Transcript Patient Centered Primary Care Collaborative

Patient Centered Primary Care
Collaborative
Edwina Rogers
Executive Director
Patient-Centered Primary Care Collaborative
601 Thirteenth St., NW, Suite 400 North
Washington, D.C. 20005
Direct: 202.724.3331
Mobile: 202.674-7800
[email protected]
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Overview of Activity
•22 Multi-stakeholder
Pilots in 16 States
•8 State Medicare
Pilots Planned for 2009
•44 States and the
District of Columbia
Have Passed over 330
Laws and/or Have
PCMH Activity
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Blue Cross Blue Shield Plan Pilots
(as of January 2009)
Pilots in progress
Pilots in planning phase
for 2009 implementation
Pilot activity in early stages
of development
Multi-Stakeholder demonstration
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Overview of the PCPCC
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Now in our 3rd year
Over 500 signing members
Advancing the Patient Centered Medical Home
(PCMH) concept in the public and private sectors
Hosting Meetings, Summits and Congressional
Briefings
Weekly Call Thursday at 11:00 AM EST
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Call-in Number: 712.432.3900
Passcode: 471334#
Weekly “Center” calls established to
operationalize work of PCPCC
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Collaborative Principles
The Patient Centered Primary Care Collaborative is a coalition of major
employers, consumer groups, patient quality organizations, health plans, labor
unions, hospitals, clinicians and many others who have joined together to
develop and advance the patient centered medical home. The Collaborative
believes that, if implemented, the patient centered medical home will improve
the health of patients and the viability of the health care delivery system. In
order to accomplish our goal, employers, consumers, patients, clinicians and
payers have agreed that it is essential to support a better model of
compensating clinicians.
Compensation under the Patient-Centered Medical Home model would
incorporate enhanced access and communication, improve coordination of care,
rewards for higher value, expand administrative and quality innovations and
promote active patient and family involvement. The Patient-Centered Medical
Home model will also engage patients and their families in positive ongoing
relationships with their clinicians. Further, the Patient-Centered Medical Home
will improve the quality of care delivered and help control the unsustainable
rising costs of healthcare for both individuals and plan-sponsors.
If you agree, please visit us at www.pcpcc.net and join today!
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The Patient-Centered Primary Care
Collaborative
Examples of Broad Stakeholder Support & Participation
Providers
333,000 primary care
 ACP
 AAFP
 AAP
 AOA
 ABIM
 ACC
 ACOI
 AHI
 Pfizer
The
Patient-Centered
Medical Home
 Microsoft
 Business Coalitions
 Merck & Co.
80 Million lives
Patients
 United
 Aetna
 Humana
 CIGNA
 HCSC
 WellPoint
Most of the Fortune 500
 IBM
 General Motors
 FedEx  General Electric
Payers
 BCBSA
Purchasers –
 NCQA
 AFL-CIO
 National Partnership
for Women and Families
 Foundation for Informed
Decision Making
 SEIU
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Patient Centered Primary Care Collaborative
Four ‘Centers’
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Center for Multi-Stakeholder Demonstration: Identify
community-based pilot sites in order to test and evaluate
the concept; offer hands-on technical assistance, share
best practices, and identify funding sources to advance
adoption.
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Center to Promote Public Payer Implementation:
Assist state Medicaid agencies and other public payers as
they implement and refine programs to embed the Patient
Centered Medical Home model by offering technical
assistance; sharing best practices and giving guidance on
the development of successful funding models.
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Center for Health Benefit Redesign and
Implementation: Create standards and buying criteria
to serve as a guide and tool for large and small
employers/purchasers in order to build the market
demand for adoption of the Medical Home model.
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Center for eHealth Information Adoption and
Exchange: Evaluate use and application of information
technology to support and enable the development and
broad adoption of information technology in private
practice and among community practitioners.
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JOINT PRINCIPLES OF THE
PCMH (FEBRUARY 2007)
The following principles were written and agreed upon by
the four Primary Care Physician Organizations – the
American Academy of Family Physicians, the American
Academy of Pediatrics, the American College of Physicians,
and the American Osteopathic Association.
