligned with the overall aims of the MACRA requirements for clinicians, many of which have not been defined by the Secretary, and therefore require contractor flexibility. It is vital to leverage previous clinician relationships (i.e. those developed by RECs, QIOs, Transforming Clinical Practice Initiative and other federal technical assistance programs). Additionally, MQIDTA (QPP-SURS) contractors are expected to demonstrate how they will assess needs and provide customized support to previously under or unsupported clinicians (i.e. advanced practice clinicians such as nurse practitioners, physician assistants, specialists, long term or post-acute care professionals, and clinicians not using certified HIT). MQIDTA (QPP-SURS) contractors will develop and implement an approach that allows for tailored assistance to serve eligible clinicians along the spectrum of need. A key goal is to provide the right level of technical assistance at the right time in a way that provides the best possible value to the government. This means development and use of a technical assistance approach that aids clinicians to effectively solve their challenges most efficiently. In extreme cases, technical assistance including a physical “boots on the ground” presence in practices may be required.

How will MQIDTA (QPP-SURS) meet these Goals?

C.3.2 Eligibility Requirements In accordance with the MACRA legislation, MQIDTA (QPP-SURS) contractors may include entities such as Quality Improvement Organizations (QIOs), Regional Extension Centers (RECs) or Regional Health Collaborative (RHCs). MQIDTA (QPP-SURS) contractors are encouraged to collaborate in order to strengthen the application, reach, and scope of services being provided to MIPS eligible clinicians. It is required that the MQIDTA (QPP-SURS) contractor meet the eligibility criteria for the contract goals in providing a comprehensive direct technical assistance approach. The approach will assist in mitigating the challenges faced by small and individual clinicians in rural and other under resourced areas. The MQIDTA (QPP-SURS) contractor is required to bring unique, extensive expertise and experience in order to strengthen the overall strategy in the provision of direct technical assistance. These multi-dimensional challenges will be addressed in tandem by the three types of organizational requirements:

· Requirement 1 - Comprehensive experience and measurable success in providing customized and local direct technical assistance to Medicare and Medicaid health care clinicians (especially those in small, underserved, and rural practices) to adopt and optimize the use of certified HIT

· Requirement 2 - Comprehensive experience and history in working with key stakeholders to implement innovative tools and successful interventions to assist clinicians in addressing quality improvement interventions for Medicare beneficiaries and quality measurement reporting

· Requirement 3 - Multi-stakeholder organization that implements initiatives to improve the quality and affordability of health care services. This organization should be governed by stakeholders that represent clinicians groups, hospitals and health systems; healthcare payers; healthcare purchasers and consumers and entities representing consumers.

These criteria will maximize outreach to MIPS-eligible clinicians in individual and small group practices, and assist in the prioritization of rural and other clinicians in medically underserved areas needing direct technical assistance. CMS may provide guidance related to geographical areas for direct technical assistance, including potential prioritization of clinicians who have not received direct technical assistance in the past.

C.3.3 OUTCOMES AND MEASURES

The goal of this SOW is to support clinicians in individual and small group practices in achieving all four MIPS performance measures of quality improvement, resource use, clinical practice improvement activities, and advancing care information of certified HIT. Important additional intermediate goals will be that clinicians are pleased and satisfied with the technical assistance and support they receive, whether it is for virtual, on-line and telephone technical assistance, participation in learning and action networks, direct technical assistance provided by the contractor in their offices, or other types of technical assistance. MQIDTA (QPP-SURS) contractor performance will be individually monitored and the program collectively assessed on the following proposed metric during the contract period:

· CMS urges contractors to establish and commit to customer service and other goals in their proposals, related to the following desired outcomes:

· Desired Outcomes:

· Serve all clinicians in your defined contiguous area that meet the criteria for small, rural, health professional underserved and medically underserved areas

· Provide customized technical assistance to clinician at the level in which they need and that provides the greatest value

· Ensure eligible clinician’s satisfaction with technical assistance which includes timeliness of touch, support, and useful resources

· Ensure cross pollination of collaboration and education with external stakeholders interested and engaged in this type of work including Practice Transformation Networks (PTNs), Support and Alignment Networks (SANs) and others

· Increase the number of eligible MIPS eligible clinicians participating in MIPS and APM programs

· Transform clinical practices by educating clinicians on successful techniques related to the four MIPS performance categories

· Collaborate with the MIPS/APM Service Center, including accessing and entering service information into a database

· Align with HHS priorities based on the CMS Quality Strategy and National Prevention Strategy

C.3.4 REQUIREMENTS TO BE PERFORMED

Independently, and not as an agent of the Government, the Contractor shall furnish all the necessary services, qualified personnel, material, equipment and facilities not otherwise provided by the Government, as needed to perform the requirements of this SOW. The MQIDTA (QPP-SURS) contractor will cooperate and collaborate with CMS partners, stakeholders and other Federal Agencies involved in similar efforts as applicable to tasks specified in this SOW. The “Operational Requirements” applies to the overall management of the contract.

