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Status Update. Quality Counts (QC) Lunch & Learn Webinar January 4, 2011 Sue Butts-Dion, Project Director Lisa Letourneau, MD MPH, Executive Director, QC. Key Players. Funders Maine Health Access Foundation Harvard Pilgrim Healthcare Robert Wood Johnson Foundation Davis Foundation

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Status Update

Quality Counts (QC) Lunch & Learn Webinar

January 4, 2011

Sue Butts-Dion, Project Director

Lisa Letourneau, MD MPH, Executive Director, QC


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Key Players

Funders

Maine Health Access Foundation

Harvard Pilgrim Healthcare

Robert Wood Johnson Foundation

Davis Foundation

Martin’s Point

Conveners

Evaluators

Muskie School of Public Health

  • Conveners

    • Maine Quality Forum

    • Maine Health Management Coalition

    • Quality Counts

  • Payers

    • MaineCare (Medicaid)

    • Aetna

    • Anthem

    • Harvard Pilgrim Health Care


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Those Most Key…The Practices

  • Belgrade Regional Health Center

  • Blue Hill Family Medicine

  • Central Maine Family Practice Topsham

  • Community Health Center

  • Court Street Family Practice

  • Dexter Family Practice

  • DFD Russell Medical Center

  • EMMC Center for Family Medicine

  • MMC Husson Internal Medicine

  • Four Seasons Family Practice

  • Lifespan Family Healthcare

  • MMC Family Medicine – Portland

  • Maine Medical Partners – Westbrook Internal Medicine

  • Mid-Maine Internal Medicine – No Vassalboro

  • Newport Family Practice

  • PCHC Penobscot Community Health Center

  • PCHC Helen Hunt Health Center Seaport Family Practices

  • SMMC Prime Care

  • Swift River Health Care

  • Wilson Stream Family Practice

  • Winthrop Family Practice (MGHA)

  • EMMC Husson Pediatrics

  • Maine Medical Partners- Westbrook Pediatrics

  • PCHC Penobscot Pediatrics

  • Winthrop Pediatric & Adolescent Medicine


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AND, their QI Coaches

  • Renea Anderson, EMH

  • Angela Best, MMCPHO

  • Jodi Beck, MaineGeneral

  • Linda Coleman, Maine Network for Health

  • Valli Geiger, MePCA

  • Pam Hageny, MePCA

  • Jacqueline Madore, MMC

  • Muriel Michaud, CMHC

  • Linda Nadeau, St. Mary’s Health System

  • Georges Nashan, Maine Network for Health

  • Lori Newcomb, EMH

  • Carol Overman, MaineGeneral

  • Kris Scrutchfield , MMCPHO

  • Sandra Wardwell, NP, PCHC


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Key Pilot Elements

  • 3-year multi-payer PCMH pilot

  • Collaborative effort of key stakeholders and major payers

  • Adopted common mission & vision, guiding principles for Maine PCMH model

  • Identified Ten Core Expectations

  • Selected 22 adult / 4 pediatric PCP practices across state

  • Conducting rigorous outcomes evaluation (clinical, cost, patient experience)

  • Supporting practice transformation and learning

  • Thousands of patients impacted



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Key Goals/ Measures

  • Progress Towards Full Implementation of Ten Core Expectations

    • Overall Improvement

    • 5 Must pass elements (leadership, team based approach & access)

    • Moderate Progress to Fully Implemented in the 10 categories (20 elements total)

  • Meet Participation Requirements

    • NCQA

    • Meet > 80% requirements

  • Improve Experience/Satisfaction

    • Patients & Families

    • Workforce

  • Improve Clinical Quality

    • Diabetes

    • Cardiovascular

    • Depression

    • Tobacco

    • Prevention

  • Reduce Waste

    • Emergency Department Visits

    • Avoidable Tests

    • Hospitalizations

    • Generic Pharmacy


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Maine PCMH Pilot “Core Expectations” for Practices

  • Demonstrated physician leadership for improvement

  • Team-based approach

  • Population risk-stratification and management

  • Practice-integrated care management

  • Same-day access

  • Behavioral-physical health integration

  • Inclusion of patients & families

  • Connection to community / local HMP

  • Commitment to waste reduction

  • Integration of health IT

Core Expectation Definitions available at www.mainequalitycounts.org


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Core Expectation Summary

  • Pilot average improved in 100% of the core expectations from base line assessment through December 2010

    • Most improvement in following areas (on average):

      • Integrated Care Management (all 3 elements)

      • Connecting with community partners (HMPs)

      • Engaging Patients in ongoing work of practice

    • Biggest opportunity for continued improvement (on average) :

      • Engaging Patients and Family Members

      • Connecting with community partners (HMPs)

