Patient-Centered Medical Home & Multi-Payer Demo

1. Patient-Centered Medical Home & Multi-Payer Demo Training Webinar # 1 David Halpern, MD, MPH May 18th, 2011

2. Nice To “Meet” You David Halpern, MD, MPH Practice Support Consultant for CCNC Primary Care Physician at Duke Training: • MD (2004) Cornell University • MPH (2010) UNC-Chapel Hill • Internship/Residency in Internal Medicine at University of Pennsylvania • Fellowship in Geriatric Medicine at UNC • Fellowship in Preventive Medicine at UNC

3. Today’s Agenda • What is a Patient-Centered Medical Home? • What is the Multi-Payer Demo Project? • What are the Benefits for Me and My Practice?

4. What is a Patient-Centered Medical Home (PCMH)?

5. Patient-Centered Medical Home The PCMH is a model of primary care re-design intended to improve the quality and efficiency of primary care delivery

6. Patient-Centered Medical Home • Emphasizes the relationship between patients and their primary care physicians • Employs a team-based approach to care • Integrates evidence-based practices, clinical decision-support tools, disease registries, and health information technology to improve population management and preventive care

7. Medical Home “Joint Principles” • Personal Physician • Physician-Directed Practice • Whole-Person Orientation • Care Coordination/Integration • Quality & Safety • Enhanced Access • Payment Adopted by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA) in Febraury, 2007

8. Medical Home “Joint Principles” • Personal Physician Each patient has an ongoing relationshipwith a personal physician, who provides comprehensive, continuous primary care.

9. Medical Home “Joint Principles” • Physician-Directed Practice The physician is responsible for directing a team that takes collective responsibility for patient care.

10. Medical Home “Joint Principles” • Whole-Person Orientation The physician is responsible for providing comprehensive care at all stages of life and for coordinating care as necessary with appropriate specialists.

11. Medical Home “Joint Principles” • Care Coordination/Integration A patient’s care is coordinated across all elements of our complex health system (subspecialty care, hospitals, nursing homes, etc) through disease registries, information technology, health information exchange, and/or other means to ensure that the patient is getting needed and desired care in an appropriate manner.

12. Medical Home “Joint Principles” • Quality & Safety Quality and safety are hallmarks of a PCMH; evidence-based practices, clinical decision-support tools, regular quality improvement efforts, and information technology all combine to ensure that patient outcomes attain the highest level of excellence.

13. Medical Home “Joint Principles” • Enhanced Access Patients have enhanced access to their physicians and their practices as a result of open scheduling, expanded hours, and/or additional options for communication between patients, physicians, and staff.

14. Medical Home “Joint Principles” • Payment Reimbursement appropriately reflects the added value patients receive from being part of a PCMH practice.

15. Benefits of the PCMH Model PCMH practices provide care that is: Higher Quality • Improves Patient Outcomes More Efficient • More Timely and Cost-Effective

16. Benefits of the PCMH Model Quality – Patient Outcomes • Fewer ER visits • Fewer hospital admissions • Lower mortality rates • Better preventive service delivery • Better chronic disease care • Higher patient satisfaction

17. Benefits of the PCMH Model Efficiency – Cost • Lower total costs of care • Shorter patient wait times • Less staff burnout/turnover • Higher staff satisfaction/productivity

18. What is the Multi-Payer Advanced Primary Care Practice Demonstration Project (MAPCP)?

19. Background WHO – The World Health Report 2000 • Ranked healthcare performance/quality of 191 countries • US was ranked 37th • Behind nearly all of Western Europe, Canada, Japan, Australia, and Israel

20. Source: Anderson. Health Affairs 27, no. 6 (2008): 1718–1727

21. Primary Care Is The Backbone • “U.S. states with higher ratios of primary care physicians to population had better health outcomes” • “Areas with higher ratios of primary care physicians to population had much lower total health care costs than did other areas” Source: Starfield. Milbank Quarterly 83, no. 3 (2005): 457-502

22. What is the Multi-Payer Demo? • Centers for Medicare and Medicaid Services (CMS) is the Federal agency in charge of Medicare and Medicaid • CMS funds “demonstration projects” to test and evaluate new models of health care delivery across the US

23. What is the Multi-Payer Demo? • The purpose of the Multi-Payer Advanced Primary Care Practice “demonstration project” (MAPCP) is to evaluate the effectiveness of the PCMH model, when supported by both public and private payers • NC is one of 8 states that was awarded an MAPCP demo

24. What is the Multi-Payer Demo? • 7 rural counties across NC were chosen to participate in the demo: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga

25. What is the Multi-Payer Demo? • To participate, practices in these counties must obtain PCMH recognition from the National Committee for Quality Assurance (NCQA) during the first year of the demo (no later than 9/30/12) • In return for implementing the PCMH model, practices will earn incentive payments from the largest public and private payers in NC: CMS and BCBS-NC/SHP.

26. Support for the MAPCP • Community Care of North Carolina (CCNC) • Practice Support • Training Webinars • Informatics Center Resources • AHEC & Regional Extension Center (REC) • EMR adoption and implementation • Registry Support • QI Consultants

27. What are the Benefits forMe and My Practice?

28. Recognition of Added Value Incentive Payments from Medicare • CMS will pay a per member per month fee for each Medicare patient in practices achieving PCMH recognition through NCQA: • Level 1 = $2.50 PMPM ($30 each year) • Level 2 = $3.00 PMPM ($36 each year) • Level 3 = $3.50 PMPM ($42 each year)

29. Recognition of Added Value Increased Reimbursement from BCBS • Eligibility for the Blue Quality Physicians Program (BQPP), a recognition program for primary care practices that builds on PCMH recognition from NCQA • Once you qualify for the BQPP, BCBS will increase its fee structure by 10% or more for all of your BCBS/SEHP patients

30. CMS Incentives – Example(per physician per year) PCMH Level (calculated using a panel of 2,500 patients per provider)

31. BCBS Incentives – Example(per physician per year) PCMH Level (calculated using an annual revenue of $400K per provider)

32. Next Steps (Homework) Put Training Webinars On Your Calendar • June 8 • June 22 • July 6 • July 20 • August 3 • August 17 • August 31 all from 12PM - 1PM

33. Next Steps (Homework) • Build Your PCMH Team: • Identify a “PCMH Champion” who will help guide the practice through the quality transformation process • Identify a “Communicator-In-Chief” who will serve as a point person for interactions with Community Care and other support staff • Identify a “Lead Administrator” who will track progress, organize materials, complete the PMCH application (should have computer skills)

34. Next Steps (Homework) • Begin team discussions about where the manpower will come from. Practice transformation is valuable for your patients and your practice, but it takes time. • Will you: • Be able to reduce your patient load? • Have to extend your hours? • Need to work on the weekends? • Need to shift duties/responsibilities?

35. Next Steps (Homework) Get the EMR ball rolling today… • Sign up for AHEC’sREC services (free) by completing an application at www.ncahecrec.net

36. Community Care PCMH Team • David Halpern, MD, MPH Community Care of North Carolina (CCNC) • R.W. “Chip” Watkins, MD, MPH, FAAFP Community Care of North Carolina (CCNC) • Brent Hazelett, MPA North Carolina Academy of Family Physicians (NCAFP) • Elizabeth Walker Kasper, MSPH North Carolina Healthcare Quality Alliance (NCHQA)

37. Partners

38. Questions? Feel free to contact me: David Halpern, MD, MPH (215) 498-4648 dhalpern@n3cn.org