West Virginia Medical Home Incentive Pilot

1. West Virginia Medical Home Incentive Pilot Presented to: PCPCC Center for Multi-payer Demonstrations April 6, 2010 Christine St. Andre Roger Chaufournier

2. Background • Medicaid Transformation Grants---conceptual support for medical home model • Project management contract through West Virginia University/ CSI Solutions, LLC to implement the grants • Development of West Virginia Health Improvement Institute as a forum for multiple stakeholders to collaborate in improving the health status of the citizens of WV • Evolved from Medicaid-sponsored to independent 501(c)3 with broad stakeholder board

3. West Virginia Health Improvement Institute AIM:To improve the health status of all West Virginians through aligned initiatives focusing on improved access; prevention; promotion of wellness and healthy lifestyle choices; and optimal evidence based chronic illness management Stakeholder Advisory Group Meets Quarterly Virtual Engagement On-Going Coordinating Committee Provider Education Self Management Adoption of HIT Measurement/ Reimbursement/ Reporting Evaluation & Innovation Pilots Pilots Pilots Innovation Community 300+ Primary Care Providers

4. Institute Design Elements • Broad participation across professional organizations, payers, advocacy groups, providers • Work groups to focus on specific topics of interest and importance • Use of pilot projects to test changes/ intervention on a small scale prior to decisions on full state-wide implementation • Creation of an Innovation Community of interested providers committed to the medical home model and willing to participate in pilot initiatives

5. Innovation Community • Virtual community of primary care providers committed to improving the health of the population • Voluntary process • 300+ primary care providers • Access to opportunities for training and pilot participation and supported by a virtual office

6. Pilots currently underway • A pediatric obesity pilot • A pilot on training in the Stanford Self-Management program • A pilot focused on empowering young Medicaid mothers with health literacy skills so as to better utilize the health care system • Testing of a provider incentive program for adoption of technology • Pilot to explore interest and scalability of an open source EMR • A pilot to test the ability of providers to report on a key set of quality measures • A pilot focused on the chronically sick and disabled using an expanded care team and pharmacist • A pilot to test sharing a care coordinator among several small private practices • A Medical Home Performance Incentive pilot using a shared savings incentive model

7. Medical Home Performance Incentive Pilot-Pilot Basics • Developed by Measurement Work Group to test effectiveness of the Patient-Centered Medical Home model in WV and to inform future reimbursement • Uses NCQA PCMH Recognition criteria • Outcomes assessment to include: • Clinical process measures • Clinical outcome measures • Utilization • Cost • Alignment with evolving definition of “Meaningful Use”

8. Pilot Basics • Beginning with 6 month readiness phase • Practice assessment • Modified collaborative approach—face to face learning session for the care team, webcasts, monthly team calls • Training and coaching on NCQA standards and practice redesign • Preparation for measures reporting • 12 month assessment phase following the readiness period

9. Pilot Basics • Payer participation: • UniCare (managed Medicaid) • Mountain State BlueCross Blue Shield • PEIA (state employee plan) • Shared savings incentive model-up to 2.5% of total claims cost based on comparison of assessment period to 2009 claims • No change in ongoing reimbursement • Twelve month savings pooled across all providers and patients; distribution to be based on physician performance on process and outcomes measures • Payout targeted for Fall, 2011

10. Participating practices • Targeted 50 physicians; have 33 • Limited the number of physicians from each organization • 7 FQHC’s • 9 free clinics---all in the state • One large IPA • 2 academic practices • 2 small private practices • One rural health clinic • All have an EMR in place, but this was not a requirement

11. Expectations of Practices • Make a commitment: participation agreement, business associate agreements • Apply for NCQA recognition within 9 months • Care team participation in the face to face session, webcasts, and monthly calls • Monthly reporting the aggregate clinical measures for all patients using the measures required for CMS EMR incentives • Provide patient lists for attribution

12. Expectations of Participating Payers • Verify patient lists for attribution • Agree to share savings up to 2.5% of total 2009 claims cost for the participating patients/ members and contribute this amount to the overall incentive pool • Agree on a uniform approach to calculation of savings • Agree on incentive pool distribution methodology • Provide cost and utilization feedback where possible based on claims data • Use results to inform future reimbursement changes

13. Patient Attribution • Practices use practice management or EMR system to look back 18 months and identify any patient that has been seen during that time. • Exclude any people seen as a result of cross-coverage and others that were known to be one-time occurrences • Provide a list of all patients, with their designated payer to the WVHII staff • Lists are aggregated by payer for confirmation of coverage during the entire 2009 period

14. How did we sell participation to practices? • Financial upside from the incentive component • Best practice models they will be exposed to could help drive internal efficiencies and throughput • Market value of TA offered (estimated at approximately $25k per practice) • Participation will jump start the practice down the pathway of meaningful use • This is a showcase demonstration project of national significance • Intend to influence the remaining reimbursement system if we all succeed

15. Role and Support from WVHII • Project management • Training, technical assistance, and coaching • Reporting site that will aggregate data and track individual as well as group performance • Virtual office and listserv for sharing resources • Compensation for lost revenue resulting from attendance at all day learning session • Payment for NCQA assessment tool and application

18. Challenges we’ve faced • Not all payers are participating • Medicaid need for plan amendment in order to compensate differently • Medicare • Several smaller payers in the state • Providers take the full risk • Difficulty in recruitment • Measurement strategy not yet final • Meaningful use and CMS incentives must be considered to avoid re-work and duplication

19. Current status • In readiness phase with face to face learning session held in February • Practices completing practice assessments • Compiling patient lists for attribution • Expect 12 month assessment phase to begin July 1 • Payers meeting next month to establish savings calculation • Now that we have started, more people want to get involved!

20. Contact Information • www.wvhealthimprovement.org • Christine St. André cstandre@spreadinnovation.com • Roger Chaufournier • rchaufournier@spreadinnovation.com