exploring the patient centered medical home
TRANSCRIPT
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Exploring the Patient Centered Medical Home
Mary Takach, MPH, RN
Program Director
National Academy for State Health Policy
Arizona Association of Community Health
Centers Annual Meeting
February 9, 2011
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NASHP
24-year-old non-profit, non-partisan organization
Offices in Portland, Maine and Washington, D.C.
Academy members
Peer-selected group of state health policy leaders
No dues—commitment to identify needs and guide work
Working together across states, branches and agencies to advance, accelerate and implement workable policy solutions that address major health issues
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NASHP Medical Home Projects
The Commonwealth Fund: Advancing Medical Homes in Medicaid
Round I 2007-2009 (CO, ID, LA, MN, NH, OK, OR, WA)
Round II 2009-2010 (AL, IA, KS, MD, MT NE, TX, VA)
Round III 2011-2012 (RFA released 1/2011)
Office of the Assistant Secretary for Planning & Evaluation in the US Department HHS
With RTI, evaluation design for Medicaid State Plan Option for Chronically Ill Health Homes (Section 2703 Affordable Care Act)
Federal HRSA Bureau of Primary Health Care
Informing state policymaking as it affects health centers through a National Cooperative Agreement
Federal HRSA Maternal Child Health Bureau
Coordinating medical home policies between State Title V & Medicaid
Presentation goals
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Describe how state policy makers are
using the medical home model to
transform primary care delivery systems
Describe the roles that health centers &
state primary care associations are
playing in these efforts
Discuss how federal health care reform
might accelerate these efforts
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What’s so new about medical homes?
Today’s Care Health Care Homes
Patients are recipients of services by providers and clinics.
Patients and families are partners in the provision and planning of care.
My patients are those who make appointments to see me.
Our patients are those who have agreed to participate in our HCH and understand how to contact our HCH.
Care is determined by today’s problem and time available today.
Proactive care planning is developed with the patient / family to anticipate patients needs.
Care varies by memory or skill of the provider.
Care is standardized with evidence-based guidelines and planned visits.
Patients are responsible to coordinate their own care.
A team, including the care coordinator, coordinates care with patients and families.
I know I deliver high quality care because I’m well trained.
We measure our quality and outcomes and make ongoing changes to improve it. We include patients / families in our quality work.
It’s up to the patient to tell us what happened to them.
We use a registry to track visits and tests and we do follow-up after ED visits and hospital admissions.
Clinical operations center on meeting the doctor’s needs.
A multidisciplinary team works at the top of our licenses to serve patients.
Slide courtesy of Minnesota Department of Health/ Minnesota Department of Human
Services
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Since 2006, most states have new Medicaid
or CHIP medical home initiatives
AK
NH MA
ME
NJ
CT RI
DE
VT
NY
DC MD
NC
PA
VA WV
FL
GA
SC
KY
IN OH
MI
TN
MS AL
MO
IL
IA
MN
WI
LA
AR OK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AZ
NM
ID OR
WA
NV
CA
States with at least one effort that met criteria for analysis
SOURCE: NASHP analysis
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Medicaid medical home efforts vary
widely
Some start with sub populations
Most target high cost populations...
...then plan to go state-wide
Most have legislative or Governor support
Many have state funding, most do not
Several use state plan amendments or Medicaid waivers
All delivery systems: FFS, PCCM, MCO
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Five Areas of Activity
Forming Key Partnerships
Defining and Recognizing a Medical Home
Purchasing and Reimbursement
Support for Changing Practices
Measuring Results
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Forming Key Partnerships
Planning with providers & consumers
health centers, provider & consumer associations
Working with QI collaboratives
Collaborating with other state agencies
Public health/Title V, Mental Health, Governor’s Offices, legislators
Partnering with foundations & universities
Joining forces with other payers/purchasers
State & public employees
Multi-payer medical home initiatives
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17 States are Participating (or Plan to
Participate) in Multi-payer Initiatives
AK
NH MA
ME
NJ
CT RI
DE
VT
NY
DC MD
NC
PA
VA WV
FL
GA
SC
KY
IN OH
MI
TN
MS AL
MO
IL
IA
MN
WI
LA
AR OK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AZ
NM
ID OR
WA
NV
CA
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Defining Medical Homes
Joint Principles
Colorado (adults)
Idaho
Louisiana*
Maine
Michigan
New York
Oklahoma*
Pennsylvania
Rhode Island
Vermont
*modified Joint Principles
State-grown definitions
Colorado (children)
Kansas
Maryland
Minnesota
Montana
Nebraska
North Carolina
Oregon
Washington
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Recognizing medical homes
Why Recognize?
