Patient-Centered Medical Home

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Patient-Centered Medical Home Multi-Payer Demo

• Training Webinar 1
• David Halpern, MD, MPH
• May 18th, 2011

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Nice To Meet You

• David Halpern, MD, MPH
• Practice Support Consultant for CCNC
• Primary Care Physician at Duke
• Training
• MD (2004) Cornell University
• MPH (2010) UNC-Chapel Hill
• Internship/Residency in Internal Medicine at
  University of Pennsylvania
• Fellowship in Geriatric Medicine at UNC
• Fellowship in Preventive Medicine at UNC

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Todays Agenda

• What is a Patient-Centered Medical Home?
• What is the Multi-Payer Demo Project?
• What are the Benefits for Me and My Practice?

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What is a Patient-Centered Medical Home (PCMH)?
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Patient-Centered Medical Home

• The PCMH is a model of primary care re-design
  intended to improve the quality and efficiency of
  primary care delivery

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Patient-Centered Medical Home

• Emphasizes the relationship between patients and
  their primary care physicians
• Employs a team-based approach to care
• Integrates evidence-based practices, clinical
  decision-support tools, disease registries, and
  health information technology to improve
  population management and preventive care

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Medical Home Joint Principles

1. Personal Physician
2. Physician-Directed Practice
3. Whole-Person Orientation
4. Care Coordination/Integration
5. Quality Safety
6. Enhanced Access
7. Payment

Adopted by the American Academy of Family
Physicians (AAFP), American Academy of Pediatrics
(AAP), American College of Physicians (ACP), and
American Osteopathic Association (AOA) in
Febraury, 2007
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Medical Home Joint Principles

• Personal Physician
• Each patient has an ongoing relationship
  with a personal physician, who provides
  comprehensive, continuous primary care.

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Medical Home Joint Principles

• Physician-Directed Practice
• The physician is responsible for directing a
  team that takes collective responsibility for
  patient care.

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Medical Home Joint Principles

• Whole-Person Orientation
• The physician is responsible for providing
  comprehensive care at all stages of life and for
  coordinating care as necessary with appropriate
  specialists.

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Medical Home Joint Principles

• Care Coordination/Integration
• A patients care is coordinated across all
  elements of our complex health system
  (subspecialty care, hospitals, nursing homes,
  etc) through disease registries, information
  technology, health information exchange, and/or
  other means to ensure that the patient is getting
  needed and desired care in an appropriate manner.

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Medical Home Joint Principles

• Quality Safety
• Quality and safety are hallmarks of a PCMH
  evidence-based practices, clinical
  decision-support tools, regular quality
  improvement efforts, and information technology
  all combine to ensure that patient outcomes
  attain the highest level of excellence.

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Medical Home Joint Principles

• Enhanced Access
• Patients have enhanced access to their
  physicians and their practices as a result of
  open scheduling, expanded hours, and/or
  additional options for communication between
  patients, physicians, and staff.

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Medical Home Joint Principles

• Payment
• Reimbursement appropriately reflects the
  added value patients receive from being part of a
  PCMH practice.

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Benefits of the PCMH Model

• PCMH practices provide care that is
• Higher Quality
• Improves Patient Outcomes
• More Efficient
• More Timely and Cost-Effective

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Benefits of the PCMH Model

• Quality Patient Outcomes
• Fewer ER visits
• Fewer hospital admissions
• Lower mortality rates
• Better preventive service delivery
• Better chronic disease care
• Higher patient satisfaction

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Benefits of the PCMH Model

• Efficiency Cost
• Lower total costs of care
• Shorter patient wait times
• Less staff burnout/turnover
• Higher staff satisfaction/productivity

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What is the Multi-Payer Advanced Primary Care
Practice Demonstration Project (MAPCP)?
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Background

• WHO The World Health Report 2000
• Ranked healthcare performance/quality of 191
  countries
• US was ranked 37th
• Behind nearly all of Western Europe, Canada,
  Japan, Australia, and Israel

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Source Anderson. Health Affairs 27, no. 6
(2008) 17181727
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Primary Care Is The Backbone

• U.S. states with higher ratios of primary care
  physicians to population had better health
  outcomes
• Areas with higher ratios of primary care
  physicians to population had much lower total
  health care costs than did other areas

Source Starfield. Milbank Quarterly 83, no. 3
(2005) 457-502
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What is the Multi-Payer Demo?

