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Maine PCMH Pilot Phase 2 Expansion Introduction. Objectives. Welcome! Brief overview Maine PCMH Pilot Review benefits and expectations for Phase 2 practices Preparing to join Pilot – next steps. Why We’re Here. Maine’s Medical Home Movement. ~ 540 Maine Primary Care Practices . - PowerPoint PPT Presentation
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Maine PCMH Pilot Phase 2 Expansion
Introduction
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Objectives
Welcome!Brief overview Maine PCMH Pilot Review benefits and expectations for
Phase 2 practicesPreparing to join Pilot – next steps
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Why We’re Here3
Maine’s Medical Home Movement
~ 540 Maine Primary Care Practices
26 Maine PCMH Pilot Practices
50 Pilot Phase 2
Practices
14 FQHCs CMS
Advanced Primary Care (APC) Demo
100+ Nat’l Committee for Quality Assurance (NCQA)
PCMH Recognized Practices
~130+ MaineCare Health Home-
eligible Practices
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Maine PCMH Pilot Leadership
Maine Quality Counts
Maine Qualit
y Forum Maine
Health Manageme
nt Coalition
MaineCare
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Maine PCMH Pilot Key elements:
Convened by Maine Quality Forum, Maine Quality Counts, Maine Health Management Coalition
Originally, 3-year multi-payer PCMH pilot (now 5 yrs)
Collaborative effort of key stakeholders, major payers
Use common mission & vision, guiding principles for Maine PCMH model
Phase 1 includes 22 adult/ 4 pediatric PCP practices across state
Practices receive support for practice transformation & shared learning
Pilot committed to engaging consumers/ patients at all levels
USM Muskie team conducting rigorous outcomes evaluation (clinical, cost, patient experience of care)
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Phase 1 Practices
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Maine PCMH Pilot Practice “Core Expectations”
1. Demonstrated physician leadership2. Team-based approach3. Population risk-stratification and management4. Practice-integrated care management5. Same-day access6. Behavioral-physical health integration7. Inclusion of patients & families8. Connection to community / local community resources9. Commitment to waste reduction10. Patient-centered HIT
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Maine PCMH Pilot – Payment Model
Major private payers participating + Medicaid + Medicare (MAPCP demo)
3-component PCMH payment: NEW prospective (pmpm) PCMH care management
payments – approx $3pmpm commercial payers & Medicaid; $7pmpm Medicare
Ongoing FFS payments Ongoing health plan performance payments for
meeting quality targets (i.e. existing P4P programs)
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But What Does it All Mean - to Patients?
Vision for Change – Phase I Teams (June 09)• “They were here for me”• “Everybody here feels like family”• “They really help us get through the system”• “I feel well cared for in my practice”• “They know what I need and when I need it”• “I don’t feel so alone or anxious anymore”• “Wow – all my needs were met!”
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CMS MAPCP Demo
Medicare (CMS) Multi-Payer Advanced Practice (MAPCP) “medical Home” Pilot
Medicare joined Pilot a payerAllowed introduction of Community Care TeamsStronger focus on reducing waste & avoidable costs –
particularly readmissionsAbility to access Medicare data for reporting,
identifying pts at riskOpportunity for 50 additional practices to join “Phase
2” of Pilot (Jan 2013)
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Maine PCMH Pilot - MAPCP Timeline
ME PCMH Pilot - Original
ME PCMH Pilot - Extended
Jan 1, 2010
Dec 31, 2014
Jan 1, 2012
Pilot Expansion
2011 2012 2013 Dec 31, 2014
MAPCP Demo – 3yr
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Multi-Payer Pilot Phase 2 Expansion
• 107 practices applied; 84 qualified for multi-payer Pilot
• Expectations:– Strong leadership for change– NCQA PCMH recognition (Level 1 or higher)-
complete status survey by July 18th– Fully implemented Electronic Medical Record (EMR)– Commitment to implement Pilot Core Expectations
• 50 new adult practices selected for participation in multi-payer Pilot, highly competitive process!
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Maine PCMH Pilot – Existing + 50 Expansion Practice Sites
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Community Care Teams
Multi-disciplinary, community-based, practice-integrated care teams
Build on successful models (NC, VT, NJ)Support patients & practices in Pilot sites, helping
patients overcome barriers to care, improve outcomesReceive pmpm payments from Medicaid, Medicare,
commercial payersKey element of cost-reduction strategy, targeting high-
cost patients to reduce avoidable costs (avoidable ED use, admissions)
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PCMH Practice
High-need Individual
Maine PCMH Pilot Community Care Teams
Transportation
Workplace
Environment
Food Systems
Shopping
Income
HeatFaith
Community
Literacy
Coaching
Physical Therapy
Hospital Services
Specialists
Outpatient Services
Med Mgt
HousingCare Mgt
Behav. Health & Sub Abuse
Family
Schools
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Eligibility Maine PCMH Pilot Expansion
Practice meets MaineCare Health Home requirementsAdult primary care practice site with at least one full-time
primary care physician or nurse practitionerPractice site does not currently participate in the CMS FQHC
Advanced Primary Care (APC) DemonstrationMinimum patient panel of 1000+ patients enrolled in Pilot
health plans (Anthem BCBS, Aetna, Harvard Pilgrim Health Care, MaineCare, and Medicare).