C.3.4.1 Operational Requirements The MQIDTA (QPP-SURS) contractor will achieve high-quality operations by managing for customer service and results. Overall project management is the key to the success of the MQIDTA (QPP-SURS) contract. The SOW requirements are results-oriented, including measures and performance goals for contract requirements that align with Agency goals and industry standards. Projects of such complexity require a systematic, deliberate, and calculated approach to achieve overall program goals. The MQIDTA (QPP-SURS) contractor will follow a basic project management framework described in a comprehensive strategic plan, which includes, but is not limited to, a contract management plan, implementation strategy, and continuous internal quality improvement program.

C.3.4.1.1 Comprehensive Strategic Plan The Comprehensive Strategic Plan, hereafter referred to as “Strategic Plan” will, at a minimum, include the following components:

a. Vision Statement

b. Mission Statement

c. Organization Core Values

d. Implementation Strategy

e. Customer Service Feedback Plan

f. Sustainability Plan

g. Management Plan

h. Emergency Preparedness Plans

i. Continuous Internal Quality Improvement Program Plan

To optimize MQIDTA (QPP-SURS) internal operations, the MQIDTA (QPP-SURS) contractor will provide a comprehensive strategic plan that aligns with CMS goals and allows CMS to understand the method(s), modes and actions the contractor will use over the life of the contract to ensure all requirements are successfully executed and goals are met. MQIDTA (QPP-SURS)MQIDTA (QPP-SURS)The MQIDTA (QPP-SURS) contractor will provide a detailed description of the strategies and activities planned to address the strategic requirements set forth in this SOW. All individual components of the Strategic Plan will be identified and discussed in separate sections. It is imperative that the MQIDTA (QPP-SURS) contractor clearly articulates how they will:

1. Collaborate with other health care quality improvement and delivery system reform initiatives within and outside of CMS and avoid duplication of work with other CMS contractors involved in those initiatives. In an effort to avoid duplication of efforts, the MQIDTA (QPP-SURS) contractor may be asked to share the names of recruited participants with other health care quality improvement and delivery system reform leaders.

1. Integrate and/or coordinate tasks throughout the life of the contract. CMS requires the MQIDTA (QPP-SURS) contractor to foster the most efficient use of resources, interventions (including recruitment and quality improvement strategies), personnel, and achievement of desired outcomes for quality improvement tasks under this contract.

1. Contribute to the creation of a culture of sharing (with CORs, CMS SMEs, and other MQIDTA (QPP-SURS) contractors) the following information: successful interventions, promising practices, data on progress goals (including customer service), lessons learned, and other relevant information that has led to significant improvement in health, health care and lower cost of health care for beneficiaries.

A single Draft Strategic Plan will be submitted as part of the technical proposal with all of the referenced components presented in separate sections. The Draft Strategic Plan will be discussed in greater detail during the Kick-Off Meeting. The MQIDTA (QPP-SURS) contractor will update the Strategic Plan to a Final Draft with any agreed-upon changes discussed at the Kick-Off Meeting. The Final Draft is due 21 days after award. The Final Strategic Plan is due 90 calendar days after award. Strategic Plan updates shall be provided within 21 days of the start date of any change event.

C.3.4.1.1.2 Customer Service Feedback Plan CMS believes that Clinician experience with technical assistance will have a direct impact on program participation. The MQIDTA (QPP-SURS) contractor will ensure clinicians: 1) receive the right set of resources and tailored technical assistance to make clinicians successful, 2) are not burdened, and 3) value program participation. The MQIDTA (QPP-SURS) contractor will develop a plan, including proposal for reporting more frequently than annual satisfaction surveys, to obtain quantifiable clinician feedback related to their customized technical assistance intervention.

