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Advancing Health Care Reform in Maine: Why, What, & How?. Aging Advocacy Summit November 2012 Lisa M. Letourneau MD, MPH. Objectives. Identify factors contributing to the urgent case for transforming US health care system Introduce key components of Maine’s emerging model for change

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Advancing Health Care Reform in Maine: Why, What, & How?

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Advancing health care reform in maine why what how

Advancing Health Care Reform in Maine:Why, What, & How?

Aging Advocacy Summit

November 2012

Lisa M. Letourneau MD, MPH


Objectives

Objectives

  • Identify factors contributing to the urgent case for transforming US health care system

  • Introduce key components of Maine’s emerging model for change

    • Patient Centered Medical Home (PCMH)

    • Community Care Teams (CCTs)

    • Accountable Care Organizations (ACOs)

  • Describe the role of consumers in supporting , driving this change


Who we are

: Who We Are

  • Independent, multi-stakeholder alliance in Maine working to transform health and healthcare by leading, collaborating, and aligning improvement efforts

  • Only organization working to improve quality of care for all Maine people

  • Members include consumers, doctors, nurses, hospitals, health systems, payers, employers, government, policy makers, and others working to improve health and healthcare


What we do

: What We Do

  • Align health care quality improvement efforts

  • Engage consumers meaningfully in improving health and health care

  • Establish sustainable system of quality improvement support for providers

  • Improve integration of behavioral and physical healthcare


Major programs

: Major Programs

  • Aligning Forces for Quality

  • Maine Patient Centered Medical Home Pilot

  • Improving Behavioral Health Integration

  • Transforming Care at the Bedside

  • QC Learning Community

  • QC Annual Conference (“Best Practice College”)

5


A compelling case for action

A Compelling Case for Action


Vision for a transformed health care system

Vision for a Transformed Health Care System

Healthy, productive, connected people & families

…receiving healthcare from a highly functioning “accountable care organization”

… supported by a robust & well-supported system of primary care providers


What we want from our health care

What We Want from Our Health Care

  • Relationship with our providers that crosses settings, time, & place

  • Caring, compassionate interactions

  • Coordination & integration of care across providers

  • Ability to access care 24/7 – when & where we need it

  • Time, time, time…


But what do we get

But What Do We Get?

The 15 minute visit!


The result the current medical home

The Result: The Current Medical Home


Why follow the money

Why? Follow the Money!

  • What we want:

  • Relationship, time with our providers

  • Caring, compassionate interactions

  • Coordination & integration of care

  • Ability to access care 24/7

  • What we pay for:

  • Visits

  • Tests

  • Procedures

  • Procedures

  • Procedures


The stalemate that blocks change

The Stalemate That Blocks Change

Employers & payers unwilling to pay for desired services unless providers demonstrate value AND show potential to save money

Providers unable to transform practice without viable & sustainable payment for desired services

BUT


A recipe for change

A Recipe for Change?


Community leadership for change

Community Leadership for Change

Maine Quality Counts

DHA’s Maine Quality Forum

Maine Health Management Coalition

MaineCare

14


The medical home acos models for change

The Medical Home & ACOs: Models for Change!

Employers & payers pay for desired services if providers can demonstrate value AND reduce spending

= Payment Reform

Providers change practice, create value with viable & sustainable payment for desired services

= Delivery System Change

AND


Defining medical home

Defining Medical Home

“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.”

American Academy Pediatrics


Maine pcmh pilot practices

Maine PCMH Pilot Practices

17


Maine pcmh pilot core expectations for practices

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 to care

  • Behavioral-physical health integration

  • Inclusion of patients & families

  • Connection to community / local HMP

  • Commitment to reducing avoidable spending & waste

  • Integration of health IT


Community care teams

Community Care Teams

  • Multi-disciplinary, community-based, practice-integrated care teams

  • Build on successful models (NC, VT, NJ)

  • Support patients & practices in Pilot sites, help most high-needs patients overcome barriers – esp. social needs - to care, improve outcomes

  • Key element of cost-reduction strategy, targeting high-needs, high-cost patients to reduce avoidable costs (ED use, admits)

19


Advancing health care reform in maine why what how

Maine PCMH Pilot Community Care Teams

Schools

Transportation

Environment

  • Community Care Team

Housing

Outpatient Services

Workplace

Care Mgt

Family

Food Systems

High-need Individual

PCMH Practice

Med Mgt

Specialists

  • Community Resources

Shopping

Coaching

Hospital Services

Behav. Health & Sub Abuse

Income

Physical Therapy

Heat

Literacy

Faith Community


Maine s medical home movement

Maine’s Medical Home Movement

~ 540 Maine Primary Care Practices

~130+ MaineCare HH Practices?

