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Patient Centered Primary Care Collaborative

Patient Centered Primary Care Collaborative

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Patient Centered Primary Care Collaborative

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  1. Patient Centered Primary Care Collaborative Edwina Rogers Executive Director Patient Centered Primary Care Collaborative 601 Thirteenth St., NW, Suite 400 North Washington, D.C. 20005 Direct: 202.724.3331 Mobile: 202.674.7800

  2. Overview of Activity • 27 Multi-stakeholder Pilots in 20 States • 8 State Medicare Pilots Planned for 2009 • 44 States and the District of Columbia Have Passed over 330 Laws and/or Have PCMH Activity

  3. Blue Cross Blue Shield Plan Pilots (as of January 2009) Pilots in planning phase for 2009 implementation Pilots in progress Pilot activity in early stages of development Multi-Stakeholder demonstration

  4. Some New 2009 Single-Payer Health Plan Demonstration Pilots • Key PCMH Pilot Programs Either in Place or in Development • Cigna PCMH Pilot in New Hampshire • Aetna has PCMH Pilots in • Colorado • Maine • Mid-Hudson Valley • Pennsylvania • Central New Jersey • Priority Health PCMH Pilot Program in Michigan • Wellpoint, Inc. PCMH Pilot in New York City • UnitedHealth Medical Home Pilot in Arizona (Tucson & Phoenix) • Blue Cross Blue Shield PCMH Pilot in Nebraska in early stages of development = New Demonstration Pilots Taking Place or in the Process of Being Enacted

  5. State Initiatives to Advance Medical Homes in Medicaid/SCHIP = Identified to have a medical home initiative Source: National Academy for State Health Policy State Scan, November 2008

  6. Patient-Centered Medical Home 2009 Overview of Pilot Activity and Planning Discussions RI Multi-Payer pilot discussions/activity Identified pilot activity No identified pilot activity – 6 States

  7. Overview of the PCPCC • Now finishing our 3rd year • Over 630 signing members • Advancing the Patient Centered Medical Home (PCMH) concept in the public and private sectors • Hosting Meetings, Summits and Congressional Briefings • Weekly Call Thursday at 11:00 AM EST • Call-in Number: 712.432.3900 • Passcode: 471334# • Weekly “Center” calls established to operationalize work of PCPCC

  8. PCPCC: 2008-2009 Key Organizations Joining PCPCC Since April 28th Stakeholder Meeting • Cleveland Clinic • Department of Veterans Affairs • Minnesota Department of Health • National Council on Aging • Harvard Medical School • Medical Home News • Minnesota Healthcare Network 4

  9. How do you start to fix the foundational issue around why our healthcare system is so expensive and yet so broken? Average health spend per capita ($US PPP)

  10. The World Health Organizations ranks the U.S. as the 37th best overall healthcare system in the world

  11. History of the Medical Home Concept • The first known documentation of the term “medical home” Standards of Child Health Care, AAP in 1967 by the AAP Council on Pediatric Practice -- “medical home -- one central source of a child’s pediatric records” History of the Medical Home Concept Calvin Sia, Thomas F. Tonniges, Elizabeth Osterhus and Sharon Taba Pediatrics 2004;113;1473-1478 • Patient Centered – IOM • I would strongly urge the adoption of the Danish model of the Patient Centered Medical Home -- Karen Davis Commonwealth Fund • 2009 Medical Home Wikipedia page: Henrik Jensen Niels Rossing M.D.

  12. Collaborative Principles • The Patient Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and many others who have joined together to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, clinicians and payers have agreed that it is essential to support a better model of compensating clinicians. • Compensation under the Patient-Centered Medical Home model would incorporate enhanced access and communication, improve coordination of care, rewards for higher value, expand administrative and quality innovations and promote active patient and family involvement. The Patient-Centered Medical Home model will also engage patients and their families in positive ongoing relationships with their clinicians. Further, the Patient-Centered Medical Home will improve the quality of care delivered and help control the unsustainable rising costs of healthcare for both individuals and plan-sponsors. • If you agree, please visit us at and join today!

