Patient-Centered Medical Home The Colorado Multi-Stakeholder Pilot Experience

1. Patient-Centered Medical Home The Colorado Multi-Stakeholder Pilot Experience PCPCC Stakeholder Meeting March 30, 2010 Julie Schilz BSN, MBA Colorado Clinical Guidelines Collaborative IPIP and PCMH Manager PCPCC: Co-Chair Center for Multi-Stakeholder Demonstrations

3. Colorado Multi-Payer, Multi-State Patient Centered Medical Home Pilot

4. Considerations in Demonstration Developmenthttp://www.pcpcc.net/files/PCMH_Demo-Guidelines_03-09.pdf • Name, start date and timeframe • Geography-community, statewide, phased approach • Convening entity/project contacts • Medical home definition and recognition • Goals, guiding principles, payment model, evaluation • Population of focus-all, Pediatric only, Adult only • Participating stakeholders • Demographics of participating practices • Practice transformation support

5. Belmar Family Medicine Broomfield Family Practice Clinix Health Services of Colorado DeYoung Family Medicine Family Care Southwest Family Practice Associates Ideal Family Healthcare Internal Medicine Clinic of Fort Collins Lakewood Family Medicine Lone Tree Family Practice Michael Mignoli MD, Internal Med Miramont Family Medicine Mountaintop Family Health Provident Adult & Senior Medicine Southpark Internal Medicine Westminster Medical Clinic The Front Line Innovators!

6. Health Plans Aetna Anthem-Wellpoint CIGNA Colorado Access Colorado Medicaid (HCPF) Humana United Healthcare Employers Colorado Business Group on Health Centura IBM McKesson State of Colorado Patient Centered Primary Care Collaborative (PCPCC) Physician Societies AAFP/CAFP American College of Physicians Colorado Medical Society Others Colorado Health Department (CDPHE) University of Colorado-Denver Consumers Hospitals HealthONE Centura Exempla Memorial Hospital Colorado Hospital Association Others Associated IPAs Integrated Physician Network Northern Colorado IPA Physician Health Partners Primary Physician Partners South Metro Physicians MedSouth Pilot Partner Region Health Improvement Collaborative of Greater Cincinnati Pilot Evaluator Meredith Rosenthal PhD-Harvard School of Public Health Funders The Colorado Trust /The Commonwealth Fund Multi-Payer Pilot Stakeholders CCGC: Convening Organization and Technical Assistance Provider

7. Colorado Multi-Stakeholder Multi-State PCMH Pilot Overview • Guiding Principles • The Joint Principles • NCQA PPC-PCMH Recognition • Three Tiered Payment Structure • Public & Private Payer Participation • Multi-Stakeholder Steering committee with decision making capabilities • Family Medicine (14) and Internal Medicine Practices (2)-Single physician up to 8 physicians • NCQA Recognition: 14 @ Level III and 2 @ Level II • Evaluation-System Value i.e. Cost, Quality and Provider, Provider Staff, Patient Satisfaction • Measures: For QI-44 measures phased over the pilot duration Start and End Dates Technical Assistance Start-12.1.2008 Pilot Start (i.e. Payment Start) 5.1.2009 Pilot End Date 4.30.2011 or perhaps 2012

10. Reimbursement for the OutcomesWe Need in Health Caree Problems with current model-overuse, underuse and “test passing” For more information: www.pcpcc.net/content/proposed-hybridblendedreimbursement-model

11. Quality Improvement Activities Technology Infrastructure 1 2 & 3 4 Care Team with Care Plan Manager – Care Coordinator Components of PMPM for Practices to Transform into Medical Homes Leadership/Culture Change EMR/Registry Functionality Communication Platform Practice Redesign Phone Calls & E-Mails – 24/7 Coverage Data Use for Pop. Mgmt & Reporting Administrative Costs Team Mtgs & Learning Collaboratives Attribution Reconciliation Patient Experience Surveys Technology - Hardware • Customer Service – Patient Centeredness • Coordination of Care: • Mental Health • Behaviorists (CDE, Nutritionist, Smoking Cessation, Asthma Educator • Complex Case Managers • Monitor Registry: Follow Up/Outreach • Track tests/reports from specialists, hospitals, health plans, etc… • Patient self management support & self efficacy • Community Resources

12. Pay for Performance Model Two Components • Quality – 60%: • Diabetes • CVD • Tobacco • Depression • Cost – 40%: • ER Visits • Hospital Admits • Generic Pharmacy P4P Cost Measures P4P Quality Measures • ER Visits • “Avoidable ER Visits” list • Overall Hospital Admissions • “Avoidable Admissions” list • Generic Pharmacy • Most Prevalent/Costly list • MEASURED ACROSS ALL PRACTICES

13. 1. Office Redesign 2. Technology 3. Integrating Care 4. Patient Centered Technical Assistance Based on IPIP - Planned Care Model - IHI Care Plan - Registry Focused Approach Related to NCQA Tool Common Communication Platform HIPAA Compliant E-Mail In Office QI Coaches Learning Collaboratives & Calls Monthly Practice Reporting Patient Portal- Engagement Expand Services; Coordinate/ Integrate care with “Medical Neighborhood” using Compacts Enhance Access Form Partnership with Patients – Shared Decision Making Co-Located/Shared/Referred Services Care Plan Manager/Coordinator Patient Activation & Satisfaction (Experience)

15. Questions? Thank You! Julie Schilz JSchilz@coloradoguidelines.org www.coloradoguidelines.org Patient Centered Primary Care Collaborative www.pcpcc.net