Principles:
Ongoing relationship with personal physician
Physician directed medical practice
Whole person orientation
Coordinated care across the health system
Quality and safety
Enhanced access to care
Payment recognizes the value added
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ENDORSEMENTS
The PCMH Joint Principles have received endorsements from 13 specialty health
care organizations:
The 13 organizations endorsing the Joint Principles are:
•The American Academy of Chest Physicians
•The American Academy of Hospice and Palliative Medicine
•The American Academy of Neurology
•The American College of Cardiology
•The American College of Osteopathic Family Physicians
•The American College of Osteopathic Internists
•The American Geriatrics Society
•The American Medical Directors Association
•The American Society of Addiction Medicine
•The American Society of Clinical Oncology
•The Society for Adolescent Medicine
•The Society of Critical Care Medicine
•The Society of General Internal Medicine
The PCMH Joint Principles have recently also received an endorsement from the
American Medical Association.
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Defining the Medical Home
Superb
Access to
Care
Patient
Engagement
•Patients can easily make appointments and
select the day and time.
•Waiting times are short.
•eMail and telephone consultations are
offered.
•Off-hour service is available.
•Patients have the option of being informed
and engaged partners in their care.
•Practices provide information on treatment
plans, preventative and follow-up care
reminders, access to medical records,
assistance with self-care, and counseling.
Care
Coordination
Team Care
in Care
Clinical
Information
Systems
•These systems support high-quality care,
practice-based learning, and quality
improvement.
•Practices maintain patient registries;
monitor adherence to treatment; have easy
access to lab and test results; and receive
reminders, decision support, and
information on recommended treatments.
Patient
Feedback
Publically
available
information
Source: Health2 Resources 9.30.08
•Specialist care is coordinated,
and systems are in place to
prevent errors that occur when
multiple physicians are involved.
•Follow-up and support is
provided.
•Integrated and coordinated team
care depends on a free flow of
communication among physicians,
nurses, case managers and other
health professionals.
•Duplication of tests and procedures
is avoided.
•Patients routinely provide feedback
to doctors; practices take advantage
of low-cost, internet-based patient
surveys to learn from patients and
inform treatment plans.
•Patients have accurate,
standardized information on
physicians to help them choose a
practice that will meet their
needs.
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PCPCC Payment Model
(May 2007)
The Patient-Centered Primary Care Collaborative
recommends a three-part payment methodology,
Including:
A)
A monthly care coordination payment for the physician’s work
that falls outside of a face-to face visit and for the health
information technologies needed to achieve better outcomes,
B)
A visit-based fee-for-service component that is recognized for
services that are currently paid under the present fee-forservice payment system, and
C)
A performance-based component that recognizes achievement
of service, patient centeredness, quality and efficiency goals.
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EVIDENCE OF COST SAVINGS
& QUALITY IMPROVEMENT
•Barbara
Starfield of Johns Hopkins University
Within the United States, adults with a primary care physician rather than a specialist had 33
percent lower costs of care and were 19 percent less likely to die.
In both England and the United States, each additional primary care physician per 10,000
persons is associated with a decrease in mortality rate of 3 to 10 percent.
• In the United States, an increase of just one primary care physician is associated with 1.44
fewer deaths per 10,000 persons.
A medical home can reduce or even eliminate racial and ethnic disparities in access and
quality for insured persons.
•Commonwealth Fund has reported:
Denmark has organized its entire health care system around patient-centered medical
homes, achieving the highest patient satisfaction ratings in the world. Denmark has
among the lowest per capita health expenditures and highest primary care rankings.
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•Center
for Evaluative Clinical Sciences at Dartmouth, states in the US relying more on primary care
have:
lower Medicare spending,
lower resource inputs,
lower utilization,
and better quality of care.
