Coordinated by: Lead Support Major Support Additional Support

100% Access HealthColumbus

Board & Staff

Individual & Corporate Donations

Patient-Centered Primary Care Collaborative of Central Ohio

Q4 Learning Session

Patient-centered medical home teams

from central Ohio sharing actionable best practices to improve care coordination

Please save the following dates for 2013 Quarterly Learning Sessions from 7:30-10:30AM:

February 22, May 31, September 27, December 6

Patient-Centered Primary Care

Briefing on National, State & Local Activity

= strong potential for negative implications

= uncertain implications at this time

= strong potential for positive implications

Activity Monitor Dec

A. CMMI: Comprehensive Primary Care Initiative (CPCI)

B. CMMI: State Innovation Models (SIM)

C. Medicare: Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration

D. Medicare: Physician Payment Formula (27% reduction in Medicare reimbursements effective 1/1/2013)

E. Medicaid: Medicare rates for primary care services in 2013 & 2014

F. Ohio: Medicaid Health Homes

G. Ohio: Medicare-Medicaid Integrated Care Delivery System (ICDS)

H. Ohio: Patient-Centered Primary Care Collaborative

I. Ohio: Medicaid Expansion

J. Ohio: Health Insurance Exchange

K. Local: Commercial Plans Shifting Resources to Primary Care

Activity Monitor Dec

A. CMMI: Comprehensive Primary Care Initiative (CPCI)

B. CMMI: State Innovation Models (SIM)

C. Medicare: Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration

D. Medicare: Physician Payment Formula (27% reduction in Medicare reimbursements effective 1/1/2013)

E. Medicaid: Medicare rates for primary care services in 2013 & 2014

F. Ohio: Medicaid Health Homes

G. Ohio: Medicare-Medicaid Integrated Care Delivery System (ICDS)

H. Ohio: Patient-Centered Primary Care Collaborative

I. Ohio: Medicaid Expansion

J. Ohio: Health Insurance Exchange

K. Local: Commercial Plans Shifting Resources to Primary Care

CMMI: Comprehensive Primary Care Initiative (CPCI)

CMMI: Comprehensive Primary Care Initiative (CPCI)

Ohio & Kentucky: Cincinnati-Dayton Region • 75 Primary Care Practices • 261 Providers • 10 Payers • Estimated 44,500 Beneficiaries Served • Aetna CareSource (Ohio only), Centene Corporation (Ohio only),

Amerigroup (Ohio only), Anthem Blue Cross Blue Shield of Ohio, Humana, HealthSpan, Medical Mutual, Ohio Medicaid, UnitedHealthcare

7 regions • 500 primary care practices • 2,144 providers • 313,000 Medicare beneficiaries

Testing two models simultaneously: a service delivery model and a payment model

• $275 million competitive funding opportunity for states to design and test multi-payer payment and delivery models that deliver high-quality care and improve health system performance

• $50 million for up to 25 Model Design Awards to support state payment reform planning and design efforts

• $225 million for up to 5 Model Testing Awards to test and evaluate multi-payer health system transformation models

• Ohio applied for a $3 million Model Design Award (plus $4.1 million in-kind from the state and participating health plans) to develop and submit a Model Testing Application in June 2013

• www.healthtransformation.ohio.gov/CurrentInitiatives/Payforhealthcarebasedonvaluenotvolume.aspx

State Innovation Model Grant Opportunity

SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.

1. Expand the capacity and availability of qualified medical homes to most Ohioans across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe

2. Define and administer episode-based payments for a majority of acute medical events across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe

Ohio’s State Innovation Model Proposal

SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.

Payment Reform Project Plan and Timeline

SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.

Oct Nov Dec Jan Feb Mar Apr May

Stakeholder engagement

Preparation

Model 2: Episode-based payments design

Model testing proposal

Infrastructure planning

Model 1: PCMH/medical homes design

10

Implementation Schedule

Green - October 2012 Blue - April 2013 Yellow - July 2013

Medicaid Health Home for SPMI Implementation Schedule

Stark

Wood

Wayne

Butler

Lorain

Clark

Union

Trumbull

Franklin

Fulton

Portage

Clinton

Lucas

Medina

Warren

Greene

Summit

Madison

Pickaway

Geauga

Clermont

Delaware

Lake

Hamilton

Cuyahoga

Columbiana

Mahoning

Montgomery

Ottawa

Ohio ICDS Regions

Central

Molina

Aetna

NW

Aetna

Buckeye

WC

MolinaBuckeye

SW

Molina

Aetna

NE

United

CareSource

Buckeye

EC

United

CareSource

NEC

UnitedCareSource

ICDS Regions and Demo Counties

Central

EC - East Central

NE - Northeast

NEC- Northeast Central

NW - Northwest

SW - Southwest

WC - West Central

Integrated Care

Delivery

for Individuals

Enrolled in both

Medicare and

Medicaid

Why?

