Maine PCMH Pilot Phase 2 Expansion Introduction

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Objectives

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Welcome!

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Brief overview Maine PCMH Pilot

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Review benefits and expectations for Phase 2 practices

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Preparing to join Pilot – next steps

Why We’re Here

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Maine’s Medical Home Movement

~ 540 Maine Primary Care Practices 100+ Nat’l Committee for Quality Assurance (NCQA) PCMH Recognized Practices ~130+ MaineCare Health Home eligible Practices 26 Maine PCMH Pilot Practices 50 Pilot Phase 2 Practices 14 FQHCs CMS Advanced Primary Care (APC) Demo

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Maine PCMH Pilot Leadership

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Maine Quality Counts Maine Quality Forum

Maine Health Management Coalition MaineCare

Maine PCMH Pilot

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Key elements:

 Convened by Maine Quality Forum, Maine Quality Counts, Maine Health Management Coalition  Originally, 3-year multi-payer PCMH pilot (now 5 yrs)  Collaborative effort of key stakeholders, major payers  Use common mission & vision, guiding principles for Maine PCMH model  Phase 1 includes 22 adult/ 4 pediatric PCP practices across state  Practices receive support for practice transformation & shared learning  Pilot committed to engaging consumers/ patients at all levels  USM Muskie team conducting rigorous outcomes evaluation (clinical, cost, patient experience of care)

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Phase 1 Practices

Maine PCMH Pilot Practice “Core Expectations”

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Demonstrated physician leadership Team-based approach Population risk-stratification and management Practice-integrated care management Same-day access Behavioral-physical health integration Inclusion of patients & families 8.

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Connection to community / local community resources Commitment to waste reduction 10.

Patient-centered HIT

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Maine PCMH Pilot – Payment Model

9 Major private payers participating + Medicaid + Medicare (MAPCP demo) 3-component PCMH payment:    NEW prospective (pmpm) PCMH care management payments – approx $3pmpm commercial payers & Medicaid; $7pmpm Medicare Ongoing FFS payments Ongoing health plan performance payments for meeting quality targets (i.e. existing P4P programs)

But What Does it All Mean - to Patients?

• • • • • • • 10 Vision for Change – Phase I Teams (June 09) “ They were here for me” “Everybody here feels like family” “They really help us get through the system” “I feel well cared for in my practice” “They know what I need and when I need it” “I don’t feel so alone or anxious anymore” “Wow – all my needs were met!”

CMS MAPCP Demo

11  Medicare (CMS) Multi-Payer Advanced Practice (MAPCP) “medical Home” Pilot  Medicare joined Pilot a payer  Allowed introduction of Community Care Teams  Stronger focus on reducing waste & avoidable costs – particularly readmissions  Ability to access Medicare data for reporting, identifying pts at risk  Opportunity for 50 additional practices to join “Phase 2” of Pilot (Jan 2013)

Maine PCMH Pilot - MAPCP Timeline

Jan 1, 2010 2011 2012 ME PCMH Pilot - Original Jan 1, 2012 2013 Dec 31, 2014 MAPCP Demo – 3yr ME PCMH Pilot - Extended 12

Pilot Expansion

Dec 31, 2014

Multi-Payer Pilot Phase 2 Expansion

13 • 107 practices applied; 84 qualified for multi payer Pilot • – – – – Expectations: Strong leadership for change NCQA PCMH recognition (Level 1 or higher) complete status survey by July 18th Fully implemented Electronic Medical Record (EMR) Commitment to implement Pilot Core Expectations • 50 new adult practices selected for participation in multi-payer Pilot, highly competitive process!

Maine PCMH Pilot – Existing + 50 Expansion Practice Sites

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Community Care Teams

 15 Multi-disciplinary, community-based, practice integrated care teams  Build on successful models (NC, VT, NJ)  Support patients & practices in Pilot sites, helping patients overcome barriers to care, improve outcomes  Receive pmpm payments from Medicaid, Medicare, commercial payers  Key element of cost-reduction strategy, targeting high cost patients to reduce avoidable costs (avoidable ED use, admissions )

Maine PCMH Pilot Community Care Teams

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Workplace Food Systems Shopping Environment Schools Housing Transportation Care Mgt Outpatient Services Family High-need Individual PCMH Practice Med Mgt Coaching Specialists Behav. Health & Sub Abuse Hospital Services Income Heat Faith Community Physical Therapy

Literacy

Eligibility Maine PCMH Pilot Expansion

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Practice meets MaineCare Health Home requirements  Adult primary care practice site with at least one full-time primary care physician or nurse practitioner  Practice site does not currently participate in the CMS FQHC Advanced Primary Care (APC) Demonstration  Minimum patient panel of 1000+ patients enrolled in Pilot health plans (Anthem BCBS, Aetna, Harvard Pilgrim Health Care, MaineCare, and Medicare).

