Lisa M. Letourneau MD, MPH Quality Counts Maine Health Workforce Forum March 2011

Objectives Introduce PCMH model Review highlights, key components of Maine PCMH Pilot Identify implications of PCMH model on workforce development

Primary Care: Why Care? Survivability! Need to address frustration on all levels Patients Physicians & practice teams Payers / Employers Anticipate coming payment changes as part of wider payment reform efforts

The Stalemate that Blocks Change Employers & payers unwilling to pay for desired services unless primary care demonstrates value AND create potential to save money Providers unable to transform practice without viable & sustainable payment for desired services BUT

The Medical Home: A Model 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 AND saves money = Payment Reform AND

American Academy Pediatrics Defining Medical Home “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” American Academy Pediatrics

Maine PCMH Pilot Leadership Maine Quality Forum Quality Counts Maine Health Management Coalition MaineCare

Maine PCMH Pilot Key elements: 3-year multi-payer PCMH pilot Collaborative effort of key stakeholders, major payers Adopted common mission & vision, guiding principles for Maine PCMH model Selected 22 adult / 4 pedi PCP practices across state Supporting practice transformation & shared learnings beyond pilot practices Committed to engaging consumers/ patients at all levels Conducting rigorous outcomes evaluation (clinical, cost, patient experience of care)

Maine PCMH Pilot - Timeline Jan 2009: Call for practice applications May 2009: Practices notified – start of 6mo “ramp-up period” Sept 2009: NCQA PPC-PCMH applications completed Sept-Dec: practices contracted with payers Jan 2010: Start date for PCMH payments Jan 2010- Dec 2012: 3-year PCMH Pilot

Maine PCMH Pilot Practice “Core Expectations” Demonstrated physician leadership Team-based approach Population risk-stratification and management Practice-integrated care management Same-day access Behavioral-physical health integration Inclusion of patients & families Connection to community / local HMP Commitment to waste reduction Patient-centered HIT

Support for Practice Transformation PCMH Learning Collaborative IHI “BTS” model; 3 Learning Sessions/yr Practice QI Coaches Most from existing PHOs, med groups Using microsystems approach to QI Technical assistance “experts” BH integration, work with consumers, HIT Ongoing feedback reports Clinical, claims data

Maine PCMH Pilot – Payment Model All four private payers & Medicaid participating (soon Medicare – APC demo) Using “standard” 3-component payment: Prospective (pmpm) care management payment – approx $3pmpm Ongoing FFS payments Performance payment for meeting quality targets (existing P4P programs)

Workforce Implications? Pilot “Core Expectations” Demonstrated physician leadership Team-based approach Population risk-stratification and management Practice-integrated care management Same-day access Behavioral-physical health integration Inclusion of patients & families Connection to community / local HMP Commitment to waste reduction Patient-centered HIT

PCMH - Workforce Implications Need for new roles in practice team More mid-level providers Care managers (RN, LCSWs) Health coaches Behavioral health HIT Other? (e.g. med management)

PCMH - Workforce Implications Need for new competencies in team Physician/NP as practice leader QI capacity, coaching Data management MA as health coach for behavior change Teamwork – all!

Community Health Teams Multi-disciplinary, community-based, practice-integrated care teams Build on successful models (NC, VT, NJ) Support patients & practices in Pilot sites, helping patients overcome barriers to care, improve outcomes Key element of cost-reduction strategy, targeting high-cost patients to reduce avoidable costs (ED use, admits)

Where We’re Aiming: Medical Home Is Where… Patients feel welcomed Staff takes pleasure in working Providers feel energized every day

www.mainequalitycounts.org

Contact Info / Questions Lisa Letourneau MD, MPH Letourneau.lisa@gmail.com 207.415.4043 Sue Butts Dion sbutts@maine.rr.com Maine PCMH Pilot www.mainequalitycounts.org (See “Resource Library” & “News” sections) Additional info on PCMH model, pilots www.pcpcc.net