• Centers for Medicare and Medicaid Services (CMS)
  is the Federal agency in charge of Medicare and
  Medicaid
• CMS funds demonstration projects to test and
  evaluate new models of health care delivery
  across the US

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What is the Multi-Payer Demo?

• The purpose of the Multi-Payer Advanced Primary
  Care Practice demonstration project (MAPCP) is
  to evaluate the effectiveness of the PCMH model,
  when supported by both public and private payers
• NC is one of 8 states that was awarded an MAPCP
  demo

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What is the Multi-Payer Demo?

• 7 rural counties across NC were chosen to
  participate in the demo Ashe, Avery, Bladen,
  Columbus, Granville, Transylvania, and Watauga

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What is the Multi-Payer Demo?

• To participate, practices in these counties must
  obtain PCMH recognition from the National
  Committee for Quality Assurance (NCQA) during the
  first year of the demo (no later than 9/30/12)
• In return for implementing the PCMH model,
  practices will earn incentive payments from the
  largest public and private payers in NC CMS and
  BCBS-NC/SHP.

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Support for the MAPCP

• Community Care of North Carolina (CCNC)
• Practice Support
• Training Webinars
• Informatics Center Resources
• AHEC Regional Extension Center (REC)
• EMR adoption and implementation
• Registry Support
• QI Consultants

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What are the Benefits for Me and My Practice?
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Recognition of Added Value

• Incentive Payments from Medicare
• CMS will pay a per member per month fee for each
  Medicare patient in practices achieving PCMH
  recognition through NCQA
• Level 1 2.50 PMPM (30 each year)
• Level 2 3.00 PMPM (36 each year)
• Level 3 3.50 PMPM (42 each year)

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Recognition of Added Value

• Increased Reimbursement from BCBS
• Eligibility for the Blue Quality Physicians
  Program (BQPP), a recognition program for primary
  care practices that builds on PCMH recognition
  from NCQA
• Once you qualify for the BQPP, BCBS will increase
  its fee structure by 10 or more for all of your
  BCBS/SEHP patients

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CMS Incentives Example(per physician per year)
of patients who have Medicare of patients who have Medicare of patients who have Medicare
  30 40 50
1 22,500 30,000 37,500  
2 27,000   36,000 45,000  
3 31,500   42,000 52,500
PCMH Level
(calculated using a panel of 2,500 patients per
provider)
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BCBS Incentives Example (per physician per
year)
of patients who have BCBS/SEHP of patients who have BCBS/SEHP of patients who have BCBS/SEHP
  30 40 50
1 12,000 16,000 20,000  
2 18,000   24,000 30,000  
3 24,000   32,000 40,000
PCMH Level
(calculated using an annual revenue of 400K per
provider)
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Next Steps (Homework)

• Put Training Webinars On Your Calendar
• June 8
• June 22
• July 6
• July 20
• August 3
• August 17
• August 31

all from 12PM - 1PM
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Next Steps (Homework)

• Build Your PCMH Team
• Identify a PCMH Champion who will help guide
  the practice through the quality transformation
  process
• Identify a Communicator-In-Chief who will serve
  as a point person for interactions with Community
  Care and other support staff
• Identify a Lead Administrator who will track
  progress, organize materials, complete the PMCH
  application (should have computer skills)

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Next Steps (Homework)

• Begin team discussions about where the manpower
  will come from. Practice transformation is
  valuable for your patients and your practice, but
  it takes time.
• Will you
• Be able to reduce your patient load?
• Have to extend your hours?
• Need to work on the weekends?
• Need to shift duties/responsibilities?

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Next Steps (Homework)

• Get the EMR ball rolling today
• Sign up for AHECs REC services (free) by
  completing an application at
• www.ncahecrec.net

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Community Care PCMH Team

• David Halpern, MD, MPH
• Community Care of North Carolina (CCNC)
• R.W. Chip Watkins, MD, MPH, FAAFP
• Community Care of North Carolina (CCNC)
• Brent Hazelett, MPA
• North Carolina Academy of Family Physicians
  (NCAFP)
• Elizabeth Walker Kasper, MSPH
• North Carolina Healthcare Quality Alliance
  (NCHQA)

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Partners
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Questions?

• Feel free to contact me
• David Halpern, MD, MPH
• [phone]
• dhalpern_at_n3cn.org