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EVIDENCE OF COST SAVINGS
& QUALITY IMPROVEMENT
Chronic Care for Diabetes – BCBS of ND Reported
•6% decrease in hospital admissions
•24 % decrease emergency room
•$500, Per member per years savings
The state of North Carolina reported savings of $244 million for FY04 for
their 720,000 Medicaid recipient program.
Horizon BCBS of NJ reported that the cost per patient, complying with
diabetes testing in engaged medical homes, was substantially less than
those in non-engaged medical homes.
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Simple Cost Avoidance
NC Savings (FY04)
Category of Service
Inpatient
Estimated Savings from Benchmark
$142,085,680
Outpatient
$51,865,028
Emergency Room
$25,944,553
Primary Care, Specialist
$45,498,709
Pharmacy
$(15,526,996)
Other
$(5,065,238)
Totals
$244,801,735
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North Carolina Pilot Project Details
AccessCare Network Sites
AccessCare Network Counties
Access II Care of Western NC
Access III of Lower Cape Fear
Carolina Collaborative Comm. Care
Carolina Community Health Partnership
Northwest Community Care Network
Comm. Care Partners of Gtr. Mecklenburg
Community Care Plan of Eastern NC
Community Health Partners
Northern Piedmont Community Care
Partnership for Health Management
Sandhills Community Care Network
Southern Piedmont Community Care Plan
Community Care of Wake and Johnston Counties
Central Care Health Network
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NCQA PPC-PCMH Content and Scoring
Standard 1: Access and Communication
A. Has written standards for patient access and
patient communication**
B. Uses data to show it meets its standards for
patient access and communication**
Pts
Standard 2: Patient Tracking and Registry Functions
A. Uses data system for basic patient information
(mostly non-clinical data)
B. Has clinical data system with clinical data in
searchable data fields
C. Uses the clinical data system
D. Uses paper or electronic-based charting tools
to organize clinical information**
E. Uses data to identify important diagnoses and
conditions in practice**
F. Generates lists of patients and reminds patients and
clinicians of services needed (population management)
Pts
Standard 3: Care Management
A. Adopts and implements evidence-based
guidelines for three conditions **
B. Generates reminders about preventive services for
clinicians
C. Uses non-physician staff to manage patient care
D. Conducts care management, including care plans,
assessing progress, addressing barriers
E. Coordinates care//follow-up for patients who
receive care in inpatient and outpatient facilities
Pts
Standard 4: Patient Self-Management Support
A. Assesses language preference and other
communication barriers
B. Actively supports patient self-management**
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Pts
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Standard 5: Electronic Prescribing
A. Uses electronic system to write prescriptions
B. Has electronic prescription writer with safety checks
C. Has electronic prescription writer with cost checks
Pts
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Standard 6: Test Tracking
A. Tracks tests and identifies abnormal results
systematically**
B. Uses electronic systems to order and retrieve tests and
flag duplicate tests
Pts
Standard 7: Referral Tracking
A. Tracks referrals using paper-based or electronic
system**
Standard 8: Performance Reporting and
Improvement
A. Measures clinical and/or service performance
by physician or across the practice**
B. Survey of patients’ care experience
C. Reports performance across the practice or by
physician **
D. Sets goals and takes action to improve
performance
E. Produces reports using standardized measures
F. Transmits reports with standardized measures
electronically to external entities
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Pts
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Standard 9: Advanced Electronic Communications
A. Availability of Interactive Website
B. Electronic Patient Identification
C. Electronic Care Management Support
**Must Pass Elements
Pts
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NCQA PPC-PCMH Scoring
Level of Qualifying
Points
Must Pass Elements
at 50% Performance Level
Level 3
75-100
10 of 10
Level 2
50-74
10 of 10
Level 1
25-49
5 of 10
Not recognized
0-24
<5
Levels: If there is a difference in Level achieved between the
number of points and “Must Pass”, the practice will be awarded the
lesser level; for example, if a practice has 65 points but
passes only 7 “Must Pass” Elements, the practice will achieve at
Level 1.
Practices with a numeric score of 0 to 24 points or less than 5
“Must Pass” Elements are not Recognized.
