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Patient-Centered Medical Home Pilots Landscape as of 06/19/2008

Patient-Centered Medical Home Pilots Landscape as of 06/19/2008. PCMH Pilots Map.

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Patient-Centered Medical Home Pilots Landscape as of 06/19/2008

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  1. Patient-Centered Medical Home Pilots Landscape as of 06/19/2008

  2. PCMH Pilots Map Note: this chart is from Carol Flamm, who leads the PCPCC Center for Multistakeholder Demonstrations. It doesn’t bear any one-to-one relationship to the PCMH pilot details included in this deck, but is offered as an example of how the state and local activities might be summarized. RI Multi-Payer pilot discussions/activity Identified pilot activity No identified pilot activity

  3. PCMH Pilots Summary (multi-payer and significant single payer projects)

  4. PCMH Pilots Summary (multi-payer and significant single payer projects)

  5. PCMH Pilots Detail 2-5 year pilot to demonstrate improved cost and quality of care. P4P / Medical Home project funded by $1.5M grant from NYDOH. EHR (eClinical Works); ePrescribing (RxHub and SureScripts); provider portals (HealthVision); data aggregation & analytics (IPRO and VIPS); Continuity of Care Document for interoperable data elements between ambulatory care practices & other health entities (e.g., hospitals); Masspro support for practice assessment and redesign; multi-disciplinary approach John Blair jblair@taconicipa.com (845) 897-6359 Asha Upadhyay asha@thincrhio.org (845) 896-4726, Ext. 3205

  6. PCMH Pilots Detail 2-year pilot to reduce fragmentation and implement systems and processes, using evidence-based clinical guidelines and improve healthcare in Colorado. Guiding Principles: Joint Principles, NCQA PPC-PCMH, 3-Tiered Reimbursement (FFS, Care Management Fee and P4P) Use of disease registries;Reach My Doctor; Technical support for Practice Transformation and achievement of NCQA PPC-PCMH. Measurement on Cost, Quality (Chronic Disease and Prevention) and Provider Office/Patient Satisfaction. Evaluation Methodology-Matched Comparison Group Marjie Harbrecht mharbrecht@coloradoguidelines.org (720) 297-1681 Julie Schilz jschilz@coloradoguidelines.org (720) 297-1681

  7. PCMH Pilots Detail 2-year demo of PCMH model by Group Health Inc. (GHI), a New York State health insurer, and Health Plan (HP) of New York, a large HMO. "advanced health information technology" to direct services to patients and coordinate services from other physician; care coordination services and technical support to redesign physician offices and management systems Judith Fifeld fifield@nso1.uchc.edu (860) 679-3815

  8. PCMH Pilots Detail 2-year pilot to demonstrate that PCMH model is sustainable, i.e. provides better care, provides more cost-effective care, enhances patient satisfaction with medical care received and provides improved professional satisfaction for primary care physicians Practices must satisfy nine NCQA PPC standards for a PCMH (access and communication, patient tracking and registry, care management, patient self-management support, electronic prescribing, test tracking, referral tracking, performance reporting and improvement and advanced electronic communications). Insurers providing or funding dedicated nurse for practice support. $3PMPM funding for practices NCQA PPC-PCMH recognized (Level 1 in 6 mos, Level 2 in 18 mos) Deidre Gifford dgifford1@riqio.dspd.org Lynn Pezzullo lpezzullo@riqio.sdps.org (401) 528-3222

  9. PCMH Pilots Detail Coalition to promote and provide practical support for medical homes -- family-centered, comprehensive coordinated primary health care -- for children and youth with special health care needs. Provide medical home for every WA State CSHCN by 2010 Developing performance indicators to identify whether children have an effective medical home. Identifying stakeholder representatives who can formulate performance measures to be used starting in 2009 to link quality improvement measures with provider rate increases. MaryAnne Lindeblad lindem@dshs.wa.gov (360) 725-1786

  10. PCMH Pilots Detail Statewide implementation of the Chronic Care Model (a PCMH-like model) involving learning collaboratives, practice coaches, an incentive alignment strategies for providers and consumers. Practice coaches, consumer self-management training, patient registries, statewide pooled claims database, practice certification process, performance measures, evaluation plan and public reporting, communication plan Phil Magistro pmagistro@state.pa.gov (717) 214-8174 Michael Bailit mbailit@bailit-health.com (781) 453-1166

  11. PCMH Pilots Detail Pilot supported with a 1 million grant from CDPHP. Will look at the Allen Goroll payment reform model. Three practices will all have support with an on the ground transformation model. Facilitators are being provided by TransforMED and paid for by CDPHP. The practices will be paid for PCMH services whether or not the patient is a CDPHP member. So, 100% of the patients are in the pilot. The breakout is 40% CDPHP members, a mixture of ASO and commercial. About 17 % are Medicare, 30 % Blues, 8% MVP. Brian J. Morrissey bmorriss@cdphp.com (518) 641-5220

