Transcript PCMH Training Webinar 1 - Multi-Payer

Patient-Centered Medical Home
& Multi-Payer Demo
Training Webinar # 1
David Halpern, MD, MPH
May 18th, 2011
Nice To “Meet” You
David Halpern, MD, MPH
Practice Support Consultant for CCNC
Primary Care Physician at Duke
Training:
• MD (2004) Cornell University
• MPH (2010) UNC-Chapel Hill
• Internship/Residency in Internal Medicine at
University of Pennsylvania
• Fellowship in Geriatric Medicine at UNC
• Fellowship in Preventive Medicine at UNC
Today’s Agenda
• What is a Patient-Centered Medical
Home?
• What is the Multi-Payer Demo Project?
• What are the Benefits for Me and My
Practice?
What is a Patient-Centered
Medical Home (PCMH)?
Patient-Centered Medical Home
The PCMH is a model of primary care
re-design intended to improve the quality
and efficiency of primary care delivery
Patient-Centered Medical Home
• Emphasizes the relationship between
patients and their primary care physicians
• Employs a team-based approach to care
• Integrates evidence-based practices,
clinical decision-support tools, disease
registries, and health information
technology to improve population
management and preventive care
Medical Home “Joint Principles”
1)
2)
3)
4)
5)
6)
7)
Personal Physician
Physician-Directed Practice
Whole-Person Orientation
Care Coordination/Integration
Quality & Safety
Enhanced Access
Payment
Adopted by the American Academy of Family Physicians (AAFP),
American Academy of Pediatrics (AAP), American College of Physicians
(ACP), and American Osteopathic Association (AOA) in Febraury, 2007
Medical Home “Joint Principles”
1) Personal Physician
Each patient has an ongoing
relationship with a personal
physician, who provides
comprehensive, continuous primary
care.
Medical Home “Joint Principles”
2) Physician-Directed Practice
The physician is responsible for
directing a team that takes collective
responsibility for patient care.
Medical Home “Joint Principles”
3) Whole-Person Orientation
The physician is responsible for
providing comprehensive care at all
stages of life and for coordinating care
as necessary with appropriate
specialists.
Medical Home “Joint Principles”
4) Care Coordination/Integration
A patient’s care is coordinated across all
elements of our complex health system
(subspecialty care, hospitals, nursing
homes, etc) through disease registries,
information technology, health information
exchange, and/or other means to ensure
that the patient is getting needed and
desired care in an appropriate manner.
Medical Home “Joint Principles”
5) Quality & Safety
Quality and safety are hallmarks of a
PCMH; evidence-based practices,
clinical decision-support tools, regular
quality improvement efforts, and
information technology all combine to
ensure that patient outcomes attain
the highest level of excellence.
Medical Home “Joint Principles”
6) Enhanced Access
Patients have enhanced access to their
physicians and their practices as a
result of open scheduling, expanded
hours, and/or additional options for
communication between patients,
physicians, and staff.
Medical Home “Joint Principles”
7) Payment
Reimbursement appropriately reflects
the added value patients receive from
being part of a PCMH practice.
Benefits of the PCMH Model
PCMH practices provide care that is:
Higher Quality
– Improves Patient Outcomes
More Efficient
– More Timely and Cost-Effective
Benefits of the PCMH Model
Quality – Patient Outcomes
– Fewer ER visits
– Fewer hospital admissions
– Lower mortality rates
– Better preventive service delivery
– Better chronic disease care
– Higher patient satisfaction
Benefits of the PCMH Model
Efficiency – Cost
– Lower total costs of care
– Shorter patient wait times
– Less staff burnout/turnover
– Higher staff satisfaction/productivity
What is the
Multi-Payer Advanced Primary
Care Practice Demonstration
Project (MAPCP)?
Background
WHO – The World Health Report 2000
– Ranked healthcare performance/quality
of 191 countries
– US was ranked 37th
– Behind nearly all of Western Europe,
Canada, Japan, Australia, and Israel
Source: Anderson. Health Affairs 27, no. 6 (2008): 1718–1727
Primary Care Is The Backbone
• “U.S. states with higher ratios of primary
care physicians to population had better
health outcomes”
• “Areas with higher ratios of primary care
physicians to population had much lower
total health care costs than did other
areas”
Source: Starfield. Milbank Quarterly 83, no. 3 (2005): 457-502
What is the Multi-Payer Demo?