C.3.4.1.1.3 Sustainability Plan The MQIDTA (QPP-SURS) contractor will develop a plan to sustain the relationships and improvements established by the collaboration and participate in a rapid-learning cycle. This will include the standardized submission of challenges as defined by the program, which will be entered on a regular basis using a business intelligence tool as defined by CMS to highlight successful interventions and lessons learned for dissemination at a larger scale across the health care continuum.

C.3.4.1.1.4 Management Plan The MQIDTA (QPP-SURS) contractor shall establish and execute a management structure that strongly and seamlessly supports contract operations. A Management Plan will be provided that is results oriented and, at a minimum, includes:

· Effective lines of communication,

· Budget and cost controls

· Quality assurance reviews

· Project schedule management

· Resource management to include staffing matrices by requirement/sub-requirement

· Progress reviews and performance monitoring

· Risk management

· Change management

· Timely delivery

· Clearly defined roles, responsibilities, lines of authority, and resources appropriately aligned to services and deliverables.

MQIDTA (QPP-SURS) contractors will ensure that all work efforts are integrated and give attention to crosscutting tasks. As the prime contractor, the MQIDTA (QPP-SURS) contractor shall coordinate all subcontracted work to ensure that the efforts of all parties under the contract (management, administrative, and staff) are combined into a cohesive whole. In addition to the management plan, the contractor shall also communicate activities via a tool that is accessible to the public.

C.3.4.1.1.5 Emergency Preparedness Plans The MQIDTA (QPP-SURS) contractor will develop the Emergency Preparedness Plans as a subsection of the Strategic Plan.

C.3.4.1.1.6 Continuous Internal Quality Improvement Program Plan The purpose of the Continuous Internal Quality Improvement Program Plan (CIQIP) is to support and foster an environment of continuous quality improvement within the MQIDTA (QPP-SURS) contractor operation. Such an environment helps to assure success of the MQIDTA (QPP-SURS) contractor in their performance of the contract through ongoing assessment of and improvement when necessary in areas that are critical to organizational success. These include but are not limited to:

· Leadership

· Human Resources

· Customer Satisfaction

· Performance Measures

· Process Management

· Outcomes

CMS encourages each MQIDTA (QPP-SURS) contractor to collaborate with other MQIDTA (QPP-SURS) contractors in developing and implementing CIQI programs. The MQIDTA (QPP-SURS) contractor shall share lessons learned regarding these CIQIP activities with other MQIDTA (QPP-SURS) contractors using the available mechanisms, including MQIDTA (QPP-SURS) conferences, newsletters, and databases.

CIQIP Requirements The MQIDTA (QPP-SURS) contractor shall have a CIQIP that encompasses all quality improvement (QI) requirements, and other major activities including administrative functions such as financial management. The CIQIP shall include the following elements:

1. Identify QI components and/or activities that are included;

1. Based on the Management Plan and overall Strategic Plan, identify measures/monitors of performance that relate to the elements of those plans, including but not limited to each of the QI components and/or activities.

1. Include measures that assess critical outcomes or SOW targets, as well as measures that assess processes related to those outcomes (e.g. measures that assess the implementation and effectiveness of activities designed to achieve the outcome).

1. Develop goals or thresholds for all measures, including goals or targets at various points within the contract period that allow for correction when performance does not appear to be on track to achieve contract goals or targets.

1. Develop timeframes at which measures are to be assessed against the goals/targets.

1. At least quarterly, or more often as performance indicates or otherwise directed, use measures, results, and other information to assess to the likelihood of meeting goals/targets.

1. Analyze those areas where performance fails to achieve expected targets or thresholds and identify any cause or potential cause of failure.

1. Identify changes in the process that address identified causes of failure and how the changes will improve performance.

1. Implement selected changes designed to improve your process and performance.

1. Determine whether improvements were successful, and make further adjustments to the process as needed.

1. Document all aspects of the CIQIP including but not limited to

· QI Components and major activities included

· Measures

· Targets/goals and timeframes at which the targets/goals are to be achieved

· Results of performance at the specified timeframes

· Description of the analysis conducted when measures fail to achieve targets/goals and results of the analysis

· Improvement actions identified and those selected that address the findings of the analysis

· Critical dates and planning for the implementation of improvement actions and

· Re-measurement results

· Communication of the CIQIP and its results across the organization as well as to CMS leadership.

