NASHP - October 5, 2010 Lisa M. Letourneau MD, MPH Quality Counts Learning the ABCs of APCs and Medical Homes

Objectives Review basic elements, goals for Maine PCMH Pilot Highlight unique features of Maine Pilot Share lessons learned to date Look forward to upcoming opportunities (ACA)

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 Dec 2012: 3-year PCMH Pilot

Maine PCMH Strengths & Challenges Public-private partnership - 3 conveners Consumer / patient engagement Expectations & support for practice transformation Ongoing data feedback for improvement Ensuring sufficient payment vs. demonstrating accountability for costs

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

Keeping Patients at Center of Maine PCMH Pilot Patients/consumers included in Maine Pilot planning, governance Patient/consumer focus groups held as part of Pilot planning Patient-oriented informational, educational tools Pilot practices required to include patients in redesign efforts Patient experience (CG-CAHPS) part of Pilot evaluation Efforts linked w/ AF4Q consumer engagement

Maine PCMH Pilot Practice “Core Expectations” 1.Demonstrated physician leadership 2.Team-based approach 3.Population risk-stratification and management 4.Practice-integrated care management 5.Same-day access 6.Behavioral-physical health integration 7.Inclusion of patients & families 8.Connection to community / local HMP 9.Commitment to waste reduction 10.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

PCMH Evaluation & Data for Improvement Patient experience of care –CG-CAHPS patient surveys Clinical quality measures –Adult & pedi Cost & resource use (HealthDialog rpts) –Hosp’s, readmissions, ED use, imaging Practice changes

Data Feedback: Clinical Quality Practices commit to reporting clinical quality measures quarterly Use 31 clinical quality measures (adult), aligned with meaningful use measures Started with 2008 (baseline), then Q onward Practices use online data reporting system (developed for Pilot), receive comparative feedback reports

Clinical Data Feedback X

Data Feedback: Cost & Resource Use Use claims from Maine All-Claims Paid Database, via MHDO MQF contracts with Health Dialog to produce reports First reports delivered to practices mid- August, using 2008 claims data Anticipate ongoing, q6mos reports

Provider Performance Measurement Reports August 2010

Performance Summary Performance summary includes: Demographics about practice’s panel Overall practice performance compared to peers in 3 areas of unwarranted variation Evaluation of overall effectiveness and efficiency Practice’s score on 6 key utilization measures Best opportunities for improvement in the practice

Best Opportunities for Improvement Shows where practice is significantly different from peers AND where the total impact of improving is highest

Lessons Learned Maine PCMH Pilot Change starts with effective leadership –Primary selection criteria for Pilot –Don’t assume physician leadership skills - need ongoing support Change happens through effective teams NCQA PPC-PCMH  “medical home” It’s all about relationships – with patients AND within teams Recognize value of “outside” coaching

Potential Opportunities CMS Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration Affordable Care Act –Section 2702: Health Homes (Medicaid) –Section 3502: Community Health Teams (Medicaid Health Homes) –Section 4108: Incentives for Chronic Disease Prevention

Medicare Med Home Demo Maine application submitted, proposed new… $7 pmpm to providers, $3 pmpm for community-based care management To meet expectations for budget-neutrality (i.e. must project $10 pmpm savings), Maine proposed… 6-7% decreases in inpatient admissions (CVD & Resp) 5% decrease in ED visits 5% decrease in specialty consultations 5% decrease in imaging use

Maine PCMH Pilot - Issues TBD Will new payment be enough to support true practice transformation? How best to engage specialists, hospitals in shared goals, producing cost savings? How to engage patients in new partnership? How to spread learnings to other “non-Pilot” practices And more??

Contact Info / Questions  Lisa Letourneau MD, MPH  Sue Butts Dion  Maine PCMH Pilot (See “Major Programs”  “PCMH Pilot”)