• Centers for Medicare and Medicaid
Services (CMS) is the Federal agency in
charge of Medicare and Medicaid
• CMS funds “demonstration projects” to
test and evaluate new models of health
care delivery across the US
What is the Multi-Payer Demo?
• The purpose of the Multi-Payer
Advanced Primary Care Practice
“demonstration project” (MAPCP) is to
evaluate the effectiveness of the
PCMH model, when supported by both
public and private payers
• NC is one of 8 states that was awarded
an MAPCP demo
What is the Multi-Payer Demo?
• 7 rural counties across NC were chosen to
participate in the demo: Ashe, Avery,
Bladen, Columbus, Granville,
Transylvania, and Watauga
What is the Multi-Payer Demo?
• To participate, practices in these counties
must obtain PCMH recognition from the
National Committee for Quality Assurance
(NCQA) during the first year of the demo
(no later than 9/30/12)
• In return for implementing the PCMH model,
practices will earn incentive payments from
the largest public and private payers in NC:
CMS and BCBS-NC/SHP.
Support for the MAPCP
• Community Care of North Carolina (CCNC)
– Practice Support
– Training Webinars
– Informatics Center Resources
• AHEC & Regional Extension Center (REC)
– EMR adoption and implementation
– Registry Support
– QI Consultants
What are the Benefits
for
Me and My Practice?
Recognition of Added Value
Incentive Payments from Medicare
– CMS will pay a per member per month
fee for each Medicare patient in practices
achieving PCMH recognition through
NCQA:
• Level 1 = $2.50 PMPM ($30 each year)
• Level 2 = $3.00 PMPM ($36 each year)
• Level 3 = $3.50 PMPM ($42 each year)
Recognition of Added Value
Increased Reimbursement from BCBS
– Eligibility for the Blue Quality Physicians
Program (BQPP), a recognition program
for primary care practices that builds on
PCMH recognition from NCQA
– Once you qualify for the BQPP, BCBS will
increase its fee structure by 10% or
more for all of your BCBS/SEHP patients
CMS Incentives – Example
(per physician per year)
PCMH Level
% of patients who have Medicare
30%
40%
50%
1
$22,500
$30,000
$37,500
2
$27,000
$36,000
$45,000
3
$31,500
$42,000
$52,500
(calculated using a panel of 2,500 patients per provider)
BCBS Incentives – Example
(per physician per year)
PCMH Level
% of patients who have BCBS/SEHP
30%
40%
50%
1
$12,000
$16,000
$20,000
2
$18,000
$24,000
$30,000
3
$24,000
$32,000
$40,000
(calculated using an annual revenue of $400K per provider)
Next Steps (Homework)
Put Training Webinars On Your Calendar
– June 8
– June 22
– July 6
– July 20
– August 3
– August 17
– August 31
all from
12PM - 1PM
Next Steps (Homework)
• Build Your PCMH Team:
– Identify a “PCMH Champion” who will help
guide the practice through the quality
transformation process
– Identify a “Communicator-In-Chief” who will
serve as a point person for interactions with
Community Care and other support staff
– Identify a “Lead Administrator” who will track
progress, organize materials, complete the
PMCH application (should have computer skills)
Next Steps (Homework)
• Begin team discussions about where the
manpower will come from. Practice
transformation is valuable for your patients
and your practice, but it takes time.
– Will you:
• Be able to reduce your patient load?
• Have to extend your hours?
• Need to work on the weekends?
• Need to shift duties/responsibilities?
Next Steps (Homework)
Get the EMR ball rolling today…
– Sign up for AHEC’s REC services
(free) by completing an application at
www.ncahecrec.net
Community Care PCMH Team
• David Halpern, MD, MPH
Community Care of North Carolina (CCNC)
• R.W. “Chip” Watkins, MD, MPH, FAAFP
Community Care of North Carolina (CCNC)
• Brent Hazelett, MPA
North Carolina Academy of Family Physicians (NCAFP)
• Elizabeth Walker Kasper, MSPH
North Carolina Healthcare Quality Alliance (NCHQA)
Partners
Questions?
Feel free to contact me:
David Halpern, MD, MPH
(215) 498-4648
[email protected]