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Maine PCMH Pilot Phase 2 Expansion Introduction 1.

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Presentation on theme: "Maine PCMH Pilot Phase 2 Expansion Introduction 1."— Presentation transcript:

1 Maine PCMH Pilot Phase 2 Expansion Introduction 1

2 Objectives Welcome! Brief overview Maine PCMH Pilot Review benefits and expectations for Phase 2 practices Preparing to join Pilot – next steps 2

3 Why We’re Here 3

4 Maine’s Medical Home Movement ~ 540 Maine Primary Care Practices 26 Maine PCMH Pilot Practices 50 Pilot Phase 2 Practices 14 FQHCs CMS Advanced Primary Care (APC) Demo 100+ Nat’l Committee for Quality Assurance (NCQA) PCMH Recognized Practices ~130+ MaineCare Health Home- eligible Practices 4

5 Maine PCMH Pilot Leadership Maine Quality Counts Maine Quality Forum Maine Health Management Coalition MaineCare 5

6 Maine PCMH Pilot Key elements:  Convened by Maine Quality Forum, Maine Quality Counts, Maine Health Management Coalition  Originally, 3-year multi-payer PCMH pilot (now 5 yrs)  Collaborative effort of key stakeholders, major payers  Use common mission & vision, guiding principles for Maine PCMH model  Phase 1 includes 22 adult/ 4 pediatric PCP practices across state  Practices receive support for practice transformation & shared learning  Pilot committed to engaging consumers/ patients at all levels  USM Muskie team conducting rigorous outcomes evaluation (clinical, cost, patient experience of care) 6

7 Phase 1 Practices 7

8 Maine PCMH Pilot Practice “Core Expectations” 1. Demonstrated physician leadership 2. Team-based approach 3. Population risk-stratification and management 4. Practice-integrated care management 5. Same-day access 6. Behavioral-physical health integration 7. Inclusion of patients & families 8. Connection to community / local community resources 9. Commitment to waste reduction 10. Patient-centered HIT 8

9 Maine PCMH Pilot – Payment Model Major private payers participating + Medicaid + Medicare (MAPCP demo) 3-component PCMH payment:  NEW prospective (pmpm) PCMH care management payments – approx $3pmpm commercial payers & Medicaid; $7pmpm Medicare  Ongoing FFS payments  Ongoing health plan performance payments for meeting quality targets (i.e. existing P4P programs) 9

10 But What Does it All Mean - to Patients? Vision for Change – Phase I Teams (June 09) “They were here for me” “Everybody here feels like family” “They really help us get through the system” “I feel well cared for in my practice” “They know what I need and when I need it” “I don’t feel so alone or anxious anymore” “Wow – all my needs were met!” 10

11 CMS MAPCP Demo Medicare (CMS) Multi-Payer Advanced Practice (MAPCP) “medical Home” Pilot Medicare joined Pilot a payer Allowed introduction of Community Care Teams Stronger focus on reducing waste & avoidable costs – particularly readmissions Ability to access Medicare data for reporting, identifying pts at risk Opportunity for 50 additional practices to join “Phase 2” of Pilot (Jan 2013) 11

12 Maine PCMH Pilot - MAPCP Timeline ME PCMH Pilot - Original ME PCMH Pilot - Extended Jan 1, 2010 Dec 31, 2014 Jan 1, 2012 Pilot Expansion 2011 2012 2013 Dec 31, 2014 MAPCP Demo – 3yr 12

13 Multi-Payer Pilot Phase 2 Expansion 107 practices applied; 84 qualified for multi- payer Pilot Expectations: – Strong leadership for change – NCQA PCMH recognition (Level 1 or higher)- complete status survey by July 18th – Fully implemented Electronic Medical Record (EMR) – Commitment to implement Pilot Core Expectations 50 new adult practices selected for participation in multi-payer Pilot, highly competitive process! 13

14 Maine PCMH Pilot – Existing + 50 Expansion Practice Sites 14

15 Community Care 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 Receive pmpm payments from Medicaid, Medicare, commercial payers Key element of cost-reduction strategy, targeting high- cost patients to reduce avoidable costs (avoidable ED use, admissions ) 15

