NASHP  - October 5, 2010 Lisa M. Letourneau MD, MPH Quality Counts Learning the ABCs of APCs and Medical Homes
Objectives <ul><li>Review basic elements, goals for Maine PCMH Pilot </li></ul><ul><li>Highlight unique features of Maine ...
Maine PCMH Pilot  <ul><li>Key elements: </li></ul><ul><ul><li>3-year multi-payer PCMH pilot </li></ul></ul><ul><ul><li>Col...
Maine PCMH Pilot - Timeline <ul><li>Jan 2009: Call for practice applications  </li></ul><ul><li>May 2009: Practices notifi...
Maine PCMH Strengths & Challenges <ul><li>Public-private partnership - 3 conveners </li></ul><ul><li>Consumer / patient en...
Maine PCMH Pilot Leadership  Quality Counts Maine Quality Forum Maine Health Management Coalition
Keeping Patients at Center of Maine  PC MH Pilot <ul><li>Patients/consumers included in Maine Pilot planning, governance <...
Maine PCMH Pilot  Practice “Core Expectations” <ul><ul><li>Demonstrated physician leadership </li></ul></ul><ul><ul><li>Te...
Support for Practice Transformation <ul><li>PCMH Learning Collaborative </li></ul><ul><ul><li>IHI “BTS” model; 3 Learning ...
PCMH Evaluation &  Data for Improvement <ul><li>Patient experience of care </li></ul><ul><ul><li>CG-CAHPS patient surveys ...
Data Feedback: Clinical Quality  <ul><li>Practices commit to reporting clinical quality measures quarterly </li></ul><ul><...
Clinical Data Feedback X
Clinical Data Feedback
Data Feedback:  Cost & Resource Use  <ul><li>Use claims from Maine All-Claims Paid Database, via MHDO </li></ul><ul><li>MQ...
Provider Performance Measurement Reports August 2010
Performance Summary <ul><li>Performance summary includes: </li></ul><ul><li>Demographics about practice’s panel </li></ul>...
Best Opportunities for Improvement <ul><li>Shows where practice is significantly different from peers AND where the total ...
Lessons Learned  Maine PCMH Pilot <ul><li>Change starts with effective leadership </li></ul><ul><ul><li>Primary selection ...
Potential Opportunities <ul><li>CMS Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration </li></ul><ul><li>Aff...
Medicare Med Home Demo <ul><li>Maine application submitted, proposed new… </li></ul><ul><ul><li>$7 pmpm to providers, </li...
Maine PCMH Pilot - Issues TBD <ul><li>Will new payment be enough to support true practice transformation? </li></ul><ul><l...
www.mainequalitycounts.org
Contact Info / Questions <ul><ul><li>Lisa Letourneau MD, MPH </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul...
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Letourneau Maine Learning the ABCs of APCs

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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

  1. 1. NASHP - October 5, 2010 Lisa M. Letourneau MD, MPH Quality Counts Learning the ABCs of APCs and Medical Homes
  2. 2. Objectives <ul><li>Review basic elements, goals for Maine PCMH Pilot </li></ul><ul><li>Highlight unique features of Maine Pilot </li></ul><ul><li>Share lessons learned to date </li></ul><ul><li>Look forward to upcoming opportunities (ACA) </li></ul>
  3. 3. Maine PCMH Pilot <ul><li>Key elements: </li></ul><ul><ul><li>3-year multi-payer PCMH pilot </li></ul></ul><ul><ul><li>Collaborative effort of key stakeholders, major payers </li></ul></ul><ul><ul><li>Adopted common mission & vision, guiding principles for Maine PCMH model </li></ul></ul><ul><ul><li>Selected 22 adult / 4 pedi PCP practices across state </li></ul></ul><ul><ul><li>Supporting practice transformation & shared learnings beyond pilot practices </li></ul></ul><ul><ul><li>Committed to engaging consumers/ patients at all levels </li></ul></ul><ul><ul><li>Conducting rigorous outcomes evaluation (clinical, cost, patient experience of care) </li></ul></ul>
  4. 4. Maine PCMH Pilot - Timeline <ul><li>Jan 2009: Call for practice applications </li></ul><ul><li>May 2009: Practices notified – start of 6mo “ramp-up period” </li></ul><ul><li>Sept 2009: NCQA PPC-PCMH applications completed </li></ul><ul><li>Sept-Dec: practices contracted with payers </li></ul><ul><li>Jan 2010: Start date for PCMH payments </li></ul><ul><li>Jan 2010- Dec 2012: 3-year PCMH Pilot </li></ul>
  5. 5. Maine PCMH Strengths & Challenges <ul><li>Public-private partnership - 3 conveners </li></ul><ul><li>Consumer / patient engagement </li></ul><ul><li>Expectations & support for practice transformation </li></ul><ul><li>Ongoing data feedback for improvement </li></ul><ul><li>Ensuring sufficient payment vs. demonstrating accountability for costs </li></ul>
  6. 6. Maine PCMH Pilot Leadership Quality Counts Maine Quality Forum Maine Health Management Coalition
  7. 7. Keeping Patients at Center of Maine PC MH Pilot <ul><li>Patients/consumers included in Maine Pilot planning, governance </li></ul><ul><li>Patient/consumer focus groups held as part of Pilot planning </li></ul><ul><li>Patient-oriented informational, educational tools </li></ul><ul><li>Pilot practices required to include patients in redesign efforts </li></ul><ul><li>Patient experience (CG-CAHPS) part of Pilot evaluation </li></ul><ul><li>Efforts linked w/ AF4Q consumer engagement </li></ul>
