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ACHP’s Patient Center Medical Home & Payment Reform Learning Our Way to New Models

ACHP’s Patient Center Medical Home & Payment Reform Learning Our Way to New Models. Patient Centered Primary Care Collaborative March 30 – Washington, DC. ACHP Mission. ACHP and its members improve the health of the communities we serve and

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ACHP’s Patient Center Medical Home & Payment Reform Learning Our Way to New Models

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  1. ACHP’s Patient Center Medical Home & Payment ReformLearning Our Way to New Models Patient Centered Primary Care Collaborative March 30 – Washington, DC

  2. ACHP Mission ACHP and its members improve the health of the communities we serve and actively lead the transformation of health care so that it is safe, effective, patient-centered, timely, efficient and equitable.

  3. ACHP Member Organization Attributes • Quadruple Aim • Community-based • Close Provider Partnerships • Community Benefit

  4. ACHP Members

  5. ACHP Patient Centered Medical Home Collaborative • The ACHP PCMH Collaborative is committed to achieving and demonstrating Triple Aim outcomes through reinventing the way primary care is incented and delivered. • Synopsis: • Created “integrator” standards for health plans • Developing Practice Transformation toolkit • Measuring/evaluating progress along Triple Aim • Piloting multiple models for reimbursement • Forums for reporting progress and learning

  6. Practice Transformation Reimbursement Model Reduced Cost Trend($PM/PM) Model of Key Elements for Achieving Sustainable Outcomes Practice Metrics (Leading Indicators) Global Metrics(Lagging Indicators)

  7. ACHP Payment Transformation: Guiding Principles • Over a period of years, enhance the ability of primary care physicians to achieve Triple Aim goals (reduced cost trend, enhanced patient experience, improved population health) • Collaborate with specialists and hospitals to ensure comprehensive alignment of care redesign and reimbursement • Develop models that can be adopted across a broad spectrum of primary care practices

  8. Capital District Physician’s Health Plan Reimbursement Model New model results in potential 57%increase in total income for physicians. FFS - RBRVS 10% FFS 89% Risk Adjusted Comp. Payment 67% Bonus 27% Care Coordination 5% 6% P4P 2008 2009-10

  9. Geisinger Reimbursement Model % Increase *** Efficiency Gain Sharing Efficiency Gain Sharing * * must meet quality metrics to share **new sites receive for 18 months ***percentage beyond 15% is dependent on the total amount of efficiency gain 15% Increase Practices Transforming Stipends ** P4P Payment P4P Payment P4P Payment Fee-For-Service Fee-For-Service Fee-For-Service 2005 2006-10 2011

  10. Independent Health Reimbursement Model Fee-For-Service Capitation Payment (monthly) 30% Increase Fee-For-Service Care Coordination Payment (monthly) P4P Payment P4P Payment P4P Payment 2008 2009-10 2011

  11. Priority Health Reimbursement Model ?% Increase 70% Risk-adjusted Capitation & FFS 15% Increase overall comp 77% Base (Added payment for phone, group, after-hours, and e-visits) 85% Base Pay (FFS or Capitation) 10% Infrastructure 3% Infrastructure (grants) 20% P4P 20 % P4P 15% P4P 2011 – 2012 Theoretical 2008 2009-10

  12. Practice Transformation Reimbursement Model Reduced Cost Trend($PM/PM) Summary Practice Metrics (Leading Indicators) Global Metrics(Lagging Indicators)

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