nashp - october 5, 2010 lisa m. letourneau md, mph quality counts learning the abcs of apcs and...
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NASHP - October 5, 2010
Lisa M. Letourneau MD, MPHQuality Counts
Learning the ABCs of APCs and Medical Homes
Objectives
• Review basic elements, goals for Maine PCMH Pilot
• Highlight unique features of Maine Pilot
• Share lessons learned to date
• Look forward to upcoming opportunities (ACA)
Maine PCMH Pilot Key elements:
– 3-year multi-payer PCMH pilot– Collaborative effort of key stakeholders, major payers– Adopted common mission & vision, guiding principles for Maine
PCMH model– Selected 22 adult / 4 pedi PCP practices across state – Supporting practice transformation & shared learnings beyond pilot
practices– Committed to engaging consumers/ patients at all levels– Conducting rigorous outcomes evaluation (clinical, cost, patient
experience of care)
Maine PCMH Pilot - Timeline• Jan 2009: Call for practice applications
• May 2009: Practices notified – start of 6mo “ramp-up period”
• Sept 2009: NCQA PPC-PCMH applications completed
• Sept-Dec: practices contracted with payers
• Jan 2010: Start date for PCMH payments
• Jan 2010- Dec 2012: 3-year PCMH Pilot
Maine PCMH Strengths & Challenges
• Public-private partnership - 3 conveners
• Consumer / patient engagement
• Expectations & support for practice transformation
• Ongoing data feedback for improvement
• Ensuring sufficient payment vs. demonstrating accountability for costs
Maine PCMH Pilot Leadership
Quality Counts
Maine Quality Forum
Maine Health Management
Coalition
Keeping Patients at Center of Maine PCMH Pilot
• Patients/consumers included in Maine Pilot planning, governance
• Patient/consumer focus groups held as part of Pilot planning
• Patient-oriented informational, educational tools• Pilot practices required to include patients in redesign
efforts• Patient experience (CG-CAHPS) part of Pilot
evaluation• Efforts linked w/ AF4Q consumer engagement
Maine PCMH Pilot Practice “Core Expectations”
1. Demonstrated physician leadership2. Team-based approach3. Population risk-stratification and management4. Practice-integrated care management5. Same-day access6. Behavioral-physical health integration7. Inclusion of patients & families8. Connection to community / local HMP9. Commitment to waste reduction10.Patient-centered HIT
Support for Practice Transformation
• PCMH Learning Collaborative– IHI “BTS” model; 3 Learning Sessions/yr
• Practice QI Coaches– Most from existing PHOs, med groups– Using microsystems approach to QI
• Technical assistance “experts”– BH integration, work with consumers, HIT
• Ongoing feedback reports – Clinical, claims data
PCMH Evaluation & Data for Improvement
• Patient experience of care– CG-CAHPS patient surveys
• Clinical quality measures– Adult & pedi
• Cost & resource use (HealthDialog rpts)– Hosp’s, readmissions, ED use, imaging
• Practice changes
Data Feedback: Clinical Quality • Practices commit to reporting clinical quality
measures quarterly
• Use 31 clinical quality measures (adult), aligned with meaningful use measures
• Started with 2008 (baseline), then Q1 2010 onward
• Practices use online data reporting system (developed for Pilot), receive comparative feedback reports
Clinical Data Feedback
X
Clinical Data Feedback
Data Feedback: Cost & Resource Use
• Use claims from Maine All-Claims Paid Database, via MHDO
• MQF contracts with Health Dialog to produce reports
• First reports delivered to practices mid-August, using 2008 claims data
• Anticipate ongoing, q6mos reports
Provider Performance Measurement ReportsAugust 2010
Performance SummaryPerformance summary includes:• Demographics about
practice’s panel• Overall practice performance
compared to peers in 3 areas of unwarranted variation
• Evaluation of overall effectiveness and efficiency
• Practice’s score on 6 key utilization measures
• Best opportunities for improvement in the practice
Best Opportunities for Improvement
• Shows where practice is significantly different from peers AND where the total impact of improving is highest
Lessons Learned Maine PCMH Pilot
• Change starts with effective leadership– Primary selection criteria for Pilot
– Don’t assume physician leadership skills - need ongoing support
• Change happens through effective teams
• NCQA PPC-PCMH “medical home”
• It’s all about relationships – with patients AND within teams
• Recognize value of “outside” coaching
Potential Opportunities
• CMS Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration
• Affordable Care Act– Section 2702: Health Homes (Medicaid)– Section 3502: Community Health Teams
(Medicaid Health Homes)– Section 4108: Incentives for Chronic
Disease Prevention
Medicare Med Home Demo• Maine application submitted, proposed new…
• $7 pmpm to providers,• $3 pmpm for community-based care management
• To meet expectations for budget-neutrality (i.e. must project $10 pmpm savings), Maine proposed…• 6-7% decreases in inpatient admissions (CVD & Resp)• 5% decrease in ED visits• 5% decrease in specialty consultations• 5% decrease in imaging use
Maine PCMH Pilot - Issues TBD
• Will new payment be enough to support true practice transformation?
• How best to engage specialists, hospitals in shared goals, producing cost savings?
• How to engage patients in new partnership?
• How to spread learnings to other “non-Pilot” practices
• And more??
Contact Info / Questions Lisa Letourneau MD, MPH• [email protected]• 207.415.4043
Sue Butts Dion• [email protected]
Maine PCMH Pilot• www.mainequalitycounts.org
(See “Major Programs” “PCMH Pilot”)