The MQIDTA (QPP-SURS) contractor shall make available in accordance with the Schedule of Deliverables and on request by CMS, documentation of measurements, plan, results, and improvement actions for all quality improvement components and major activities.

C.3.4.2 Enrollment and Assessment The contractor must identify, assess, and enroll clinicians in the program, by completing the following activities:

a. The enrollment effort is intended to span the life of the contract. CMS anticipates initial enrollment for MIPS implementation to be more robust in the first year of the contract.

b. Collaborate with multiple stakeholders and other MIPS/APM communication and outreach mechanisms to enroll small practice clinicians (15 clinicians or fewer), targeting rural and underserved clinicians, and other small practice clinicians, eligible clinicians not participating in PQRS or Advancing Care Information, clinicians with historical underperformance in MIPS, as defined by CMS, in order to provide direct technical assistance to those clinicians to achieve neutral or positive MIPS performance thresholds, or to fully transition into an APM model. The definition of a practice is yet to be defined via rulemaking, but may be defined as all professionals who operate under a single billing entity for MIPS.

c. Engage at least 50% of the eligible clinicians in the targeted geographic area into the program within six (6) months of receiving the award. Within nine (9) months, 90% of projected participants should be engaged. Contractors should engage 100% of eligible clinicians within the targeted geographic area within 1 year of the start of the contract. The contractor will provide CMS with a detailed project plan for enrolled clinician MIPS achievement to CMS within ninety (90) days of enrollment and every calendar quarter thereafter. Engagement is defined as:

· An established connection with the clinician with the understanding that assistance will be provided based on clinician/practice needs.

The contractor will provide CMS with a detailed project plan for enrolled clinician MIPS achievement to CMS within ninety (90) days of enrollment and every calendar quarter thereafter using CMS’ to be defined business intelligence tools.

d. Assess the individual level of technical assistance needed for each clinician to facilitate the development of a customized direct technical assistance plan tailored to each clinician’s needs.

e. Prioritize small or individual practices of 15 or fewer professionals in rural and other underserved settings as well as those with the greatest need of technical assistance. Rural care settings include practices located in non-metropolitan counties, using HRSA’s most recent Area Health Resources File, available here: http://ahrf.hrsa.gov/ . Practices will be considered to be located in Health Professional Shortage Areas (HPSAs) based on the most current zip code HPSA designations (located http://www.hrsa.gov/shortage)

MQIDTA (QPP-SURS) contractors shall focus efforts on providing assistance to the greatest number of clinicians within the following categories:

(1) Individual and small practice clinicians

(2) Clinicians located in primary care HPSAs

(3) Clinicians in practices located in rural counties

(4) Clinicians serving large underserved populations

(5) Clinicians with the greatest need of technical assistance

These categories are not mutually exclusive; clinicians who fall into more than one of these categories shall be prioritized in the provision of direct technical assistance.

C.3.4.3 Customized Direct Technical Assistance By participating in MQIDTA (QPP-SURS), clinicians/practices will be able to receive customized direct technical assistance tailored to their needs and peer-level support to deliver care in a patient-centric and efficient manner, better positioning them for success in an emerging environment, as mandated by the QPP, which prioritizes value and outcomes over volume. The successful completion of this requirement directly relates to the timely delivery of individual service offerings that constitute direct technical assistance provision, as evidenced by experience in previous programs such as QIOs and RECs. Successful MQIDTA (QPP-SURS) contractors will be those that provide assistance to the greatest number of MIPS eligible clinicians within the prioritized categories in the successful transition into APMs and/or success in MIPS performance categories, and commit to meeting quantifiable outcomes. MQIDTA (QPP-SURS) contractors are required to provide the right services and level of support to clinicians at the right time. This means that MQIDTA (QPP-SURS) contractors must be prepared and quickly respond to clinicians in need of technical assistance, in highly efficient ways. The following table includes, but is not limited to, needs and services pertaining to customized direct technical assistance needs of MIPS clinicians for which the MQIDTA (QPP-SURS) contractor will be responsible.

