maine pcmh pilot & community care teams: a targeted strategy to improve care & control costs...
TRANSCRIPT
Maine PCMH Pilot & Community Care Teams:
A Targeted Strategy to Improve Care & Control Costs for High-Needs Patients
Lisa M. Letourneau MD, MPHMeHAF Legislative Breakfast
March 2013
The Medical Home: A Start for Change!
Providers transform practice, create value with viable &
sustainable payment for desired services
= Practice Transformation
Employers & payers pay for desired services because
primary care demonstrates value & saves money
= Payment Reform
AND
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Maine PCMH Pilot Leadership
Maine Quality Counts
DHA’s Maine Quality Forum
Maine Health Management
Coalition
MaineCare (Medicaid) 3
Maine PCMH Pilot Expansion
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Maine PCMH Pilot Practice “Core Expectations”
1. Demonstrated physician leadership2. Team-based approach3. Population risk-stratification and management4. Practice-integrated care management5. Same-day access6. Behavioral-physical health integration7. Inclusion of patients & families8. Connection to community / local HMP9. Commitment to waste reduction
10. Patient-centered HIT
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Community Care Teams• Multi-disciplinary, community-based, practice-
integrated care teams
• Build on successful models (NC, VT, NJ)
• Support patients & practices in Pilot sites, help most high-needs patients overcome barriers – esp. social needs - to care, improve outcomes
• Key element of cost-reduction strategy, targeting high-needs, high-cost patients to reduce avoidable costs (ED use, admits)
PCMH Practice
High-need Individual
Maine PCMH Pilot Community Care Teams
Transportation
Workplace
Environment
Food Systems
Shopping
Income
HeatFaith
Community
Literacy
Coaching
Physical Therapy
Hospital Services
Specialists
Outpatient Services
Med Mgt
HousingCare Mgt
Behav. Health & Sub Abuse
Family
Schools
Maine Medicaid (MaineCare) Health Homes InitiativeStage A:
• Health Home = PCMH primary care practice + CCT • Payment weighted toward medical home• Eligible Members:
• Two or more chronic conditions• One chronic condition and at risk for another
Stage B:• Health Home = CCT with behavioral health expertise + PCMH
primary care practice• Payment weighted toward CCT• Eligible Members:
• Adults with Serious Mental Illness• Children with Serious Emotional Disturbance
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PCMH Practice
Health Homes Beneficiary
Coaching
Med Mgt
Care Mgt
Behav. Health & Sub Abuse
MaineCare Health Homes Proposal
Stage A: Help Individuals with Chronic Conditions
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Health Homes Beneficiary
PCMH Practice
Coaching
Med Mgt
Care Mgt
Behav Health & Sub Abuse
MaineCare Health Homes Proposal
Stage B: Help Individuals with Severe Mental
Illness and/or Children with Serious Emotional
Disturbance
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Unique Features of Maine Approach• Defining “Health Home” as PCMH + CCT• Adding CCT services to specifically support
high-needs, high-cost members (recognizing these mbrs can often outstrip capacity of most primary care practices – even PCMHs!)
• Recognizes differences between “routine”/chronic disease care management & CCT multi-disciplinary team approach for most high-needs mbrs
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Financing CCTs: Maine Approach• Linked CCT model, payment to multi-payer
PCMH model• Leveraged public, private payers agreement to
provide pmpm payment• Participation in CMS MAPCP demo brought in
Medicare as payer• Alignment of ACA Health Homes with multi-
payer Pilot provided opportunity to leverage federal 90:10 match for CCT services
Maine’s Medical Home Movement
~ 540 Maine Primary Care Practice Sites
25 Maine PCMH Pilot Practices
50 Pilot Phase 2
Practices
14 FQHCs CMS APC
Demo
100+ NCQA PCMH Recognized Practices
70 MaineCare HH-only Practices
Payers: • Medicare• Medicaid (HH)• Commercial
plans (Anthem, Aetna, HPHC)
• Self-funded employers
Payer: Medicare
Payer: Medicaid
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: Who We Are• Independent, multi-stakeholder alliance in Maine
working to transform health and healthcare by leading, collaborating, and aligning improvement efforts
• Only organization working to improve quality of care for all Maine people
• Members include consumers, doctors, nurses, hospitals, health systems, payers, employers, government, policy makers, and others working to improve health and healthcare
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Contact Info / Questions Lisa Letourneau MD, MPH
• [email protected]• 207.415.4043
Maine Quality Counts• www.mainequalitycounts.org
Maine PCMH Pilot• www.mainequalitycounts.org
(See “Programs” PCMH)
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