Medical Home Pilot Business Plan

1. Medical Home Pilot Business Plan Florida Academy of Family Physicians E. Coy Irvin Jr., M.D., M.B.A. Senate Health Regulation Committee March 4, 2010

2. Proposed Partners Florida Academy of Family Physicians Florida Association of Community Health Centers Florida Medical Association Florida Osteopathic Medical Association Health First Network Prestige Health Choice PSN

3. Business Plan for:1. Escambia and Santa Rosa Counties 2. Okaloosa and Walton Counties

5. There are NO managed care plans in area one AHCA Report Area 1: Medicaid February 2010 5

6. Medicaid Savings can be achieved with the support of Community Providers • To achieve savings any Medicaid initiative must be in partnership with the Provider Community who focus on • Care coordination • Chronic disease management • Reduction of emergency room visits and in patient days • Utilize health information technology • To engage this Community, Providers must have; • Input into the process • Transparency of information, and • Partnerships with a risk entity they trust • Increase Medicaid provider reimbursement 6

7. It is estimated that no new money will need to be appropriated for this Pilot

8. MediPass Enrollment Measures Escambia and Santa Rosa Counties Escambia Santa Rosa Total Patients 26,523 8,544 35,067 Patients Age 18 and Over 7,436 2,314 9,750 Patients Under 18 19,087 6,230 25,317

9. MediPass Expenditures for 2009Escambia and Santa Rosa Counties Escambia Santa Rosa Total Patients 18 and Over $38,189,432.25 $9,984,736.66 $48,174,168.91 Patients Under 18 $18,261,336.42 $7,094,708.23 $25,356,044.65

10. Medical Home Pilot Project Business Plan for Escambia and Santa Rosa Counties • Coverage of MediPass participants in two county area • 35,067 individuals • Develop a network of physicians for medical homes • 70 physicians • Network will be composed of private practice physicians, hospital employed and community health center physicians • Family Practice • Geriatrics • Internal Medicine • Pediatrics • Psychiatric care will be carved out to Lakeview Center ( Already in Place ) • Team will also include ARNPs, pharmacists, PAs, case managers as well as nurse managers

11. Participating FacilitiesEscambia and Santa Rosa Counties Baptist Hospital Gulf Breeze Hospital Sacred Heart Hospital Santa Rosa Medical Center

12. Data Driven Care Coordinationfor the Model • Data collection from • EMRs • Claims Data from Risk Entity • Pharmacy Data • Chart Review • Patient Satisfaction and Provider Satisfaction surveys • Health Analytics Data Base • Pensacola Network (waiting for name)

13. Provider Payment Elements for the Model • Revenue: Estimated cap payment per member per month will be determined by AHCA blended rate • Provider Payments: • Participating physicians will be paid on a fee for service basis closer to Medicare rates • Physician will also receive a management fee of $3 per member per month for level I care. Fee will be adjusted higher for level II or III care. • Provider incentive package for capacity, outcomes, cost

14. Hospital RateEscambia and Santa Rosa Counties Hospitals will receive a per diem rate of $1,300

15. MediPass Enrollment Measures Okaloosa and Walton Counties Okaloosa Walton Total Patients 9,195 4,190 13,385 Patients Age 18 and Over 1,203 1,112 2,315 Patients Under 18 7,992 3,078 11,070

16. MediPass Expenditures for 2009Okaloosa and Walton Counties Okaloosa Walton Total Patients 18 and Over $9,288,752 $6,984,721 $16,273,473 Patients Under 18 $10,397,237 $3,981,513 $14,378,750

17. Medical Home Pilot Project Business Plan for Okaloosa and Walton Counties • Coverage of MediPass participants in two county area • 13,385 individuals • Develop a network of physicians for medical homes • ___ physicians • Network will be composed of private practice physicians, hospital employed and community health center physicians • Family Practice • Geriatrics • Internal Medicine • Pediatrics • Psychiatric care will be carved out to Lakeview Center ( Already in Place ) • Team will also include ARNPs, pharmacists, PAs, case managers as well as nurse managers

18. Participating FacilitiesOkaloosa and Walton Counties North Okaloosa Medical Center Twin Cities Hospital White-Wilson Medical Center

19. Building a Sustainable Medical Home Model ensures reduction in costs & improved patient outcomes Transparency of Data means improvement of patient outcomes Community recognizes the benefits of a medical home and it’s continuation AHCA Quality and Reporting Requirements are met Primary care physicians & staff are valued for their care coordination When these criteria are met, the evidence demonstrates that the Medical Home Model grows in a community 19

20. Medicaid Expenditures 07-08 08-09 Escambia $219,892,680 $249,705,832 Santa Rosa $56,075,048 $63,105,437 Okaloosa $75,425,759 $90,077,154 Walton $23,239,218 $25,975,848

21. Florida Medicaid Fee For Service Expenditures for Drug and Non-Drug Services FY2008-2009 Non-Drug Drug Escambia $154320547 $9480115 Santa Rosa $36316180 $3356324 Okaloosa $63680445 $4857026 Walton $15051399 $1062525

22. Estimated Dollar Savings(Medicaid) Pilot will achieve at least an 8% savings for the State for each member enrolled in the program. Based upon experience in other Areas Savings through reduction in Fraud and Abuse as well as AHCA administrative costs associated with Fee for Service Medicaid are not estimated

23. Risk Bearing Entity Prestige Health Choice, LLC What Is Prestige Health Choice, LLC A capitated Provider Service Network serving Medicaid members Owned and controlled by Health Choice Network and its member FQHC centers Approximately 41,600 Members Accredited by AAAHC 23

24. Three Year Pilot Project • Start – upon authorization being signed into law • Organization of care network & Implementation of operation plan (1st Quarter) • Acceptance of enrollees (2nd Quarter) • Comply with AHCA meds encounter data, QI compliance, and other requirements - ongoing • Final report submitted to the Governor & Legislature July 1, 2013