  13. The Patient-Centered Primary Care Collaborative Examples of Broad Stakeholder Support & Participation Providers 333,000 primary care Purchasers – Most of the Fortune 500 • ACP • AAP • IBM • Ohio • AAFP • AOA • Iowa • FedEx • General Electric • ABIM • ACC • Dow • ACOI • AHI • Business Coalitions The Patient-Centered Medical Home • Microsoft • Merck & Co. 80 Million lives Payers Patients • AARP • AFL-CIO • BCBSA • Aetna • National Consumers League • United • Humana • CIGNA • Kaiser Permanente • SEIU • Foundation for Informed Decision Making • WellPoint • Geisinger

  14. Patient Centered Primary Care Collaborative Four ‘Centers’ - Over 770 volunteer members • Center for Multi-Stakeholder Demonstration: Identify community-based pilot sites in order to test and evaluate the concept; offer hands-on technical assistance, share best practices, and identify funding sources to advance adoption. • Center to Promote Public Payer Implementation: Assist state Medicaid agencies and other public payers as they implement and refine programs to embed the Patient Centered Medical Home model by offering technical assistance; sharing best practices and giving guidance on the development of successful funding models. • Center for Health Benefit Redesign and Implementation: Create standards and buying criteria to serve as a guide and tool for large and small employers/purchasers in order to build the market demand for adoption of the Medical Home model. • Center for eHealth Information Adoption and Exchange: Evaluate use and application of information technology to support and enable the development and broad adoption of information technology in private practice and among community practitioners. 204 224 197 145 9

  15. Joint Principles of the PCMH (February 2007) • The following principles were written and agreed upon by the four Primary Care Physician Organizations – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. • Principles: Ongoing relationship with personal physician Physician directed medical practice Whole person orientation Coordinated care across the health system Quality and safety Enhanced access to care Payment recognizes the value added

  16. The PCMH Joint Principles have received endorsements from 18 specialty health care organizations: The American Academy of Chest Physicians The American Academy of Hospice and Palliative Medicine The American Academy of Neurology The American College of Cardiology The American College of Osteopathic Family Physicians The American College of Osteopathic Internists The American Geriatrics Society The American Medical Directors Association The American Society of Addiction Medicine The American Society of Clinical Oncology The Society for Adolescent Medicine The Society of Critical Care Medicine The Society of General Internal Medicine American Medical Association Association of Professors of Medicine Association of Program Directors in Internal Medicine Clerkship Directors in Internal Medicine Infectious Diseases Society of Medicine Endorsements

  17. Defining the Medical Home • Patients have accurate, standardized information on physicians to help them choose a practice that will meet their needs. Publically available information Source: Health2 Resources 9.30.08 8

  18. PCPCC Payment ModelMay 2007 Key physician and practice accountabilities/ value added services and tools Proactively work to keep patients healthy and manage existing illness or conditions Incentives Coordinate patient care among an organized team of health care professionals Incentives Performance Standards Utilize systems at the practice level to achieve higher quality of care and better outcomes Incentives Focus on whole person care for their patients 16

  19. Barbara Starfield of Johns Hopkins University Within the United States, adults with a primary care physician rather than a specialist had 33 percent lower costs of care and were 19 percent less likely to die. In both England and the United States, each additional primary care physician per 10,000 persons is associated with a decrease in mortality rate of 3 to 10 percent. In the United States, an increase of just one primary care physician is associated with 1.44 fewer deaths per 10,000 persons. Commonwealth Fund has reported:  A medical home can reduce or even eliminate racial and ethnic disparities in access and quality for insured persons. Denmark has organized its entire health care system around patient-centered medical homes, achieving the highest patient satisfaction ratings in the world. Denmark has among the lowest per capita health expenditures and highest primary care rankings. Center for Evaluative Clinical Sciences at Dartmouth, states in the US relying more on primary care have: lower Medicare spending, lower resource inputs, lower utilization, and better quality of care. Evidence of Cost Savings & quality improvement

  20. BCBS of ND Reported - Chronic Care for Diabetes 6% decrease in hospital admissions 24 % decrease emergency room $500, Per member per years savings North Carolina reported savings of $244 million for FY04 for their 720,000 Medicaid recipient program. Horizon BCBS of NJ reported that the cost per patient, complying with diabetes testing in engaged medical homes, was substantially less than those in non-engaged medical homes. Evidence of cost Savings & Quality Improvement

  21. Simple Cost Avoidance NC Savings (FY04)

  22. Community Care Plan of Eastern NC Community Health Partners Northern Piedmont Community Care Southern Piedmont Community Care Plan Partnership for Health Management Carolina Collaborative Comm. Care Carolina Community Health Partnership Sandhills Community Care Network Northwest Community Care Network Comm. Care Partners of Gtr. Mecklenburg North Carolina Pilot Project Details AccessCare Network Sites AccessCare Network Counties Access II Care of Western NC Access III of Lower Cape Fear Community Care of Wake and Johnston Counties Central Care Health Network

