Patient Centered Primary Care Collaborative

1. Patient Centered Primary Care Collaborative Edwina Rogers Executive Director Patient-Centered Primary Care Collaborative 601 Thirteenth St., NW, Suite 400 North Washington, D.C. 20005 Direct: 202.724.3331 Mobile: 202.724.3332 erogers@pcpcc.net

2. Overview of Activity • 22 Multi-stakeholder Pilots in 16 States • 8 State Medicare Pilots Planned for 2009 • 44 States and the District of Columbia Have Passed over 330 Laws and/or Have PCMH Activity

3. Blue Cross Blue Shield Plan Pilots (as of January 2009) Pilots in planning phase for 2009 implementation Pilots in progress Pilot activity in early stages of development Multi-Stakeholder demonstration

4. Overview of the PCPCC • Now in our 3rd year • Over 475 signing members • Advancing the Patient Centered Medical Home (PCMH) concept in the public and private sectors • Hosting Meetings, Summits and Congressional Briefings • Weekly Call Thursday at 11:00 AM EST • Call-in Number: 712.432.3900 • Passcode: 471334# • Weekly “Center” calls established to operationalize work of PCPCC

5. Collaborative Principles • The Patient Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and many others who have joined together to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, clinicians and payers have agreed that it is essential to support a better model of compensating clinicians. • Compensation under the Patient-Centered Medical Home model would incorporate enhanced access and communication, improve coordination of care, rewards for higher value, expand administrative and quality innovations and promote active patient and family involvement. The Patient-Centered Medical Home model will also engage patients and their families in positive ongoing relationships with their clinicians. Further, the Patient-Centered Medical Home will improve the quality of care delivered and help control the unsustainable rising costs of healthcare for both individuals and plan-sponsors. • If you agree, please visit us at www.pcpcc.net and join today!

6. The Patient-Centered Primary Care Collaborative Examples of Broad Stakeholder Support & Participation Providers 333,000 primary care Purchasers – Most of the Fortune 500 • ACP • AAP • IBM • General Motors • AAFP • AOA • FedEx • General Electric • ABIM • ACC • Pfizer • Microsoft • ACOI • AHI • Business Coalitions The Patient-Centered Medical Home • Merck & Co. 80 Million lives Payers Patients • NCQA • AFL-CIO • BCBSA • Aetna • National Partnership for Women and Families • Humana • United • HCSC • CIGNA • Foundation for Informed Decision Making • WellPoint • SEIU

7. Patient Centered Primary Care CollaborativeFour ‘Centers’ Center for Multi-Stakeholder Demonstration: Identify community-based pilot sites in order to test and evaluate the concept; offer hands-on technical assistance, share best practices, and identify funding sources to advance adoption. Center to Promote Public Payer Implementation: Assist state Medicaid agencies and other public payers as they implement and refine programs to embed the Patient Centered Medical Home model by offering technical assistance; sharing best practices and giving guidance on the development of successful funding models. Center for Health Benefit Redesign and Implementation: Create standards and buying criteria to serve as a guide and tool for large and small employers/purchasers in order to build the market demand for adoption of the Medical Home model. Center for eHealth Information Adoption and Exchange: Evaluate use and application of information technology to support and enable the development and broad adoption of information technology in private practice and among community practitioners. 10

8. Joint Principles of the PCMH (February 2007) • The following principles were written and agreed upon by the four Primary Care Physician Organizations – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. • Principles: Ongoing relationship with personal physician Physician directed medical practice Whole person orientation Coordinated care across the health system Quality and safety Enhanced access to care Payment recognizes the value added

9. The PCMH Joint Principles have received endorsements from 13 specialty health care organizations: The 13 organizations endorsing the Joint Principles are: The American Academy of Chest Physicians The American Academy of Hospice and Palliative Medicine The American Academy of Neurology The American College of Cardiology The American College of Osteopathic Family Physicians The American College of Osteopathic Internists The American Geriatrics Society The American Medical Directors Association The American Society of Addiction Medicine The American Society of Clinical Oncology The Society for Adolescent Medicine The Society of Critical Care Medicine The Society of General Internal Medicine The PCMH Joint Principles have recently also received an endorsement from the American Medical Association. Endorsements

10. Defining the Medical Home • Patients have accurate, standardized information on physicians to help them choose a practice that will meet their needs. Publically available information Source: Health2 Resources 9.30.08 8

11. PCPCC Payment Model (May 2007) The Patient-Centered Primary Care Collaborative recommends a three-part payment methodology, Including: A) A monthly care coordination payment for the physician’s work that falls outside of a face-to face visit and for the health information technologies needed to achieve better outcomes, B) A visit-based fee-for-service component that is recognized for services that are currently paid under the present fee-for-service payment system, and C) A performance-based component that recognizes achievement of service, patient centeredness, quality and efficiency goals.

