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IBM Healthcare and Life Sciences Patient-Centered Medical Home Pilots Landscape as of 06/19/2008.

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Presentation on theme: "IBM Healthcare and Life Sciences Patient-Centered Medical Home Pilots Landscape as of 06/19/2008."— Presentation transcript:

1 IBM Healthcare and Life Sciences Patient-Centered Medical Home Pilots Landscape as of 06/19/2008

2 © 2007 IBM Corporation IBM Healthcare and Life Sciences 2 PCMH Pilots Map Multi-Payer pilot discussions/activity RI Identified pilot activity No identified pilot activity Note: this chart is from Carol Flamm, who leads the PCPCC Center for Multistakeholder Demonstrations. It doesn’t bear any one-to-one relationship to the PCMH pilot details included in this deck, but is offered as an example of how the state and local activities might be summarized.

3 © 2007 IBM Corporation IBM Healthcare and Life Sciences 3 PCMH Pilots Summary (multi-payer and significant single payer projects) StateRegionConvening AuthoritySlideNotes New YorkMid-Hudson ValleyTHINC RHIO5 ColoradoStatewide Colorado Clinical Guidelines Collaborative 6 New YorkNew York City Group Health & Health Plan of NY 7 Rhode IslandStatewide RI Office of Health Insurance Commissioner 8 WashingtonStatewide Wash. State Dept. of Health 9 PennsylvaniaSoutheast Governor’s Office of Health Reform 10 New YorkAlbany CDPHP 11 TennesseeMemphis Memphis Business Group on Health 12 New HampshireDartmouth-Hitchcock patients CIGNA and Dartmouth- Hitchcock 13 TexasDallas, Houston, San Antonio, Austin Texas Academy of Internal Medicine 14 MichiganStatewide Michigan Primary Care Initiative 15 OhioSouthwest Greater Cincinnati Health Improvement Collaborative 16

4 © 2007 IBM Corporation IBM Healthcare and Life Sciences 4 PCMH Pilots Summary (multi-payer and significant single payer projects) StateRegionConvening AuthoritySlideNotes North CarolinaStatewide North Carolina Division of Medical Assistance (Medicaid ) 17 WashingtonSeattle – Everett – Renton Area Boeing Company18 VermontStatewideBCBS of Vermont19 MichiganStatewideBCBS of Michigan20

5 © 2007 IBM Corporation IBM Healthcare and Life Sciences 5 PCMH Pilots Detail State: New York Region: Mid-Hudson Valley Convening Authority: THINC RHIO Payer(s): Aetna, CDPHP, United HealthCare, MVP, Wellpoint, Hudson Health Overview: Providers and covered lives: 500 providers; 1M lives PCMH components: Project contact(s): Link to press release:Notes: 2-5 year pilot to demonstrate improved cost and quality of care. P4P / Medical Home project funded by $1.5M grant from NYDOH. John Blair jblair@taconicipa.com (845) 897-6359 Asha Upadhyay asha@thincrhio.org (845) 896-4726, Ext. 3205 EHR (eClinical Works); ePrescribing (RxHub and SureScripts); provider portals (HealthVision); data aggregation & analytics (IPRO and VIPS); Continuity of Care Document for interoperable data elements between ambulatory care practices & other health entities (e.g., hospitals); Masspro support for practice assessment and redesign; multi-disciplinary approach

6 © 2007 IBM Corporation IBM Healthcare and Life Sciences 6 PCMH Pilots Detail State: Colorado Region: Statewide, but primarily Front Range and Denver centered Convening Authority: Colorado Clinical Guidelines Collaborative (CCGC) Payer(s): Aetna, Anthem-WellPoint, Cigna, Humana, Rocky Mtn Health Plan, United, and Medicaid Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: 6/17/08: Seeking Funding for Technical Assistance and Evaluation. The Commonwealth Fund will choose Pilot Evaluator. 2-year pilot to reduce fragmentation and implement systems and processes, using evidence-based clinical guidelines and improve healthcare in Colorado. Marjie Harbrecht mharbrecht@coloradoguidelines.org (720) 297-1681 Julie Schilz jschilz@coloradoguidelines.org (720) 297-1681 Guiding Principles: Joint Principles, NCQA PPC-PCMH, 3-Tiered Reimbursement (FFS, Care Management Fee and P4P) Use of disease registries;Reach My Doctor; Technical support for Practice Transformation and achievement of NCQA PPC-PCMH. Measurement on Cost, Quality (Chronic Disease and Prevention) and Provider Office/Patient Satisfaction. Evaluation Methodology-Matched Comparison Group

