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Blueprint Integrated Pilot Programs. Funding Blueprint Budget Global Commitment Catamount Fund Federal Funds Grant Support Payer Support Medicaid BCBS.

Published byArianna Monroe Modified over 10 years ago

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Presentation on theme: "Blueprint Integrated Pilot Programs. Funding Blueprint Budget Global Commitment Catamount Fund Federal Funds Grant Support Payer Support Medicaid BCBS."— Presentation transcript:

1 Blueprint Integrated Pilot Programs

2 Funding Blueprint Budget Global Commitment Catamount Fund Federal Funds Grant Support Payer Support Medicaid BCBS Cigna MVP Clinical Transformation VPQ Coordinated Training Clinical Microsystems Provider Incentives Participation & Training Community Activation Local Programs Self Management Healthier Living Workshops Health Information Technology VPQ Hosted Registry (VHR) Evaluation VPQ Registry Reports VCHIP Chart Review VITL Health Information Exchange Network Local Care Support CCT Financial Reform CCT support Provider Payment Prevention Public Health Specialist on CCT Local Prevention Team Health Information Technology VITL EMR Pilot Project VPQ Hosted Web Based CIS with eRx VITL Health Information Exchange Network Multi payer claims data base Clinical / demographic data base Integrated data base Peer Review Process Blueprint Communities (Act 191, 2006) ProgramsProducts Blueprint Medical Home Pilots (Act 71, 2007) Evaluation Infrastructure Improved Care Delivery (Diabetes) IT enhanced care (Diabetes) Improved self mgmt (HLW attendees) Local exercise / prevention programs VHR - Descriptive statistics (Diabetes) VCHIP – Chart review Sustainable Transformation Advanced Medical Home Improved Care Delivery (General) Local care support & DM services Sustainable Financial Reform Improved Self Mgmt (Multi-faceted) IT enhanced care -Chronic disease -Health maintenance -eRx Prevention & Wellness Programs -Community team -Evidence based -Linked with care delivery Evidence based healthcare process Routine QA / QI Evaluation of health impact Evaluation of cost of care impact Predictive modeling (claims / clinical) Epidemiologic / outcomes research CCT Utilization Patterns

3 Primary Care PCMH -Docs -NPs -PAs -Staff Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist CCT Support Panel Management Coaching Patient / family contact Assessment Reinforce treatment plan Education Reminders Self management Social / Economic Support Liaison to other programs Enrollment assistance Prevention & Self Management Referral to community programs Coordinate community programs Vermont Health Information Platform (VITL) Referral & care supportEducation & ImprovementPublic Health & Prevention PCMH Payment reform Comprehensive guideline based care Health maintenance & prevention Chronic conditions Panel management Coaching Reminders Goal setting Health IT – planned visits Health IT – population management Health IT – eRx Paper based or EMR practices Referrals, Communication & QI Planning Model for Health & Prevention

4 DocSite: Individualized visit planner (health maintenance & chronic disease) DocSite: Sophisticated reporting that supports population management DocSite: Electronic prescribing DocSite: Works with an EMR or as stand alone care support system EMRs: Broader scope of functionality (at the individual patient level!!!) EMRs & DocSite have COMPLIMENTARY clinical functions Registries such as DocSite can be an extension of an EMR (a module) HIE should support the FULL RANGE of clinical scenarios Practices and providers will adapt to best fit Key points – BP plan to expand use of HIT

5 Model for Health & Prevention 1.All practice & CCT personnel use EMR for all data entry and care support (1 way data exchange to DocSite - data to be used to evaluate program) 2.Practice & CCT personnel use EMR for all data entry and use DocSite for population reports (Requires 1 way data exchange to DocSite) 3.Practice personnel use EMR for all data entry. CCT uses DocSIte for data entry and population reports (2 way data exchange) 4.Practice personnel use EMR for all data entry and use DocSite visit planner to help guide visit. CCT uses DocSIte for data entry and population reports (2 way data exchange) 5.Most practice personnel use EMR for data entry. The staff that are doing the intake assessment use survey and risk assessments in DocSite, enter vital signs in DocSite, and generate visit planner (2 way data exchange) Examples of how clinical work flow can vary - supported by complimentary health IT products