 Completion of Maine PCMH Pilot Phase 2 Expansion “Memorandum of Agreement” (MOA)  Agreement to contribute modest PMPM toward practice transformation support

What It Means for New Practices

18  Practices joining multi-payer PCMH Pilot in January 2013 will receive…  New PCMH payments from participating payers  Medicare, Medicaid (HH), Aetna, Anthem, HPHC  Community Care Team support for highest needs pts  Practice transformation support (fee required)  Expectations  Commitment to implement Pilot Core Expectations, demonstrate improvements in quality & cost savings  Contribute practice transformation support fee

Pilot Participation Requirements

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Baseline on-site practice assessment

 Expectation outlined in original MOA  Intended to identify practice PCMH strengths & opportunities for improvement  Pilot supports 50% costs; practices required to support remaining 50% (est’d ~ $500)  Scheduled as 2 d visit in practice (Sept – Dec)  Aiming for reports back to all practices before Jan 2013

Pilot Participation Requirements

20  Leadership team to attend Learning Sessions  3 sessions/year (Feb – June – Oct) – dates TBD!

 Will be held in 1 central location (alternate Augusta/Bangor/other?)  At least 3 team members must attend (up to 5 team members may attend)  Participate in monthly leadership webinars  Work collaboratively with QI Coach  Submit bi-monthly Core Expectation Status Rpts  Submit quarterly Clinical Outcomes Data Rpts

Pilot Participation Requirements

21  Practice Transformation Support fees  CMS requirement to provide same level of practice transformation support as Phase 1  Supports  Central project management  QI coaching  PCMH Learning Collaborative & Learning Sessions  Webinars, web-based tools  Est’d to be $0.25pmpm ($3pmpy), based on panel sizes reported in practice application

Maine PCMH Pilot – Revenue Projection Possible "Actual" Scenario (Using Median Panel size = 3500 patients) $10 500

Practice Net Revenue* Practice Transformation Support Fee ($0.25 pmpm= $3pmpy)

$173 670

*Example based on 3,500 panel composition: • 25% Commercial Payer (~$3pmpm) • 20% MaineCare ($3.50pmpm + $3.50 pmpm PCCM fee) • 25% Medicare ($6.95 pmpm) 22

Lessons from 1

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PCMH Demo

23  Becoming a PCMH requires transformation (not incremental change)  Technology needed for PCMH is not “plug & play”  Transformation to PCMH requires personal transformation (esp. physicians!)  Change fatigue is serious concern  Transformation to PCMH is developmental process, & local process  The medical home is not something that can be “installed”

Lessons Learned from Maine PCMH Pilot

24  Change starts with effective leadership – clinician, administrative, and organizational  Recognize risks of “change overload” – need to focus, prioritize, sequence change efforts  Recognize that successful change happens only through effective teams (make changes with people, not to people)  Recognize value of external & internal QI coaching

Change is Hard

25 • Hard to change your shorts while running! (and hard to practice while practicing) • PCMH requires practice and personal change • People fear change (loss) - any change

Sustaining Change is Even Harder!

26 • PCMH requires transformation, not incremental change • Making many changes is harder than single change • Sustaining change can be exhausting • Marathon, not a sprint!

Next Steps

27  Participate in practice on-site assessment (Sept Dec)  Attend monthly “ramp-up” team calls/webinars (2 nd Thurs each month, 7:30A & 4:30P)  Plan for leadership team to attend Expansion Launch – November 16, 2012  Augusta Civic Center  Hold your own team meetings (ideally, weekly!), spread communications about Pilot across team

Summing Up: Medical Home Is Where…

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Patients feel welcomed

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Staff takes pleasure in working

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Physicians feel energized every day

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www.mainequalitycounts.org

Contact Info / Questions

30  Maine PCMH Pilot: www.mainequalitycounts.org

(See “Major Programs”  “PCMH Pilot”) • • PCMH • Nancy Grenier, RN: [email protected]

, tel 240.8767

• • Kaleigh Sloan, MPH: [email protected]

, tel 622.3374 X 220 Lisa Letourneau MD, MPH: [email protected]

CCTs: Helena Peterson : [email protected]

, tel. 266-7211  MaineCare Health Homes  Michelle Probert: [email protected]

, tel. 287-2641