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

1. 1 No timeNo time

2. 2 Brief review 30 Seconds just to orient to our work. Correlation with care model Brief review 30 Seconds just to orient to our work. Correlation with care model

3. Other initiatives. Safety-Net, Medicaid for Children and the Family Medicine residency program.Other initiatives. Safety-Net, Medicaid for Children and the Family Medicine residency program.

4. 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 4 Guidelines: Collaboration and Leadership, Practice Recognition, Practice Support, Reimbursement Model, Assessment and Reporting of Results The overall considerations in creating a successful collaborative for Patient-Centered Medical Home (PCMH) are the project title, the project location (state, region within the state), the target start date, the pilot/demo length, the convening entity/project contacts, the goal of the pilot, the participating stakeholders, the expected (or actual) demographics of participating practices, the medical home recognition program, the practice transformation support (including technology), the payment model, and the project evaluation.1 For example: What will the official title of the collaborative be? What will the length of the pilot be? Who should serve as the convening organization? Is there no bias? What should be used for the guiding principles? Who should participate as stakeholders: payers, providers, patients, other? What should be used for the Patient-Centered Medical Home measurement: National Committee for Quality Assurance (NCQA) Physician Practice Connections (PPC)-PCMH, or another tool? During this discussion, we will explore these and other considerations in detail and follow up with and example of a successful pilot program. 1. Patient-Centered Primary Care Collaborative. Patient-Centered Medical Home: Building Evidence and Momentum. Available at: http://www.pcpcc.net/content/pcpcc_pilot_report.pdf. Guidelines: Collaboration and Leadership, Practice Recognition, Practice Support, Reimbursement Model, Assessment and Reporting of Results The overall considerations in creating a successful collaborative for Patient-Centered Medical Home (PCMH) are the project title, the project location (state, region within the state), the target start date, the pilot/demo length, the convening entity/project contacts, the goal of the pilot, the participating stakeholders, the expected (or actual) demographics of participating practices, the medical home recognition program, the practice transformation support (including technology), the payment model, and the project evaluation.1 For example: What will the official title of the collaborative be? What will the length of the pilot be? Who should serve as the convening organization? Is there no bias? What should be used for the guiding principles? Who should participate as stakeholders: payers, providers, patients, other? What should be used for the Patient-Centered Medical Home measurement: National Committee for Quality Assurance (NCQA) Physician Practice Connections (PPC)-PCMH, or another tool? During this discussion, we will explore these and other considerations in detail and follow up with and example of a successful pilot program. 1. Patient-Centered Primary Care Collaborative. Patient-Centered Medical Home: Building Evidence and Momentum. Available at: http://www.pcpcc.net/content/pcpcc_pilot_report.pdf.

5. 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

6. 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 6

7. 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 7 14 achieved Level III 2 achieved Level II14 achieved Level III 2 achieved Level II

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10. 10 Reimbursement for the Outcomes We Need in Health Caree Two cited rationales for payment reform: infrastructure support: Several have modeled the costs to a practice to operate a medical home and have found that it requires additional resources in the practice setting, including PCP and other care team member time on traditionally non-billable activities, care management, HIT, and space and equipment. incentive alignment: Many believe that only changes to the payment system that motivate and support efficient and effective care and counter the FFS “treadmill” incentive will generate practice transformation. Two cited rationales for payment reform: infrastructure support: Several have modeled the costs to a practice to operate a medical home and have found that it requires additional resources in the practice setting, including PCP and other care team member time on traditionally non-billable activities, care management, HIT, and space and equipment. incentive alignment: Many believe that only changes to the payment system that motivate and support efficient and effective care and counter the FFS “treadmill” incentive will generate practice transformation.

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13. Technical Assistance Four Components One and Two: Basic to Practice Transformation Three and Four start to bring in whole person orientation and Medical Home Concepts. Office Redesign is built on utilizing the Core foundational Components of Improving Performance in Practice and Ed Wagners Care Model. The work is rounded out with IHI principles of the Model For Improvement and PDSA Cycles. Practice Coaches facilitate redesign working toward “teaching the practice to fish”. The learning collaboratives serve to bring the practices together to build a community. These could be regular evening meetings that are more frequent, day sessions or 1.5-2 day sessions Monthly Reporting is a must in this work to support a sustainable culture of quality improvement. We have just started to implement Practice Narrative Reports. Registry functionality supports Population management which is at the core of Practice Transformation.Four Components One and Two: Basic to Practice Transformation Three and Four start to bring in whole person orientation and Medical Home Concepts. Office Redesign is built on utilizing the Core foundational Components of Improving Performance in Practice and Ed Wagners Care Model. The work is rounded out with IHI principles of the Model For Improvement and PDSA Cycles. Practice Coaches facilitate redesign working toward “teaching the practice to fish”. The learning collaboratives serve to bring the practices together to build a community. These could be regular evening meetings that are more frequent, day sessions or 1.5-2 day sessions Monthly Reporting is a must in this work to support a sustainable culture of quality improvement. We have just started to implement Practice Narrative Reports. Registry functionality supports Population management which is at the core of Practice Transformation.

15. 15 Questions? Thank You! Julie Schilz JSchilz@coloradoguidelines.org www.coloradoguidelines.org Patient Centered Primary Care Collaborative www.pcpcc.net