PCPCC Medical Home update, April 2010


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The Patient Centered Primary Care Collaborative has been working for years to build evidence and knowledge about how to improve healthcare by providing a medical "home" for each of us - a place where all our records reside, where the staff know us, etc. This April 2010 by Executive Director Edwina Rogers shows the phenomenal range of results they've produced.

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PCPCC Medical Home update, April 2010

  1. 1. Patient Centered Primary Care Collaborativeand the National Patient Centered Medical Home Movement<br />Edwina Rogers<br />Executive Director<br />Patient Centered Primary Care Collaborative<br />601 Thirteenth St., NW, Suite 400 North<br />Washington, D.C. 20005<br />Direct: 202.724.3331<br />Mobile: 202.674.7800<br />erogers@pcpcc.net<br />1<br />
  2. 2. Overview of Activity<br /><ul><li>27 Multi-stakeholder and other Pilots in 18 States
  3. 3. 44 States and the District of Columbia Have Passed over 330 Laws and/or Have PCMH Activity
  4. 4. Medicaid and Medicare Activity</li></ul>2<br />
  5. 5. 3<br />Blue Cross Blue Shield Plan Pilots (As of March 2010)<br />Pilots in planning phase for 2010 implementation<br />Pilots in progress<br />Pilot activity in early stages of development<br />Multi-Stakeholder demonstration<br />
  6. 6. AK<br />VA<br />There are 37 States Working to Advance Medical Homes for Medicaid or CHIP Beneficiaries<br />WA<br />ME<br />ND<br />MT<br />OR<br />VT<br />ID<br />MN<br />NH<br />MA<br />WI<br />NY<br />SD<br />MI<br />WY<br />RI<br />CT<br />PA<br />IA<br />NJ<br />NE<br />NV<br />OH<br />UT<br />IN<br />DE<br />IL<br />MD<br />CO<br />CA<br />WV<br />DC<br />KS<br />MO<br />KY<br />NC<br />TN<br />AZ<br />OK<br />SC<br />AR<br />NM<br />GA<br />AL<br />MS<br />TX<br />LA<br />FL<br />HI<br />States with at least one effort that met criteria for analysis<br />SOURCE: NASHP analysis<br />
  7. 7. Patient-Centered Medical Home<br />Overview of Pilot Activity and Planning Discussions <br />RI<br />Multi-Payer pilot discussions/activity<br />Identified pilot activity<br />No identified pilot activity – 5 States<br />5<br />
  8. 8. PCPCC Membership and Activity Overview<br />National Convener on the PMCH<br />Legislative and Regulatory Advocacy<br />Develop PCMH Policy<br /><ul><li>More than 700 members
  9. 9. 54 Executive Committee Members
  10. 10. 20 Advisory Board Members
  11. 11. 5 Centers
  12. 12. 7 Task Forces
  13. 13. 3 Annual Conferences & Summits
  14. 14. Monthly Calls (National PCMH Movement Briefings, CMD, CPPI, CCE)
  15. 15. Bi-Weekly Calls (CEE, CeHIA)
  16. 16. National Weekly Call (Thursday, 11AM EDT)
  17. 17. Phone number: 712.432.3900
  18. 18. Passcode: 471334
  19. 19. Host Regular Webinars</li></ul>6<br />
  20. 20. The Patient-Centered Primary Care Collaborative <br />Examples of Broad Stakeholder Support & Participation<br />Providers 333,000 primary care<br />Purchasers –<br />Most of the Fortune 500<br /><ul><li>ACP
  21. 21. AAP
  22. 22. IBM
  23. 23. Ohio
  24. 24. AAFP
  25. 25. AOA
  26. 26. Iowa
  27. 27. FedEx
  28. 28. General Electric
  29. 29. ABIM
  30. 30. ACC
  31. 31. Dow
  32. 32. ACOI
  33. 33. AHI
  34. 34. Business Coalitions</li></ul>The <br />Patient-Centered Medical Home<br /><ul><li>Microsoft
  35. 35. Merck & Co.</li></ul>80 Million lives<br />Payers<br />Patients<br /><ul><li>AARP
  36. 36. AFL-CIO
  37. 37. BCBSA
  38. 38. Aetna
  39. 39. National Consumers League
  40. 40. United
  41. 41. Humana
  42. 42. CIGNA
  43. 43. Kaiser Permanente
  44. 44. SEIU
  45. 45. Foundation for Informed Decision Making
  46. 46. WellPoint</li></ul>7<br /><ul><li>Geisinger</li></li></ul><li>Patient Centered Primary Care Collaborative Five ‘Centers’ - Over 770 volunteer members<br />Center for Multi-Stakeholder Demonstration: Identify community-based pilot sites in order to test and evaluate the concept; offer hands-on technical assistance, share best practices, and identify funding sources to advance adoption.<br />Center to Promote Public Payer Implementation: Assist state Medicaid agencies and other public payers as they implement and refine programs to embed the Patient Centered Medical Home model by offering technical assistance; sharing best practices and giving guidance on the development of successful funding models.<br />Center for Employer Engagement: Create standards and buying criteria to serve as a guide and tool for large and small employers/purchasers in order to build the market demand for adoption of the Medical Home model.<br />Center for eHealth Information Adoption and Exchange: Evaluate use and application of information technology to support and enable the development and broad adoption of information technology in private practice and among community practitioners. <br />Center for Consumer Engagement: Engage the consumer in awareness activities through three ways: day-to-day operations, messaging and pilots. The center will continue the use of “Patient Centered Medical Home”, but focus on how the concept and its components are communicated to the public and partner with large consumer groups to capitalize on their visibility and existing efforts.<br />9<br />8<br />
