1. Maine AAP ~ Asthma Pilot ~ Learning Session April 2010 Lisa M. Letourneau MD, MPH Quality Counts

2. I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. Disclosure Statement

3. Objectives Describe Maine PCMH Pilot Understand how asthma fits into PCMH –Role of care managers –Role of patients in improving asthma Asthma quality measures moving forward

4. Defining Medical Home “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” American Academy Pediatrics

5. The Stalemate that Blocks Change Providers unable to transform practice without viable & sustainable payment for desired services Employers & payers unwilling to pay for desired services unless primary care demonstrates value AND create potential to save money BUTBUT

6. The Medical Home: A Model for Change! Providers transform practice, create value with viable & sustainable payment for desired services = Practice Transformation Employers & payers pay for desired services because primary care demonstrates value AND saves money = Payment Reform ANDAND

7. AAFP-AAP-ACP-AOA-AMA PCMH Joint Principles 1.Every patient has a personal physician 2.Care is provided by a physician-directed team who collectively care for patient 3.Personal physician is responsible for providing all patient’s needs, or arranging for services to be provided by others 4.Care is coordinated and integrated across all aspects of healthcare system 5.Quality and safety are hallmarks 6.Patients are offered enhanced access to care (e.g. expanded hours, enhanced communication ) 7.Payment appropriate recognizes added value of PCMH

9. Maine PCMH Pilot Key elements: –3-year multi-payer PCMH pilot –Collaborative effort of key stakeholders, all major payers –Adopted common mission & vision, guiding principles for Maine PCMH model –Selected 22 adult / 4 pedi PCP practices across state –Supporting practice transformation & shared learnings beyond pilot practices –Committed to engaging consumers/ patients at all levels –Planning rigorous outcomes evaluation (clinical, cost, patient experience of care)

10. Maine PCMH Pilot Leadership Quality Counts Maine Quality Forum Maine Health Management Coalition

11. Maine PCMH Pilot - Timeline Jan 2009: Call for practice applications May 2009: Practices notified – start of 6mo “ramp-up period” Sept 2009: NCQA PPC-PCMH applications completed Sept-Dec: practices contracted with payers Jan 2010: Start date for PCMH payments Jan 2010- Dec 2012: 3-year PCMH Pilot

14. Maine PCMH – Pediatric Practices 6 applicants; 4 selected –Demonstrated commitment to PCMH –High MaineCare populations Participating practices: –EMMC / Husson Pediatrics –Maine Med Partners / Westbrook Peds – PCHC / Penobscot Pediatrics –Winthrop Peds & Adolescent Medicine

15. Maine PCMH Pilot – Payment Model All four private payers & Medicaid participating (??Medicare – APC demo) Using “standard” 3-component payment:  Prospective (pmpm) care management payment – approx $3pmpm  Ongoing FFS payments  Performance payment for meeting quality targets (existing P4P programs)

16. 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 HMP 9.Commitment to waste reduction 10.Patient-centered HIT

17. Support for Practice Transformation PCMH Learning Collaborative –IHI “BTS” model; 3 Learning Sessions/yr Practice QI Coaches –Most from existing PHOs, med groups –Using microsystems approach to QI Technical assistance “experts” –BH integration, work with consumers, HIT Ongoing feedback reports –Clinical, claims data

18. PCMH & Improving Asthma Care 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 HMP 9.Commitment to waste reduction 10.Patient-centered HIT

19. PCMH Evaluation Patient experience of care –CG-CAHPS patient surveys Clinical quality measures –Adult & pedi Cost & resource use –Hosp’s, readmissions, ED use, imaging Practice changes

20. Pedi Quality Measures Align with other state, national programs –Pathways to Excellence –CHIPRA –ARRA/ “Meaningful Use” measures Likely asthma measures –ED use –Controller use –?Symptom assessment

21. Lessons Learned Maine PCMH Pilot Change starts with effective leadership –Primary selection criteria for Pilot –Don’t assume physician leadership skills - need ongoing support Change happens through effective teams NCQA PPC-PCMH  “medical home” It’s all about relationships – with patients AND within teams Recognize value of “outside” coaching

22. Where We’re Aiming: Medical Home Is Where… Patients feel welcomed Staff takes pleasure in working Physicians feel energized every day

23. Maine PCMH Pilot - Issues TBD Will new payment be enough to support true practice transformation? How best to engage specialists, hospitals in shared goals, shared cost savings? How to engage patients in new partnership? How to spread learnings to other “non-Pilot” practices And more??

24. PCMH Creating Hope for a Better System With thanks to Dr. Tom Bodenheimer, Dept. Family & Community Med, UCSF “I cannot say whether things will get better if we change; what I can say is they must change if we are to get better” - Georg Christoph Lichtenberg ( 1742-1799)

25. www.mainequalitycounts.org

26. Contact Info / Questions  Lisa Letourneau MD, MPH Letourneau.lisa@gmail.com 207.415.4043  Sue Butts Dion sbutts@maine.rr.com  Maine PCMH Pilot www.mainequalitycounts.org (See “Resource Library” & “News” sections)  Additional info on PCMH model, pilots www.pcpcc.net