7 © 2007 IBM Corporation IBM Healthcare and Life Sciences 7 PCMH Pilots Detail State: New York Region: New York City Convening Authority: Group Health Inc. and Health Plan of New York Payer(s): Group Health Inc. and Health Plan of New York Overview: Providers and covered lives: 50 practices; 100 providers; 20k covered lives PCMH components: Project contact(s): Link to press release: XXXXXXXXXX XXXXXXXXXXXXXXXX Notes: 2-year demo of PCMH model by Group Health Inc. (GHI), a New York State health insurer, and Health Plan (HP) of New York, a large HMO. Judith Fifeld fifield@nso1.uchc.edu (860) 679-3815 "advanced health information technology" to direct services to patients and coordinate services from other physician; care coordination services and technical support to redesign physician offices and management systems

8 © 2007 IBM Corporation IBM Healthcare and Life Sciences 8 PCMH Pilots Detail State: Rhode Island Region: Statewide Convening Authority: RI Office of Health Insurance Commissioner Payer(s): BCBSRI, United, Neighborhood Health Plan, Medicaid Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXX XXXXXXXXXXXXXXXX Notes: 2-year pilot to demonstrate that PCMH model is sustainable, i.e. provides better care, provides more cost-effective care, enhances patient satisfaction with medical care received and provides improved professional satisfaction for primary care physicians Deidre Gifford dgifford1@riqio.dspd.org Lynn Pezzullo lpezzullo@riqio.sdps.org (401) 528-3222 Practices must satisfy nine NCQA PPC standards for a PCMH (access and communication, patient tracking and registry, care management, patient self- management support, electronic prescribing, test tracking, referral tracking, performance reporting and improvement and advanced electronic communications). Insurers providing or funding dedicated nurse for practice support. $3PMPM funding for practices NCQA PPC-PCMH recognized (Level 1 in 6 mos, Level 2 in 18 mos)

9 © 2007 IBM Corporation IBM Healthcare and Life Sciences 9 PCMH Pilots Detail State: Washington Region: Statewide Convening Authority: Wash. State Dept. of Health, Children with Special Health Care Needs Program Payer(s): Public sector project Overview: Providers and covered lives: All WA state children age birth to 17 years PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Coalition to promote and provide practical support for medical homes -- family-centered, comprehensive coordinated primary health care -- for children and youth with special health care needs. Provide medical home for every WA State CSHCN by 2010 MaryAnne Lindeblad lindem@dshs.wa.gov (360) 725-1786 Developing performance indicators to identify whether children have an effective medical home. Identifying stakeholder representatives who can formulate performance measures to be used starting in 2009 to link quality improvement measures with provider rate increases.

10 © 2007 IBM Corporation IBM Healthcare and Life Sciences 10 PCMH Pilots Detail State: Pennsylvania Region: Southeast Convening Authority: Governor’s Office of Health Reform Payer(s): Aetna, AmeriChoice (Medicaid), Health Partners (Medicaid), Independence Blue Cross, Keystone Mercy Health Plan (Medicaid) Overview: Providers and covered lives: 33 practices; 165 clinician FTE’s; 176k patients PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Statewide implementation of the Chronic Care Model (a PCMH-like model) involving learning collaboratives, practice coaches, an incentive alignment strategies for providers and consumers. Phil Magistro pmagistro@state.pa.gov (717) 214-8174 Michael Bailit mbailit@bailit-health.com (781) 453-1166 Practice coaches, consumer self-management training, patient registries, statewide pooled claims database, practice certification process, performance measures, evaluation plan and public reporting, communication plan

