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The Greater New Orleans Primary Care Access and Stabilization ...

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The Greater New Orleans Primary Care Access and Stabilization ...

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    1. The Greater New Orleans Primary Care Access and Stabilization Grant (PCASG)

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    3. 2 Introduction and Background The Louisiana Public Health Institute (LPHI) Health Systems Development Division Primary Care Access and Stabilization Grant (PCASG)

    4. 3 Primary Care Access and Stabilization Grant Three year (July 2007 through September 2010) $100 million federal grant to LA DHH, with LPHI as the state’s local partner administering the grant Discretionary Deficit Reduction Act funding made available by the HHS Secretary to address critical gaps post-Katrina

    5. Role of LPHI as the state’s local partner Determination of clinic eligibility Disbursement of payments utilizing the LDHH/CMS approved payment methodology Technical support in quality and process improvement Performance monitoring 4

    6. PCASG Goals – Building a bridge from hurricane recovery to a sustainable model Increase access to care on a population basis Provide evidenced based, high quality health care Develop and organized system of care Develop sustainable business entities

    7. What PCASG is NOT Not a medical home demonstration project/ research Not a reimbursement system (allowable expenditures defined by federal rules) Not Managed Care 6

    8. About PCASG Providers Includes 25 public and private non-for-profit organizations in DHH Region I (all willing and eligible) Serve everyone, regardless of ability to pay Providing outpatient primary and behavioral healthcare through 80 service delivery sites (including mobile units) 7

    9. Who is served by PCASG participants 8

    10. Distribution of Grant Funds Base payment (for stabilization) based on number of eligible healthcare providers Semi-annual supplemental payments based on weighted patient counts (5 total) 10% of each round reserved for clinics with approved pharmacy services 5% P4P distributed in 3 rounds 9

    11. Grantee Payment Schedule 10

    12. Payment Factors/ Weights

    13. 12 PCASG Quality Program Overview Quality program based on peer reviewed literature / NCQA PPC-PCMH framework: Establishes minimum quality standards 24/7 access to clinician Same day appointments for urgent care Implementation of evidence based practice for 1 important condition Creates optional pay for performance guidelines anchored in NCQA PPC/PCMH

    14. 13 Optional Quality Improvement Incentive Component 3 Payment Tiers Graduated requirements / graduated payments 5% of PCASG grant funds available for performance payments ($3.85M) Anchored in the NCQA PPC-PCMH framework 3 opportunities for payment – divided evenly Feb 2009 - $1.283M June 2009 - $1.283M Dec 2009 - $1.283M

    15. 14 PCASG Performance Payment Criteria Tier I – Pays 1x 4 of 10 required and 20 points Majority of sites must pass Tier II – Pays 3x (may qualify for NCQA PPC-PCMH recognition level I) 5 of 10 required and 25 points Majority of sites must pass Tier III – Pays 6x 8 of 10 required and 50 points Majority of sites must pass

    16. External Evaluation The Commonwealth Fund is supporting an external evaluation Looking for changes in user experience, practice characteristics, and system costs over the life of the grant UCSF research team (led by Diane Rittenhouse, MD) has been engaged by CMWF 15

    17. Key Take-Aways Alignment of the PC/BH delivery system (uniform data reporting, minimum quality standards, etc.) possible because of central infrastructure to help set common goals, establish performance measures, coordinate communication, etc. 16

    18. Key Take-Aways Moving a large number of heterogeneous practices forward towards becoming medical homes cannot happen overnight, but it is doable (we hope) by tailoring the program design to establish realistic minimum standards, stage implementation, and establish incentives for those that can exceed minimum standards 17

    19. Key Lessons There needs to be an upfront investment in infrastructure to accommodate transformation, and continued enhanced investment in medical homes if we are to realize the potential return on investment PCASG provides the subsidy to make this doable 18

    20. Ongoing Challenges Network development: We can’t get the job done with outpatient primary care (broadly defined) alone (additional vertical and horizontal networking necessary) What happens when the grant ends? $25M annual service capacity shortfall in Region I? HIT to achieve goals and measure progress not an allowable expenditure 19

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