  12. PCMH Pilots Detail Several phone discussions and two face-to-face meetings with potential stakeholders in a multi-payer pilot of PCMH; led primarily by ACP and Memphis Business Group on Health. Agreement on 5/7/08 to form Steering Committee of interested stakeholders. to be determined Cristie Travis (MBGH) ctravis493@aol.com (901) 767-9585 Shari Erickson (ACP) serickson@mail.acponline.org (202) 261-4551

  13. PCMH Pilots Detail Primary care providers affiliated with Dartmouth-Hitchcock will be paid for the medical services they provide, reimbursed an additional amount for enhanced services such as care management they provide and be rewarded through a “pay for performance” structure for improving quality and appropriate health care. In the pilot, patients, especially those with chronic illness or ongoing medical needs, will have access to enhanced care coordination, communications, appointment availability and education to help them navigate their health care system, while physicians will receive additional reimbursement for providing these enhanced services and supportive infrastructure. Dartmouth-Hitchcock has a tradition of pursuing these objectives; both organizations say the new pilot program will help to accelerate existing efforts. Dick Salmon (CIGNA) dick.salmon@cigna.com (901) 767-9585 Barbara Walters (Dartmouth-Hitchcock)

  14. PCMH Pilots Detail Meeting on 6/27/2008 in Austin to inform and assess local stakeholder interest. The Texas Academy of Internal Medicine is also seeking business groups that may be interested in participating in the effort. to be determined Neil Kirschner (ACP) nkirschner@mail.acponline.org (202) 261-4535

  15. PCMH Pilots Detail Through collaboration between public health and primary care, by 2010, key system level barriers will be resolved; by 2015, every consumer of primary care services in Michigan will consistently receive evidence-based preventive and chronic disease care, and changes to assure quality care will have been embedded in primary care practices across the state Initial focus areas will be: prevention(aligned with RX for Healthier MI and MI Steps Up), Physical Inactivity, Poor Nutrition, Tobacco Use and Exposure; Chronic Disease Care & Management: Asthma & Diabetes Janet Olzekski, MD - chair mccullochs@michigan.gov (517) 373-3740 Donald Nease, MD – vice chair (734) 936-4660

  16. PCMH Pilots Detail Initial stages of discussion. $1.7M grant from R.W. Johnson Foundation under Aligning Forces for Quality initiative to focus on improved healthcare messaging for patients with diabetes. Medical Home forum held at Univ. of Cincinnati on March 17; presenters included Michael Sherman, Corp. Medical Director of Physician Strategies at Humana. PCMH pilot kick-off meeting may be held sometime in summer 2008. Paul Grundy has been contacted as a potential speaker. Craig Brammer, MD craig.brammer@uc.edu (202) 261-4535

  17. PCMH Pilots Detail Started 1998-1999 as way to manage Medicaid patients in rural area—medical home model –particularly targeted at small practices that did not have a lot of resources—goal was to link them with a local hospital and other safety net providers – gave payment to providers and to networks for them to put resources into the community (e.g. case managers, recently added a clinical pharmacist) -goal is organizing MDs Allen Dobson MD adobson@cabarrusfamily.com (704) 721-2073 Jeffrey Simms jeffrey.simms@ncmail.net (919) 855-4100

  18. PCMH Pilots Detail Ambulatory Intensive Caring Unit model, similar to that being employed by UNITE HERE. In 2nd year of pilot targeted to serving the top 20% of employees and dependents projected to be greatest need of future health care. A dedicated core primary care team of 1-2 physicians and a nurse case manager sees enrolled patients. Boeing is actively involved in the pilot’s day-to-day management and is paying a PMPM payment to each MD in addition to the providers’ regular FFS reimbursement. The practice-embedded nurse case manager is thought to be the key to the model’s success. Theresa Helle theresa.m.helle@boeing.com (704) 721-2073

  19. PCMH Pilots Detail Pilot Pay for Quality Program is aligned with The Chronic Care Model and the VT Blueprint for Health. P4Q pilot program started in 2005 with diabetes and was roughly built off of the structure of the NCQA Diabetes Physician Recognition Program MD participation in the P4Q program requires the proactive adoption of the following practice infrastructure changes, derived from the Health System component of The Chronic Care Model. Increased reimbursement is available for office-based E & M, consultations, preventive medicine and counseling codes. The enhanced reimbursement applies to all of the practices patients, not just those with select chronic conditions. Practices may utilize some BCBSVT tools and services to satisfy program entry requirements, or use enhanced funding to support development of their own infrastructure and systems. Sharon Winn winns@bcbsvt.com (802) 371-3230

  20. PCMH Pilots Detail Initial stages of discussion, BCBSM Physician Group Incentives will embody elements of chronic care model and PC-MH. 2008 initiatives will focus on: individual care management, extended access, test tracking, patient registry, performance reporting and patient-provider agreement. Implementation of differential reimbursement for PGIP physicians who meet criteria for BCBSM designation as a PC-MH will begin mid-2009 Thomas Simmer (BCBSM CMO) tsimmer@bcbsm.com Margaret Mason MMason@bcbsm.com

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