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Letourneau Maine Learning the ABCs of APCs

Letourneau Maine Learning the ABCs of APCs



Dr. Letourneau has a particular interest in helping to build connections between public health and clinical care, and the role of physicians in helping to develop and lead health improvement efforts.

Dr. Letourneau has a particular interest in helping to build connections between public health and clinical care, and the role of physicians in helping to develop and lead health improvement efforts.



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    Letourneau Maine Learning the ABCs of APCs Letourneau Maine Learning the ABCs of APCs Presentation Transcript

    • NASHP - October 5, 2010 Lisa M. Letourneau MD, MPH Quality Counts Learning the ABCs of APCs and Medical Homes
    • Objectives
      • Review basic elements, goals for Maine PCMH Pilot
      • Highlight unique features of Maine Pilot
      • Share lessons learned to date
      • Look forward to upcoming opportunities (ACA)
    • Maine PCMH Pilot
      • Key elements:
        • 3-year multi-payer PCMH pilot
        • Collaborative effort of key stakeholders, 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
        • Conducting rigorous outcomes evaluation (clinical, cost, patient experience of care)
    • 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 Strengths & Challenges
      • Public-private partnership - 3 conveners
      • Consumer / patient engagement
      • Expectations & support for practice transformation
      • Ongoing data feedback for improvement
      • Ensuring sufficient payment vs. demonstrating accountability for costs
    • Maine PCMH Pilot Leadership Quality Counts Maine Quality Forum Maine Health Management Coalition
    • Keeping Patients at Center of Maine PC MH Pilot
      • Patients/consumers included in Maine Pilot planning, governance
      • Patient/consumer focus groups held as part of Pilot planning
      • Patient-oriented informational, educational tools
      • Pilot practices required to include patients in redesign efforts
      • Patient experience (CG-CAHPS) part of Pilot evaluation
      • Efforts linked w/ AF4Q consumer engagement
    • 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
    • Support for Practice Transformation
      • PCMH Learning Collaborative
        • IHI “BTS” model; 3 Learning Sessions/yr
      • Practice QI Coaches
        • Most from existing PHOs, med groups
        • Using microsystems approach to QI
      • Technical assistance “experts”
        • BH integration, work with consumers, HIT
      • Ongoing feedback reports
        • Clinical, claims data
    • 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
      • Practices commit to reporting clinical quality measures quarterly
      • Use 31 clinical quality measures (adult), aligned with meaningful use measures
      • Started with 2008 (baseline), then Q1 2010 onward
      • Practices use online data reporting system (developed for Pilot), receive comparative feedback reports
    • Clinical Data Feedback X
    • Clinical Data Feedback
    • 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
    • Provider Performance Measurement Reports August 2010
    • 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
    • Best Opportunities for Improvement
      • Shows where practice is significantly different from peers AND where the total impact of improving is highest
    • 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
    • Potential Opportunities
      • CMS Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration
      • Affordable Care Act
        • Section 2702: Health Homes (Medicaid)
        • Section 3502: Community Health Teams (Medicaid Health Homes)
        • Section 4108: Incentives for Chronic Disease Prevention
    • Medicare Med Home Demo
      • Maine application submitted, proposed new…
        • $7 pmpm to providers,
        • $3 pmpm for community-based care management
      • To meet expectations for budget-neutrality (i.e. must project $10 pmpm savings), Maine proposed…
        • 6-7% decreases in inpatient admissions (CVD & Resp)
        • 5% decrease in ED visits
        • 5% decrease in specialty consultations
        • 5% decrease in imaging use
    • Maine PCMH Pilot - Issues TBD
      • Will new payment be enough to support true practice transformation?
      • How best to engage specialists, hospitals in shared goals, producing cost savings?
      • How to engage patients in new partnership?
      • How to spread learnings to other “non-Pilot” practices
      • And more??
    • www.mainequalitycounts.org
    • Contact Info / Questions
        • Lisa Letourneau MD, MPH
        • [email_address]
        • 207.415.4043
      • Sue Butts Dion
        • [email_address]
      • Maine PCMH Pilot
        • www.mainequalitycounts.org
          • (See “Major Programs”  “PCMH Pilot”)