6 Primary Care PCMH -Docs -NPs -Staff Community Care Team (CCT) e.g. NP, RN, MSW, Dietician, Behavior Specialist, Community Health Worker, VDH Public Health Specialist Referrals & Communication Vermont Health Information Platform (VITL) Hospital -Educators -Transitional care -Ambulatory center (wellness programs) Referral & care supportEducation & ImprovementPublic Health & Prevention Policies and Systems Local, state, and federal policies and laws, economic and cultural influences, media Community Physical, social and cultural environment Organizations Schools, worksites, faith-based organizations, etc Relationships Family, peers, social networks, associations Individual Knowledge, attitudes, beliefs Adapted from: McElroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly 15:351-377, 1988. Support for evidence based public health, prevention, & policy Model for Health & Prevention

7 St. Johnsbury Family HC Chronic Care Coor.5 FTE Beh. Health Spec..5 FTE Concord Health Ctr. Chronic Care Cood.5 FTE Beh. Health Spec..5 FTE Danville Health Center Chronic Care Coor.5 FTE Beh. Health Spec.5 FTE Corner Medical Chronic Care Coor 1 FTE Beh. Health Spec 1 FTE Other OVHA Care Managers Hospital Care Managers Hospital-based CC Educators Community-based Advocates Community Connections Community Health Workers CC Comm. Health Worker VDH District Office Public Health Specialist Ladies First Coordinator. Calodenia Int. Medicine Chronic Care Cood.5 FTE Beh. Health Spec..5 FTE St. Johnsbury Community Care Team Primary Care Practices

8

9 Analysis & Review Achieve objective? Modify of Healthcare Process Modify Measures & Methods Performance Measure Relevant to objective Objective BLUEPRINT PILOT PROGRAM Plan For Program Evaluation & Improvement

10 The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patients family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. There are nine PPC standards, including 10 must pass elements, which can result in one of three levels of recognition. Practices seeking PPC- PCMH complete a Web-based data collection tool and provide documentation that validates responses.

11 Standards

12 NCQA PCMH Scoring 020406080100 0-24 NR25-4950-7475-100 NCQA Level Points Must Pass <55 of 1010 of 10 NR Level 1 Level 2Level 3

13 Proposed Model for Provider Payment All PC Providers Start Payment $ 1.20 PPPM At 25 points and 5 of 10 MP elements Adjust Payment (Range 25 – 100 PCMH Points).08 / PPPM / unit 1 unit = 5 NCQA Points Requires 10 of 10 MP criteria > 50 points Potential Range of Payment $1.20 – $2.39 PPPM 020406080100 0-24 NR25-4950-7475-100 NCQA Level Points Must Pass <55 of 1010 of 10 NR Level 1 Level 2Level 3

14 NCQA PCMH Points Average Payment 00.00 5 100.00 150.00 200.00 251.20 301.28 351.36 401.44 451.52 501.60 551.68 601.76 651.84 701.92 752.00 802.07 852.15 902.23 952.31 1002.39 Provider Payment Table ($PPPM for each provider) Requires 5 of 10 must pass elements Requires 10 of 10 must pass elements

15 NCQA Scoring & Provider Payment 5 of 10 MP10 of 10 MP

16 Practice Evaluation & Quality Improvement VPQ (current) Clinical Microsystems Training VHR DocSite VCHIP (current) Chart Review ACIC (readiness) Focus Groups VCHIP (proposed) Review against NCQA standards Onsite Review Analysis of DocSite data Report based on NCQA scoring Payment VPQ (proposed) Use reports Guide Microsystems Training Guide QA / QI planning Focused on NCQA PCMH Stds Ongoing QA / QI

17 Practice Evaluation & Payment Model VCHIP Report NCQA Review Start Payment Retroactive to index date $ PPPM calculation -initial NCQA score -active patient panel Active patient panel (attribution) -visit <12 months to practice PCP -eligibility check Paid quarterly vs. monthly 30 days 30 days VCHIP Report NCQA Review 6 months Adjust Payment Retroactive to 6 month interval date $ PPPM calculation -refreshed NCQA score -refreshed active patient panel Active patient panel (attribution) -visit <12 months to practice PCP -eligibility check Paid quarterly vs. monthly

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