· How to read MIPS report

· Creating MIPS-score improvement plan

· Peer learnings for improvement

· Virtual groups in accordance with MACRA and implementation through rulemaking, as amended

· Identification of local APMs: analysis of participation requirements, business/clinical implications, timing

· Customer Service

· Clinician Outreach and Education

· Practice Readiness

· Practice Facilitation

· Customer Service

· Clinician Outreach and Education

· Practice Readiness

· Practice Facilitation

· HIT Optimization

· Practice Workflow Redesign

· Change Management

· Strategic Planning

· Assist clinicians in fully transitioning to APMs

· Enable Partnerships with Local Stakeholders

· Clinical Quality Reporting (note: e-reporting strongly encouraged but not required under MIPS)

· Meaningful Use Optimization

· Continuous update/education of new quality measures for proceeding year

· Transition to APMs in accordance with rulemaking

· Strategic Planning

· Change Management

· Downloading and understanding quality and resource reports

· Practice Facilitation

· Data Analytics for Population Health Management

· Medical Home services

· Care Coordination

· Beneficiary engagement (including care plans for individuals with complex needs, self-management)

· Patient safety and practice assessment

· Use of Remote Monitoring and telehealth

· EHR and HIT Readiness Assessments

· E-prescribing

· Participation in a public health registry

· Privacy and Security Assessments

· Patient/Consumer Engagement

· Health Information Exchange

· HIT Interoperability

· Meaningful Use Optimization

At minimum, the MQIDTA (QPP-SURS) contractor will provide customized direct technical assistance to support practice/clinician achievement of:

a. 80% of MQIDTA (QPP-SURS)-Eligible Clinicians achieving improved MIPS composite score

b. 100% MQIDTA (QPP-SURS)- Eligible Clinicians implementing and measuring quality improvement interventions in practice

c. 80% of MQIDTA (QPP-SURS)- Eligible Clinicians participating in LANs

The MQIDTA (QPP-SURS) contractor must continue to provide ongoing customized direct technical assistance to all identified recipients at minimal cost throughout the life of this contract. This assistance may link to any and all tasks outlined in the SOW to ensure that the provision of customized direct technical assistance meets the evolving needs of eligible professionals. A key goal is to provide the right level of technical assistance at the right time in a way that provides the best possible value to the government. This means developing and using technical assistance approaches that assist clinicians and effectively solve their challenges with the least possible amount of intervention and expenditure of resources, progressing, if necessary to a physical “boots on the ground” presence in practices.

C.3.4.4 Customer Satisfaction The MQIDTA (QPP-SURS) contractor is encouraged to find smart, easy ways to continuously assess and improve the customer satisfaction of those clinicians who receive their technical assistance in conjunction with information provided from the Customer Service Feedback Plan.

The contractor will conduct practice, clinician, and patient surveys (as applicable) annually to gauge clinician/practice satisfaction with the direct technical assistance provision including identification of whether such assistance helps alleviate administrative reporting burden.

Additionally, the contractor will facilitate clinician participation in CMS requested feedback.

a. Surveys will be pre-developed in electronic format by CMS and contractors to ensure consistency

b. Contractor performance will be partially assessed based on the responses to these surveys. CMS support contractor(s) will validate the data.

C.3.4.5 Practice/Clinician Demographic Information The MQIDTA (QPP-SURS) contractor will document practice/clinicians demographic information including participation in other models or programs. Information on practice/clinician participation in other models or programs will be used for knowledge management as well as increasing synergy and teamwork, while avoiding overlap and duplication of effort.

a. Customer Relationship Management Tool The MQIDTA (QPP-SURS) contractor will record all practice and clinician demographic information, including but not limited to both clinician and practice National Physician Identifier (NPI), in the Office of the National Coordinator (ONC) for Health Information Technology (HIT)Customer Relationship Management (CRM) tool or other CMS designated system at a minimum on a monthly basis.

b. Tracking Eligible Practice/Clinician Participation in Models or Programs In order to facilitate the tracking of eligible clinician participation in such other models or programs and to avoid overlap and duplication of effort, MQIDTA (QPP-SURS) contractors will be required to perform an initial and frequent periodic ongoing environmental scans of such initiatives that MQIDTA (QPP-SURS) participating clinicians in their networks may have joined, and to report the results to CMS using CMS-designated tool. The MQIDTA (QPP-SURS) contractor will work collaboratively with MIPS/APM outreach and education activities including help desk, QIOs, State Innovation Model, RECs, PTNs and other HHS programs for alignment, synergy, and to prevent duplication of effort.

Within 90 days of award:

· Scan the local and immediate environment to identify others who may be receiving HHS or other federal support for related work

· Reach out and discuss how to prevent duplication of effort and achieve synergy with others who are working in this arena

· Document the MQIDTA (QPP-SURS)’s actions and plans to prevent duplication with the COR.