  47. 47. PCPCC Center and Task ForceRecent Deliverables<br />Value Based Insurance Design Report<br />Payment Reform Task Force Report<br />PCMH Transformation Resource Guide<br />Medication Management Guide<br />Emmi Solutions PCMH Video (soon to be available in Spanish)<br />Pilot Activity Tracking from CMD website<br />Letters to Congress<br />Letters Regarding Meaningful Use<br />9<br />
  48. 48. History of the Medical Home Concept<br />The first known documentation of the term “medical home”: Standards of Child Health Care, AAP in 1967 by the AAP Council on Pediatric Practice -- “medical home -- one central source of a child’s pediatric records” History of the Medical Home Concept Calvin Sia, Thomas F. Tonniges, Elizabeth Osterhus and Sharon TabaPediatrics 2004;113;1473-1478<br />Patient Centered – IOM <br />“I would strongly urge the adoption of the Danish model of the Patient Centered Medical Home” -- Karen Davis, Commonwealth Fund <br />2010 Medical Home Wikipedia page: http://en.wikipedia.org/wiki/Medical_home<br />PCPCC Facebook Page<br />10<br />
  49. 49. Joint Principles of the PCMH (February 2007)<br />The following principles were written and agreed upon by the four Primary Care Physician Organizations – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.<br />Principles:<br />Ongoing relationship with personal physician<br />Physician directed medical practice<br />Whole person orientation<br />Coordinated care across the health system<br />Quality and safety <br />Enhanced access to care<br />Payment recognizes the value added<br />11<br />
  50. 50. Endorsements<br />The PCMH Joint Principles have received endorsements from 18 specialty health care organizations:<br /><ul><li>The American Academy of Chest Physicians
  51. 51. The American Academy of Hospice and Palliative Medicine
  52. 52. The American Academy of Neurology
  53. 53. The American College of Cardiology
  54. 54. The American College of Osteopathic Family Physicians
  55. 55. The American College of Osteopathic Internists
  56. 56. The American Geriatrics Society
  57. 57. The American Medical Directors Association
  58. 58. The American Society of Addiction Medicine
  59. 59. The American Society of Clinical Oncology
  60. 60. The Society for Adolescent Medicine
  61. 61. The Society of Critical Care Medicine
  62. 62. The Society of General Internal Medicine
  63. 63. American Medical Association
  64. 64. Association of Professors of Medicine
  65. 65. Association of Program Directors in Internal Medicine
  66. 66. Clerkship Directors in Internal Medicine
  67. 67. Infectious Diseases Society of Medicine</li></ul>12<br />
  68. 68. Defining the Medical Home<br /><ul><li>Patients have accurate, standardized information on physicians to help them choose a practice that will meet their needs.</li></ul>Publicly available information<br />Source: Health2 Resources 9.30.08<br />8<br />13<br />
  69. 69. Accountable Care Organizations<br />Source: Premier Healthcare Alliance<br />14<br />
  70. 70. PCPCC Payment ModelMay 2007<br />Key physician and practice accountabilities/ value added services and tools<br />Proactively work to keep patients healthy and manage existing illness or conditions<br />Incentives<br />Coordinate patient care among an organized team of health care professionals<br />Incentives<br />Performance Standards<br />Utilize systems at the practice level to achieve higher quality of care and better outcomes<br />Incentives<br />Focus on whole person care for their patients (including behavioral health)<br />16<br />15<br />
  71. 71. At least 14 Independent Evaluations in 11 States . . . And Growing<br />RI<br />CMS will select 8 states for the Medicare Medical Home Demonstration<br />16<br />
  72. 72. Several PCMH Evaluations Underway…<br />17<br />
  73. 73. PCMH Evaluations (cont.)<br />18<br />
  74. 74. Community Implications - Published Results of PCMH Projects to Date<br />Source: PCPCC Pilot Guide, 2009<br />19<br />
  75. 75. Community Implications – Published Results of PCMH Projects (cont.)<br />Source: PCPCC Pilot Guide, 2009<br />20<br />
  76. 76. Community Implications – Published Results of PCMH Projects (cont.)<br />Source: Metcare Press Release, February 23, 2010<br />21<br />
  77. 77. Community Implications – PreliminaryFindings of Other PCMH Projects (cont.)<br />Source: PCPCC Pilot Guide, 2009<br />22<br />
