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Oklahoma’s Patient Centered Medical Home What is a Patient Centered Medical Home (PCMH)? Partnership between a patient and a provider Team approach for health care coordination Framework Maintaining Partnerships Defining & Qualifying a Medical Home Realigning Reimbursement Supporting Providers 3 Goals Enhance patient choice & participation Promote preventive & primary care Provide care in the appropriate setting Realign incentives to improve quality Develop health information technology Maintaining Partnerships Medical Advisory Task Force Statewide town hall meetings Large group provider training Developing Medical Home Joint Principles of the Patient-Centered Medical Home Medical home assessment tool Targeted education Add’l info on PCMH and tier evaluations can be found on OHCA’s web site at: http://www.okhca.org/providers.aspx?id=8470&menu=74&parts=8482_10165&terms=patient+cent ered+medical+home Realigning Reimbursement Care coordination fee Visit based fee-for-service component Transitional payments for 1st year only The Patient Centered Primary Care Collaborative http://www.patientcenteredprimarycare.org/ Supporting Providers Provider Services SoonerExcel / Provider Profiles Practice Facilitation Web-based Information Add’l info on SoonerExcel can be found on OHCA’s public web site at: http://www.okhca.org/providers.aspx?id=9426&menu=74&parts=8482_10165 Patient Centered Medical Home Timeline Feb 2007 MAT created; research and development of transition plan March 2008 Statewide outreach campaign Sept 2008 PCP contract distributed Jan 2009 PCMH launched Summer 2010 HAN begins 9 Health Access Networks (HAN) Integrated health care delivery system Organized to restructure and improve the access, quality and continuity of care Organized to enhance the capabilities of the network’s affiliated PCPs 10 HAN Components Electronic medical records Access to specialty care Telemedicine Quality improvement Care coordination for complex health needs 11 SoonerCare Choice PCMH Program January 2009 – June 2010 12 SoonerCare Choice PCMH PCP Network: June 2010 244 SoonerCare Choice PCPs have been added to the network 1,531 PCPs are contracted at 779 locations with a total capacity for 1,023,944 members 449,216 members are enrolled statewide Member capacity being utilized is 41.30% 13 SoonerCare Choice PCMH: PCP Tier Summary January 2009 June 2010 Tier 1 = 445 Tier 2 = 223 Tier 3 = 31 Total = 699 Tier 1 = 521 Tier 2 = 213 Tier 3 = 45 Total = 779 Tier count is determined by provider location 14 15 SoonerCare Choice PCMH Member Capacity Number of PCMH Locations by Member Capacity 300 250 240 204 218 200 150 117 100 50 0 Members 50-500 50-500 501-1500 501-1500 1501-2500 1501-2500 2500+ 2501+ 16 SoonerCare Choice PCMH Member Capacity Utilized and Available By Tier 120% 100% Available Utilized 80% 59% 60% 88% 80% 91% 40% 41% 20% 0% 12% Tier 1 20% Tier 2 9% Tier 3 Membership 17 What We’ve Learned • Adequate budget! • Smooth transition • Improved PCP selection • Importance of SoonerExcel 18 Quality Measures • HEDIS measures • CAHPS® Member Satisfaction Surveys (Consumer Assessment of Healthcare Providers Systems) – Adult Survey included 9 months of the medical home transition – Child Survey included 6 months of the medical home transition • CMS 416 Report 19 HEDIS 2010 rates Year 1 Medical Home (based on calendar year 2009 data) HEDIS Measures SoonerCare Choice by Calendar Year 2001 2002 2003 2004 2005 2006 2007 2008 2009 41.6% 46.6% 51.2% 53.6% 56.6% 56.3% 57.2% 59.7% 62.1% Breast Cancer Screening (BCS) N/A N/A 29.8% 29.2% 31.9% 34.1% 35.3% 37.0% 41.3% Cervical Cancer Screening (CCS) N/A N/A 32.6% 34.5% 43.5% 42.3% 43.9% 44.6% 46.7% Child Health Checkups in first 15 months (1 or more visits) (W15) 87.6% 91.4% 92.6% 91.6% 95.2% 96.5% 96.8% 97.3%*** 97.4% Child Health Checkups 3-6 yrs (1 or more visits) (W34) 35.3% 40.1% 47.3% 48.6% 54.7% 56.7% 57.1% 60.0%*** 64.9% N/A N/A 23.7% 23.8% 25.9% 25.9% 28.6% 32.1%*** 40.1% 12-24 months 88.1% 89.5% 90.8% 91.4% 91.6% 94.3% 94.1% 94.4% 96.2% 25 months - 6 yrs 74.1% 77.0% 79.3% 78.2% 78.7% 81.2% 81.4% 83.2% 86.8% 7-11 yrs 76.7% 79.0% 79.2% 77.3% 81.5% 80.4% 80.8% 82.8% 87.6% 12-19 yrs N/A N/A 77.4% 77.0% 81.7% 79.8% 80.1% 81.6% 85.8% 20-44 yrs 68.4% 68.8% 69.8% 71.6% 72.0% 74.9% 75.6% 78.4% 83.3% 45-64 yrs 80.3% 81.5% 81.3% 81.8% 82.8% 84.2% 85.2% 86.8% 89.7% Annual Dental Visit (Combined rate < 21 years) (ADV) Child Health Checkups Child Health Checkups adolescent (1 or more visits) (AWC) Children's Access to PCP (CAP) (at least one PCP visit) Adult Access to Preventive/Amb Health Services (AAP) Significant increase from previous year Significant decrease from previous year Last update: August 31, 2010 20 SFY 2010 CAHPS® Adult Health Survey • Rising satisfaction with health care and customer service • Statistically significant improvement in access to care Members always getting treatment quickly Rate increased from 52.01% to 59.58% 21 SFY 2009 CAHPS® Child Health Survey • High satisfaction steady across six quality measures • Statistically significant improvement in 2 areas Overall rating of child’s health plan: Rating increased from 8.24 to 8.73 Always getting care quickly: Rate increased from 51.89% to 70.28% 22 CMS 416 Report • Effectiveness of the EPSDT program • 80% CMS screening benchmark Child Health Exams EPSDT screening rate FFY 2008 (Oct 07-Sept 08) 73% FFY 2009 (Oct 08- Sept 09) 83% 23 SoonerCare Choice PCMH: Member Inquiries Jan-Dec 2008 Jan-Dec 2009 Jan-June 2010 407,408 438,276 449,216 Access to Care 7,833 1,322 509 Same Day / Next Day Access to Care 1,670 13 4 Members 24 Resources • AAFP PCMH: www.aafp.org/pcmh • Patient-Centered Primary Care Collaborative: www.pcpcc.net • TransforMED: www.transformed.com • For input on OK PCMH Program: [email protected] • Updates in global and banner messages, provider letters, OHCA public website at www.okhca.org/medical-home 25 For More Information . . . Melody Anthony, Provider Services Director Provider Services – 877.823.4529 option 2 405.522.7360 [email protected] Patricia Johnson, QA/QI Director 405.522.7184 [email protected] Rebecca Pasternik-Ikard, Chief Operating Officer 405.522.7208 [email protected] 26