C.3.4.6 Implementation of Quality Improvement Program The MQIDTA (QPP-SURS) contractor must assist with implementation of a quality improvement (QI) program, such as Million Hearts or other QI program that is appropriate for the practice for all enrolled practices/clinicians.

a. Within three (3) months of enrolling clinicians in the program, the MQIDTA (QPP-SURS) contractor will provide documentation on the quality improvement program to which they will be working with the practice/clinician, document baseline performance scores for all clinicians in that practice, and provide documentation on the performance goal to be achieved.

b. On a monthly basis (or more frequently as necessary) from that point, the MQIDTA (QPP-SURS) contractor will provide CMS performance updates for each clinician within the practice, until the practice achieves its performance goal, and quarterly following that time period to ensure the performance goal is maintained. If performance targets are not met, MQIDTA (QPP-SURS) contractor will work with clinicians to achieve performance goal again by performing a root cause analysis.

C.3.4.7 Certified Health Information Technology The MQIDTA (QPP-SURS) contractor will ensure practice/clinician move towards using certified HIT to electronically report quality metrics to CMS for the 2017 reporting period. The MQIDTA (QPP-SURS) contractor must provide direct technical assistance in implementing or upgrading to 2015 certified technology that meets all EHR Incentive Program and MIPS program requirements when available. The MQIDTA (QPP-SURS) contractor will provide ongoing direct technical assistance to ensure enrolled clinicians achieve advancing care information, as well as any additional MIPS-related measures as to be defined by the Secretary. Practices/clinicians should receive sufficient direct technical assistance to upgrade and implement to 2015 certified technology no later than December 31, 2017.

C.3.4.8 Advancing Care Information (Meaningful Use) The MQIDTA (QPP-SURS) contractor will provide customized direct technical assistance to ensure practices/clinicians achieve at least a 50% or improving score on the meaningful use portion of their MIPS. The contractor will work with practices/clinicians to determine which of the Advancing Care Information objectives are most relevant to their practice and assist them in achieving higher scores on those metrics. The measures are categorized by MQIDTA (QPP-SURS) enrollees who had EHR at the time of MQIDTA (QPP-SURS) enrollment and those enrollees who did not have EHR at time of enrollment.

C.3.4.9 Learning and Action Networks The MQIDTA (QPP-SURS) contractor must enable Peer-to-Peer Learning through collaboration and engagement with Learning and Action Networks (LANs) systematically which will be facilitated by other CMS contractor(s). The targeted outcome for LANs is 80% of participating eligible clinicians participate in LAN activities to facilitate achievement of overall program targets.

C.3.4.10 Performance Evaluation The MQIDTA (QPP-SURS) contractor must collaborate with CMS/COR on implementing Performance Evaluation for both outcome measures and MQIDTA (QPP-SURS) contractor performance.

a. Outcome Measures The MQIDTA (QPP-SURS) contractor will comply with the targeted outcomes established within the SOW.

b. Contractor Performance Measures The MQIDTA (QPP-SURS) contractor’s performance will be evaluated throughout the term of the contract, as well as through the deliverables. Contractor performance may include, but is not limited to:

1. Review of work in progress by COR/CMS SME or a designee thereof

2. Progress reports at the end of each phase, as to be determined by COR/CMS SME

3. Inspection of deliverables

4. Review and approval of interim or draft reports

5. Engagement and enrollment (including practice/clinician prioritization)

i. Within 3 months of enrolling clinicians in the program, the MQIDTA (QPP-SURS) contractor will provide documentation on the quality improvement program to which they will be working with the practice/clinician

ii. Information on numbers of clinicians supported, through which technical assistance mechanisms (i.e., online, phone, meetings, physical presence in practice, other), and at what levels of resource/cost/value

6. Patient, practice, clinician satisfaction with MQIDTA (QPP-SURS) contractor direct technical assistance

7. Practice/Clinician success and improvement

C.3.5 REQUIRED MEETINGS

The MQIDTA (QPP-SURS) contractor will participate in required meetings, MQIDTA (QPP-SURS) conferences, and CMS site visits as specified in the following sub-tasks.

