Patient-Centered Medical Home (PCMH): A model of Delivering Primary Care

1. Patient-Centered Medical Home (PCMH):A model of Delivering Primary Care Presented by: Kimtuyen Tran Smith College ‘13 Undergrad, CHCACT Intern June 13, 2012

2. Purpose of Presentation Mission of Community Health Center Association of CT (CHCACT) Mission of Federally Qualified Health Centers (FQHCs) What is a Patient Centered Medical Home (PCMH) and Why It Is Important CT’s PCMH Initiative

3. Mission of CHCACT 1 • CHCACT is a Primary Care Association that provides training and technical assistance to FQHCs in CT Mission: To enable CT FQHCs to provide access to the highest quality health care and social services to CT’s medically underserved populations.

4. Mission of FQHC FQHCs serve individuals in medically underserved communities 14 CT FQHCs 13 CT FQHCs are members of CHCACT FQHCs provide primary care, behavioral health, and dental care

5. Why do FQHCs exist? • The way in which healthcare is financed allows for poor areas to be underserved. • Private practices essentially run like a business • Medicaid does not pay for the costs of care • The uninsured cannot afford to pay for the costs • The Federal Government pays a cost-based reimbursement

6. Crisis in Primary Care 2 65 million Americans live in officially designated primary care shortage areas Only 27% of adults in U.S. can easily contact their primary care provider 50% of patients do not understand what their primary care providers told them because visits are too short to properly address their health concerns Lack of coordination between PCPs, specialists, and hospitals

7. PCMH Model • Patient Centered Medical Homes (PCMH) are not buildings, nursing homes, or hospitals, but a different way of delivering care.3

8. Joint Principles of the PCMH Adopted by AAFP, ACP, AAP, AOA 4: • Personal Clinician (MD, NP, PA all of whom have their own panel of patients and practice in primary care) • Clinician Directed Medical Practice • Whole Person Orientation • Care is Coordinated and Integrated • Quality and Safety are Hallmarks • Enhanced Access • Payment Reform

9. Health Care Reform: Opportunity to redesignthe way health care is delivered and funded • Workforce Supply and Training • Obama Administration and HHS Announce New $250 Million Investment to Strengthen Primary Health Care Workforce Through: (1) Creating additional primary care residency slots; (2) Supporting physician assistant training in primary care; (3) Encouraging students to pursue full-time nursing careers; (4) Establishing new nurse practitioner-led clinics; and (5) Encouraging states to plan for and address health professional workforce needs • Medicaid and Medicare Pilots • Section 2703 of the Patient Protection and Affordable Care Act creates a new Medicaid state plan option to cover medical homes, beginning January 1, 2011, under which certain Medicaid enrollees with chronic conditions could designate a health home, as defined by the Secretary. States that choose to offer this benefit option, will be reimbursed for payments by the federal government 90% for the first eight fiscal quarters. • Establishment of Center for Medicare and Medicaid Innovation within CMS. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients in each program. • Payment Reform • Payments to primary care physicians. Requires that Medicaid payment rates to primary care physicians for furnishing primary care services be no less than 100% of Medicare payment rates in 2013 and 2014. • Expanding access to primary care services and general surgery services. Beginning in 2011, provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years

10. Where are the PCMHs? Picture Courtesy of NCQA PCMH 2011 Overview 5

11. EVIDENCE OF COST SAVINGS &QUALITY IMPROVEMENT 7 Johns Hopkins Guided Care PCMH Model 24% reduction in total hospital inpatient days 15% fewer ER visits 37% decrease in skilled nursing facility days Annual net Medicare savings of $75,000 per PCMH care coordinator nurse deployed in practice HealthPartners Medical Group BestCare PCMH Model • 39% decrease in emergency department visits • 24% decrease in hospital admissions per enrollee • Overall costs for enrollees decreased by 8%

12. EVIDENCE OF COST SAVINGS & QUALITY IMPROVEMENT 7 Community Care of North Carolina 40% decrease in hospitalizations for asthma 16% lower ER visits Cumulative savings of $974.5 million over 6 years (2003-2008) Erie County PCMH Model • Decreased duplication of services and tests • Lowered hospitalization rates • Estimated savings of $1 million for every 1,000 enrollees

13. Why should FQHCs become a PCMH? • It builds on what FQHCs have been doing for years: • Providing comprehensive primary care and supportive services • Being accountable for quality of care delivered • Chronic Care Model and Access Redesign • Reporting to stakeholders our performance measures • Evidence suggests that a PCMH improves outcomes and reduce costs • New payment systems are aligning with PCMH

14. Connecticut’s PCMH Initiative CT’s goal is for 100% of Medicaid Patients to be in a PCMH by 2014 CT’s Initiative began for Medicaid patients in January 2012

15. Where are the PCMHs? 179 Sites and 663 Clinicians Recognized as PCMH in CT Picture Courtesy of NCQA Recognition Directory 8

16. PCMH Challenges Motivation and Prioritization Across the Organization Initial Capital and Restructuring Costs Coordinating Care within the Practice and Beyond Staff Training Electronic Medical Records Scheduling (Extended/Alternative Hours of Service)

17. References Community Health Center Association of Connecticut. (https://www.chcact.org/Content/Who_We_Are.asp) Health Affairs. "Patient-Centered Medical Homes.” September 14, 2010. (http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=25) CT Health Policy Project. “FAQs about patient-centered medical homes in CT.” March 10, 2011. (http://www.cthealthpolicy.org/medicalhome/20110310_faqs_pcmh_ct.pdf) Patient-Centered Primary Care Collaborative. “Joint Principles of the Patient Centered Medical Home” March 2007. (http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home) National Committee for Quality Assurance. “PCMH 2011 Overview.” January 13, 2011 (http://www.ncqa.org/LinkClick.aspx?fileticket=ag3nmIPXs5s%3d&tabid=631&mid=2435&forcedownload=true) CT Medicaid Managed Care Council. “Care Management PCMH Committee: Patient Centered Medical Home Presentation.” May 17,2012 (http://www.cga.ct.gov/ph/medicaid/mmcc/pccm/minutes/2012/0517/PCMH%20Care%20Management%20Committee%20Presentation%20%205%2017%202012%20-Revised.pdf) Patient-Centered Primary Care Collaborative. “Outcomes of Implementing Patient Centered Medical Home Interventions: A review of the Evidence from Prospective Evaluation Studies in the Unites States.” November 16, 2010 (www.pcpcc.net/files/evidence_outcomes_in_pcmh.pdf) National Committee for Quality Assurance. Recognition Directory. (http://recognition.ncqa.org/PSearchResults.aspx?state=CT&rp=5) Patient-Centered Primary Care Collaborative. “Introduction to PCMH Video,” 2010. (http://www.pcpcc.net/content/emmi)

18. Patient Centered Medical Home Video9

19. Q & A