Maine AAP ~ Asthma Pilot ~ Learning Session April 2010

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

2. Disclosure Statement 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.

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 Employers & payers unwilling to pay for desired services unless primary care demonstrates value AND create potential to save money Providers unable to transform practice without viable & sustainable payment for desired services BUT

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 AND

7. AAFP-AAP-ACP-AOA-AMAPCMH Joint Principles • Every patient has a personal physician • Care is provided by a physician-directed team who collectively care for patient • Personal physician is responsible for providing all patient’s needs, or arranging for services to be provided by others • Care is coordinated and integrated across all aspects of healthcare system • Quality and safety are hallmarks • Patients are offered enhanced access to care (e.g. expanded hours, enhanced communication ) • 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 Maine Quality Forum Quality Counts 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” • Demonstrated physician leadership • Team-based approach • Population risk-stratification and management • Practice-integrated care management • Same-day access • Behavioral-physical health integration • Inclusion of patients & families • Connection to community / local HMP • Commitment to waste reduction • 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 • Demonstrated physician leadership • Team-based approach • Population risk-stratification and management • Practice-integrated care management • Same-day access • Behavioral-physical health integration • Inclusion of patients & families • Connection to community / local HMP • Commitment to waste reduction • 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. Patients feel welcomed Staff takes pleasure in working Physicians feel energized every day Where We’re Aiming: Medical Home Is Where…

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. “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) PCMH Creating Hope for a Better System With thanks to Dr. Tom Bodenheimer, Dept. Family & Community Med, UCSF

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