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How NCQA PPC-PCMH Recognition
Works
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Physician/practice
• Self-assess, collect data using Web-based software
• Submit documentation to NCQA when ready
• May be asked to submit more data if needed
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NCQA
• Evaluates and scores all applications
• Checks licensure of physician
• Audits a sample of applications
• Posts Recognized physicians on web
• Distributes list of Recognized physicians monthly to health plans
and others
• Physicians sent media kit, press releases, letter & certificate
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Meaningful Use: Meaningful Connections
Why this report- Why now?
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Unprecedented urgency to
change our health care
“system.”
American Recovery and
Reinvestment Act – over $19B
for health IT infrastructure.
Natural synergy between
PCMH and health IT.
Offer needed guidance to the
industry.
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What is included in the Resource Guide?
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Defines health IT capabilities
essential to PCMH.
Crosswalks capabilities with
functional priorities supporting
PCMH.
Explores how
patients/consumers are currently
using health IT to connect.
Representative sample of 19
case example responses from
primary care providers.
Appendices include
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Guidelines for PCMH Demonstration
Projects
Consumer Principles
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Consumer Toolkit
“Boots-on-the-Ground”
Case Examples – Over 100
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Primary care providers in private practice – we asked them:
 What kind of health IT systems do you use?
 In what way does health IT and exchange support your practice
or organization?
 How do you use health IT to improve patient engagement?
 What have your results been in terms of improved care
processes, clinical outcomes, or increased patient satisfaction as
a result of health IT?
 What objective evidence do you have that using health IT has
achieved positive impacts?
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Patient Centered Primary Care Collaborative
“Purchaser Guide” Released July, 2008
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Developed by the PCPCC Center for
Benefit Redesign and Implementation
in partnership with NBCH and the
Center’s multi-stakeholder advisory
panel.
Guide offers employers and buyers
actionable steps as they work with
health plans in local markets - over
6000 copies downloaded and/or
distributed.
Includes contract language, RFP
language and overview of national
pilots.
Includes steps employers can take to
involve themselves now in local
market efforts.
The PCPCC is holding a series of
Webinars, sponsored by Pfizer, on the
Purchaser Guide.
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Patient Centered Primary Care Collaborative
“Building Evidence and Momentum – Compendium of PCMH Pilots” Released
October 2008
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Developed by the PCPCC Center for
Multi-stakeholder Demonstration
through a grant from AAFP offering a
state-by-state sample of key pilot
initiatives.
Offers key contacts, project status,
participating practices and market
scan of covered lives; physicians.
Inventory of : recognition program
used, practice support (technology),
project evaluation, and key resources.
Begins to establish framework for
program evaluation/ market tracking.
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Guidelines for Patient Centered Medical
Home (PCMH) Demonstration Projects
There has been significant interest and activity in the development of demonstration
projects regarding the Patient Centered Medical Home (PCMH) care model over the past
several years. These public, private or public/private projects combine the efforts of
payers, providers and other health care stakeholders to test elements of the PCMH care
model. A set of guidelines to help ensure that demonstration projects purporting to test
the PCMH model are broadly consistent with the joint principles was developed by the
American Academy of Pediatrics, the American Academy of Family Physicians, the
American College of Physicians and the American Osteopathic Association. In addition, the
standardization promoted by the acceptance of these guidelines will help facilitate more
meaningful interpretation and understanding of the “lessons learned” from the results of
the different PCMH demonstration projects.
Recommendations
A.
Collaboration and Leadership
B.
Practice Recognition
B.
Practice Support
C.
Reimbursement Model
D.
Assessment and Reporting of Results
A full description of the Guidelines can be found on the Patient Centered Primary Care
Collaborative website.
