Medical Home Model: Care for the Chronically Ill   Linda Magno Director, Medicare Demonstrations
Medical Home Demonstration <ul><li>Tax Relief and Health Care Act of 2006—Sec. 204 </li></ul><ul><li>…redesign the health ...
Key Parameters <ul><li>3 years </li></ul><ul><li>8 sites—urban, rural, underserved areas </li></ul><ul><li>“Personal physi...
Design Issues <ul><li>Minimum requirements for medical home </li></ul><ul><ul><li>Capacity of practice to coordinate care ...
Design Issues <ul><li>Practice eligibility </li></ul><ul><ul><li>External certification </li></ul></ul><ul><ul><li>Self-ce...
Design Issues <ul><li>Payment </li></ul><ul><ul><li>Should care management fee vary with practice characteristics? Patient...
Development Timetable <ul><li>Consultation– spring 2007 </li></ul><ul><li>Design contract: RFP – May 2007, award – Sept. 2...
Improved Expanded Medical Home <ul><li>Children’s Health and Medicare Protection Act of 2007—Sec. 306 </li></ul><ul><li>…r...
    Features Medical Home Improved/Expanded Medical Home Statutory authority Tax Relief and Health Care Act of 2006 Childr...
Features Medical Home Improved/Expanded Medical Home Definition Physician practice in charge of targeting beneficiaries fo...
  Features Medical Home Improved/Expanded Medical Home Role of HIT Monitor and track health status of patients and provide...
For More Information <ul><li>www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp#TopOfPage </li></ul>
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Medical Home Demonstrations: CMS and Federal Initiatives

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Medical Home Demonstrations: CMS and Federal Initiatives

  1. 1. Medical Home Model: Care for the Chronically Ill Linda Magno Director, Medicare Demonstrations
  2. 2. Medical Home Demonstration <ul><li>Tax Relief and Health Care Act of 2006—Sec. 204 </li></ul><ul><li>…redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations </li></ul>
  3. 3. Key Parameters <ul><li>3 years </li></ul><ul><li>8 sites—urban, rural, underserved areas </li></ul><ul><li>“Personal physician” responsible for ongoing support, oversight, guidance to implement plan of care </li></ul><ul><li>High-need patients: multiple chronic illnesses </li></ul>
  4. 4. Design Issues <ul><li>Minimum requirements for medical home </li></ul><ul><ul><li>Capacity of practice to coordinate care </li></ul></ul><ul><ul><ul><li>Staffing </li></ul></ul></ul><ul><ul><ul><li>Health assessment tool </li></ul></ul></ul><ul><ul><ul><li>Other resources (patient self-management education and support) </li></ul></ul></ul><ul><ul><li>Where is practice on continuum of adoption/use of health information technology (HIT)? </li></ul></ul><ul><ul><ul><li>Patient access to personal health info </li></ul></ul></ul>
  5. 5. Design Issues <ul><li>Practice eligibility </li></ul><ul><ul><li>External certification </li></ul></ul><ul><ul><li>Self-certification </li></ul></ul><ul><ul><li>Other </li></ul></ul><ul><li>Beneficiary roles/responsibilities </li></ul><ul><ul><li>Enrollment </li></ul></ul><ul><ul><li>Ability to move from one medical home to another </li></ul></ul><ul><ul><li>Cost-sharing </li></ul></ul>
  6. 6. Design Issues <ul><li>Payment </li></ul><ul><ul><li>Should care management fee vary with practice characteristics? Patient characteristics? </li></ul></ul><ul><ul><ul><li>Beneficiary risk profile </li></ul></ul></ul><ul><ul><ul><li>Degree of HIT use </li></ul></ul></ul><ul><ul><li>Measurement of shared savings </li></ul></ul><ul><ul><ul><li>Randomization of applicant practices </li></ul></ul></ul><ul><li>Site selection/recruitment of practices </li></ul>
  7. 7. Development Timetable <ul><li>Consultation– spring 2007 </li></ul><ul><li>Design contract: RFP – May 2007, award – Sept. 2007 </li></ul><ul><li>Final demonstration design – June 2008 </li></ul><ul><li>Implementation contract – August 2008 </li></ul><ul><li>Start demonstration – January 2009 </li></ul>
  8. 8. Improved Expanded Medical Home <ul><li>Children’s Health and Medicare Protection Act of 2007—Sec. 306 </li></ul><ul><li>…redesign health care delivery system to provide accessible, continuous, comprehensive, and coordinated care to Medicare beneficiaries </li></ul><ul><li>Provide care management fees to physicians delivering continuous and comprehensive care </li></ul>
  9. 9.     Features Medical Home Improved/Expanded Medical Home Statutory authority Tax Relief and Health Care Act of 2006 Children’s Health and Medicare Protection Act of 2007 Duration 3 years 3 years Location 8 sites – urban, rural, and underserved areas Nationally representative sample – physicians serving urban, rural, and underserved areas Number of practices Unspecified 500 practices: 100 HIT-enhanced; others serving populations at higher risk for health disparities Type of practices <3 physicians; larger practices in rural and underserved areas <4 physicians; larger practices in rural and underserved areas
  10. 10. Features Medical Home Improved/Expanded Medical Home Definition Physician practice in charge of targeting beneficiaries for participation; and responsible for providing safe, secure technology to promote patient access to personal health info, developing a health assessment tool, and providing training programs for personnel involved in care coordination Physician-directed practice certified as meeting standards re: access and communication; managing patient information; managing and coordinating care; providing patients with assistance/encouragement in self-management; resources to manage care; performance monitoring Role of physician Ongoing support, oversight, guidance to implement plan of care; integrated, coherent, cross-discipline medical care developed in partnership w/ patients and all other physicians furnishing care to patient Accessible, continuous, coordinated, and comprehensive care for beneficiaries
  11. 11.   Features Medical Home Improved/Expanded Medical Home Role of HIT Monitor and track health status of patients and provide patients with enhanced, convenient access to services Interoperable EHR integrated with decision support capabilities, support of e-prescribing, CPOE, outcome measurement, patient education Beneficiary population High-need, i.e., multiple chronic illnesses Any Medicare beneficiary served by a participating practice Payment Care management fee plus shared savings Monthly care management fee Funding Medicare savings attributable to medical home $500 million
  12. 12. For More Information <ul><li>www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp#TopOfPage </li></ul>
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