  8. 8. Maine PCMH Pilot Practice “Core Expectations” <ul><ul><li>Demonstrated physician leadership </li></ul></ul><ul><ul><li>Team-based approach </li></ul></ul><ul><ul><li>Population risk-stratification and management </li></ul></ul><ul><ul><li>Practice-integrated care management </li></ul></ul><ul><ul><li>Same-day access </li></ul></ul><ul><ul><li>Behavioral-physical health integration </li></ul></ul><ul><ul><li>Inclusion of patients & families </li></ul></ul><ul><ul><li>Connection to community / local HMP </li></ul></ul><ul><ul><li>Commitment to waste reduction </li></ul></ul><ul><ul><li>Patient-centered HIT </li></ul></ul>
  9. 9. Support for Practice Transformation <ul><li>PCMH Learning Collaborative </li></ul><ul><ul><li>IHI “BTS” model; 3 Learning Sessions/yr </li></ul></ul><ul><li>Practice QI Coaches </li></ul><ul><ul><li>Most from existing PHOs, med groups </li></ul></ul><ul><ul><li>Using microsystems approach to QI </li></ul></ul><ul><li>Technical assistance “experts” </li></ul><ul><ul><li>BH integration, work with consumers, HIT </li></ul></ul><ul><li>Ongoing feedback reports </li></ul><ul><ul><li>Clinical, claims data </li></ul></ul>
  10. 10. PCMH Evaluation & Data for Improvement <ul><li>Patient experience of care </li></ul><ul><ul><li>CG-CAHPS patient surveys </li></ul></ul><ul><li>Clinical quality measures </li></ul><ul><ul><li>Adult & pedi </li></ul></ul><ul><li>Cost & resource use (HealthDialog rpts) </li></ul><ul><ul><li>Hosp’s, readmissions, ED use, imaging </li></ul></ul><ul><li>Practice changes </li></ul>
  11. 11. Data Feedback: Clinical Quality <ul><li>Practices commit to reporting clinical quality measures quarterly </li></ul><ul><li>Use 31 clinical quality measures (adult), aligned with meaningful use measures </li></ul><ul><li>Started with 2008 (baseline), then Q1 2010 onward </li></ul><ul><li>Practices use online data reporting system (developed for Pilot), receive comparative feedback reports </li></ul>
  12. 12. Clinical Data Feedback X
  13. 13. Clinical Data Feedback
  14. 14. Data Feedback: Cost & Resource Use <ul><li>Use claims from Maine All-Claims Paid Database, via MHDO </li></ul><ul><li>MQF contracts with Health Dialog to produce reports </li></ul><ul><li>First reports delivered to practices mid-August, using 2008 claims data </li></ul><ul><li>Anticipate ongoing, q6mos reports </li></ul>
  15. 15. Provider Performance Measurement Reports August 2010
  16. 16. Performance Summary <ul><li>Performance summary includes: </li></ul><ul><li>Demographics about practice’s panel </li></ul><ul><li>Overall practice performance compared to peers in 3 areas of unwarranted variation </li></ul><ul><li>Evaluation of overall effectiveness and efficiency </li></ul><ul><li>Practice’s score on 6 key utilization measures </li></ul><ul><li>Best opportunities for improvement in the practice </li></ul>
  17. 17. Best Opportunities for Improvement <ul><li>Shows where practice is significantly different from peers AND where the total impact of improving is highest </li></ul>
  18. 18. Lessons Learned Maine PCMH Pilot <ul><li>Change starts with effective leadership </li></ul><ul><ul><li>Primary selection criteria for Pilot </li></ul></ul><ul><ul><li>Don’t assume physician leadership skills - need ongoing support </li></ul></ul><ul><li>Change happens through effective teams </li></ul><ul><li>NCQA PPC-PCMH  “medical home” </li></ul><ul><li>It’s all about relationships – with patients AND within teams </li></ul><ul><li>Recognize value of “outside” coaching </li></ul>
  19. 19. Potential Opportunities <ul><li>CMS Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration </li></ul><ul><li>Affordable Care Act </li></ul><ul><ul><li>Section 2702: Health Homes (Medicaid) </li></ul></ul><ul><ul><li>Section 3502: Community Health Teams (Medicaid Health Homes) </li></ul></ul><ul><ul><li>Section 4108: Incentives for Chronic Disease Prevention </li></ul></ul>
  20. 20. Medicare Med Home Demo <ul><li>Maine application submitted, proposed new… </li></ul><ul><ul><li>$7 pmpm to providers, </li></ul></ul><ul><ul><li>$3 pmpm for community-based care management </li></ul></ul><ul><li>To meet expectations for budget-neutrality (i.e. must project $10 pmpm savings), Maine proposed… </li></ul><ul><ul><li>6-7% decreases in inpatient admissions (CVD & Resp) </li></ul></ul><ul><ul><li>5% decrease in ED visits </li></ul></ul><ul><ul><li>5% decrease in specialty consultations </li></ul></ul><ul><ul><li>5% decrease in imaging use </li></ul></ul>
  21. 21. Maine PCMH Pilot - Issues TBD <ul><li>Will new payment be enough to support true practice transformation? </li></ul><ul><li>How best to engage specialists, hospitals in shared goals, producing cost savings? </li></ul><ul><li>How to engage patients in new partnership? </li></ul><ul><li>How to spread learnings to other “non-Pilot” practices </li></ul><ul><li>And more?? </li></ul>
  22. 22. www.mainequalitycounts.org
  23. 23. Contact Info / Questions <ul><ul><li>Lisa Letourneau MD, MPH </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><ul><li>207.415.4043 </li></ul></ul><ul><li>Sue Butts Dion </li></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>Maine PCMH Pilot </li></ul><ul><ul><li>www.mainequalitycounts.org </li></ul></ul><ul><ul><ul><li>(See “Major Programs”  “PCMH Pilot”) </li></ul></ul></ul>
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