1. Harvard Pilgrim Quality Programs
September 12, 2018

2. Network Medical Management Team
Physician leaders are key agents of change in the medical system
Network Medical Management team fosters and facilitates two-way communication between Harvard Pilgrim and individual physician thought leaders around key topics of mutual interest, their patients and Harvard Pilgrim members
Provide consultation, strategy and practice supports to contracted entities in the areas of quality, satisfaction, utilization and patient safety to improve care outcomes and to mitigate medical cost trends.

3. Quality Advance Program Quality Grants
CT Quality Programs
Quality Programs:
Quality Advance Program
Quality Grants

4. Elements QAP (Quality Advance Program) -CT
Rewards for excellence
Submit HEDIS performance (all payer data) -1 process measure, 3 outcome measures
Results are compared to the National Quality Compass
Infrastructure -Two initiatives required:
Prevent unplanned hospital admissions
Reduce avoidable Emergency Department visits
Conduct annual patient experience survey –
CMS Medicare Shared Savings Program survey results
Health Equity
Select one initiative from 2 options; added social determinates

5. The HPHC Quality Grants
For the past 19 years, Harvard Pilgrim has funded more than 235 initiatives totaling more than $20 million dollars
Program topics are updated annually to meet HPHC business strategies and best health care practices
Initiatives align with state market health care strategies
Last year’s program funded 13 initiatives designed to improve care delivery and reduce costs within a variety of care delivery models

6. Quality Grants Program Timeline
Funding approval annually – October
Program areas of focus are updated annually
Notices to contracting managers HPHC & LCU contacts
Program updates to website HPHC Quality Grants
Grant proposals submitted – February 2019
Notifications of funding April 2019
Grant cycle May – May 2019

7. Topics of interest 2018 The 2018 Suggested Topic Areas for Focus
Substance Abuse Avoidance and Intervention
Care Transitions
Integration of Behavioral Health into Primary Care Setting
Health Equity & Health Care Disparities
Chronic Illness & Health Care Proxies
Emergency Room Utilization

8. Funded Grants for 2018
LCU/Institution
State
Proposal Name
Topic (s) Addressed in Proposal
Community Health Center Association of Connecticut Submission Project Echo CT
Building an Integrated Approach to Pain Management and Opioid Addiction in Federally Qualified Health Centers through Project Echo
Substance Abuse Avoidance and Intervention
Connecticut Center for Primary Care and ProHealth Physicians
Integrating Primary & Behavioral Health Care with eConsults
Integration of Behavioral Health and Primary Care
Boston Children’s Hospital MA
Integration of substance use services in pediatric primary care
Identification and management of substance use problems and disorders in pediatric primary care.
Lowell General PHO
Chronic Kidney Disease Program
a. Care transitions to prevent unnecessary ED visits and readmissions b. Chronic illness and documentation of HCPs
Upham’s Corner Health Committee, Inc.
Streamlining Transitions of Care In A Value-Based Model of Care
Care Transitions
Valley Medical Group/ Baycare Health
Improving the Mission of Advance Care Planning at Valley Medical Group
Chronic Illness and Documentation of Health Care Proxies
InterMed ME
NICU to Home Transitions
Maine Quality Counts
Project ECHO Medication Assisted Treatment: Building Competency and Capacity for Primary Care Teams in Northern New England
Substance Use Avoidance and Intervention: Initiatives that enhance integration of SUD‐related behavioral health into the primary care setting
MaineHealth Accountable Care Organization
Strengthening the ties that bind – delivering wrap-around ambulatory care for high risk patients with COPD and CHF
Penobscot Community Health Care in collaboration with St. Joseph Healthcare
Improving Transitions of Care Through Innovative Community Provider Partnerships
Partnering across the care continuum to improve care delivery and outcomes for patients transitioning home or to a skilled nursing facility after a hospital stay
Cheshire Medical Center/ Dartmouth-Hitchcock NH
Prescribe for Health: Transforming Care though Clinical-Community Integration
Behavioral Health, Substance Misuse, Health Equity and Health Care Proxies for those with One or More Chronic Illnesses

9. Connecticut Grants awarded 2018
Community Health Center Association of Connecticut- Building an integrated approach to Pain Management
Connecticut Center for Primary Care and ProHeatlh Physicians – Integrating Primary and Behavioral Health care with eConsults