1. THINC’S P4P PROJECT IN THE HUDSON VALLEY: QUALITY METRICS AND THE MEDICAL HOME Susan Stuard Executive Director, THINC

2. Agenda  Susan Stuard will talk about the project design  John Blair, MD will discuss the specifics of the medical home transformation work

3. Project Design

4. THINC’s P4P Project  In 2007, THINC was awarded a P4P grant from the NYS Department of Health  The request for grant applications sought projects implementing quality metrics, quality report cards, and health plan incentives  THINC, MedAllies and the Taconic IPA decided to leverage this project and add a significant medical home component

5. EHR Install Base  Key component to the Hudson Valley project is the existing physician EHR install base  THINC has a HEAL 1 grant from NYS DOH to implement 1,000 EHRs in physician’s offices  Quarter of the way through that work  As a result, THINC and its vendor, MedAllies, have a strong understanding of EHR implementations and the associated workflow and change management issues  Combine these 250 EHRs with existing EHRs at larger practices and we a good group to work with for medical home

6. Project Participants 500 primary care physicians in Hudson Valley  250 in quality metrics group only  250 in quality metrics and medical home group Six health plans  Provide claims data for metrics to data aggregator  Pay incentives after second quality report card  Participate actively in project design via the THINC Quality Committee

7. Project Management THINC  Manage grant and deliverables  Work with health plans to determine payment process and triggers  Use THINC Quality Committee to ensure collaborative process for development of project goals and implementation MedAllies  Enable development of quality reporting with ViPS and from EHR  Intensive planning for medical home transformation initiative Taconic IPA  Intensive planning for medical home transformation initiative  Physician recruitment Cornell  Conduct evaluation, data gathering, analysis, etc.

8. Budget  NYS DOH grant award is almost $1.8 million  20% for project management and evaluation  80% to match health plan incentives ~ $1.4 million  Great majority of costs for medical home transformation are being underwritten by the Taconic IPA and MedAllies

9. Quality Reports  Q1 2009 Report  2007 data  HEDIS Measures  Q4 2009 Report  2008 data  HEDIS Measures  EMR Measures  NCQA Medical Home  Recognize the limitations of using 2007 and 2008 in a 2009 implementation – but this is a grant requirement THINC Taconic Health Information Network and Community

10. HEDIS Measures  Required to pick from among 34 measures selected by the NYS Pay for Performance Workgroup  Our claims-based project measures are: 1. Breast Cancer Screening 2. Colorectal Cancer Screening 3. Chlamydia Screening Rates 4. HbA1C Testing 5. Lipid Measurement in Diabetics 6. Eye Exam in Diabetics 7. Urine Protein Screening 8. Asthma: Pharmacologic Therapy 9. Appropriate Treatment for Children with Upper Respiratory Infection 10. Appropriate Testing for Children with Pharyngitis

11. EMR Measures  Also will add EHR-based clinical measures in the second report card  Will pull four from among these six:  Controlling High Blood Pressure  HbA1C Poorly Controlled  Blood Pressure Control/Management in Diabetics  LDL Cholesterol Level in Diabetics <130  Eye Exam in Diabetics  Urine Protein Screening  In subsequent report cards, starting in 2010, will add more EHR-based clinical metrics THINC Taconic Health Information Network and Community

12. Incentive Payments  Incentive payments will be issued after 2 nd quality metrics report card in Q4 2009  20% of incentive payments goes to scoring on quality metrics and 80% goes to achievement of NCQA PPC- PCMH Medical Home Level 2 certification  Approximate breakdown ~ $1000 on quality metrics and ~ $10,000 for medical home level 2

13. Health Plan Data Aggregator Claims Data Summary HEDIS Measures Using claims data and attribution logic, aggregator generates summary measures MedAllies Reporting Engine From spec, health plan generates data file for Hudson Valley Physician Health Plan Letter and Report Card Report Card and Data File Physician EHR Summary EHR/Clinical Measures Data from Physician EHR THINC Report Card ( with Medical Home Status in Q4 2009) Report Card ( with Medical Home Status in Q4 2009) Incentive Payment MH Status THINC P4P Project High-Level Data Flow

14. Evaluation  Working with Rainu Kaushal, MD, MPH, and Lisa Kern, MD, MPH, at Weill Cornell Medical College to conduct a robust academic evaluation of project  Goal is to determine incremental effects of P4P incentives and medical home implementation on quality and costs  Design should allow isolation of the separate effects of EHRs, P4P, and the medical home  Evaluation design should produce results rigorous enough to inform policy debate as well as participant health plans’ designs for future incentive programs

15. Challenges  Setting aside the huge challenge of moving 250 physicians with EHRs to medical home level 2 within 12 months (John will address)  Coordinating among six health plans who all have different ideas about what should trigger an incentive payments and how attribution methodology should be applied  Tremendous effort to undertake this type of evaluation  IRB approvals, participant agreements, control group recruitment, baseline data gathering, etc.  Unknown effort to be expended to implement the EHR- based clinical measures

16. Questions  Please feel free to reach out to me with questions Susan S. Stuard Executive Director THINC RHIO Phone: 845-896-4726 x.3018 sstuard@thincrhio.org