C.3.5.1 Kick-off Meeting Within two (2) weeks (10 business days) of the contract award, the MQIDTA (QPP-SURS) contractor will hold a “kickoff” meeting via teleconference with the CMS COR and appropriate CMS and ONC staff to discuss the overall objectives, specific elements of work to be performed, and review and clarify scope of work as well as the delivery schedule for this contract. Delineation of roles and responsibilities, the establishment of communication protocols, and a proposed evaluation strategy will also be discussed. The MQIDTA (QPP-SURS) contractor will prepare a written agenda and send it electronically to CMS for review two (2) business days prior to the meeting. CMS in collaboration with ONC will review and provide recommendations to the MQIDTA (QPP-SURS) contractor within one (1) business day of the meeting. The agenda should include, at minimum, the items outlined above; however, it may be expanded. The MQIDTA (QPP-SURS) contractor will provide the conference line and meeting space for the kick-off meeting.

Within three (3) working days post kick-off meeting, the MQIDTA (QPP-SURS) contractor will provide an electronic summary of the discussion to all participants. Contractors shall review the submitted summary and provide feedback, if needed. Once CMS in collaboration with ONC has reviewed and agreed on the meeting summary, the MQIDTA (QPP-SURS) contractor shall electronically acknowledge receipt and agreement of the final version.

C.3.5.2 Monthly Meetings The MQIDTA (QPP-SURS) contractor shall participate in monthly conference calls with CMS COR or designee to review and summarize progress. Calls may be scheduled more or less frequently, as requested by the CMS COR. The MQIDTA (QPP-SURS) contractor shall prepare the agenda based on the items below and provide an electronic summary of the discussion within three (3) business days of the meeting. The meetings will document:

· Progress during the prior period in completing tasks

· Any problems or major issues encountered; 1) how they came to be; and 2) how they are being addressed. Major issues may include those that involve changes in scope of work, timeline, outcomes, resources, or cost.

· Any foreseeable problems and plans to eliminate or mitigate those problems.

· Any expected change to the delivery schedule and budget

· An electronic summary of items discussed and any action items (along with their deadlines) resulting from the call

C.3.5.3 Site Visits CMS reserves the right to conduct site visits to evaluate any aspect of MQIDTA (QPP-SURS) work, anticipated at minimum annually.

C.3.5.4 Conferences and Travel CMS reserves the right to hold, at a minimum, annual conferences discussing MQIDTA (QPP-SURS). The MQIDTA (QPP-SURS) contractor may travel to annual MQIDTA (QPP-SURS) conferences and the CMS Quality Conference, held by CMS, with minimum participation. All travel must be approved in advance by the COR.

Conference Attendance Requests (CARs): When the MQIDTA (QPP-SURS) contractor plans to have a meeting and/or conference directly related to the performance of the contract, the MQIDTA (QPP-SURS) contractor shall follow the current HHS and CMS travel and meeting policy. The CAR is due four months prior to the planned conference and all travel must be approved by the COR.

C.3.6 REPORTING REQUIREMENTS

The MQIDTA (QPP-SURS) contractor will comply with the reporting requirements specified in the following sub-tasks.

C.3.6.1 Monthly Progress Reports In preparation of monthly meetings, the contractor shall prepare a progress report on the 1st of each month. Progress reports along with the agenda should be electronically submitted to the COR three (3) business days prior to the monthly meeting.

The progress report shall include updates on the following items:

· Progress of current projects and all tasks

· Progress towards meeting contract objectives and targets

· Include reports for any additional reporting requirements identified in tasks

· Any problems or major issues encountered; 1) how they came to be; and 2) how they are being addressed. Major issues may include those that involve changes in scope of work, timeline, outcomes, resources, or cost.

· Customer service feedback and timeliness of technical assistance

· Any foreseeable problems and plans to eliminate or mitigate those problems

· Any expected change to the delivery schedule and budget

· Number of hours worked

Progress reports are not to exceed two (2) typed pages front and back.

Within two (2) business days post monthly meeting, an electronic summary of items discussed and any action items (along with their deadlines) resulting from the call should be electronically delivered to the CMS COR.

C.3.6.2 Outcomes and Measures Reporting MQIDTA (QPP-SURS) contractors will be required to report status of process and outcome measures to CMS on an ongoing basis as defined by CMS using CMS-designated tools.

C.3.6.3 Annual Reports The contractor shall develop and submit Annual Reports at the guidance of CMS. Reports are due one month after the completion of each 12-month period of performance with the exception of the final year of the contract. The Final Report will cover the final year of the contract.

C.3.6.4 Final Report The contractor shall develop a draft final report within 6 weeks of contract end date for review.