Establishes concrete expectations for practices & patients
Reassures payers that extra payment translates to extra services
Reassures providers that improved care translates to improved payment
Motivates medical practices to change
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Recognizing Medical Homes
NCQA PPC-PCMH
Colorado (adults)
Iowa
Louisiana
Maine*
Maryland*
Massachusetts*
Michigan**
New York
Pennsylvania*
Rhode Island
Vermont
*modified NCQA
**NCQA or BCBS
State-grown standards
Colorado (children)
Kansas
Minnesota
Nebraska
North Carolina
Oklahoma
Oregon
Texas
Washington
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Purchasing & Reimbursement
Payments for ongoing medical home costs
Monthly care management payments
Do all health centers receive monthly care management payments?
Can health centers receive payments to provide care management for other practices?
Lump sum payments
Enhanced Fee For Service payments for certain visits
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Purchasing & Reimbursement
Payments for ongoing medical home costs (cont.)
Payments for new visit codes (i.e. behavioral health and after hour visit codes)
Can health centers provide these services for other practices/patients?
Can health centers provide after hours care for other practices/patients?
Payments to community networks
Can a health center be a community network?
Payment incentives for performance Are health centers able to take on risk?
Managed care contracts
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Support for Changing Practices
Provider adoption of good practices Learning collaboratives
Practice coaches/on-site technical assistance
Conference calls/check-ins
Info to providers on performance/patients
$$ / technical assistance for HIT/HIE Registry, EHR, eRx
Care coordination Practice-based: PA, MN, RI, VT
Community-based: MT, NC, OK, VT
State-based: CO, OK
Patient/family-based: ME, MN, NE
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Measuring results
Pennsylvania
Engaged providers
Health status
Costs
Clinical quality of care
Provider satisfaction
Pt self-care knowledge
Rhode Island
NCQA score
Health outcomes
Costs
Clinical quality of care
Patient experience
Vermont
NCQA score
Health status
Costs
Clinical quality of care
Outcomes of interests in a few multi-payer pilots
2014 is tomorrow
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If you build it (medical home system),
…. 1. Increase primary care payments
Section 1202 (Reconciliation Bill): Increased Primary Care Medicaid Reimbursement for Primary Care Providers
Section 4106: Improving access to preventive services for eligible adults in Medicaid
Section 5501: Increased Primary Care Medicare Reimbursement for Primary Care Providers
Section 5502. Medicare FQHC Improvements
2. Increase system capacity
Section 4101. $50 million School Based Health Clinics
Section 5507. $425 million Health Workforce Demonstrations
Section 5508. $230 million Teaching Health Centers for primary care residency programs
Section 10503. $11 billion CHC & NHSC Fund
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… they will come. 3. Provide better infrastructure support
Section 3502: Community Health Teams
Section 5405: Primary Care Extension Program
4. Provide new models of care
Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions
Section 2706. Pediatric ACO Demonstration Project
Section 3021: $10 billion Center for Medicare and Medicaid Innovation in CMS
Section 4108. $100 million Incentives for Prevention of Chronic Disease in Medicaid
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Other sources of funding to build your
“dream home”
Federal ARRA funding
Meaningful use & PCMH standards
Public/private partnerships:
Multi-payer initiatives: Medicare Multi-payer Advanced Primary Care (APC) demo
Foundation grants
Pharma, commercial plans, provider associations
Federal FQHC APC demo
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Opportunities for health centers
Federal support is unprecedented
Partner! Partner!
Do your homework. Know your state, know other states
http://www.nashp.org/med-home-map
Go big: Align operations with PCMH goals
Go bigger: Break down walls
Go biggest: Break down ceiling
Partner! Partner!