  23. Pilot: Geisinger Health System

  24. At least 14 Independent Evaluations in 11 States . . . And Growing RI CMS will select 8 states for the Medicare Medical Home Demonstration

  25. Several PCMH Evaluations Underway… • Approximately 14 independent evaluations represented in the PCMH Evaluators’ Collaborative (other evaluators are welcome to participate) • The evaluations are examining a breadth of demonstrations: • From one payer to multi-payer pilots • Involve anywhere from 5-70 primary care practices with 28-250 clinicians • Include 27,000 -- 1,000,000 beneficiaries • Many include safety net centers, pediatric sites and Medicaid as a payer • Variety of payment models (hybrid, PMPM, annual comprehensive PC fee) • All have the evaluations have comparison groups • Key Questions Under Investigation: • What does it take to become a medical home? • Do PCMHs improve: • Clinical Quality? • Patients’ Experiences? • Physician/Staff Experience? • Efficiency? • Is this sustainable/ are practices financially stable?

  26. PPC1A: Written standards for patient access and patient communication PPC1B: Use of data to show meeting standards PPC2D: Use of paper or electronic-based charting tools to organize clinical information PPC2E: Use of data to identify important diagnoses and conditions in practice PPC3A: Adoption and implementation of evidence-based guidelines for three conditions PPC4B: Active support of patient self-management PPC6A: Tracking system to test and identify abnormal results PPC7A: Tracking referrals with paper-based or electronic system PPC8A: Measurement of clinical and/or service performance PPC8C: Performance reporting by physician or across the practice PCMH Must Pass Elements

  27. NCQA PPC-PCMH Content and Scoring **Must Pass Elements

  28. NCQA PPC-PCMH Scoring Levels: If there is a difference in Level achieved between the number of points and “Must Pass”, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 “Must Pass” Elements, the practice will achieve at Level 1. Practices with a numeric score of 0 to 24 points or less than 5 “Must Pass” Elements are not Recognized.

  29. Meaningful Use: Meaningful Connections Why this report- Why now? • Unprecedented urgency to change our health care “system.” • American Recovery and Reinvestment Act – over $19B for health IT infrastructure. • Natural synergy between PCMH and health IT. • Offer needed guidance to the industry.

  30. What is included in the Resource Guide? • Defines health IT capabilities essential to PCMH. • Crosswalks capabilities with functional priorities supporting PCMH. • Explores how patients/consumers are currently using health IT to connect. • Representative sample of 19 case example responses from primary care providers. • Appendices include • Guidelines for PCMH Demonstration Projects • Consumer Principles • Consumer Toolkit

  31. Patient Centered Primary Care Collaborative“Purchaser Guide” Released July, 2008 Developed by the PCPCC Center for Benefit Redesign and Implementation in partnership with NBCH and the Center’s multi-stakeholder advisory panel. Guide offers employers and buyers actionable steps as they work with health plans in local markets - over 6000 copies downloaded and/or distributed. Includes contract language, RFP language and overview of national pilots. Includes steps employers can take to involve themselves now in local market efforts. The PCPCC is holding a series of Webinars, sponsored by Pfizer, on the Purchaser Guide. 11

  32. Patient Centered Primary Care Collaborative“Building Evidence and Momentum – Compendium of PCMH Pilots” Released October 2008 Developed by the PCPCC Center for Multi-stakeholder Demonstration through a grant from AAFP offering a state-by-state sample of key pilot initiatives. Offers key contacts, project status, participating practices and market scan of covered lives; physicians. Inventory of : recognition program used, practice support (technology), project evaluation, and key resources. Begins to establish framework for program evaluation/ market tracking. 12

  33. TODAY’S CARE MEDICAL HOME CARE My patients are those who make appointments to see me Our patients are those who are registered in our medical home Patients’ chief complaints or reasons for visit determines care We systematically assess all our patients’ health needs to plan care Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

  34. Information Flow- Consumer Materials Four minute video for waiting room viewing; deep-dive on PCMH (Flash) Promotes Primary Care (brochure) Deep-dive focus on PCMH (brochure) What consumers can expect- PCMH consumer principles (brochure) Guidance to create your own practice brochure in support of PCMH model (paper)

