1. Delaware PCMH Initiative October 2010

2. Rationale for PCMH Better health quality and outcomes Better health quality and outcomes Lower health care costs Lower health care costs Increased patient satisfaction Increased patient satisfaction Increased provider satisfaction Increased provider satisfaction

3. Rationale for PCMH The Dartmouth Atlas recently demonstrated unacceptable variations in cost and health care utilization are associated with the ineffective use of primary care.

4. Rationale for PCMH Timely, acuity-stratified care delivered via a health care team's coordinated efforts could save 100,000 lives yearly and control costs, according to a Geisinger study published in the September Annals of Surgery.

5. What is a Patient-Centered Medical Home The PCMH concept aims to provide continuous, comprehensive, coordinated care through a partnership between patients and their personal healthcare team. The PCMH concept aims to provide continuous, comprehensive, coordinated care through a partnership between patients and their personal healthcare team. PCMH practices provide care through: PCMH practices provide care through: Evidence-based medicine; Evidence-based medicine; Expanded access and communication; Expanded access and communication; Wellness and prevention; Wellness and prevention; Care coordination and integration; and, Care coordination and integration; and, Culturally and linguistically sensitive care. Culturally and linguistically sensitive care. Practices are incentivized through payment reform to be a PCMH. Practices are incentivized through payment reform to be a PCMH.

6. Example from Maryland Payment and Incentive Model for Providers Carriers would use their traditional fee structure, plus- Carriers would use their traditional fee structure, plus- A fixed per patient per month (PPPM) payment for enhanced care coordination and practice transformation. A fixed per patient per month (PPPM) payment for enhanced care coordination and practice transformation. A fixed PPPM plus possible additional incentives based on shared savings and quality improvements/performance A fixed PPPM plus possible additional incentives based on shared savings and quality improvements/performance

7. Phases Pre-planning – Planting the Seeds Pre-planning – Planting the Seeds Planning – Building the Foundation Planning – Building the Foundation Implementation Implementation

8. Pre-planning – Planting the Seeds Medical Society of DE Task Force Medical Society of DE Task Force A number of existing related efforts A number of existing related efforts Great momentum Great momentum Establishment of principles Establishment of principles Multi-payer Multi-payer All individuals regardless of age or chronic condition All individuals regardless of age or chronic condition Payment reform – 3 prongs Payment reform – 3 prongs Defined primary care as family practice, general internal medicine and general pediatric practices Defined primary care as family practice, general internal medicine and general pediatric practices

9. Planning – Building the Foundation Governance and operating structure, roles and responsibilities; Governance and operating structure, roles and responsibilities; Vision, goals, objectives, scope, patient and practice level outcomes; Vision, goals, objectives, scope, patient and practice level outcomes; Partnership building (including written agreements); Partnership building (including written agreements); Identification of needs, including acquisition of funds, IT and policy needs Identification of needs, including acquisition of funds, IT and policy needs Plans for payment reform Plans for payment reform Practice engagement Practice engagement Family/patient engagement Family/patient engagement Evaluation plan Evaluation plan

10. Implementation – Pilot Optimistic goal to begin in the Fall of 2011 Optimistic goal to begin in the Fall of 2011 Details yet to be worked out – (e.g. duration, number of practices) Details yet to be worked out – (e.g. duration, number of practices) Building systems of care for after the pilot Building systems of care for after the pilot

11. Governance Co-leadership of the MSD and DHSS/DPH Co-leadership of the MSD and DHSS/DPH MSD – MSD – Provider engagement and advocacy Provider engagement and advocacy Leadership and previous experience Leadership and previous experience Dr. Gill – expertise and experience Dr. Gill – expertise and experience SOD/DHSS/DPH- SOD/DHSS/DPH- Safe Harbor Safe Harbor Funding streams Funding streams Existing infrastructure Existing infrastructure Prevention-focused Prevention-focused Integration of public health and primary care Integration of public health and primary care Dr Rattay – expertise and experience Dr Rattay – expertise and experience

12. Management Services to Support Pilot Planning Secured WAMS Secured WAMS Professional expertise: Professional expertise: Design, implementation and management of health service delivery programs Design, implementation and management of health service delivery programs Ambulatory care operations management Ambulatory care operations management Planning and staffing multi-stakeholder initiatives and consortium; e.g. the Delaware Cancer Consortium, CHAP, VIP, the Delaware Covering Kids & Families Program Planning and staffing multi-stakeholder initiatives and consortium; e.g. the Delaware Cancer Consortium, CHAP, VIP, the Delaware Covering Kids & Families Program Physician education and residency training programs Physician education and residency training programs Deliverables: Deliverables: Assistance with stakeholder engagement Assistance with stakeholder engagement Communication and meeting support Communication and meeting support Written Materials and Research Written Materials and Research Pilot Project Plan and Timeline Pilot Project Plan and Timeline

13. Many Stakeholders Executive Team – small and nimble Executive Team – small and nimble Steering Group – varied representation, advisory Steering Group – varied representation, advisory Subcommittees – focused on topical/operational issues (e.g. payment reform, evaluation, practice improvements, policy) Subcommittees – focused on topical/operational issues (e.g. payment reform, evaluation, practice improvements, policy)

14. Learning From Others Collaboration is key to success Collaboration is key to success Example - Involvement of the employer community is critical Example - Involvement of the employer community is critical A collaborative learning approach works well A collaborative learning approach works well Whole-practice transformation is necessary Whole-practice transformation is necessary Multi-payer Multi-payer All ages and diseases All ages and diseases Prevention-focused Prevention-focused Adequate practice incentives and technical assistance is important Adequate practice incentives and technical assistance is important HIT – HIE and EHR/EMR is a huge advantage HIT – HIE and EHR/EMR is a huge advantage

15. Timeline, Deliverables and Cost: Quarter 1 Bring stakeholders together as a Steering Committee as well as defining functional subcommittees Bring stakeholders together as a Steering Committee as well as defining functional subcommittees ID the goals and objectives ID the goals and objectives Assess whether legislation is needed and prepare for proposal Assess whether legislation is needed and prepare for proposal Technical Assistance from the Patient-Centered Primary Care Collaborative (PCPCC) Technical Assistance from the Patient-Centered Primary Care Collaborative (PCPCC)

16. Timeline, Deliverables and Cost: Quarter 2 Form workgroups to address key operational and strategic considerations for the pilot. Form workgroups to address key operational and strategic considerations for the pilot. Draft an operating structure and budget Draft an operating structure and budget Define the roles of government and other partners Define the roles of government and other partners Prepare written proposal and other materials needed to elicit support from partners (e.g. funders and payers). Prepare written proposal and other materials needed to elicit support from partners (e.g. funders and payers). Promote legislation if needed Promote legislation if needed Begin funding recruitment Begin funding recruitment

17. Timeline, Deliverables and Cost: Quarters 3 and 4 Agreements in place (e.g. MOU’s) Agreements in place (e.g. MOU’s) Finalize payment reform methodology Finalize payment reform methodology Secure funding commitments Secure funding commitments Recruit practices Recruit practices Finalize evaluation plan Finalize evaluation plan Support personnel capacity (e.g hiring of care coordinators) Support personnel capacity (e.g hiring of care coordinators)