steffen-Maryland Multi‐payer PCMH Program Update

  • 1,348 views
Uploaded on

Ben Steffen, MA, Center Director, Maryland Health Care Commission, gives an update on the Maryland Multi‐payer PCMH Program (MMPP) at the New Tactics for Building Medical Homes in State Medicaid and …

Ben Steffen, MA, Center Director, Maryland Health Care Commission, gives an update on the Maryland Multi‐payer PCMH Program (MMPP) at the New Tactics for Building Medical Homes in State Medicaid and CHIP Programs webinar.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
1,348
On Slideshare
0
From Embeds
0
Number of Embeds
2

Actions

Shares
Downloads
3
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Update on theMaryland Multi‐payer PCMH Program (MMPP) National Academy for State Health Policy December 16, 2010 Ben Steffen  Maryland Health Care Commission 1
  • 2. Maryland MMPP Operational GoalsPhase 1 – Pilot Program – 50 practices – 200 providers – At least 200,000 patients – 5 largest commercial payers ‐‐ Build multi‐payer into program’s DNA.  All major commercial payers will participate and as many public  payers as are willing to join• Participation goals have been exceeded – Web‐based application process – First step in selection is automated application scoring• A current challenge ‐‐ expand initiative to self‐insured  – Maryland welcomes opportunities to work with other  states in  devising strategies to engage self‐insured employers 2
  • 3. Maryland PCMH Requirements• To receive enhanced PCMH payment in the Maryland  program, practices must: – Sign participation agreement – Participate in learning collaborative – Demonstrate compliance with the NCQA PCMH  recognition standards (including the Maryland required  elements) • Level 1+ by Dec. 31, 2011 • Level 2+ by Dec. 31, 2012 – Practices must also report on a set of performance  measures aligned with the federal HIT “meaningful use” requirements   – Meet utilization measures. 3
  • 4. PCMH Financial Model } Savings OpportunityTotal Cost of Care Total Cost of Care • In the medical home, primary care services  and pharmacy utilization will likely increase. • Better patient management and outcomes  will reduce emergency room (ER) visits and  hospitalizations, producing net savings • A portion of the expected savings are used  to fund fixed payments to the medical home • The medical home also receives a share of  actual savings (incentive payment) 4
  • 5. Payment Model Fee‐For‐ServicePrimary care practices will continue to be reimbursed under their existing fee‐for‐service payment arrangements with health plans. + Fixed Payment (Care Coordination Fee)Primary care practices will receive a fixed, per patient per month fee (paid semi‐annually).  The purpose of this fee is to defray the costs of providing enhanced primary care services, including care coordination. + Incentive Payment (Shared Savings)Primary care practices will receive a share of any savings generated by improved patient outcomes.  Savings calculations will be  performed using the MHCC’s all‐payer claims database. 5
  • 6. PCMH Fixed Payment• Adjusted for: – Payer Type (commercial, Medicaid, Medicare) – Practice Size – NCQA Recognition Level• Fixed payment ranges: – Commercial: $3.51 to $6.01 per person per month  (PPPM) – Medicaid: $4.08 to $7.00 PPPM – Medicare Advantage: $9.62 PPPM 6
  • 7. PCMH Incentive Payment• Incentive payments are based on shared savings• Practices are eligible for incentive payments if they: – Meet performance and measurement criteria – Achieve savings relative to their own baseline• Calculations to be performed by MHCC, which may  adjust for case mix or outliers• Achieve savings, report on quality, reduce utilization 7
  • 8. Wrapping Up – Challenges We Need To Address• Are we using the appropriate baseline for calculating saving?  – In a 3 year program a practice‐specific versus a normative baseline is  easier to implement.• Are projected savings reasonable? – Savings based on analysis of 6 conditions, it is likely that practices could  achieve additional savings through improved care beyond what we  estimated from the 6 conditions. – Other pilots have reported savings in the range of 10 percent.• Are the fixed payments (25% of projected saving) too low/high? – Practices with large numbers high risk patients will  need greater fixed  payments – argues for risk adjusting the fixed payment. – If fixed payments are too high, practices will learn that they have no  chance for producing incentives and will stop trying.• Program financial incentives will likely require adjustment during the initial  the 3 year program.  That is a benefit of starting small.   8