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Patient-Centered Medical Home

The Colorado Multi-Stakeholder Pilot Experience

PCPCC Stakeholder Meeting

March 30, 2010Julie Schilz BSN, MBA

Colorado Clinical Guidelines Collaborative

IPIP and PCMH Manager

PCPCC: Co-Chair Center for Multi-Stakeholder Demonstrations

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Colorado Multi-Payer, Multi-State Patient Centered Medical Home Pilot

Considerations in Demonstration Development

http://www.pcpcc.net/files/PCMH_Demo-Guidelines_03-09.pdf

Name, start date and timeframe Geography-community, statewide, phased approach Convening entity/project contacts Medical home definition and recognition Goals, guiding principles, payment model, evaluation Population of focus-all, Pediatric only, Adult only Participating stakeholders Demographics of participating practices Practice transformation support

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Belmar Family Medicine Broomfield Family Practice Clinix Health Services of

Colorado DeYoung Family Medicine Family Care Southwest Family Practice Associates Ideal Family Healthcare

Internal Medicine Clinic of Fort Collins

Lakewood Family Medicine Lone Tree Family Practice Michael Mignoli MD, Internal Med Miramont Family Medicine Mountaintop Family Health Provident Adult & Senior Medicine Southpark Internal Medicine Westminster Medical Clinic

The Front Line Innovators!

Multi-Payer Pilot StakeholdersHealth Plans Aetna Anthem-Wellpoint CIGNA Colorado Access Colorado Medicaid (HCPF) Humana United Healthcare

Employers Colorado Business Group on Health Centura IBM McKesson State of Colorado Patient Centered Primary Care

Collaborative (PCPCC)

Physician Societies AAFP/CAFP American College of Physicians Colorado Medical Society

Others Colorado Health Department (CDPHE) University of Colorado-Denver Consumers

Hospitals HealthONE Centura Exempla Memorial Hospital Colorado Hospital Association OthersAssociated IPAs Integrated Physician Network Northern Colorado IPA Physician Health Partners

Primary Physician Partners South Metro Physicians

MedSouthPilot Partner Region Health Improvement Collaborative of

Greater Cincinnati

Pilot Evaluator Meredith Rosenthal PhD-Harvard School of

Public Health

Funders The Colorado Trust /The Commonwealth

Fund

CCGC: Convening Organization and Technical Assistance Provider6

Guiding Principles– The Joint Principles– NCQA PPC-PCMH Recognition– Three Tiered Payment Structure– Public & Private Payer Participation

Multi-Stakeholder Steering committee with decision making capabilities

Family Medicine (14) and Internal Medicine Practices (2)-Single physician up to 8 physicians

NCQA Recognition: 14 @ Level III and 2 @ Level II Evaluation-System Value i.e. Cost, Quality and Provider, Provider

Staff, Patient Satisfaction Measures: For QI-44 measures phased over the pilot duration

Start and End Dates

Technical Assistance Start-12.1.2008

Pilot Start (i.e. Payment Start) 5.1.2009

Pilot End Date 4.30.2011 or perhaps 20127

Colorado Multi-Stakeholder Multi-State PCMH Pilot Overview

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Reimbursement for the Outcomes We Need in Health Care

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Problems with current model-overuse, underuse and “test passing”

For more information:www.pcpcc.net/content/proposed-hybridblendedreimbursement-model

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Components of PMPM for Practices to Transform into Medical Homes

1Quality Improvement Activities

Leadership/Culture Change

Practice Redesign

Data Use for Pop. Mgmt & Reporting

Team Mtgs & Learning Collaboratives

Patient Experience Surveys

Technology Infrastructure

2 & 3EMR/Registry Functionality

Attribution Reconciliation

Technology - Hardware

Communication Platform

Administrative Costs

4Care Team with Care Plan Manager – Care Coordinator

• Customer Service – Patient Centeredness

• Monitor Registry: Follow Up/Outreach

• Track tests/reports from specialists, hospitals, health plans, etc…

• Patient self management support & self efficacy

• Coordination of Care:• Mental Health• Behaviorists (CDE, Nutritionist,

Smoking Cessation, Asthma Educator• Complex Case Managers

• Community Resources

Phone Calls & E-Mails – 24/7 Coverage

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Pay for Performance ModelTwo Components

Quality – 60%: Diabetes CVD Tobacco Depression

Cost – 40%: ER Visits Hospital Admits Generic Pharmacy

P4P Quality Measures P4P Cost Measures

ER Visits“Avoidable ER Visits” list Overall Hospital Admissions“Avoidable Admissions” list Generic PharmacyMost Prevalent/Costly list

MEASURED ACROSS ALL PRACTICES

1. Office Redesign

Technical Assistance

Based on IPIP - Planned Care Model - IHI

Focused Approach Related to NCQA Tool

In Office QI CoachesLearning Collaboratives & Calls

Monthly Practice Reporting

2. Technology

Common Communication PlatformHIPAA Compliant E-Mail

Care Plan - Registry

Patient Portal- Engagement

3. Integrating Care

Expand Services; Coordinate/ Integrate care with “Medical Neighborhood”

using Compacts

Care Plan Manager/Coordinator

Co-Located/Shared/Referred Services

4. Patient Centered

Enhance Access

Patient Activation & Satisfaction (Experience)

Form Partnership with Patients – Shared Decision Making

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Questions?

Thank You!

Julie Schilz

JSchilz@coloradoguidelines.orgwww.coloradoguidelines.org

Patient Centered Primary Care Collaborative

www.pcpcc.net