W EST V IRGINIA M EDICAL H OME I NCENTIVE P ILOT Presented to: PCPCC Center for Multi-payer Demonstrations April 6, 2010 Christine St. Andre Roger Chaufournier

B ACKGROUND Medicaid Transformation Grants---conceptual support for medical home model Project management contract through West Virginia University/ CSI Solutions, LLC to implement the grants Development of West Virginia Health Improvement Institute as a forum for multiple stakeholders to collaborate in improving the health status of the citizens of WV Evolved from Medicaid-sponsored to independent 501(c)3 with broad stakeholder board

W EST V IRGINIA H EALTH I MPROVEMENT I NSTITUTE Stakeholder Advisory Group Meets Quarterly Virtual Engagement On-Going Provider Education Self Management Adoption of HIT Measurement/ Reimbursement/ Reporting Innovation Community 300+ Primary Care Providers Pilots Coordinating Committee Evaluation & Innovation AIM : To improve the health status of all West Virginians through aligned initiatives focusing on improved access; prevention; promotion of wellness and healthy lifestyle choices; and optimal evidence based chronic illness management

I NSTITUTE D ESIGN E LEMENTS Broad participation across professional organizations, payers, advocacy groups, providers Work groups to focus on specific topics of interest and importance Use of pilot projects to test changes/ intervention on a small scale prior to decisions on full state-wide implementation Creation of an Innovation Community of interested providers committed to the medical home model and willing to participate in pilot initiatives

I NNOVATION C OMMUNITY Virtual community of primary care providers committed to improving the health of the population Voluntary process 300+ primary care providers Access to opportunities for training and pilot participation and supported by a virtual office

P ILOTS CURRENTLY UNDERWAY A pediatric obesity pilot A pilot on training in the Stanford Self-Management program A pilot focused on empowering young Medicaid mothers with health literacy skills so as to better utilize the health care system Testing of a provider incentive program for adoption of technology Pilot to explore interest and scalability of an open source EMR A pilot to test the ability of providers to report on a key set of quality measures A pilot focused on the chronically sick and disabled using an expanded care team and pharmacist A pilot to test sharing a care coordinator among several small private practices A Medical Home Performance Incentive pilot using a shared savings incentive model

M EDICAL H OME P ERFORMANCE I NCENTIVE P ILOT - P ILOT B ASICS Developed by Measurement Work Group to test effectiveness of the Patient-Centered Medical Home model in WV and to inform future reimbursement Uses NCQA PCMH Recognition criteria Outcomes assessment to include: Clinical process measures Clinical outcome measures Utilization Cost Alignment with evolving definition of “Meaningful Use”

P ILOT B ASICS Beginning with 6 month readiness phase Practice assessment Modified collaborative approach—face to face learning session for the care team, webcasts, monthly team calls Training and coaching on NCQA standards and practice redesign Preparation for measures reporting 12 month assessment phase following the readiness period

P ILOT B ASICS Payer participation: UniCare (managed Medicaid) Mountain State BlueCross Blue Shield PEIA (state employee plan) Shared savings incentive model-up to 2.5% of total claims cost based on comparison of assessment period to 2009 claims No change in ongoing reimbursement Twelve month savings pooled across all providers and patients; distribution to be based on physician performance on process and outcomes measures Payout targeted for Fall, 2011

P ARTICIPATING PRACTICES Targeted 50 physicians; have 33 Limited the number of physicians from each organization 7 FQHC’s 9 free clinics---all in the state One large IPA 2 academic practices 2 small private practices One rural health clinic All have an EMR in place, but this was not a requirement

E XPECTATIONS OF P RACTICES Make a commitment: participation agreement, business associate agreements Apply for NCQA recognition within 9 months Care team participation in the face to face session, webcasts, and monthly calls Monthly reporting the aggregate clinical measures for all patients using the measures required for CMS EMR incentives Provide patient lists for attribution

E XPECTATIONS OF P ARTICIPATING P AYERS Verify patient lists for attribution Agree to share savings up to 2.5% of total 2009 claims cost for the participating patients/ members and contribute this amount to the overall incentive pool Agree on a uniform approach to calculation of savings Agree on incentive pool distribution methodology Provide cost and utilization feedback where possible based on claims data Use results to inform future reimbursement changes

P ATIENT A TTRIBUTION Practices use practice management or EMR system to look back 18 months and identify any patient that has been seen during that time. Exclude any people seen as a result of cross-coverage and others that were known to be one-time occurrences Provide a list of all patients, with their designated payer to the WVHII staff Lists are aggregated by payer for confirmation of coverage during the entire 2009 period

H OW DID WE SELL PARTICIPATION TO PRACTICES ? Financial upside from the incentive component Best practice models they will be exposed to could help drive internal efficiencies and throughput Market value of TA offered (estimated at approximately $25k per practice) Participation will jump start the practice down the pathway of meaningful use This is a showcase demonstration project of national significance Intend to influence the remaining reimbursement system if we all succeed

R OLE AND S UPPORT FROM WVHII Project management Training, technical assistance, and coaching Reporting site that will aggregate data and track individual as well as group performance Virtual office and listserv for sharing resources Compensation for lost revenue resulting from attendance at all day learning session Payment for NCQA assessment tool and application

C HALLENGES WE ’ VE FACED Not all payers are participating Medicaid need for plan amendment in order to compensate differently Medicare Several smaller payers in the state Providers take the full risk Difficulty in recruitment Measurement strategy not yet final Meaningful use and CMS incentives must be considered to avoid re-work and duplication

C URRENT STATUS In readiness phase with face to face learning session held in February Practices completing practice assessments Compiling patient lists for attribution Expect 12 month assessment phase to begin July 1 Payers meeting next month to establish savings calculation Now that we have started, more people want to get involved!

C ONTACT I NFORMATION Christine St. André Roger Chaufournier