West virginia medical home initiative through the health improvement institute
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West Virginia Medical Home Initiative Through the Health Improvement Institute. AAFP Southeast Family Medicine Forum Briefing and Overview August, 2008. Medicaid Transformation Grants.

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West virginia medical home initiative through the health improvement institute

West Virginia Medical Home Initiative Through the Health Improvement Institute

AAFP Southeast Family Medicine Forum

Briefing and Overview

August, 2008


Medicaid transformation grants

Medicaid Transformation Grants

Centers for Medicare & Medicaid Services (CMS) initiative under DRA providing grants to states for innovative improvement of Medicaid program

WV DHHR received 5 awards

Each award is focused on a different aspect of Medicaid Redesign

Each grant has 24 month timeline


Advanced medical home

Advanced Medical Home

Medicaid Transformation Grants

  • Five CMS grants awards:

  • Personal Responsibility

  • Health System Improvement

  • Applied Technology

  • Stronger Medicaid Program

  • Enhanced Medication Management


Health system improvement grant focused on

Health System Improvement Grant focused on:

Improving primary care delivery system

Creating patient-centered medical homes

Launching Health Improvement Institute to help facilitate enhancement of primary care system of care

Activities in this area are coordinated by project management team


West virginia medical home initiative through the health improvement institute

THE PREVALENT SYSTEM OF CARE DELIVERY

Practice

working in a vacuum

20-55%

Compliance with

Evidence

Based

Guidelines

45% Internet traffic is patients seeking self management info

Less than 18% use IT for patient care

40% waste

& inefficiency

Reimbursement

Piecemeal

Fee for Service

Delays & Waits for access 1-12 weeks

3:1 Staffing Ratio


The potential the pioneers

The Potential-The Pioneers

CareSouth Carolina

Source: Ann Lewis, CEO CareSouth Carolina

Time with doctor has gone from 8.2 minutes to 12.5 minutes

Total visit time has gone from 90 minutes to 42 minute average

HbA1c for their population of focus came down from 11 to 8

Encounters and revenue for behavioral health services skyrocketed (in Medicaid cost based reimbursed and Medicare is 60% of the cap for behavioral counseling services)

There are several key clinical indicators where they have reversed the health disparities and outcomes for minority populations are better

Third available appointment has gone from 140 to 0 days

Went from breakeven/deficit spending to 7% positive margin

Total average aggregate costs of care for people with Diabetes 30-70% less than all other providers

Grew from 16,000 patients to 40,000


Planned care in the new environment

PLANNED CARE IN THE NEW ENVIRONMENT

Guidelines

In exam room

With PDAs

EMR eliminate

All paper

Registry used

For Master

Scheduling

Community

Resources

Part of care team

Reimbursement

Aligned to support

Planned care

Group Visits

Used 25%

17% visits by

Email

Open Access

No shows decrease to

2-5%

Continuous

Flow minimize

On-site time

Care Team Work Spread 8:1 Ratio

M.D. N..P. N.P. R.N. R.N. M.A. DIETICIAN EXTERNAL

TEAM


Diabetes outcome measures october 2005 september 2006

Diabetes Outcome MeasuresOctober 2005 – September 2006

All MCI diabetes patients n = 8631


West virginia medical home initiative through the health improvement institute

CMS Profit = $8.00 / test

Yields $100,000 / yr.


Transformational change in the health care delivery system

Transformational change:In the Health Care Delivery System

For Medicaid patients with Diabetes receiving these services 2000-2002

Source: South Carolina Office of Budget and Control 2004


West virginia health improvement institute

West Virginia Health Improvement Institute

Stakeholder Advisory Group

Meet Quarterly

Virtual Engagement On-Going

Steering Committee

Provider

Education

Self Management

Adoption of

HIT

Measurement/

Reimbursement/

Reporting

Pilots

Pilots

Pilots Measures&

Pilots

Innovation Community

150+ Practices


Medical home learning community

Medical Home Learning Community

Recruitment Cohort

WV Health Improvement Institute

Demonstrations

Results

  • 120-150 Practice

  • Teams

  • Team-based learning around a care team

  • Learn elements of Medical Home

  • Test practice changes

  • Share ideas, successes and failures with each other

  • Monitor and report common measures of performance

  • Evolve the practice into a patient-centered medical home

  • Measurement and

  • Reimbursement

  • Workgroup

  • Measures for monthly reporting

Payer Pay for Performance Demonstration

•Performance measures

•Clinical outcomes measures

•New reimbursement models

•Economic indicators reflected in Medicaid claims and health status of overall Medicaid populations

•Increased successful adoption of EHRs

•New care models to spread to providers across the state

•Medical Home penetration

  • Self-Management

  • Workgroup

  • Coaching and technical assistance

  • Topic-specific webcasts

Self-Management Demonstration

  • Adoption of Electronic

  • Health Records

  • Workgroup

  • Coaching and technical assistance

Electronic Health Records Demonstration

  • Provider Training and

  • Support Workgroup

  • Coaching and technical assistance

  • Measures for monthly reporting

  • Topic-specific webcasts

  • Monthly team calls

  • Virtual short-cycle learning sessions


Communication vehicles

Communication Vehicles

Quarterly Meetings

www.wvhealthimprovement.org

Newsletter


Rchaufournier@spreadinnovation com 301 529 7858

Roger Chaufournier

[email protected]


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