11 © 2007 IBM Corporation IBM Healthcare and Life Sciences 11 PCMH Pilots Detail State: New York Region: Albany Convening Authority: Capital District Physicians’ Health Plan, Inc. (CDPHP) Payer(s): CDPHP Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Pilot supported with a 1 million grant from CDPHP. Will look at the Allen Goroll payment reform model. Three practices will all have support with an on the ground transformation model. Facilitators are being provided by TransforMED and paid for by CDPHP. Brian J. Morrissey bmorriss@cdphp.com (518) 641-5220 The practices will be paid for PCMH services whether or not the patient is a CDPHP member. So, 100% of the patients are in the pilot. The breakout is 40% CDPHP members, a mixture of ASO and commercial. About 17 % are Medicare, 30 % Blues, 8% MVP.

12 © 2007 IBM Corporation IBM Healthcare and Life Sciences 12 PCMH Pilots Detail State: Tennessee Region: Memphis Convening Authority: Memphis Business Group on Health Payer(s): BCBSTN, Humana Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Several phone discussions and two face-to-face meetings with potential stakeholders in a multi- payer pilot of PCMH; led primarily by ACP and Memphis Business Group on Health. Agreement on 5/7/08 to form Steering Committee of interested stakeholders. to be determined Cristie Travis (MBGH) ctravis493@aol.com (901) 767-9585 Shari Erickson (ACP) serickson@mail.acponline.org (202) 261-4551

13 © 2007 IBM Corporation IBM Healthcare and Life Sciences 13 PCMH Pilots Detail State: New Hampshire Region: Statewide Convening Authority: CIGNA and Dartmouth-Hitchcock Payer(s): CIGNA Overview: Providers and covered lives: 17k CIGNA members receiving primary care from Dartmouth-Hitchcock providers PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: In the pilot, patients, especially those with chronic illness or ongoing medical needs, will have access to enhanced care coordination, communications, appointment availability and education to help them navigate their health care system, while physicians will receive additional reimbursement for providing these enhanced services and supportive infrastructure. Dartmouth-Hitchcock has a tradition of pursuing these objectives; both organizations say the new pilot program will help to accelerate existing efforts. Dick Salmon (CIGNA) dick.salmon@cigna.com (901) 767-9585 Barbara Walters (Dartmouth-Hitchcock) Primary care providers affiliated with Dartmouth-Hitchcock will be paid for the medical services they provide, reimbursed an additional amount for enhanced services such as care management they provide and be rewarded through a “pay for performance” structure for improving quality and appropriate health care.

14 © 2007 IBM Corporation IBM Healthcare and Life Sciences 14 PCMH Pilots Detail State: Texas Region: Dallas, San Antonio, Houstin, Austin Convening Authority: Texas Academy of Internal Medicine Payer(s): Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Meeting on 6/27/2008 in Austin to inform and assess local stakeholder interest. The Texas Academy of Internal Medicine is also seeking business groups that may be interested in participating in the effort. to be determined Neil Kirschner (ACP) nkirschner@mail.acponline.org (202) 261-4535

15 © 2007 IBM Corporation IBM Healthcare and Life Sciences 15 PCMH Pilots Detail State: Michigan Region: Statewide Convening Authority: Michigan Primary Care Consortium Payer(s): BCBSMI, United, Humana, Aetna Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: http://michigan.gov/som/0,1607,7-192- 26847-184896--,00.html Notes: Through collaboration between public health and primary care, by 2010, key system level barriers will be resolved; by 2015, every consumer of primary care services in Michigan will consistently receive evidence-based preventive and chronic disease care, and changes to assure quality care will have been embedded in primary care practices across the state Initial focus areas will be: prevention(aligned with RX for Healthier MI and MI Steps Up), Physical Inactivity, Poor Nutrition, Tobacco Use and Exposure; Chronic Disease Care & Management: Asthma & Diabetes Janet Olzekski, MD - chair mccullochs@michigan.gov (517) 373-3740 Donald Nease, MD – vice chair (734) 936-4660