  78. 78. Community Implications – PreliminaryFindings of Other PCMH Projects (cont.)<br />Source: PCPCC Pilot Guide, 2009<br />23<br />
  79. 79. Simple Cost Avoidance<br />NC Savings (FY04)<br />24<br />
  80. 80. Case Example: Louisiana Greater New Orleans Primary Care Access and Stabilization Grant<br />Thirteen of the 25 organizations achieved recognition by NCQA as PCMHs at 36 clinic locations (ranging from levels 1-3), and more clinics are expected to achieve the recognition in 2009.<br />All organizations have implemented 24/7 access to clinician by phone and same day appointments for urgent care.<br />The total system volume (number of individuals served) has increased by 15% every six-month period starting March 2007 for outpatient primary and behavioral health care.<br />The 25 participating organizations have expanded the number of service delivery sites from 67 pre-grant to 91 today.<br />Source: PCPCC 2009 Pilot Guide<br />25<br />
  81. 81. Recognition Programs for PCMH Developed or Under Development<br />Quality Organizations <br />PCMH Standards Activity <br />2010<br />26<br />
  82. 82. 27<br />NCQA PPC-PCMH Content and Scoring<br />**Must Pass Elements<br />
  83. 83. Scoring: Building a Ladder to Excellence<br />Level 3: 75+ Points; 10/10 Must Pass<br />Level 2: 50-74 Points; 10/10 Must Pass<br />Level 1: 25-49 Points; 5/10 Must Pass<br />Increasing Complexity <br />of Services<br />
  84. 84. 29<br />Source: NCQA, December 2009<br />
  85. 85. PCMH Implementation Tools- Report Release“Aligning Incentives and Systems”Promoting Synergy Between Value-Based Insurance Design and the Patient Centered Medical Home” <br />Makes the business value case for PCMH showing link to VBID<br />Case studies: Whirlpool Company, the State of Washington, the City of Battle Creek, Mich., IBM, Roy O. Martin Lumber, CIGNA, Universal American, Geisinger Health System/Health Plan, Aetna and the State of Minnesota. <br />Authored by the Center for Employer Engagement in partnership with the National Business Coalition on Health and the University Michigan’s Center for Value-Based Insurance Design<br />30<br />
  86. 86. Meaningful Use: Meaningful Connections<br />Defines health IT capabilities essential to PCMH.<br />Crosswalks capabilities with functional priorities supporting PCMH.<br />Explores how patients/consumers are currently using health IT to connect. <br />Representative sample of 19 case example responses from primary care providers. <br />Appendices include<br />Guidelines for PCMH Demonstration Projects<br />Consumer Principles<br />Consumer Toolkit<br />31<br />
  87. 87. Patient Centered Primary Care Collaborative“Purchaser Guide” Released July, 2008<br />Developed by the PCPCC Center for Benefit Redesign and Implementation in partnership with NBCH and the Center’s multi-stakeholder advisory panel.<br />Guide offers employers and buyers actionable steps as they work with health plans in local markets - over 6000 copies downloaded and/or distributed.<br />Includes contract language, RFP language and overview of national pilots.<br />Includes steps employers can take to involve themselves now in local market efforts.<br />The PCPCC is holding a series of Webinars, sponsored by Pfizer, on the Purchaser Guide. <br />11<br />32<br />
  88. 88. Patient Centered Primary Care Collaborative“Proof in Practice– A Compilation of Patient Centered Medical Home Pilot and Demonstration Projects” Released October 2009<br />Developed by the PCPCC Center for Multi-stakeholder Demonstration through a grant from AAFP offering a state-by-state sample of key pilot initiatives.<br />Offers key contacts, project status, participating practices and market scan of covered lives; physicians.<br />Inventory of : recognition program used, practice support (technology), project evaluation, and key resources.<br />Begins to establish framework for program evaluation/ market tracking.<br />12<br />33<br />
  89. 89. 34<br />Patient Centered Primary Care Collaborative“A Collaborative Partnership – Resources to Help Consumers Thrive in the Medical Home” Released October 2009<br />Included in the Guide:<br />1. PCPCC activities and initiatives supporting consumer engagement;<br />2. Research and examples surrounding consumer engagement in PCMH demonstrations;<br />3. Tools for consumers and other stakeholders to assist with PCMH education, engagement and partnerships; and<br />4. A catalogue of resources that provides descriptions of and the means to obtain potential resources for consumers,<br />providers and purchasers seeking to better engage consumers.<br />
  90. 90. Information Flow- Consumer Materials <br />Four minute video for waiting room viewing; deep-dive on PCMH (Flash)<br />Promotes Primary Care (brochure)<br />Deep-dive focus on PCMH (brochure)<br />What consumers can expect- PCMH consumer principles (brochure)<br />Guidance to create your own practice brochure in support of PCMH model (paper)<br />35<br />
