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NH MultiStakeholder Medical Home Pilot


Center for Medical Home Improvement. Behavioral Health Association. Hospital Association ... pediatric medical homes by the Center for Medical Home Improvement ... – PowerPoint PPT presentation

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Title: NH MultiStakeholder Medical Home Pilot

NH Multi-Stakeholder Medical Home Pilot
February, 2009
NH Multi-Stakeholder Pilot Origins
  • Dialogue began within the Reimbursement Work
    Group, which was tasked with addressing
    reformation of the reimbursement system to
  • Improve the quality of care
  • Mitigate the increasing trend in cost of care
  • Align reimbursement to obtain the kind of care we
  • Act in consideration of workforce challenges that
    are exacerbated by the current system.

Reimbursement Composition
  • Reimbursement work group is comprised of
    leadership from
  • NH Medical Society and AMA Delegation
  • Commercial Carriers (Anthem Wellpoint, CIGNA and
    Harvard Pilgrim)
  • State Insurance Department and NH Medicaid
  • CMS
  • Center for Medical Home Improvement
  • Behavioral Health Association
  • Hospital Association
  • Primary Care and Independent Multi-Specialty
  • NH QIO

NH Multi-Stakeholder Pilot Origins
  • In order to achieve its goals, the Reimbursement
    Work Group felt that it must first define the
    right care
  • Clinical and carrier leadership put forth the
    concept of Medical Homes as the right way to
    deliver care
  • Rich history of implementation and success with
    pediatric medical homes by the Center for Medical
    Home Improvement
  • Timely publications from the Commonwealth Fund on
    medical homes (Beal, et al, June 2007) and
    reimbursement (Miller, September 2007)
  • Alignment with work effort by the Quality Team in

Medical Home Project Team
  • The NH Multi-Stakeholder Medical Home Project was
    initiated in January of 2008 as a joint effort of
    all NH Payers and representatives of the clinical
  • The pilot will commence on 01/01/2009, payment
    will begin 06/01/2009 and will run until
  • It is our desire and intent to offer uniformity
    in patient attribution, reimbursement, technical
    support and outcomes measurement to deliver the
    greatest effectiveness possible in program

Why Medical Homes?
  • It is about the transformation of primary care
  • Putting the patient not just at the fore, but at
    the center
  • Enforces, and requires, a team approach to care
    delivery, both within and across practices and
    sites of care
  • Is just as much about care, coordination and
    services when the patient isnt there as when
    they are
  • National movements, employer interest and payer
    support in the pilots now provide the
    reimbursement vehicle to pay for the essential
    services that should and do occur outside of an
    office visit

Patient-Centered Medical Home Joint Principles
  • Personal Physician
  • Physician directed medical practice
  • Whole person orientation
  • Care is coordinated and/or integrated
  • Quality and safety are hallmarks
  • Enhanced access

Joint Principles
  • Reimbursement should
  • Reflect the value of non-face time
  • Pay for care coordination
  • Support adoption and use of HIT for QI
  • Support enhanced communication such as secure
    email and telephone consultation
  • Allow for separate fee-for-service visit payment
  • Recognize case mix differences in patient
  • Allow for physicians to share in savings from
    reduced hospitalizations
  • Allow for additional payments for achieving
    measureable quality improvements

Pilot Decisions
  • Selection Criteria
  • Geographic Diversity
  • Demonstrated Medical Home Readiness
  • Able to reach a minimum of NCQA Level-1
  • Organizational Commitment

Pilot Decisions
  • Pilot Size
  • 11 practices with approximately 39k total members
  • Family Practice, Internal Medicine and General
  • Infrastructure Practice Support Model
  • Initial vetting and training
  • Collaboration

Pilot Decisions
  • Attribution Method (United Colorado Model)
  • Derived
  • Retrospective view of Medical EM and Rx for 18
  • Algorithm will select most recent date and will
    break ties with visit volume and spend
  • Semi-Annual reporting

Pilot Decisions
  • Reimbursement
  • Per member per month care management fee
  • Fee for service
  • Pay for performance through existing carrier
  • Evaluation
  • Proposal for evaluation design is in the process
    of review

Practices Selected
  • Practice Name City/Town Practice Type
  • Ammonoosuc Community Health Services Littleton H
    ealth Center
  • Cheshire Medical Center Dartmouth Hitchcock
    Keene Keene Ind Multi-Specialty Practice
  • Concord Hospital Family Health Center
    Concord Hospital Owned/ Residency
  • COOS County Family Health Services Berlin Healt
    h Center
  • Derry Medical Center Derry Independent MD
  • Elliot Family Medicine at Bedford
    Commons Bedford Hospital Owned Practice
  • Lamprey Health Care Newmarket Health Center
  • Life Long Care New London Independent ARNP
  • Manchester Community Health Center Manchester He
    alth Center
  • Mid-State Health Center Plymouth Health Center
  • Westside Healthcare Franklin Hospital Owned

  • Cost Utilization
  • Avoidable in-patient stays
  • ED utilization
  • Office visits (specialty, primary care)
  • Pharmacy
  • Outpatient procedures and diagnostics
  • Total cost
  • Should include risk adjustment

  • Quality
  • Claims and chart based
  • Modeled after CMS Group Practice Demo
  • Diabetes
  • Coronary Heart Disease
  • Congestive Heart Failure
  • Prevention
  • Infrastructure
  • Patient and family satisfaction
  • Practice culture, teamwork and satisfaction
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