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

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

3. 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

4. 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

5. 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

6. 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

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

8. 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)

9. 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

12. 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

13. 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

14. 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)

15. 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

16. 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)

17. 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!

18. 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)

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

21. Contact Info / Questions
Lisa Letourneau MD, MPH
Sue Butts Dion
Maine PCMH Pilot
(See “Resource Library” & “News” sections)
Additional info on PCMH model, pilots