patient-centered medical home the colorado multi-stakeholder pilot experience pcpcc stakeholder...
DESCRIPTION
Patient-Centered Medical Home The Colorado Multi-Stakeholder Pilot Experience PCPCC Stakeholder Meeting March 30, 2010. Julie Schilz BSN, MBA Colorado Clinical Guidelines Collaborative IPIP and PCMH Manager PCPCC: Co-Chair Center for Multi-Stakeholder Demonstrations. - PowerPoint PPT PresentationTRANSCRIPT
1
Patient-Centered Medical HomeThe Colorado Multi-Stakeholder Pilot
Experience
PCPCC Stakeholder MeetingMarch 30, 2010
Julie Schilz BSN, MBAColorado Clinical Guidelines Collaborative
IPIP and PCMH ManagerPCPCC: Co-Chair Center for Multi-
Stakeholder Demonstrations
2
Colorado Multi-Payer, Multi-State Patient Centered Medical Home Pilot
Considerations in Demonstration Development
http://www.pcpcc.net/files/PCMH_Demo-Guidelines_03-09.pdf
Name, start date and timeframe Geography-community, statewide, phased approach Convening entity/project contacts Medical home definition and recognition Goals, guiding principles, payment model, evaluation Population of focus-all, Pediatric only, Adult only Participating stakeholders Demographics of participating practices Practice transformation support
4
Belmar Family Medicine Broomfield Family Practice Clinix Health Services of
Colorado DeYoung Family Medicine Family Care Southwest Family Practice Associates Ideal Family Healthcare
Internal Medicine Clinic of Fort Collins
Lakewood Family Medicine Lone Tree Family Practice Michael Mignoli MD, Internal Med Miramont Family Medicine Mountaintop Family Health Provident Adult & Senior Medicine Southpark Internal Medicine Westminster Medical Clinic
The Front Line Innovators!
Multi-Payer Pilot StakeholdersHealth Plans Aetna Anthem-Wellpoint CIGNA Colorado Access Colorado Medicaid (HCPF) Humana United Healthcare
Employers Colorado Business Group on Health Centura IBM McKesson State of Colorado Patient Centered Primary Care
Collaborative (PCPCC)
Physician Societies AAFP/CAFP American College of Physicians Colorado Medical Society
Others Colorado Health Department (CDPHE) University of Colorado-Denver Consumers
Hospitals HealthONE Centura Exempla Memorial Hospital Colorado Hospital Association OthersAssociated IPAs Integrated Physician Network Northern Colorado IPA Physician Health Partners
Primary Physician Partners South Metro Physicians
MedSouthPilot Partner Region Health Improvement Collaborative of
Greater Cincinnati
Pilot Evaluator Meredith Rosenthal PhD-Harvard School of
Public Health
Funders The Colorado Trust /The Commonwealth
Fund
CCGC: Convening Organization and Technical Assistance Provider6
Guiding Principles– The Joint Principles– NCQA PPC-PCMH Recognition– Three Tiered Payment Structure– Public & Private Payer Participation
Multi-Stakeholder Steering committee with decision making capabilities Family Medicine (14) and Internal Medicine Practices (2)-Single
physician up to 8 physicians NCQA Recognition: 14 @ Level III and 2 @ Level II Evaluation-System Value i.e. Cost, Quality and Provider, Provider Staff,
Patient Satisfaction Measures: For QI-44 measures phased over the pilot duration
Start and End DatesTechnical Assistance Start-12.1.2008
Pilot Start (i.e. Payment Start) 5.1.2009Pilot End Date 4.30.2011 or perhaps 2012
7
Colorado Multi-Stakeholder Multi-State PCMH Pilot Overview
8
10
Reimbursement for the Outcomes We Need in Health Care
e
Problems with current model-overuse, underuse and “test passing”
For more information:www.pcpcc.net/content/proposed-hybridblendedreimbursement-model
11
Components of PMPM for Practices to Transform into Medical Homes
1Quality Improvement Activities
Leadership/Culture ChangePractice Redesign
Data Use for Pop. Mgmt & Reporting
Team Mtgs & Learning Collaboratives
Patient Experience Surveys
Technology Infrastructure
2 & 3EMR/Registry Functionality
Attribution Reconciliation
Technology - Hardware
Communication Platform
Administrative Costs
4Care Team with Care Plan Manager – Care Coordinator
• Customer Service – Patient Centeredness
• Monitor Registry: Follow Up/Outreach• Track tests/reports from specialists,
hospitals, health plans, etc…• Patient self management support & self
efficacy
• Coordination of Care:• Mental Health• Behaviorists (CDE, Nutritionist,
Smoking Cessation, Asthma Educator• Complex Case Managers
• Community Resources
Phone Calls & E-Mails – 24/7 Coverage
12
Pay for Performance ModelTwo Components
Quality – 60%: Diabetes CVD Tobacco Depression
Cost – 40%: ER Visits Hospital Admits Generic Pharmacy
P4P Quality Measures P4P Cost Measures
ER Visits“Avoidable ER Visits” list Overall Hospital Admissions“Avoidable Admissions” list Generic PharmacyMost Prevalent/Costly list
MEASURED ACROSS ALL PRACTICES
1. Office Redesign
Technical Assistance
Based on IPIP - Planned Care Model - IHI
Focused Approach Related to NCQA Tool
In Office QI CoachesLearning Collaboratives & Calls
Monthly Practice Reporting
2. Technology
Common Communication PlatformHIPAA Compliant E-Mail
Care Plan - Registry
Patient Portal- Engagement
3. Integrating CareExpand Services; Coordinate/ Integrate
care with “Medical Neighborhood” using Compacts
Care Plan Manager/Coordinator
Co-Located/Shared/Referred Services
4. Patient Centered
Enhance Access
Patient Activation & Satisfaction (Experience)
Form Partnership with Patients – Shared Decision Making
15
Questions?
Thank You!
Julie [email protected]
www.coloradoguidelines.org
Patient Centered Primary Care Collaborativewww.pcpcc.net