What?

How?

The need to improve patient-centered primary care as the foundation of accountable health care delivery to achieve:

• better care

• better health

• better value

Catalyze and coordinate the spread of: 1. patient-centered medical homes 2. primary care quality reporting 3. provider-based patient education & engagement 4. value-based purchasing

Coordinate local health care improvement projects in collaboration with: • consumers • providers • purchasers • payers

LOCAL: Collaborative Approach for Improving Patient-Centered Primary Care

Why?

What?

How?

The need to improve patient-centered primary care as the foundation of accountable health care delivery to achieve:

• better care

• better health

• better value

Catalyze and coordinate the spread of: 1. patient-centered medical homes 2. primary care quality reporting 3. provider-based patient education & engagement 4. value-based purchasing

Coordinate local health care improvement projects in collaboration with: • consumers • providers • purchasers • payers

LOCAL: Collaborative Approach for Improving Patient-Centered Primary Care

In coordination with Access HealthColumbus: Recognized PCMHs Emerging PCMHs Coordinated by others: Recognized PCMHs

SPREAD: Patient-Centered Medical Homes (PCMH)

238

146

1,205

0

200

400

600

800

1000

1200

Recognized PCMH

Practitioners*

Total Primary Care

Practitioners (PCPs)**

Total PCPs

Emerging PCMHs

Recognized PCMHs

SPREAD: Patient-Centered Medical Homes (PCMH)

Sources * National Committee for Quality Assurance (NCQA) ** Practicing PCPs in Franklin County provided by Columbus Medical Association

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

Estimated Patients Served by PCMHs

Recognized PCMHs

Emerging PCMHs

SPREAD PRIMARY CARE QUALITY REPORTING: PCMH Improvement Dashboard

0 10 20 30 40 50 60 70 80 90

100

2010 AVG

2012 AVG

Outcome Measures from 3 PCMHs

The following health plans and employers are participating in our local Collaborative and have implemented value-based purchasing starting with patient-centered medical homes: Aetna Anthem Blue Cross & Blue Shield Franklin County Cooperative Health Benefits Program Humana Medical Mutual of Ohio MediGold Nationwide Insurance Ohio Public Employees Retirement System School Employees Retirement System of Ohio State Teachers Retirement System of Ohio The Dispatch Printing Company The Ohio State University The Ohio State University Health Plan UnitedHealthcare

We anticipate additional purchasers will be joining our collaborative effort in 2013

SPREAD VALUE-BASED PURCHASING: Participating Organizations

New 2013 project: SPREAD PRIMARY CARE QUALITY REPORTING

Physicians and providers have accurate information to identify areas for quality improvement

Purchasers provide incentives to high-value primary care teams to accelerate transformation of

care

Primary care teams improve quality of care and demonstrate

increased value by measuring performance and care outcomes

What could happen that would make quality reporting of patient-centered primary care

available and transparent in Central Ohio?

What could be different?

More patients have improved health status and economic

productivity

New 2013 project: SPREAD PROVIDER-BASED PATIENT ENGAGEMENT

Is Patient Engagement the next “Blockbuster Drug”?

What could happen that would make effective patient engagement a standard of care in Central Ohio?

What could be different?

Patient and caregiver voices and perspectives embedded in

quality improvement initiatives

Clinicians fully utilizing their potential as the three most

trusted* professions: Nurses, Pharmacists, Doctors

(*Gallup poll)

More patients have improved health status and economic

productivity

Purchasers provide incentives to primary care teams to

accelerate patient engagement as a standard of care

New 2013 project: SPREAD PROVIDER-BASED PATIENT ENGAGEMENT

Is Patient Engagement the next “Blockbuster Drug”?

What could happen that would make effective patient engagement a standard of care in Central Ohio?

What could be different?

Patient and caregiver voices and perspectives embedded in

quality improvement initiatives

Clinicians fully utilizing their potential as the three most

trusted* professions: Nurses, Pharmacists, Doctors

(*Gallup poll)

More patients have improved health status and economic

productivity

Purchasers provide incentives to primary care teams to

accelerate patient engagement as a standard of care

Provider-based patient engagement will be focus of our February 22, 2013 Learning session

We will be inviting you and your colleagues to join us as….

PATIENTS/CONSUMERS

More details to be announced shortly!