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New NASHP Publications •A State Policymakers’ Guide to Federal Health Reform - Part I: Anticipating How Federal Health Reform will Affect State Roles Many critical aspects of federal health reform will be implemented by the states. Through program design, regulations, policies and practices, state decisions and actions already play a profound role in shaping the American health care system. Both the House and Senate reform proposals would dramatically change the federal structure within which state health policy operates. Part I of this State Policymakers’ Guide provides a high-level view of existing state roles in the health care system and how federal reform will affect those roles. Download the file: Policymakers Guide Part 1 November 2009 •State Policymakers’ Priorities for Improving the Health System This State Health Policy Briefing presents the issues identified by NASHP’s state leadership as their most significant priorities for improving their health systems. As Academy members discussed their priorities, a set of broader themes emerged. These larger policy goals are: Connect People to Needed Services; Promote Coordination and Integration in the Health System; Improve Care for Populations with Complex Needs; Orient the Health System toward Results; Increase Health System Efficiencies. This briefing also provides a more detailed list of states’ priorities presented in four major categories of state health policy: Coverage and Access; Health Systems Improvement; Special Services and Populations; and Long Term and Chronic Care. Download the file: Policymakers' Priorities November 2009 •Supporting State Policymakers’ Implementation of Federal Health Reform States will have enormous short-term and long-term needs for assistance as they grapple with federal health reform legislation. Significant federal and private resources to support state-level implementation will be necessary. Implementation support must be defined and coordinated quickly. Technical assistance must be provided in a manner that corresponds with state needs. State officials should be involved in the design of technical assistance so that it is most effective given varied state circumstances, needs, and capacities. Technical assistance should inspire innovation among leaders even as it helps all states meet minimum standards of performance. Download the file: Supporting Implementation of Federal Reform
November 2009
Will Medicare Join State Multi-Payer Medical Home Initiatives? A Conversation with States Regarding Medicare’s Proposed Advanced Primary Care Demonstration
ABCD III Using Data Integration and Information Technology to Improve Care Coordination for Young Children
•RWJF Blog: Preparing for health reform in the states, with Alan Weil
•Home | •About NASHP | •Newsroom | •E-News signup | •Employment |
•Contact Us
Search this site:
•Chronic & Long Term Care •Comprehensive Health Reform •Coverage & Access •Health System Improvement
•Specific Services & Populations
•ABCD Resource Center •Maximizing Enrollment for Kids •Medicaid and the DRA •Patient Safety Toolbox
•State Quality Improvement Partnership Toolbox
•NASHP Projects & Programs •NASHP Publications by Category •NASHP Publications by Date •NASHP Authors' Publications
•NASHP Publications by Related Topics
•Preconference Sessions •Conference Sessions •Conference Speakers
•Session Speakers
New NASHP Publications •A State Policymakers’ Guide to Federal Health Reform - Part I: Anticipating How Federal Health Reform will Affect State Roles Many critical aspects of federal health reform will be implemented by the states. Through program design, regulations, policies and practices, state decisions and actions already play a profound role in shaping the American health care system. Both the House and Senate reform proposals would dramatically change the federal structure within which state health policy operates. Part I of this State Policymakers’ Guide provides a high-level view of existing state roles in the health care system and how federal reform will affect those roles. Download the file: Policymakers Guide Part 1 November 2009 •State Policymakers’ Priorities for Improving the Health System This State Health Policy Briefing presents the issues identified by NASHP’s state leadership as their most significant priorities for improving their health systems. As Academy members discussed their priorities, a set of broader themes emerged. These larger policy goals are: Connect People to Needed Services; Promote Coordination and Integration in the Health System; Improve Care for Populations with Complex Needs; Orient the Health System toward Results; Increase Health System Efficiencies. This briefing also provides a more detailed list of states’ priorities presented in four major categories of state health policy: Coverage and Access; Health Systems Improvement; Special Services and Populations; and Long Term and Chronic Care. Download the file: Policymakers' Priorities November 2009 •Supporting State Policymakers’ Implementation of Federal Health Reform States will have enormous short-term and long-term needs for assistance as they grapple with federal health reform legislation. Significant federal and private resources to support state-level implementation will be necessary. Implementation support must be defined and coordinated quickly. Technical assistance must be provided in a manner that corresponds with state needs. State officials should be involved in the design of technical assistance so that it is most effective given varied state circumstances, needs, and capacities. Technical assistance should inspire innovation among leaders even as it helps all states meet minimum standards of performance. Download the file: Supporting Implementation of Federal Reform
November 2009
Will Medicare Join State Multi-Payer Medical Home Initiatives? A Conversation with States Regarding Medicare’s Proposed Advanced Primary Care Demonstration
ABCD III Using Data Integration and Information Technology to Improve Care Coordination for Young Children
•RWJF Blog: Preparing for health reform in the states, with Alan Weil
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