1. Medical Home Model: Care for the Chronically Ill Linda Magno Director, Medicare Demonstrations

2. Medical Home Demonstration Tax Relief and Health Care Act of 2006—Sec. 204 Tax Relief and Health Care Act of 2006—Sec. 204 …redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations …redesign the health care delivery system to provide targeted, accessible, continuous and coordinated, family-centered care to high-need populations

3. Key Parameters 3 years 3 years 8 sites—urban, rural, underserved areas 8 sites—urban, rural, underserved areas “Personal physician” responsible for ongoing support, oversight, guidance to implement plan of care “Personal physician” responsible for ongoing support, oversight, guidance to implement plan of care High-need patients: multiple chronic illnesses High-need patients: multiple chronic illnesses

4. Design Issues Minimum requirements for medical home Minimum requirements for medical home Capacity of practice to coordinate careCapacity of practice to coordinate care Staffing Staffing Health assessment tool Health assessment tool Other resources (patient self-management education and support) Other resources (patient self-management education and support) Where is practice on continuum of adoption/use of health information technology (HIT)?Where is practice on continuum of adoption/use of health information technology (HIT)? Patient access to personal health info Patient access to personal health info

5. Design Issues Practice eligibility Practice eligibility External certificationExternal certification Self-certificationSelf-certification OtherOther Beneficiary roles/responsibilities Beneficiary roles/responsibilities EnrollmentEnrollment Ability to move from one medical home to anotherAbility to move from one medical home to another Cost-sharingCost-sharing

6. Design Issues Payment Payment Should care management fee vary with practice characteristics? Patient characteristics?Should care management fee vary with practice characteristics? Patient characteristics? Beneficiary risk profile Beneficiary risk profile Degree of HIT use Degree of HIT use Measurement of shared savingsMeasurement of shared savings Randomization of applicant practices Randomization of applicant practices Site selection/recruitment of practices Site selection/recruitment of practices

7. Development Timetable Consultation– spring 2007 Consultation– spring 2007 Design contract: RFP – May 2007, award – Sept. 2007 Design contract: RFP – May 2007, award – Sept. 2007 Final demonstration design – June 2008 Final demonstration design – June 2008 Implementation contract – August 2008 Implementation contract – August 2008 Start demonstration – January 2009 Start demonstration – January 2009

8. Improved Expanded Medical Home Children’s Health and Medicare Protection Act of 2007—Sec. 306 Children’s Health and Medicare Protection Act of 2007—Sec. 306 …redesign health care delivery system to provide accessible, continuous, comprehensive, and coordinated care to Medicare beneficiaries …redesign health care delivery system to provide accessible, continuous, comprehensive, and coordinated care to Medicare beneficiaries Provide care management fees to physicians delivering continuous and comprehensive care Provide care management fees to physicians delivering continuous and comprehensive care

9. FeaturesMedical HomeImproved/Expanded Medical Home Statutory authority Tax Relief and Health Care Act of 2006 Children’s Health and Medicare Protection Act of 2007 Duration3 years Location8 sites – urban, rural, and underserved areas Nationally representative sample – physicians serving urban, rural, and underserved areas Number of practices Unspecified500 practices: 100 HIT- enhanced; others serving populations at higher risk for health disparities Type of practices <3 physicians; larger practices in rural and underserved areas <4 physicians; larger practices in rural and underserved areas

10. FeaturesMedical HomeImproved/Expanded Medical Home DefinitionPhysician practice in charge of targeting beneficiaries for participation; and responsible for providing safe, secure technology to promote patient access to personal health info, developing a health assessment tool, and providing training programs for personnel involved in care coordination Physician-directed practice certified as meeting standards re: access and communication; managing patient information; managing and coordinating care; providing patients with assistance/encouragement in self-management; resources to manage care; performance monitoring Role of physician Ongoing support, oversight, guidance to implement plan of care; integrated, coherent, cross-discipline medical care developed in partnership w/ patients and all other physicians furnishing care to patient Accessible, continuous, coordinated, and comprehensive care for beneficiaries

11. FeaturesMedical HomeImproved/Expanded Medical Home Role of HITMonitor and track health status of patients and provide patients with enhanced, convenient access to services Interoperable EHR integrated with decision support capabilities, support of e- prescribing, CPOE, outcome measurement, patient education Beneficiary population High-need, i.e., multiple chronic illnesses Any Medicare beneficiary served by a participating practice PaymentCare management fee plus shared savings Monthly care management fee FundingMedicare savings attributable to medical home $500 million

12. For More Information www.cms.hhs.gov/DemoProjectsEval Rpts/MD/list.asp#TopOfPage www.cms.hhs.gov/DemoProjectsEval Rpts/MD/list.asp#TopOfPage www.cms.hhs.gov/DemoProjectsEval Rpts/MD/list.asp#TopOfPage www.cms.hhs.gov/DemoProjectsEval Rpts/MD/list.asp#TopOfPage