12. Barbara Starfield of Johns Hopkins University Within the United States, adults with a primary care physician rather than a specialist had 33 percent lower costs of care and were 19 percent less likely to die. In both England and the United States, each additional primary care physician per 10,000 persons is associated with a decrease in mortality rate of 3 to 10 percent. • In the United States, an increase of just one primary care physician is associated with 1.44 fewer deaths per 10,000 persons. A medical home can reduce or even eliminate racial and ethnic disparities in access and quality for insured persons. Commonwealth Fund has reported: Denmark has organized its entire health care system around patient-centered medical homes, achieving the highest patient satisfaction ratings in the world. Denmark has among the lowest per capita health expenditures and highest primary care rankings. Center for Evaluative Clinical Sciences at Dartmouth, states in the US relying more on primary care have: lower Medicare spending, lower resource inputs, lower utilization, and better qualityof care. Evidence of Cost Savings & quality improvement

13. Chronic Care for Diabetes – BCBS of ND Reported 6% decrease in hospital admissions 24 % decrease emergency room $500, Per member per years savings The state of North Carolina reported savings of $244 million for FY04 for their 720,000 Medicaid recipient program. Horizon BCBS of NJ reported that the cost per patient, complying with diabetes testing in engaged medical homes, was substantially less than those in non-engaged medical homes. Evidence of cost Savings & Quality Improvement

14. Simple Cost Avoidance NC Savings (FY04)

15. Community Care Plan of Eastern NC Community Health Partners Northern Piedmont Community Care Southern Piedmont Community Care Plan Partnership for Health Management Carolina Collaborative Comm. Care Carolina Community Health Partnership Sandhills Community Care Network Northwest Community Care Network Comm. Care Partners of Gtr. Mecklenburg North Carolina Pilot Project Details AccessCare Network Sites AccessCare Network Counties Access II Care of Western NC Access III of Lower Cape Fear Community Care of Wake and Johnston Counties Central Care Health Network

17. NCQA PPC-PCMH Content and Scoring **Must Pass Elements

18. NCQA PPC-PCMH Scoring Levels: If there is a difference in Level achieved between the number of points and “Must Pass”, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 “Must Pass” Elements, the practice will achieve at Level 1. Practices with a numeric score of 0 to 24 points or less than 5 “Must Pass” Elements are not Recognized.

19. How NCQA PPC-PCMH Recognition Works • Physician/practice • Self-assess, collect data using Web-based software • Submit documentation to NCQA when ready • May be asked to submit more data if needed • NCQA • Evaluates and scores all applications • Checks licensure of physician • Audits a sample of applications • Posts Recognized physicians on web • Distributes list of Recognized physicians monthly to health plans and others • Physicians sent media kit, press releases, letter & certificate

20. Meaningful Use: Meaningful Connections Why this report- Why now? • Unprecedented urgency to change our health care “system.” • American Recovery and Reinvestment Act – over $19B for health IT infrastructure. • Natural synergy between PCMH and health IT. • Offer needed guidance to the industry.

21. What is included in the Resource Guide? • Defines health IT capabilities essential to PCMH. • Crosswalks capabilities with functional priorities supporting PCMH. • Explores how patients/consumers are currently using health IT to connect. • Representative sample of 19 case example responses from primary care providers. • Appendices include • Guidelines for PCMH Demonstration Projects • Consumer Principles • Consumer Toolkit

22. “Boots-on-the-Ground” Case Examples – Over 100 • Primary care providers in private practice – we asked them: • What kind of health IT systems do you use? • In what way does health IT and exchange support your practice or organization? • How do you use health IT to improve patient engagement? • What have your results been in terms of improved care processes, clinical outcomes, or increased patient satisfaction as a result of health IT? • What objective evidence do you have that using health IT has achieved positive impacts?