Completion of Maine PCMH Pilot Phase 2 Expansion “Memorandum of Agreement” (MOA)
Agreement to contribute modest PMPM toward practice transformation support
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What It Means for New Practices
Practices joining multi-payer PCMH Pilot in January 2013 will receive… New PCMH payments from participating payers
Medicare, Medicaid (HH), Aetna, Anthem, HPHC Community Care Team support for highest needs pts Practice transformation support (fee required)
Expectations Commitment to implement Pilot Core Expectations,
demonstrate improvements in quality & cost savings Contribute practice transformation support fee
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Pilot Participation Requirements
Baseline on-site practice assessment Expectation outlined in original MOA Intended to identify practice PCMH strengths &
opportunities for improvement Pilot supports 50% costs; practices required to support
remaining 50% (est’d ~ $500) Scheduled as 2 d visit in practice (Sept – Dec) Aiming for reports back to all practices before Jan 2013
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Leadership team to attend Learning Sessions 3 sessions/year (Feb – June – Oct) – dates TBD! Will be held in 1 central location (alternate
Augusta/Bangor/other?) At least 3 team members must attend (up to 5 team
members may attend)Participate in monthly leadership webinarsWork collaboratively with QI CoachSubmit bi-monthly Core Expectation Status RptsSubmit quarterly Clinical Outcomes Data Rpts
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Pilot Participation Requirements
Practice Transformation Support fees CMS requirement to provide same level of practice
transformation support as Phase 1 Supports
Central project management QI coaching PCMH Learning Collaborative & Learning Sessions Webinars, web-based tools
Est’d to be $0.25pmpm ($3pmpy), based on panel sizes reported in practice application
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Pilot Participation Requirements
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Maine PCMH Pilot – Revenue Projection
$173,670
$10,500
Possible "Actual" Scenario (Using Median Panel size = 3500 patients)
Practice Net Revenue*
Practice Transformation Support Fee ($0.25 pmpm= $3pmpy)
*Example based on 3,500 panel composition: 25% Commercial Payer (~$3pmpm) 20% MaineCare ($3.50pmpm + $3.50 pmpm PCCM fee) 25% Medicare ($6.95 pmpm)
Lessons from 1st PCMH Demo
Becoming a PCMH requires transformation (not incremental change)
Technology needed for PCMH is not “plug & play”Transformation to PCMH requires personal
transformation (esp. physicians!)Change fatigue is serious concernTransformation to PCMH is developmental process,
& local processThe medical home is not something that can be
“installed”
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Lessons Learned fromMaine PCMH Pilot
Change starts with effective leadership – clinician, administrative, and organizational
Recognize risks of “change overload” – need to focus, prioritize, sequence change efforts
Recognize that successful change happens only through effective teams (make changes with people, not to people)
Recognize value of external & internal QI coaching
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Change is Hard • Hard to change your
shorts while running! (and hard to practice while practicing)
• PCMH requires practice and personal change
• People fear change (loss) - any change
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Sustaining Change is Even Harder!
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• PCMH requires transformation, not incremental change
• Making many changes is harder than single change
• Sustaining change can be exhausting
• Marathon, not a sprint!
Next Steps
Participate in practice on-site assessment (Sept-Dec)
Attend monthly “ramp-up” team calls/webinars (2nd Thurs each month, 7:30A & 4:30P)
Plan for leadership team to attend Expansion Launch – November 16, 2012 Augusta Civic Center
Hold your own team meetings (ideally, weekly!), spread communications about Pilot across team
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Summing Up: Medical Home Is Where…
Patients feel welcomedStaff takes pleasure in
workingPhysicians feel energized
every day
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Contact Info / Questions
Maine PCMH Pilot: www.mainequalitycounts.org(See “Major Programs” “PCMH Pilot”)
• PCMH• Nancy Grenier, RN: [email protected], tel 240.8767• Kaleigh Sloan, MPH: [email protected] , tel 622.3374 X
220• Lisa Letourneau MD, MPH: [email protected]
• CCTs: Helena Peterson: [email protected], tel. 266-7211
MaineCare Health Homes Michelle Probert: [email protected] , tel. 287-2641
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