  91. 91. MEDICARE-MEDICAID ADVANCED PRIMARY CARE DEMONSTRATION INITIATIVE<br />On September 16, 2009 HHS Secretary Sebelius, along with Director of White House Office of Health Reform Nancy-Ann DeParle and Vermont Governor Jim Douglas, announced that the Centers for Medicare and Medicaid Services (CMS) will establish a demonstration program that will enable Medicare to join Medicaid and private insurers in innovative state-based advanced primary care initiatives.<br />New Medicare Demonstration<br /><ul><li>Design will include mechanisms to assure it generates savings for the Medicare trust funds and the federal government
  92. 92. Private insurers work in cooperation with Medicaid to set uniform standards for “Advanced Primary Care (APC) models”
  93. 93. Provide incentives for doctors to spend more time with their patients and offer better coordinated higher-quality medical care</li></ul>States Wishing to Participate in the New Demonstration Must:<br /><ul><li>Certify they have already established similar cooperative agreements between private payer and their Medicaid program;
  94. 94. Demonstrate a commitment from a majority of their primary care doctors to join the program;
  95. 95. Meet a stringent set of qualifications for doctors who participate; and
  96. 96. Integrate public health services to emphasize wellness and prevention strategies.</li></ul>36<br />
  97. 97. Encouraging Movement White House, Senate and House<br />Major provisions of the Health Care Reform bills relevant to Primary Care and PCMH <br /><ul><li>State option to provide health homes for enrollees with chronic conditions. Provide States the option of enrolling Medicaid beneficiaries with chronic conditions into a health home.
  98. 98. Pediatric Accountable Care Organization demonstration project. Establishes a demonstration project that allows qualified pediatric providers to be recognized and receive payments as Accountable Care Organizations (ACO) under Medicaid.
  99. 99. Establishment of Center for Medicare and Medicaid Innovation within CMS. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients in each program.
  100. 100. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship. Provides grants to develop and operate training programs, provide financial assistance to trainees and faculty, enhance faculty development in primary care and physician assistant programs, and to establish, maintain, and improve academic units in primary care.
  101. 101. Expanding access to primary care services and general surgery services. Beginning in 2011, provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years.
  102. 102. Payments to primary care physicians. Requires that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014.</li></ul>Other Items:<br /><ul><li>‘Grants to Establish Community Health Teams to Support a Medical Home Model’: the Secretary of HHS would establish a grant program to creating the “community health team which is community-based, multi disciplinary, interprofessional teams (on the model of medical home) to increase access to comprehensive coordinated care.
  103. 103. Enhancing Health Care Workforce Education and Training -. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home. Authorization is set at $125 million.</li></ul>37<br />
  104. 104. CMS Activity and the PCMH<br />Planned Demonstrations<br />Medicare Medical Home Demo Status - on hold pending recent health care reform legislation<br />Multi-Payer Advanced Primary Care Practice Demo Status - invitation to states and solicitation in clearance<br />Federally Qualified Health Centers Advanced Primary Care Practice Demo Status - under development<br />38<br />
  105. 105. Test Drive the New PCPCC Website !<br />Soft Launch 3.18.2010<br />Membership Webinar 4.08.2010 -Recorded<br />Major features include<br />Master calendar listing all PCPCC events<br />On-line and interactive Pilot Guide<br />User portals (consumer & patients, employer & health plans, providers & clinicians, federal & state government<br />Center portals and updates<br />http://www.pcpcc.net<br />39<br />
  106. 106. Upcoming <br />Collaborative Events<br />Thursday, July 22, 2010 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center<br />Thursday, October 21, 2010- Washington D.C., Annual Summit - Ronald Reagan Building and International Trade Center<br />40<br />
  107. 107. Contact Information<br />Visit our website – http://www.pcpcc.net<br />To request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact:<br /> Edwina Rogers<br /> Patient Centered Primary Care Collaborative<br /> Executive Director<br />202.724.3331 <br /> 202.674.7800 (cell)<br />erogers@pcpcc.net<br /> The Homer Building<br /> 601 Thirteenth St., NW, Suite 400 North<br /> Washington, DC 20005<br />41<br />