      • Waste Reduction

      • Population Risk Stratification

      • Care Management (specifically element 5c: Care management staff have defined methods for tracking outcomes for patients receiving care management services)


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Core Expectation Summary

  • Minimum Requirements

    • 5 achieved 100%

    • 13 achieved 80%-<100%

    • 8 achieved < 80%

  • Must Pass Elements

    • 5 Practices did not meet 1 or more “must pass” elements


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NCQA PPC-PCMH Recognition

  • 100% of practice achieved National Committee on Quality Assurance (NCQA) recognition for Physician Practice Connection-Patient Centered Medical Home (PPC-PCMH)

    • 13 Practices (Level 1)

    • 5 Practices (Level 2)

    • 8 Practices (Level 3)


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Learning Sessions

  • First Session June, 2009 followed by four Learning Sessions (October, 2009; February, June 7 & October 2010)

  • Nine of the 10 Core Expectations covered, at high level, at the four Learning Sessions with HIT to be covered February 11, 2010

  • Average of 135 participants


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Patient Experience Surveys

  • Surveys administered December 2009-May 2010

  • 25 of 26 practices collected 75% or more of their target number of surveys required



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Workforce-Culture Surveys

  • Administered in late Summer, 2010

  • 18 of 26 practices received >75% response rate to culture surveys

  • Results to practices October-December, 2010

  • Surveyed practices on six general dimensions:

    • adaptive reserve

    • community knowledge

    • health information technology

    • patient safety culture

    • Teamwork

    • staff burnout

  • Using Survey results to identify and feature high performing practices in various forums moving forward





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Year 2

  • Focused work on reducing unnecessary & avoidable waste and utilization

    • Regional meetings in addition to learning sessions

  • Continued data collection, reporting and analysis

  • Continued transformation support to Pilot practices


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And..

  • Preparing for CMS Multi-Payer Advanced Primary Care Demonstration—targeted start date July, 2011


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Medicare Med Home Demo

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

  • States with multi-payer pilots invited to apply – must meet eligibility criteria

    • Majority of payers must participate

    • Pilot must be consistent with natl PCMH defn’s

    • Must connect with community resources & supports

  • Maine 1 of 8 states selected by CMS – Medicare to participate as payer in state PCMH pilots


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Medicare Med Home Demo

  • CMS offers up to $10 pmpm in new Medicare payments - Maine proposed:

    • $7 pmpm to providers,

    • $3 pmpm for community-based care management

  • Must describe expectations for budget-neutrality (i.e. must project $10 pmpm savings)

  • Maine proposal – through PCMH model, achieve…

    • 6-7% decreases in inpatient admissions

    • 5% decrease in ED visits

    • 5% decrease in specialty consultations

    • 5% decrease in imaging use


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MAPCP FAQs

  • Q: Are there plans to  expand the number of PCMH Pilot sites as part of the MAPCP Demo?

  • A: Proposed to expand the number of sites in the Maine PCMH Pilot by 20 practices (22 to 42) in Year 2 of the demo –July, 2012. However, this is subject to the other payers agreeing to continue to pay.

  • Q: What is the intersection between the ME PCMH Pilot/MAPCP demo & the upcoming CMS ACO program ?

  • A: Important to note that the CMS ACO  program is a “program” and not a “demonstration” – an important distinction. This issue came up during our application for the MAPCP demo, and CMS was quite clear that they understood this could be an issue for many states & provider groups.  Given that, we had several communications from CMS that essentially said they would not consider participation in the MAPCP demo to exclude provider groups from future participation in the CMS ACO program, but would also not want to pay providers twice for the same services. 


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Top Achievements for 2010—Our Perspective

  • All practices made some progress on Core Expectations, many made substantial progress on many of them, and most Pilot practices appear to have strengthened their improvement teams

  • Pilot practices are learning from each other (e.g., site visit and communications between teams)

  • Pilot’s commitment to deliver data feedback to practices in all areas of the evaluation (i.e., pt experience, clinical quality, cost/resource use)

  • Selection for participation in CMS MAPCP demo!


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In Their Own Words…

  • Stories from the field..


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  • “What I am most proud of from our first year in the Medical Home Pilot is forming a patient advisory council- patients will be part of our decision making; teaching staff what a team means; changing access for patients; putting more money into social work and disease management- taking care of the whole person has help some very sick people feel supported.”

    • Katie Sendze,Practice Administrator

      Winthrop Family Medicine, MGMC


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  • I am proud of the group process that we have started including participants from all areas of the practice and the changes we have agreed to work on together.  I am proud of the training that we have been involved with and our staff has gained a great deal from what they are learning.

