September 2010 Lisa M. Letourneau MD, MPH Quality Counts

Objectives Review key aspects, goals for Maine PCMH Pilot Provide updates on Maine Pilot Share lessons learned to date

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)

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

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 Dec 2012: 3-year PCMH Pilot

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

Maine PCMH Pilot – Payment Model Anthem, Aetna, HPHC & MaineCare participating Common 3-component payment model: 1.Prospective (pmpm) care management payment (approx $3 pmpm) 2.Ongoing FFS payments 3.Use existing payer P4P programs Practices expected to make changes across all populations

Medicare Med Home Demo CMS “Multi-Payer Advanced Primary Care” (MAPCP) demonstration States with multi-payer pilots invited to apply – must meet eligibility criteria –Majority of payers must participate –Pilot must be consistent with natl PCMH defn’s –Must connect with community resources & supports CMS to select 6 states – Medicare to participate as payer in state PCMH pilots Maine well-positioned, but stiff competition!

Medicare Med Home Demo Timeline: Applications due Aug 15 CMS decision by fall Demo to start Jan 2011 Demo runs

PCMH Evaluation & Data for Improvement Patient experience of care –CG-CAHPS patient surveys Clinical quality measures –Adult & pedi Cost & resource use (HealthDialog rpts) –Hosp’s, readmissions, ED use, imaging Practice changes

Data Feedback: Clinical Quality Pilot expectation that practices report clinical quality measures quarterly Started with 2008 (baseline), then Q onward Adult: 31 clinical quality measures, aligned with meaningful use Using online data reporting system developed by OnPoint

Clinical Data Feedback X

Data Feedback: Cost & Resource Use Use claims from Maine All-Claims Paid Database, via MHDO MQF contracts with Health Dialog to produce reports First reports delivered to practices mid- August, using 2008 claims data Anticipate ongoing, q6mos reports

Provider Performance Measurement Reports August 2010

Performance Summary Performance summary includes: Demographics about practice’s panel Overall practice performance compared to peers in 3 areas of unwarranted variation Evaluation of overall effectiveness and efficiency Practice’s score on 6 key utilization measures Best opportunities for improvement in the practice

Performance Summary Practice’s overall score is compared to peer norm in each of 3 categories of unwarranted variation: –Effective care (evidence based treatment or intervention to improve health status or quality of life) –Supply sensitive care (services that strongly correlate with resource supply) –Preference sensitive care (conditions that have multiple treatment options and the treatment decision should reflect the patient’s preferences

Effectiveness and Efficiency Looks at overall supply sensitive cost score compared to the overall effective care gap score Practice is compared to other practices on a scatter plot with four quadrants based on the population medians

Utilization Measures Utilization measures look at overall admissions, emergency department visits, and PCP and specialist visits per 1000 patients per year Summary measures on prescription count per 1,000 patients and generic fill rate are included Colored triangles indicate where practice is significantly different from peers

Best Opportunities for Improvement Shows where practice is significantly different from peers AND where the total impact of improving is highest

Performance Impact Lists all measures where practice is significantly different from peer norm Total Impact estimates the number of opportunities or the total dollars that could be impacted if your practice were to perform at the same level as the peer norm.

Effective, Supply Sensitive, Preference Sensitive Care Each section contains 3 components: 1.Cover page with table of contents 2.Overall measure for care type 3.Overall and detail information for individual measures

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

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

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??

Contact Info / Questions  Lisa Letourneau MD, MPH  Sue Butts Dion  Maine PCMH Pilot (See “Major Programs”  “PCMH Pilot”)