1. A Private Foundation Working Toward a High Performance Health System Gauging the Safety Net Medical Home Initiative's Impact on Primary Care Melinda Abrams, M.S. Vice President, Patient-Centered Coordinated Care The Commonwealth Fund Commonwealth Fund Webinar July 9th, 2013

2. A Private Foundation Working Toward a High Performance Health System Learning Objectives 1.Briefly review the rationale for the Safety Net Medical Home Initiative and its goals/objectives 2.Summarize key achievements of the Safety Net Medical Home Initiative and its enduring contributions 3.Present key lessons from the initiative regarding sequencing, practice coaching and the value of learning communities 4.Learn about PCMH transformation from a Safety Net Medical Home site: challenges, benefits, lasting impact 2

3. A Private Foundation Working Toward a High Performance Health System Impetus for the Safety Net Medical Home Initiative New data in 2007 showed patient-centered medical homes could reduce disparities by race, income and insurance – Preventive care – Coordination of care – Chronic disease management However, the research also showed that safety net clinics were less likely than private physician offices to have the indicators of medical home Source: Beal A. et al. Closing the Divide, Commonwealth Fund New York, 2007.

4. A Private Foundation Working Toward a High Performance Health System National Context Solid evidence base on the impact of primary care on costs and outcomes (Starfield et al., 2005, Friedberg et al., 2010) Joint Principals of Patient-Centered Medical Home published March 2007 CHC Leadership 4

5. A Private Foundation Working Toward a High Performance Health System Safety Net Medical Home Initiative: Goals To develop and demonstrate a replicable and sustainable implementation model to transform safety net primary care practices into patient-centered medical homes (PCMH) To achieve benchmark performance in quality, patient experience and efficiency in safety net primary care practices To build support with key stakeholders to help sustain efforts in each region 5

6. A Private Foundation Working Toward a High Performance Health System Funders of Safety Net Medical Home Initiative

7. A Private Foundation Working Toward a High Performance Health System Panelists Jonathan Sugarman, M.D., M.P.H. Principal Investigator, Safety Net Medical Home Initiative (SNMHI) President and CEO, Qualis Health 7

8. A Private Foundation Working Toward a High Performance Health System Ed Wagner, M.D., M.P.H., M.A.C.P. Director Emeritus, MacColl Center for Health Care Innovation at the Group Health Research Institute, Group Health Cooperative 8

9. A Private Foundation Working Toward a High Performance Health System Stephen Weeg, M.Ed. Former Executive Director, Health West (participating SNMHI site) 9

10. A Private Foundation Working Toward a High Performance Health System 10 Impact, Diffusion and Spread of SNMHI

11. A Private Foundation Working Toward a High Performance Health System SNMHI Shaped Several CMMI Initiatives Medicare FQHC demonstration Comprehensive Primary Care Initiative (CPCi)

12. A Private Foundation Working Toward a High Performance Health System Influence on State Policy Massachusetts: multi-payer medical home demonstration wrapped around SNMHI Idaho: multi-payer medical home initiative underway; the SNMHI Idaho leadership shaped state demo as well as state payment policy Colorado: ensured FQHC participation in a number of statewide payment demonstrations and pilots, including regional ACOs. Oregon: new Alternative Payment Model (currently tested in 3 CHCs) grew out of Oregon SNMHI project Pittsburgh: long-standing multi-payer demonstration across the state; now Medicaid agency taking on more leadership role and SNMHI an example of how to incorporate FQHCs

13. A Private Foundation Working Toward a High Performance Health System Several Providers and Health Systems Using SNMHI Resources National Association of Community Health Centers Several primary care associations (PCAs) Academic Medical Centers (e.g., Harvard Medical School, UCSF) Veterans Health Administration Institute for Clinical Systems Improvement (Minnesota) Private health systems (e.g., Methodist, Texas Health System) Indian Health Service Multiple state Medicaid programs

14. A Private Foundation Working Toward a High Performance Health System 14 Question & Answer Session

15. A Private Foundation Working Toward a High Performance Health System 15 Resources Webinar Presentations: http://www.commonwealthfund.org/Events.aspx Commonwealth Fund SNMHI page: http://www.commonwealthfund.org/Resources/2010/The- Safety-Net-Medical-Home-Initiative.aspx http://www.commonwealthfund.org/Resources/2010/The- Safety-Net-Medical-Home-Initiative.aspx Initiative Resources on Qualis Healths Website: http://www.safetynetmedicalhome.org/

16. A Private Foundation Working Toward a High Performance Health System THANK YOU! 16 Jamie Ryan, M.P.H. Program Associate The Commonwealth Fund Kathryn Phillips, M.P.H. Director, SNMHI Qualis Health Christine Haran, M.A. Assistant Vice President of Online Information The Commonwealth Fund