23. Patient Centered Primary Care Collaborative“Purchaser Guide” Released July, 2008 Developed by the PCPCC Center for Benefit Redesign and Implementation in partnership with NBCH and the Center’s multi-stakeholder advisory panel. Guide offers employers and buyers actionable steps as they work with health plans in local markets - over 6000 copies downloaded and/or distributed. Includes contract language, RFP language and overview of national pilots. Includes steps employers can take to involve themselves now in local market efforts. The PCPCC is holding a series of Webinars, sponsored by Pfizer, on the Purchaser Guide. 11

24. Patient Centered Primary Care Collaborative“Building Evidence and Momentum – Compendium of PCMH Pilots” Released October 2008 Developed by the PCPCC Center for Multi-stakeholder Demonstration through a grant from AAFP offering a state-by-state sample of key pilot initiatives. Offers key contacts, project status, participating practices and market scan of covered lives; physicians. Inventory of : recognition program used, practice support (technology), project evaluation, and key resources. Begins to establish framework for program evaluation/ market tracking. 12

25. Guidelines for Patient Centered Medical Home (PCMH) Demonstration Projects There has been significant interest and activity in the development of demonstration projects regarding the Patient Centered Medical Home (PCMH) care model over the past several years. These public, private or public/private projects combine the efforts of payers, providers and other health care stakeholders to test elements of the PCMH care model.  A set of guidelines to help ensure that demonstration projects purporting to test the PCMH model are broadly consistent with the joint principles was developed by the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association.In addition, the standardization promoted by the acceptance of these guidelines will help facilitate more meaningful interpretation and understanding of the “lessons learned” from the results of the different PCMH demonstration projects. Recommendations Collaboration and Leadership Practice Recognition Practice Support Reimbursement Model Assessment and Reporting of Results A full description of the Guidelines can be found on the Patient Centered Primary Care Collaborative website.

26. TODAY’S CARE MEDICAL HOME CARE My patients are those who make appointments to see me Our patients are those who are registered in our medical home Patients’ chief complaints or reasons for visit determines care We systematically assess all our patients’ health needs to plan care Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

27. Patient Centered Primary Care Collaborative“Consumers & Patients” The PCPCC currently has a section on our website dedicated to Consumer and Patient issues. • i. PCMH Consumer Education Material • ii. Emmi Solutions Video • iii. PCMH Primary Care Brochure • iv. National Partnership for Women and Families Resources • v. The Center for the Advancement of Health Resources

28. Inclusion of the Medical Home Concept in Health Reform Efforts Employer Trade Associations Executive Branch Think Tanks The Patient-Centered Medical Home Plans developed by Congressional Representatives

29. Baucus- Health Care Reform Proposal (November 2008) • Expanding Medicare’s role in testing the medical home model — in which practitioners are paid explicitly for comprehensive care management services… • Medical home expansions in Medicare should focus only on providers who are committed to ensuring that patients truly receive the primary care and care management services... • Providers seeking to participate in a Medicare medical home… should meet a set of stringent service and capacity criteria in order to qualify… and be willing to have additional payments • based in part on the quality of care they deliver.

30. Other Legislative Initiatives • Senator Durbin (D-IL) and Senator Burr (R-NC) are working together on Patient Centered Medical Home Legislation • The Healthy Americans Act, sponsored by Senator Rob Wyden (D-Oregon) and Senator Bob Bennett (R-Utah) is the first bipartisan health reform proposal in more than a decade to guarantee affordable, healthcare quality for all and includes PCMH. • Senator Baucus’ White Paper is very favorable for Medical Homes. • Economic Stimulus Package includes funding for Health IT infrastructure and primary care workforce shortages. • North Carolina received a 646 waiver to take the Patient Centered Medical Home program to all of Medicare, with estimated savings by the CBO of $1.4 billion.

31. 2009 Upcoming Collaborative Events Tuesday, April 28, 2009 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center, 1300 Pennsylvania Avenue, NW Washington D.C. 20004 Thursday, July 16, 2009 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center, 1300 Pennsylvania Avenue, NW Washington D.C. 20004 Thursday October 22, 2009 - Washington D.C., Annual Summit, Washington Convention Center

32. www.pcpcc.net About the PCPCC History Members Brochure Executive Committee Advisory Board Officers Executive Bios The Patient Centered Medical Home Joint Principles Endorsements by Specialists Employer Perspectives Evidence of Quality Health Reform Proposal Reimbursement Model Collaborative Centers Center to Promote Public Payer Implementation Center for Multi-Stakeholder Demonstration Center for Benefits Redesign and Implementation Center for eHealth Information Exchange and Adoption Other PCMH Resources Pilot Project Guide Purchasers Guide Evidence Documents Consumer Materials Events National Weekly Call Thursday, 11:00AM EST

33. Contact Information Visit our website – http://www.pcpcc.net To request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact: Edwina Rogers Patient Centered Primary Care Collaborative Executive Director 202.724.3331 202.674.7800 (cell) erogers@pcpcc.net, 601 Thirteenth St., NW, Suite 400 North Washington, DC 20005