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Lisa M. Letourneau MD, MPH Quality Counts. September 2010. Objectives. Review key aspects, goals for Maine PCMH Pilot Provide updates on Maine Pilot Share lessons learned to date. Maine PCMH Pilot. Key elements: 3-year multi-payer PCMH pilot

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September 2010

Lisa M. Letourneau MD, MPH

Quality Counts

September 2010


  • Review key aspects, goals for Maine PCMH Pilot

  • Provide updates on Maine Pilot

  • Share lessons learned to date

Maine pcmh pilot
Maine PCMH Pilot

Key elements:

  • 3-year multi-payer PCMH pilot

  • Collaborative effort of key stakeholders, all major payers

  • Adopted common mission & vision, guiding principles for Maine PCMH model

  • Selected 22 adult / 4 pedi PCP practices across state

  • Supporting practice transformation & shared learnings beyond pilot practices

  • Committed to engaging consumers/ patients at all levels

  • Planning rigorous outcomes evaluation (clinical, cost, patient experience of care)

Maine pcmh pilot leadership
Maine PCMH Pilot Leadership

Maine Quality Forum

Quality Counts

Maine Health Management Coalition

Maine pcmh pilot timeline
Maine PCMH Pilot - Timeline

  • Jan 2009: Call for practice applications

  • May 2009: Practices notified – start of 6mo “ramp-up period”

  • Sept 2009: NCQA PPC-PCMH applications completed

  • Sept-Dec: practices contracted with payers

  • Jan 2010: Start date for PCMH payments

  • Jan 2010- Dec 2012: 3-year PCMH Pilot

Maine pcmh pilot practice core expectations
Maine PCMH Pilot Practice “Core Expectations”

  • Demonstrated physician leadership

  • Team-based approach

  • Population risk-stratification and management

  • Practice-integrated care management

  • Same-day access

  • Behavioral-physical health integration

  • Inclusion of patients & families

  • Connection to community / local HMP

  • Commitment to waste reduction

  • Patient-centered HIT

Maine pcmh pilot payment model
Maine PCMH Pilot – Payment Model

  • Anthem, Aetna, HPHC & MaineCare participating

  • Common 3-component payment model:

    • Prospective (pmpm) care management payment (approx $3 pmpm)

    • Ongoing FFS payments

    • Use existing payer P4P programs

  • Practices expected to make changes across all populations

Medicare med home demo
Medicare Med Home Demo

  • CMS “Multi-Payer Advanced Primary Care” (MAPCP) demonstration

  • States with multi-payer pilots invited to apply – must meet eligibility criteria

    • Majority of payers must participate

    • Pilot must be consistent with natl PCMH defn’s

    • Must connect with community resources & supports

  • CMS to select 6 states – Medicare to participate as payer in state PCMH pilots

  • Maine well-positioned, but stiff competition!

Medicare med home demo1
Medicare Med Home Demo


  • Applications due Aug 15

  • CMS decision by fall

  • Demo to start Jan 2011

  • Demo runs 2011-2013

Pcmh evaluation data for improvement
PCMH Evaluation & Data for Improvement

  • Patient experience of care

    • CG-CAHPS patient surveys

  • Clinical quality measures

    • Adult & pedi

  • Cost & resource use (HealthDialog rpts)

    • Hosp’s, readmissions, ED use, imaging

  • Practice changes

Data feedback clinical quality
Data Feedback: Clinical Quality

  • Pilot expectation that practices report clinical quality measures quarterly

  • Started with 2008 (baseline), then Q1 2010 onward

  • Adult: 31 clinical quality measures, aligned with meaningful use

  • Using online data reporting system developed by OnPoint

Data feedback cost resource use
Data Feedback: Cost & Resource Use

  • Use claims from Maine All-Claims Paid Database, via MHDO

  • MQF contracts with Health Dialog to produce reports

  • First reports delivered to practices mid-August, using 2008 claims data

  • Anticipate ongoing, q6mos reports

Performance summary
Performance Summary

Performance summary includes:

  • Demographics about practice’s panel

  • Overall practice performance compared to peers in 3 areas of unwarranted variation

  • Evaluation of overall effectiveness and efficiency

  • Practice’s score on 6 key utilization measures

  • Best opportunities for improvement in the practice

Performance summary1
Performance Summary

  • Practice’s overall score is compared to peer norm in each of 3 categories of unwarranted variation:

    • Effective care (evidence based treatment or intervention to improve health status or quality of life)

    • Supply sensitive care (services that strongly correlate with resource supply)

    • Preference sensitive care (conditions that have multiple treatment options and the treatment decision should reflect the patient’s preferences

Effectiveness and efficiency
Effectiveness and Efficiency

  • Looks at overall supply sensitive cost score compared to the overall effective care gap score

  • Practice is compared to other practices on a scatter plot with four quadrants based on the population medians

Utilization measures
Utilization Measures

  • Utilization measures look at overall admissions, emergency department visits, and PCP and specialist visits per 1000 patients per year

  • Summary measures on prescription count per 1,000 patients and generic fill rate are included

  • Colored triangles indicate where practice is significantly different from peers

Best opportunities for improvement
Best Opportunities for Improvement

  • Shows where practice is significantly different from peers AND where the total impact of improving is highest

Performance impact
Performance Impact

  • Lists all measures where practice is significantly different from peer norm

Total Impact estimates the number of opportunities or the total dollars that could be impacted if your practice were to perform at the same level as the peer norm.

Effective supply sensitive preference sensitive care
Effective, Supply Sensitive, Preference Sensitive Care

  • Each section contains 3 components:

    • Cover page with table of contents

    • Overall measure for care type

    • Overall and detail information for individual measures

Lessons learned maine pcmh pilot
Lessons Learned Maine PCMH Pilot

  • Change starts with effective leadership

    • Primary selection criteria for Pilot

    • Don’t assume physician leadership skills - need ongoing support

  • Change happens through effective teams

  • NCQA PPC-PCMH  “medical home”

  • It’s all about relationships – with patients AND within teams

  • Recognize value of “outside” coaching

Where we re aiming medical home is where

Patients feel welcomed

Staff takes pleasure in working

Physicians feel energized every day

Where We’re Aiming: Medical Home Is Where…

Maine pcmh pilot issues tbd
Maine PCMH Pilot - Issues TBD

  • Will new payment be enough to support true practice transformation?

  • How best to engage specialists, hospitals in shared goals, shared cost savings?

  • How to engage patients in new partnership?

  • How to spread learnings to other “non-Pilot” practices

  • And more??

Contact info questions
Contact Info / Questions

  • Lisa Letourneau MD, MPH


  • 207.415.4043

  • Sue Butts Dion


  • Maine PCMH Pilot


      (See “Major Programs”  “PCMH Pilot”)