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Patient-Centered Medical Home The Colorado Multi-Stakeholder Pilot Experience PCPCC Stakeholder Meeting March 30, 2010 PowerPoint PPT Presentation


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Patient-Centered Medical Home The Colorado Multi-Stakeholder Pilot Experience PCPCC Stakeholder Meeting March 30, 2010. Julie Schilz BSN, MBA Colorado Clinical Guidelines Collaborative IPIP and PCMH Manager PCPCC: Co-Chair Center for Multi-Stakeholder Demonstrations.

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Patient-Centered Medical Home The Colorado Multi-Stakeholder Pilot Experience PCPCC Stakeholder Meeting March 30, 2010

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Patient centered medical home the colorado multi stakeholder pilot experience pcpcc stakeholder meeting march 30 2010

Patient-Centered Medical Home

The Colorado Multi-Stakeholder Pilot Experience

PCPCC Stakeholder Meeting

March 30, 2010

Julie Schilz BSN, MBA

Colorado Clinical Guidelines Collaborative

IPIP and PCMH Manager

PCPCC: Co-Chair Center for Multi-Stakeholder Demonstrations


Patient centered medical home the colorado multi stakeholder pilot experience pcpcc stakeholder meeting march 30 2010

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

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


Patient centered medical home the colorado multi stakeholder pilot experience pcpcc stakeholder meeting march 30 2010

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 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

Multi-Payer Pilot Stakeholders

CCGC: Convening Organization and Technical Assistance Provider


Patient centered medical home the colorado multi stakeholder pilot experience pcpcc stakeholder meeting march 30 2010

Colorado Multi-Stakeholder Multi-State PCMH Pilot Overview

  • 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


Reimbursement for the outcomes we need in health care e

Reimbursement for the OutcomesWe Need in Health Caree

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

For more information:

www.pcpcc.net/content/proposed-hybridblendedreimbursement-model


Patient centered medical home the colorado multi stakeholder pilot experience pcpcc stakeholder meeting march 30 2010

Quality Improvement Activities

Technology Infrastructure

1

2 & 3

4

Care Team with Care Plan Manager – Care Coordinator

Components of PMPM for Practices to Transform into Medical Homes

Leadership/Culture Change

EMR/Registry Functionality

Communication Platform

Practice Redesign

Phone Calls & E-Mails – 24/7 Coverage

Data Use for Pop. Mgmt & Reporting

Administrative Costs

Team Mtgs & Learning Collaboratives

Attribution Reconciliation

Patient Experience Surveys

Technology - Hardware

  • Customer Service – Patient Centeredness

  • Coordination of Care:

    • Mental Health

    • Behaviorists (CDE, Nutritionist, Smoking Cessation, Asthma Educator

    • Complex Case Managers

  • Monitor Registry: Follow Up/Outreach

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

  • Patient self management support & self efficacy

  • Community Resources


Patient centered medical home the colorado multi stakeholder pilot experience pcpcc stakeholder meeting march 30 2010

Pay for Performance Model

Two Components

  • Quality – 60%:

  • Diabetes

  • CVD

  • Tobacco

  • Depression

  • Cost – 40%:

  • ER Visits

  • Hospital Admits

  • Generic Pharmacy

P4P Cost Measures

P4P Quality Measures

  • ER Visits

    • “Avoidable ER Visits” list

  • Overall Hospital Admissions

    • “Avoidable Admissions” list

  • Generic Pharmacy

    • Most Prevalent/Costly list

  • MEASURED ACROSS ALL PRACTICES


Technical assistance

1. Office Redesign

2. Technology

3. Integrating Care

4. Patient Centered

Technical Assistance

Based on IPIP - Planned Care Model - IHI

Care Plan - Registry

Focused Approach Related to NCQA Tool

Common Communication Platform

HIPAA Compliant E-Mail

In Office QI Coaches

Learning Collaboratives & Calls

Monthly Practice Reporting

Patient Portal- Engagement

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

Enhance Access

Form Partnership with Patients – Shared Decision Making

Co-Located/Shared/Referred Services

Care Plan Manager/Coordinator

Patient Activation &

Satisfaction (Experience)


Questions

Questions?

Thank You!

Julie Schilz

[email protected]

www.coloradoguidelines.org

Patient Centered Primary Care Collaborative

www.pcpcc.net


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