100+ NCQA PCMH Recognized Practices

Payer:

Medicaid

  • Payers:

  • Medicare

  • Medicaid

  • Commercial (Anthem, Aetna, HPHC)

  • Self-insured employers

14 FQHCs CMS APC Demo

26 Maine PCMH Pilot Practices

Payer:

Medicare

50PilotPhase 2 Practices

21


So what about acos

So…What About ACOs?

“Accountable Care Organizations (ACOs) will constitute groups of providers - physicians, other clinicians, hospitals or other providers - that together provide care and share accountability for the cost and quality of care for a population of patients”

T. Lake et al, “Lessons from the Field: Making Accountable Care Organizations Real “, NIHCR Research Brief, Jan 2011

22


Pcmh hub of wider delivery payment reform models acos

PCMH: Hub of Wider Delivery & Payment Reform Models (ACOs!)

ACO


Acos in maine what s happening

ACOs in Maine – What’s Happening?

  • Employer-Provider ACO Pilots

    • Maine Health Management Coalition leadership

    • MaineGeneral-SEHC, EMMC, other pilots

  • Medicare – multiple ACO options

    • Pioneer ACO – EMHS

    • Shared Savings programs – MH, CMMC, MePCA

  • Medicaid: Value-Based Purchasing strategy

    • Seeking “Accountable Communities” proposals

24

24


Engaging consumers partnering with patients

Engaging Consumers, Partnering with Patients

  • Untapped “force” for improving health care

  • Need to shift from provider-centered to patient-centered approaches (think banking!)

  • Need patients to better understand their role

    • To improve their health, and

    • To change health care system

  • Changing patient role requires changing culture of US health care

25


Advancing health care reform in maine why what how

Patient Engagement

  • What We Say:

  • We want patients to take active role in making decisions about their health

  • We want patients to ask questions

  • We want patients to express values & preferences

  • What We know:

  • Patients – even well educated, are reluctant to ask questions

  • Patients are fearful of challenging provider recommendations

  • Many patients feel physicians are authoritarian (vs. “authoritative”)


Advancing health care reform in maine why what how

“Better Health. Better ME!”

Consumer Engagement Campaign

  • Take Charge of Your Health:

  • Step ONE: VISIT your Primary Care Provider

  • Step TWO: ASK Questions

  • Step THREE: KNOW your numbers

  • Step FOUR: FIND and use community resources and programs to support health

27


Advancing health care reform in maine why what how

Partnering for Improvement

28


Advancing health care reform in maine why what how

ABIM “Choosing Wisely” Campaign

  • Physician-led effort to identify opportunities to improve care and decrease use of wasteful services

  • Have created lists: “5 Things Physicians & Patients Should Question”

  • Appeals to professionalism

  • Promotes partnership with patients

  • Have engaged multiple specialty physician groups

29


Advancing health care reform in maine why what how

Patient Tools

30


Consumer reports best buy drugs

Consumer Reports “Best Buy Drugs”

31


Managed care all over again

‘Old-School’ Managed Care

Focus on reducing costs

Global capitation

PCP at full financial risk

PCP as gatekeeper

Very limited information and tools

vs. PCMH + ACOs

Focus on demonstrating value

New care management fees (plus performance payments?)

Limited financial risk to PCP

Primary care team coordinates care & supports patient needs across “med neighborhood”

Improved information and tools (EMR, registries)

Managed Care All Over Again?

32


Change is hard

Change is Hard

  • Hard to repair the plane in flight

  • Hard to practice while practicing!

  • People fear change (loss) - any change


Qc 2013 save the date aligning maine s forces to achieve the triple aim of improvement

QC 2013 – Save the Date! Aligning Maine’s Forces To Achieve the Triple Aim of Improvement

  • Wed, Apr 3, 2013

  • Augusta Civic Center

  • Dr. Donald Berwick

  • Join us!

34


Www mainequalitycounts org

www.mainequalitycounts.org


Contact info questions

Contact Info / Questions

  • Lisa Letourneau MD, MPH

  • [email protected]

  • 207.415.4043

  • Maine Quality Counts

    • www.mainequalitycounts.org

  • Maine PCMH Pilot

    • www.mainequalitycounts.org

      (See “Programs”  PCMH)


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