Transcript WEST VIRGINIA MEDICAL HOME INCENTIVE PILOT Presented to: PCPCC Center for Multi-payer Demonstrations April 6, 2010 Christine St.

WEST VIRGINIA MEDICAL HOME
INCENTIVE PILOT
Presented to:
PCPCC Center for Multi-payer Demonstrations
April 6, 2010
Christine St. Andre
Roger Chaufournier
BACKGROUND
 Medicaid
Transformation Grants---conceptual
support for medical home model
 Project management contract through West Virginia
University/ CSI Solutions, LLC to implement the
grants
 Development of West Virginia Health Improvement
Institute as a forum for multiple stakeholders to
collaborate in improving the health status of the
citizens of WV
 Evolved from Medicaid-sponsored to independent
501(c)3 with broad stakeholder board
WEST VIRGINIA HEALTH IMPROVEMENT INSTITUTE
AIM: To improve the health status of all West Virginians through aligned initiatives focusing on
improved access; prevention; promotion of wellness and healthy lifestyle choices; and optimal
evidence based chronic illness management
Stakeholder Advisory Group
Meets Quarterly
Virtual Engagement On-Going
Coordinating Committee
Provider
Education
Self
Management
Pilots
Adoption of
HIT
Measurement/
Reimbursement/
Reporting
Pilots
Innovation Community
300+ Primary Care Providers
Pilots
Evaluation
& Innovation
INSTITUTE DESIGN ELEMENTS
 Broad
participation across professional
organizations, payers, advocacy groups, providers
 Work groups to focus on specific topics of interest
and importance
 Use of pilot projects to test changes/ intervention on
a small scale prior to decisions on full state-wide
implementation
 Creation of an Innovation Community of interested
providers committed to the medical home model
and willing to participate in pilot initiatives
INNOVATION COMMUNITY
 Virtual
community of primary care providers
committed to improving the health of the
population
 Voluntary process
 300+ primary care providers
 Access to opportunities for training and pilot
participation and supported by a virtual office
PILOTS CURRENTLY UNDERWAY
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A pediatric obesity pilot
A pilot on training in the Stanford Self-Management program
A pilot focused on empowering young Medicaid mothers with
health literacy skills so as to better utilize the health care
system
Testing of a provider incentive program for adoption of
technology
Pilot to explore interest and scalability of an open source EMR
A pilot to test the ability of providers to report on a key set of
quality measures
A pilot focused on the chronically sick and disabled using an
expanded care team and pharmacist
A pilot to test sharing a care coordinator among several small
private practices
A Medical Home Performance Incentive pilot using a shared
savings incentive model
MEDICAL HOME PERFORMANCE INCENTIVE PILOTPILOT BASICS
 Developed
by Measurement Work Group to test
effectiveness of the Patient-Centered Medical Home
model in WV and to inform future reimbursement
 Uses NCQA PCMH Recognition criteria
 Outcomes assessment to include:
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Clinical process measures
Clinical outcome measures
Utilization
Cost
Alignment with evolving definition of “Meaningful Use”
PILOT BASICS
 Beginning
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 12
with 6 month readiness phase
Practice assessment
Modified collaborative approach—face to face
learning session for the care team, webcasts, monthly
team calls
Training and coaching on NCQA standards and
practice redesign
Preparation for measures reporting
month assessment phase following the
readiness period
PILOT BASICS
 Payer
participation:
UniCare (managed Medicaid)
 Mountain State BlueCross Blue Shield
 PEIA (state employee plan)
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 Shared
savings incentive model-up to 2.5% of total
claims cost based on comparison of assessment
period to 2009 claims
 No change in ongoing reimbursement
 Twelve month savings pooled across all providers
and patients; distribution to be based on physician
performance on process and outcomes measures
 Payout targeted for Fall, 2011
PARTICIPATING PRACTICES
 Targeted
50 physicians; have 33
 Limited the number of physicians from each
organization
7 FQHC’s
 9 free clinics---all in the state
 One large IPA
 2 academic practices
 2 small private practices
 One rural health clinic
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 All
have an EMR in place, but this was not a
requirement
EXPECTATIONS OF PRACTICES
 Make
a commitment: participation agreement,
business associate agreements
 Apply for NCQA recognition within 9 months
 Care team participation in the face to face
session, webcasts, and monthly calls
 Monthly reporting the aggregate clinical
measures for all patients using the measures
required for CMS EMR incentives
 Provide patient lists for attribution
EXPECTATIONS OF PARTICIPATING PAYERS
 Verify
patient lists for attribution
 Agree to share savings up to 2.5% of total 2009 claims
cost for the participating patients/ members and
contribute this amount to the overall incentive pool
 Agree on a uniform approach to calculation of savings
 Agree on incentive pool distribution methodology
 Provide cost and utilization feedback where possible
based on claims data
 Use results to inform future reimbursement changes
PATIENT ATTRIBUTION
 Practices
use practice management or EMR system to
look back 18 months and identify any patient that has
been seen during that time.
 Exclude any people seen as a result of cross-coverage
and others that were known to be one-time
occurrences
 Provide a list of all patients, with their designated
payer to the WVHII staff
 Lists are aggregated by payer for confirmation of
coverage during the entire 2009 period
HOW DID WE SELL PARTICIPATION TO PRACTICES?
 Financial
upside from the incentive component
 Best practice models they will be exposed to could
help drive internal efficiencies and throughput
 Market value of TA offered (estimated at
approximately $25k per practice)
 Participation will jump start the practice down the
pathway of meaningful use
 This is a showcase demonstration project of
national significance
 Intend to influence the remaining reimbursement
system if we all succeed
ROLE AND SUPPORT FROM WVHII
 Project
management
 Training, technical assistance, and coaching
 Reporting site that will aggregate data and track
individual as well as group performance
 Virtual office and listserv for sharing resources
 Compensation for lost revenue resulting from
attendance at all day learning session
 Payment for NCQA assessment tool and
application
CHALLENGES WE’VE FACED
 Not
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all payers are participating
Medicaid need for plan amendment in order to
compensate differently
Medicare
Several smaller payers in the state
 Providers
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take the full risk
Difficulty in recruitment
 Measurement
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strategy not yet final
Meaningful use and CMS incentives must be
considered to avoid re-work and duplication
CURRENT STATUS
 In
readiness phase with face to face learning
session held in February
 Practices completing practice assessments
 Compiling patient lists for attribution
 Expect 12 month assessment phase to begin
July 1
 Payers meeting next month to establish savings
calculation
 Now that we have started, more people want to
get involved!
CONTACT INFORMATION
 www.wvhealthimprovement.org
 Christine
St. André
[email protected]
 Roger
Chaufournier
 [email protected]