16 PCMH Practice High-need Individual Maine PCMH Pilot Community Care Teams Transportation Workplace Environment Food Systems Shopping Income Heat Faith Community Literacy Coaching Physical Therapy Hospital Services Specialists Outpatient Services Med Mgt Housing Care Mgt Behav. Health & Sub Abuse Family Schools 16

17 Eligibility Maine PCMH Pilot Expansion Practice meets MaineCare Health Home requirements Adult primary care practice site with at least one full-time primary care physician or nurse practitioner Practice site does not currently participate in the CMS FQHC Advanced Primary Care (APC) Demonstration Minimum patient panel of 1000+ patients enrolled in Pilot health plans (Anthem BCBS, Aetna, Harvard Pilgrim Health Care, MaineCare, and Medicare). Completion of Maine PCMH Pilot Phase 2 Expansion “Memorandum of Agreement” (MOA) Agreement to contribute modest PMPM toward practice transformation support 17

18 What It Means for New Practices Practices joining multi-payer PCMH Pilot in January 2013 will receive…  New PCMH payments from participating payers  Medicare, Medicaid (HH), Aetna, Anthem, HPHC  Community Care Team support for highest needs pts  Practice transformation support (fee required) Expectations  Commitment to implement Pilot Core Expectations, demonstrate improvements in quality & cost savings  Contribute practice transformation support fee 18

19 Pilot Participation Requirements Baseline on-site practice assessment  Expectation outlined in original MOA  Intended to identify practice PCMH strengths & opportunities for improvement  Pilot supports 50% costs; practices required to support remaining 50% (est’d ~ $500)  Scheduled as 2 d visit in practice (Sept – Dec)  Aiming for reports back to all practices before Jan 2013 19

20 Leadership team to attend Learning Sessions  3 sessions/year (Feb – June – Oct) – dates TBD!  Will be held in 1 central location (alternate Augusta/Bangor/other?)  At least 3 team members must attend (up to 5 team members may attend) Participate in monthly leadership webinars Work collaboratively with QI Coach Submit bi-monthly Core Expectation Status Rpts Submit quarterly Clinical Outcomes Data Rpts 20 Pilot Participation Requirements

21 Practice Transformation Support fees  CMS requirement to provide same level of practice transformation support as Phase 1  Supports  Central project management  QI coaching  PCMH Learning Collaborative & Learning Sessions  Webinars, web-based tools  Est’d to be $0.25pmpm ($3pmpy), based on panel sizes reported in practice application 21 Pilot Participation Requirements

22 22 Maine PCMH Pilot – Revenue Projection

23 Lessons from 1 st PCMH Demo Becoming a PCMH requires transformation (not incremental change) Technology needed for PCMH is not “plug & play” Transformation to PCMH requires personal transformation (esp. physicians!) Change fatigue is serious concern Transformation to PCMH is developmental process, & local process The medical home is not something that can be “installed” 23

24 Lessons Learned from Maine PCMH Pilot Change starts with effective leadership – clinician, administrative, and organizational Recognize risks of “change overload” – need to focus, prioritize, sequence change efforts Recognize that successful change happens only through effective teams (make changes with people, not to people) Recognize value of external & internal QI coaching 24

25 Change is Hard Hard to change your shorts while running! (and hard to practice while practicing) PCMH requires practice and personal change People fear change (loss) - any change 25

26 Sustaining Change is Even Harder! 26 PCMH requires transformation, not incremental change Making many changes is harder than single change Sustaining change can be exhausting Marathon, not a sprint!

27 Next Steps Participate in practice on-site assessment (Sept- Dec) Attend monthly “ramp-up” team calls/webinars (2 nd Thurs each month, 7:30A & 4:30P) Plan for leadership team to attend Expansion Launch – November 16, 2012  Augusta Civic Center Hold your own team meetings (ideally, weekly!), spread communications about Pilot across team 27

28 Summing Up: Medical Home Is Where… Patients feel welcomed Staff takes pleasure in working Physicians feel energized every day 28

29 29

30 Contact Info / Questions Maine PCMH Pilot: (See “Major Programs”  “PCMH Pilot”) PCMH Nancy Grenier, RN:, tel 240.8767 Kaleigh Sloan, MPH:, tel 622.3374 X 220 Lisa Letourneau MD, MPH: CCTs: Helena Peterson :, tel. MaineCare Health Homes  Michelle Probert:, tel. 287-2641 30

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