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TODAY’S CARE
MEDICAL HOME CARE
My patients are those who make
appointments to see me
Our patients are those who are
registered in our medical home
Patients’ chief complaints or reasons
for visit determines care
We systematically assess all our
patients’ health needs to plan care
Care is determined by today’s
problem and time available today
Care is determined by a proactive plan
to meet patient needs without visits
Care varies by scheduled time and
memory or skill of the doctor
Care is standardized according to
evidence-based guidelines
Patients are responsible for
coordinating their own care
A prepared team of professionals
coordinates all patients’ care
I know I deliver high quality care
because I’m well trained
We measure our quality and make
rapid changes to improve it
Acute care is delivered in the next
available appointment and walk-ins
Acute care is delivered by open access
and non-visit contacts
It’s up to the patient to tell us what
happened to them
We track tests & consultations, and
follow-up after ED & hospital
Clinic operations center on meeting
the doctor’s needs
A multidisciplinary team works at the
top of our licenses to serve patients 26
Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
Information Flow- Consumer Materials
What consumers
can expect- PCMH
consumer principles
(brochure)
Four minute video for
waiting room viewing;
deep-dive on PCMH
(Flash)
Promotes Primary
Care (brochure)
Deep-dive
focus on PCMH
(brochure)
Guidance to create
your own practice
brochure in support
of PCMH model
(paper)
Inclusion of the Medical Home Concept
in Health Reform Efforts
Employer
Trade
Associations
Executive
Branch
The
Patient-Centered
Medical Home
Plans developed by
Congressional
Representatives
Think
Tanks
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Baucus- Health Care Reform Proposal
(November 2008)
 Expanding Medicare’s role in testing the medical
home model — in which practitioners are paid
explicitly for comprehensive care management
services…
 Medical home expansions in Medicare should
focus only on providers who are committed to
ensuring that patients truly receive the primary
care and care management services...
 Providers seeking to participate in a Medicare
medical home… should meet a set of stringent
service and capacity criteria in order to qualify…
and be willing to have additional payments
based in part on the quality of care they deliver.
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Other Legislative Initiatives
•Senator Durbin (D-IL) and Senator Burr (R-NC) are working together on
Patient Centered Medical Home Legislation
•The Healthy Americans Act, sponsored by Senator Rob Wyden (D-Oregon)
and Senator Bob Bennett (R-Utah) is the first bipartisan health reform
proposal in more than a decade to guarantee affordable, healthcare quality
for all and includes PCMH.
•Senator Baucus’ White Paper and April 2009 Report are very favorable for
Medical Homes.
•Economic Stimulus Package includes funding for Health IT infrastructure
and primary care workforce shortages.
•North Carolina received a 646 waiver to take the Patient Centered Medical
Home program to all of Medicare, with estimated savings by the CBO of
$1.4 billion.
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2009 UPCOMING
COLLABORATIVE EVENTS
Thursday, July 16, 2009 - Washington D.C., Stakeholder
Meeting - Ronald Reagan Building and International Trade
Center, 1300 Pennsylvania Avenue, NW Washington D.C.
20004
Thursday October 22, 2009 - Washington D.C., Annual
Summit, Washington Convention Center
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www.pcpcc.net
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About the PCPCC
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History
Members
Brochure
Executive Committee
Advisory Board
Officers
Executive Bios
The Patient Centered Medical
Home
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Joint Principles
Endorsements by Specialists
Employer Perspectives
Evidence of Quality
Health Reform Proposal
Reimbursement Model
Collaborative Centers
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Other PCMH Resources
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Center to Promote Public Payer
Implementation
Center for Multi-Stakeholder
Demonstration
Center for Benefits Redesign and
Implementation
Center for eHealth Information
Exchange and Adoption
Pilot Project Guide
Purchasers Guide
Evidence Documents
Consumer Materials
Events
National Weekly Call
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Thursday, 11:00AM EST
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CONTACT INFORMATION
Visit our website – http://www.pcpcc.net
To request any additional information on the PCMH or the Patient
Centered Primary Care Collaborative please contact:
Edwina Rogers
Patient Centered Primary Care Collaborative
Executive Director
202.724.3331
202.674.7800 (cell)
[email protected],
601 Thirteenth St., NW, Suite 400 North
Washington, DC 20005
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