NASHP - October 5, 2010

Lisa M. Letourneau MD, MPHQuality Counts

Learning the ABCs of APCs and Medical Homes

Objectives

• Review basic elements, goals for Maine PCMH Pilot

• Highlight unique features of Maine Pilot

• Share lessons learned to date

• Look forward to upcoming opportunities (ACA)

Maine PCMH Pilot Key elements:

– 3-year multi-payer PCMH pilot– Collaborative effort of key stakeholders, major payers– Adopted common mission & vision, guiding principles for Maine

PCMH model– Selected 22 adult / 4 pedi PCP practices across state – Supporting practice transformation & shared learnings beyond pilot

practices– Committed to engaging consumers/ patients at all levels– Conducting rigorous outcomes evaluation (clinical, cost, patient

experience of care)

Maine PCMH Pilot - Timeline• Jan 2009: Call for practice applications

• May 2009: Practices notified – start of 6mo “ramp-up period”

• Sept 2009: NCQA PPC-PCMH applications completed

• Sept-Dec: practices contracted with payers

• Jan 2010: Start date for PCMH payments

• Jan 2010- Dec 2012: 3-year PCMH Pilot

Maine PCMH Strengths & Challenges

• Public-private partnership - 3 conveners

• Consumer / patient engagement

• Expectations & support for practice transformation

• Ongoing data feedback for improvement

• Ensuring sufficient payment vs. demonstrating accountability for costs

Maine PCMH Pilot Leadership

Quality Counts

Maine Quality Forum

Maine Health Management

Coalition

Keeping Patients at Center of Maine PCMH Pilot

• Patients/consumers included in Maine Pilot planning, governance

• Patient/consumer focus groups held as part of Pilot planning

• Patient-oriented informational, educational tools• Pilot practices required to include patients in redesign

efforts• Patient experience (CG-CAHPS) part of Pilot

evaluation• Efforts linked w/ AF4Q consumer engagement

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 HMP9. Commitment to waste reduction10.Patient-centered HIT

Support for Practice Transformation

• PCMH Learning Collaborative– IHI “BTS” model; 3 Learning Sessions/yr

• Practice QI Coaches– Most from existing PHOs, med groups– Using microsystems approach to QI

• Technical assistance “experts”– BH integration, work with consumers, HIT

• Ongoing feedback reports – Clinical, claims data

PCMH Evaluation & Data for Improvement

• Patient experience of care– CG-CAHPS patient surveys

• Clinical quality measures– Adult & pedi

• Cost & resource use (HealthDialog rpts)– Hosp’s, readmissions, ED use, imaging

• Practice changes

Data Feedback: Clinical Quality • Practices commit to reporting clinical quality

measures quarterly

• Use 31 clinical quality measures (adult), aligned with meaningful use measures

• Started with 2008 (baseline), then Q1 2010 onward

• Practices use online data reporting system (developed for Pilot), receive comparative feedback reports

Clinical Data Feedback

X

Clinical Data Feedback

Data Feedback: Cost & Resource Use

• Use claims from Maine All-Claims Paid Database, via MHDO

• MQF contracts with Health Dialog to produce reports

• First reports delivered to practices mid-August, using 2008 claims data

• Anticipate ongoing, q6mos reports

Provider Performance Measurement ReportsAugust 2010

Performance SummaryPerformance summary includes:• Demographics about

practice’s panel• Overall practice performance

compared to peers in 3 areas of unwarranted variation

• Evaluation of overall effectiveness and efficiency

• Practice’s score on 6 key utilization measures

• Best opportunities for improvement in the practice

Best Opportunities for Improvement

• Shows where practice is significantly different from peers AND where the total impact of improving is highest

Lessons Learned Maine PCMH Pilot

• Change starts with effective leadership– Primary selection criteria for Pilot

– Don’t assume physician leadership skills - need ongoing support

• Change happens through effective teams

• NCQA PPC-PCMH “medical home”

• It’s all about relationships – with patients AND within teams

• Recognize value of “outside” coaching

Potential Opportunities

• CMS Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration

• Affordable Care Act– Section 2702: Health Homes (Medicaid)– Section 3502: Community Health Teams

(Medicaid Health Homes)– Section 4108: Incentives for Chronic

Disease Prevention

Medicare Med Home Demo• Maine application submitted, proposed new…

• $7 pmpm to providers,• $3 pmpm for community-based care management

• To meet expectations for budget-neutrality (i.e. must project $10 pmpm savings), Maine proposed…• 6-7% decreases in inpatient admissions (CVD & Resp)• 5% decrease in ED visits• 5% decrease in specialty consultations• 5% decrease in imaging use

Maine PCMH Pilot - Issues TBD

• Will new payment be enough to support true practice transformation?

• How best to engage specialists, hospitals in shared goals, producing cost savings?

• How to engage patients in new partnership?

• How to spread learnings to other “non-Pilot” practices

• And more??

www.mainequalitycounts.org

Contact Info / Questions Lisa Letourneau MD, MPH• Letourneau.lisa@gmail.com• 207.415.4043

Sue Butts Dion• sbutts@maine.rr.com

Maine PCMH Pilot• www.mainequalitycounts.org

(See “Major Programs” “PCMH Pilot”)