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Learning the ABCs of APCs and Medical Homes
Lisa M. Letourneau MD, MPH
Quality Counts
NASHP - October 5, 2010
Objectives
• Review basic elements, goals for Maine
PCMH Pilot
• Highlight unique features of Maine Pilot
• Share lessons learned to date
• Look forward to upcoming opportunities
(ACA)
Maine PCMH Pilot
Key elements:
– 3-year multi-payer PCMH pilot
– Collaborative effort of key stakeholders, major payers
– Adopted common mission & vision, guiding principles for
Maine PCMH model
– Selected 22 adult / 4 pedi PCP practices across state
– Supporting practice transformation & shared learnings
beyond pilot practices
– Committed to engaging consumers/ patients at all levels
– Conducting rigorous outcomes evaluation (clinical, cost,
patient experience of care)
Maine PCMH Pilot - Timeline
• Jan 2009: Call for practice applications
• May 2009: Practices notified – start of 6mo
“ramp-up period”
• Sept 2009: NCQA PPC-PCMH applications
completed
• Sept-Dec: practices contracted with payers
• Jan 2010: Start date for PCMH payments
• Jan 2010- Dec 2012: 3-year PCMH Pilot
Maine PCMH Strengths & Challenges
• Public-private partnership - 3 conveners
• Consumer / patient engagement
• Expectations & support for practice
transformation
• Ongoing data feedback for improvement
• Ensuring sufficient payment vs.
demonstrating accountability for costs
Maine PCMH Pilot Leadership
Maine
Quality
Forum
Quality
Counts
Maine Health
Management
Coalition
Keeping Patients at Center of Maine
PCMH Pilot
• Patients/consumers included in Maine Pilot
planning, governance
• Patient/consumer focus groups held as part of
Pilot planning
• Patient-oriented informational, educational tools
• Pilot practices required to include patients in
redesign efforts
• Patient experience (CG-CAHPS) part of Pilot
evaluation
• Efforts linked w/ AF4Q consumer engagement
Maine PCMH Pilot
Practice “Core Expectations”
1. Demonstrated physician leadership
2. Team-based approach
3. Population risk-stratification and management
4. Practice-integrated care management
5. Same-day access
6. Behavioral-physical health integration
7. Inclusion of patients & families
8. Connection to community / local HMP
9. Commitment to waste reduction
10.Patient-centered HIT
Support for Practice Transformation
• PCMH Learning Collaborative
– IHI “BTS” model; 3 Learning Sessions/yr
• Practice QI Coaches
– Most from existing PHOs, med groups
– Using microsystems approach to QI
• Technical assistance “experts”
– BH integration, work with consumers, HIT
• Ongoing feedback reports
– Clinical, claims data
PCMH Evaluation &
Data for Improvement
• Patient experience of care
– CG-CAHPS patient surveys
• Clinical quality measures
– Adult & pedi
• Cost & resource use (HealthDialog rpts)
– Hosp’s, readmissions, ED use, imaging
• Practice changes
Data Feedback: Clinical Quality
• Practices commit to reporting clinical
quality measures quarterly
• Use 31 clinical quality measures (adult),
aligned with meaningful use measures
• Started with 2008 (baseline), then Q1
2010 onward
• Practices use online data reporting
system (developed for Pilot), receive
comparative feedback reports
Clinical Data Feedback
X
Clinical Data Feedback
Data Feedback:
Cost & Resource Use
• Use claims from Maine All-Claims Paid
Database, via MHDO
• MQF contracts with Health Dialog to
produce reports
• First reports delivered to practices midAugust, using 2008 claims data
• Anticipate ongoing, q6mos reports
Provider Performance Measurement Reports
August 2010
Performance Summary
Performance summary
includes:
• Demographics about
practice’s panel
• Overall practice
performance compared to
peers in 3 areas of
unwarranted variation
• Evaluation of overall
effectiveness and efficiency
• Practice’s score on 6 key
utilization measures
• Best opportunities for
improvement in the practice
Best Opportunities for Improvement
• Shows where practice is significantly different from peers AND
where the total impact of improving is highest
Lessons Learned
Maine PCMH Pilot
• Change starts with effective leadership
– Primary selection criteria for Pilot
– Don’t assume physician leadership skills - need
ongoing support
• Change happens through effective teams
• NCQA PPC-PCMH  “medical home”
• It’s all about relationships – with patients AND
within teams
• Recognize value of “outside” coaching
Potential Opportunities
• CMS Multi-Payer Advanced Primary
Care Practice (MAPCP) demonstration
• Affordable Care Act
– Section 2702: Health Homes (Medicaid)
– Section 3502: Community Health Teams
(Medicaid Health Homes)
– Section 4108: Incentives for Chronic
Disease Prevention
Medicare Med Home Demo
• Maine application submitted, proposed new…
• $7 pmpm to providers,
• $3 pmpm for community-based care management
• To meet expectations for budget-neutrality (i.e.
must project $10 pmpm savings), Maine proposed…
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6-7% decreases in inpatient admissions (CVD & Resp)
5% decrease in ED visits
5% decrease in specialty consultations
5% decrease in imaging use
Maine PCMH Pilot - Issues TBD
• Will new payment be enough to support
true practice transformation?
• How best to engage specialists, hospitals in
shared goals, producing cost savings?
• How to engage patients in new partnership?
• How to spread learnings to other “non-Pilot”
practices
• And more??
www.mainequalitycounts.org
Contact Info / Questions
 Lisa Letourneau MD, MPH
• [email protected]
• 207.415.4043
Sue Butts Dion
• [email protected]
Maine PCMH Pilot
• www.mainequalitycounts.org
(See “Major Programs”  “PCMH Pilot”)