16 © 2007 IBM Corporation IBM Healthcare and Life Sciences 16 PCMH Pilots Detail State: Ohio Region: Southwest Convening Authority: Greater Cincinnati Health Improvement Collaborative Payer(s): Anthem, United (Managed Medicare and Commercial), Humana Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Initial stages of discussion. $1.7M grant from R.W. Johnson Foundation under Aligning Forces for Quality initiative to focus on improved healthcare messaging for patients with diabetes. Medical Home forum held at Univ. of Cincinnati on March 17; presenters included Michael Sherman, Corp. Medical Director of Physician Strategies at Humana. PCMH pilot kick-off meeting may be held sometime in summer 2008. Paul Grundy has been contacted as a potential speaker. Craig Brammer, MD craig.brammer@uc.edu (202) 261-4535

17 © 2007 IBM Corporation IBM Healthcare and Life Sciences 17 PCMH Pilots Detail State: North Carolina Region: Statewide Convening Authority: N. Carolina Division of Medical Assistance (Medicaid) Payer(s): Medicaid Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Started 1998-1999 as way to manage Medicaid patients in rural area—medical home model –particularly targeted at small practices that did not have a lot of resources—goal was to link them with a local hospital and other safety net providers – gave payment to providers and to networks for them to put resources into the community (e.g. case managers, recently added a clinical pharmacist) - goal is organizing MDs Allen Dobson MD adobson@cabarrusfamily.com (704) 721-2073 Jeffrey Simms jeffrey.simms@ncmail.net (919) 855-4100

18 © 2007 IBM Corporation IBM Healthcare and Life Sciences 18 PCMH Pilots Detail State: Washington Region: Seattle – Everett – Renton areas Convening Authority: Boeing Company Payer(s): Medicaid Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: A dedicated core primary care team of 1-2 physicians and a nurse case manager sees enrolled patients. Boeing is actively involved in the pilot’s day-to-day management and is paying a PMPM payment to each MD in addition to the providers’ regular FFS reimbursement. The practice-embedded nurse case manager is thought to be the key to the model’s success. Theresa Helle theresa.m.helle@boeing.com (704) 721-2073 Ambulatory Intensive Caring Unit model, similar to that being employed by UNITE HERE. In 2nd year of pilot targeted to serving the top 20% of employees and dependents projected to be greatest need of future health care.

19 © 2007 IBM Corporation IBM Healthcare and Life Sciences 19 PCMH Pilots Detail State: Vermont Region: Statewide Convening Authority: BCBS of Vermont Payer(s): BCBSVT Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: MD participation in the P4Q program requires the proactive adoption of the following practice infrastructure changes, derived from the Health System component of The Chronic Care Model. Increased reimbursement is available for office-based E & M, consultations, preventive medicine and counseling codes. The enhanced reimbursement applies to all of the practices patients, not just those with select chronic conditions. Practices may utilize some BCBSVT tools and services to satisfy program entry requirements, or use enhanced funding to support development of their own infrastructure and systems. Sharon Winn winns@bcbsvt.com (802) 371-3230 Pilot Pay for Quality Program is aligned with The Chronic Care Model and the VT Blueprint for Health. P4Q pilot program started in 2005 with diabetes and was roughly built off of the structure of the NCQA Diabetes Physician Recognition Program

20 © 2007 IBM Corporation IBM Healthcare and Life Sciences 20 PCMH Pilots Detail State: Michigan Region: Statewide Convening Authority: Blue Cross Blue Shield of Michigan Payer(s): BCBSM Overview: Providers and covered lives: PCMH components: Project contact(s): Link to press release: XXXXXXXXXXXXXXXX Notes: Initial stages of discussion, BCBSM Physician Group Incentives will embody elements of chronic care model and PC-MH. 2008 initiatives will focus on: individual care management, extended access, test tracking, patient registry, performance reporting and patient-provider agreement. Implementation of differential reimbursement for PGIP physicians who meet criteria for BCBSM designation as a PC-MH will begin mid-2009 Thomas Simmer (BCBSM CMO) tsimmer@bcbsm.com Margaret Mason MMason@bcbsm.com


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