    • Catherine Princell

      Blue Hill FM


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  • The biggest improvement that we have made as a result of the Pilot participation is that staff now think in a mind frame of “the process” that a patient has to go thru to get what they need- this is very patient centered, its not just about “our convenience” “our process”, this is a paradigm shift!

    • Katie Sendze, Practice Administrator; Winthrop Family Medicine, MGMC

  • The biggest improvement is our EMR and how we have had to prepare everyone to use it.  The change of process and attention that everyone is giving to our patient charting has really been a quality improvement initiative and our patients are already noticing a rise in the standard of care.

    • Catherine Princell

      Blue Hill FM


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  • The “blue folder” project is our biggest improvement. This is a folder for our at risk patients and they take it with them to all doctor’s visits, the pharmacy, specialist, hospital, etc. There is a complete list of medications, allergies, surgeries, specialist contact info, OTC meds, emergency contact info and standing orders such as DNR and living will. Families of these patients have responded overwhelmingly with how this has helped them and save time and medication errors. One patient called an ambulance because she thought she was having a stroke. When they got there, they saw the blue folder on the table and was able to determine exactly what meds she was on, what her allergies were and contact information even though she could not communicate.

    • Margaret Towle, Practice Admin

      Dexter Family Practice


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Advice to Other Practices This is a folder for our at risk patients and they take it with them to all doctor’s visits, the pharmacy, specialist, hospital, etc. There is a complete list of medications, allergies, surgeries, specialist contact info, OTC meds, emergency contact info and standing orders such as DNR and living will. Families of these patients have responded overwhelmingly with how this has helped them and save time and medication errors. One patient called an ambulance because she thought she was having a stroke. When they got there, they saw the blue folder on the table and was able to determine exactly what meds she was on, what her allergies were and contact information even though she could not communicate.

  • Start now with the staff. Buy in to this project by everyone is vital. Get the picture of a patient centered home in their head and what that means and begin the process of how their office can be transformed.

    Margaret Towle

    Dexter FP

I would advise any practice interested in starting the process to communicate fully with all of the players that will need to be on board to participate and look at their current process very carefully and allow a great deal of time for training.

Catherine Princell

Blue Hill FM


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ME PCMH Pilot “In the News” This is a folder for our at risk patients and they take it with them to all doctor’s visits, the pharmacy, specialist, hospital, etc. There is a complete list of medications, allergies, surgeries, specialist contact info, OTC meds, emergency contact info and standing orders such as DNR and living will. Families of these patients have responded overwhelmingly with how this has helped them and save time and medication errors. One patient called an ambulance because she thought she was having a stroke. When they got there, they saw the blue folder on the table and was able to determine exactly what meds she was on, what her allergies were and contact information even though she could not communicate.

  • “Get your doctor’s attention in the exam room” Bangor Daily News Written by Dr. Robert Allen from Penobscot Community Health Center, one of the PCMH Pilot sites, this is an article with practical tips on interacting with the patient in the exam room while, at the same time navigating through the patients’ information in the electronic medical record. More to come at Learning Session 5! http://www.mainequalitycounts.org/pcmh-tools-and-resources/cat_view/86-patient-centered-medical-home/95-health-information-technology.html

  • “Doctor’s Offices in Primary Care Experiment” This Portland Press Herald article on Nov 17, 2010 noted Maine’s selection as one of 8 states in the CMS Multi-Payer Advanced Primary Care Practice (medical home) Demonstration. http://www.pressherald.com/news/maine-doctors-offices-to-take-part-in-primary-health-care-experiment_2010-11-17.html

  • “NPR Series Focuses on Primary Care and the Medical Home”In August, National Public Radio (NPR) health policy correspondent Julie Rovner visited Maine and interviewed several primary care providers about the pressures of primary care and potential solutions, and featured the story in a three-part series on All Things Considered titled "Primary Care under Pressure". For more information and to access transcripts and listening broadcasts from the series, go to http://www.mainequalitycounts.org/pcmh/35-main/239-npr-series-focuses-on-primary-care-and-the-medical-home.html.


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Key Contacts This is a folder for our at risk patients and they take it with them to all doctor’s visits, the pharmacy, specialist, hospital, etc. There is a complete list of medications, allergies, surgeries, specialist contact info, OTC meds, emergency contact info and standing orders such as DNR and living will. Families of these patients have responded overwhelmingly with how this has helped them and save time and medication errors. One patient called an ambulance because she thought she was having a stroke. When they got there, they saw the blue folder on the table and was able to determine exactly what meds she was on, what her allergies were and contact information even though she could not communicate.

  • 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 “Resource Library” & “News” sections)

  • Additional info on PCMH model, pilots

    • www.pcpcc.net


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