  35. Inclusion of the Medical Home Concept in Health Reform Efforts Employer Trade Associations Executive Branch Think Tanks The Patient-Centered Medical Home Plans developed by Congressional Representatives

  36. Statement on the PCMH: President Obama “I support the concept of a patient-centered medical home, and as part of my health care plan, I will encourage and provide appropriate payment for providers who implement the medical home model, including physician-directed, interdisciplinary teams, care management and care coordination programs, quality assurance mechanisms, and health IT systems which collectively will help to improve care.” President Barack Obama

  37. The House Tri-Committee Health Reform Draft On June 19, 2009 the Chairmen of the three committees with jurisdiction over health policy in the U.S. House of Representatives unveiled their discussion draft for health care reform.  Included in this draft is language on the Patient Centered Medical Home (PCMH).  The draft bill includes funding of $350 million for PCMH pilot programs, which include Independent PCMHs and Community-based Medical Homes. 'The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(2)) to high need beneficiaries (as defined in subsection (b)(1)).'  On July 14, 2009 legislative language was released. Sec.1822. Medical Home Pilot Program. Establishes a 5-year pilot program to test the medical home concept with high-need Medicaid beneficiaries. The federal government would match costs of community care workers at 90% for the first two years and 75% for the next 3 years, up to a total of $1.235 billion. PCMH - HOUSE of representatives activity

  38. The Senate HELP Committee released the ‘Affordable Health Choices Act’ on June 9, 2009 outlining the committee’s option for health care reform. Section 212 of the draft legislation - ‘Grants to Establish Community Health Teams to Support a Medical Home Model’ stated that: The Secretary of HHS would establish a grant program to creating the “community health team which is community-based, multi disciplinary, interprofessional teams (on the model of medical home) to increase access to comprehensive coordinated care. Enhancing Health Care Workforce Education and Training - There is language in the bill also aimed to enhance health care workforce education and training in Family Medicine, General Internal Medicine, General Pediatrics, and Physician Assistantship by providing grants to develop and operate training programs, financial assistance of trainees and faculty, and faculty development in primary care and physician assistant programs. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home. Authorization is set at $125 million. Health literacy and shared decision making. The Senate Finance Committee released their own health care reform proposal. Their focus on primary care and the medical home model includes some areas that are of particular interest to the Collaborative and its members: CMS Innovation Center ‐ This provision would establish an Innovation Center at the Centers for Medicare & Medicaid Services (CMS) that would have the authority to test new patient‐centered payment models that encourage evidence‐based, coordinated care. Moving Toward Patient‐Centered Care ‐ The Chairman’s Mark creates a new state option and rewards states for providing chronically ill individuals enrolled in Medicaid with a health home. States that take up this option will receive an enhanced match for two years. Promoting Primary Care – To encourage more primary care doctors to be part of the system, the Chairman’s Mark would provide primary care practitioners and targeted general surgeons with a Medicare payment bonus of ten percent for five years. Payment for Accountable Care − To encourage providers to improve patient care and reduce costs, the Mark would allow high‐quality providers that coordinate care across a range of health care settings to share in savings they achieve to the Medicare program. PCMH - Senate Activity

  39. Upcoming Collaborative Events Thursday October 22, 2009- Washington D.C., Annual Summit - Washington Convention Center Tuesday, March 30, 2010 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center Thursday, July 22, 2010 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center Thursday, October 21, 2010- Washington D.C., Annual Summit - Ronald Reagan Building and International Trade Center

  40. About the PCPCC History Members Brochure Executive Committee Advisory Board Officers Executive Bios The Patient Centered Medical Home Joint Principles Endorsements by Specialists Employer Perspectives Evidence of Quality Health Reform Proposal Reimbursement Model Collaborative Centers Center to Promote Public Payer Implementation Center for Multi-Stakeholder Demonstration Center for Benefits Redesign and Implementation Center for eHealth Information Exchange and Adoption Other PCMH Resources Pilot Project Guide Purchasers Guide Evidence Documents Consumer Materials Events National Weekly Call Thursday, 11:00AM EST

  41. Contact Information Visit our website – To request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact: Edwina Rogers Patient Centered Primary Care Collaborative Executive Director 202.724.3331 202.674.7800 (cell), 601 Thirteenth St., NW, Suite 400 North Washington, DC 20005