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2. . . 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 timeframeGeography-community, statewide, phased approachConvening entity/project contactsMedical home definition and recognitionGoals, guiding principles, payment model, evaluationPopulation of focus-all, Pediatric only, Adult onlyParticipating stakeholdersDemographics of participating prac33921
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1. 1 No timeNo time
2. 2 Brief review 30 Seconds just to orient to our work. Correlation with care model Brief review 30 Seconds just to orient to our work. Correlation with care model
3. Other initiatives. Safety-Net, Medicaid for Children and the Family Medicine residency program.Other initiatives. Safety-Net, Medicaid for Children and the Family Medicine residency program.
4. Considerations in Demonstration Developmenthttp://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
4
Guidelines: Collaboration and Leadership, Practice Recognition, Practice Support, Reimbursement Model, Assessment
and Reporting of Results
The overall considerations in creating a successful collaborative for Patient-Centered Medical Home (PCMH) are the project title, the project location (state, region within the state), the target start date, the pilot/demo length, the convening entity/project contacts, the goal of the pilot, the participating stakeholders, the expected (or actual) demographics of participating practices, the medical home recognition program, the practice transformation support (including technology), the payment model, and the project evaluation.1 For example:
What will the official title of the collaborative be?
What will the length of the pilot be?
Who should serve as the convening organization? Is there no bias?
What should be used for the guiding principles?
Who should participate as stakeholders: payers, providers, patients, other?
What should be used for the Patient-Centered Medical Home measurement: National Committee for Quality Assurance (NCQA) Physician Practice Connections (PPC)-PCMH, or another tool?
During this discussion, we will explore these and other considerations in detail and follow up with and example of a successful pilot program.
1. Patient-Centered Primary Care Collaborative. Patient-Centered Medical Home: Building Evidence and Momentum. Available at: http://www.pcpcc.net/content/pcpcc_pilot_report.pdf.
Guidelines: Collaboration and Leadership, Practice Recognition, Practice Support, Reimbursement Model, Assessment
and Reporting of Results
The overall considerations in creating a successful collaborative for Patient-Centered Medical Home (PCMH) are the project title, the project location (state, region within the state), the target start date, the pilot/demo length, the convening entity/project contacts, the goal of the pilot, the participating stakeholders, the expected (or actual) demographics of participating practices, the medical home recognition program, the practice transformation support (including technology), the payment model, and the project evaluation.1 For example:
What will the official title of the collaborative be?
What will the length of the pilot be?
Who should serve as the convening organization? Is there no bias?
What should be used for the guiding principles?
Who should participate as stakeholders: payers, providers, patients, other?
What should be used for the Patient-Centered Medical Home measurement: National Committee for Quality Assurance (NCQA) Physician Practice Connections (PPC)-PCMH, or another tool?
During this discussion, we will explore these and other considerations in detail and follow up with and example of a successful pilot program.
1. Patient-Centered Primary Care Collaborative. Patient-Centered Medical Home: Building Evidence and Momentum. Available at: http://www.pcpcc.net/content/pcpcc_pilot_report.pdf.
5. 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
6. Multi-Payer Pilot Stakeholders Health 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
Others
Associated IPAs
Integrated Physician Network
Northern Colorado IPA
Physician Health Partners
Primary Physician Partners
South Metro Physicians
MedSouth
Pilot 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 6
7. 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 2012
7 14 achieved Level III
2 achieved Level II14 achieved Level III
2 achieved Level II
8. 8
10. 10 Reimbursement for the Outcomes We Need in Health Caree Two cited rationales for payment reform:
infrastructure support: Several have modeled the costs to a practice to operate a medical home and have found that it requires additional resources in the practice setting, including PCP and other care team member time on traditionally non-billable activities, care management, HIT, and space and equipment.
incentive alignment: Many believe that only changes to the payment system that motivate and support efficient and effective care and counter the FFS “treadmill” incentive will generate practice transformation.
Two cited rationales for payment reform:
infrastructure support: Several have modeled the costs to a practice to operate a medical home and have found that it requires additional resources in the practice setting, including PCP and other care team member time on traditionally non-billable activities, care management, HIT, and space and equipment.
incentive alignment: Many believe that only changes to the payment system that motivate and support efficient and effective care and counter the FFS “treadmill” incentive will generate practice transformation.
11. 11
12. 12
13. Technical Assistance Four Components
One and Two: Basic to Practice Transformation Three and Four start to bring in whole person orientation and Medical Home Concepts.
Office Redesign is built on utilizing the Core foundational Components of Improving Performance in Practice and Ed Wagners Care Model. The work is rounded out with IHI principles of the Model For Improvement and PDSA Cycles.
Practice Coaches facilitate redesign working toward “teaching the practice to fish”. The learning collaboratives serve to bring the practices together to build a community. These could be regular evening meetings that are more frequent, day sessions or 1.5-2 day sessions
Monthly Reporting is a must in this work to support a sustainable culture of quality improvement. We have just started to implement Practice Narrative Reports.
Registry functionality supports Population management which is at the core of Practice Transformation.Four Components
One and Two: Basic to Practice Transformation Three and Four start to bring in whole person orientation and Medical Home Concepts.
Office Redesign is built on utilizing the Core foundational Components of Improving Performance in Practice and Ed Wagners Care Model. The work is rounded out with IHI principles of the Model For Improvement and PDSA Cycles.
Practice Coaches facilitate redesign working toward “teaching the practice to fish”. The learning collaboratives serve to bring the practices together to build a community. These could be regular evening meetings that are more frequent, day sessions or 1.5-2 day sessions
Monthly Reporting is a must in this work to support a sustainable culture of quality improvement. We have just started to implement Practice Narrative Reports.
Registry functionality supports Population management which is at the core of Practice Transformation.
15. 15 Questions? Thank You!
Julie Schilz
JSchilz@coloradoguidelines.org
www.coloradoguidelines.org
Patient Centered Primary Care Collaborative
www.pcpcc.net