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Primary Care Modernization Project

Consumer Advisory Board

8/7/2018

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What is the Primary Care Modernization Project?

A new model for primary care in Connecticut helps providers expand their care teams and offers new ways for patients to access care outside of a traditional office visit.

It also will propose a more flexible payment model that supports these improvements in care delivery.

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How will the model be developed?

The Freedman HealthCare team is working with consumers, providers and other stakeholders as well as state and national experts to determine:

• The services primary care providers will need to offer to be eligible for additional and more flexible payments. These services will aim to make care more convenient, community-based and responsive to the needs of patients.

• A new way to pay for primary care that helps providers cover the cost of investing in these new services.

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What will success look like?

Better Health: A primary care system that helps patients stay healthy and better manage chronic diseases

including diabetes, high blood pressure and depression.

Improved Care Quality: More ways for primary care providers to easily connect their patients to the right

care, from the right provider, at the right time.

Better Patient Experience: Patient needs are at the center, patient input is heard and patients’ culture,

values and preferences are respected.

Improved Provider Satisfaction: Doctors, nurses and other healthcare providers can focus on the work

they love and achieve professional and personal goals.

More Affordable Care: Health care dollars are spent smarter so over time care becomes less expensive,

for patients, employers, health insurers and the state.

Timeline

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Jul Aug Sept Oct Nov Dec

Practice Transformation Task Force

Design Groups Review Capabilities

Payment Reform Council

Stakeholder Engagement

Consumer Engagement

Timing reflects goal to present a model to the governor-elect in November.

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What is the role of consumers in primary care

modernization?

SIM’s focus on primary care reflects what is has heard from consumers since 2013.

Care needs to be:

• More focused on the needs of patients

• More convenient

• More accessible

• More connected to patients, other care team members and community services

• More equitable

• Less stigmatizing

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What is the role of consumers in primary care

modernization?Existing SIM Committees and Workgroups – 46 consumer representatives participating, some on more than one group

Design Groups – 20 consumer representatives participating

Payment Reform Council – Two consumers spots proposed to HISC, awaiting final approval on payment reform council

Consumer Advocate and Organization Leaders Discussions – 23 identified, more on the way

Consumers Listening Sessions - Four listening sessions in very early planning states for groups of consumers with similar perspectives and needs

Previous Listening Session Feedback – Developed detailed table with findings and references, incorporated in throughout the process

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Input from Advocates, Organizational Leaders

*Pending DSS initiated collaboration agreement

Employers

Advanced Networks

Primary Care Practices

Federally Qualified Health Centers

Individual Payers

Hospitals/Health Systems

Health care provider and professional training

programs

Consumers Representing Various

Perspectives

Consumers Advocate Organizations

Initial Consumer Advocate, Organizational Leader

Discussions

Interview Goals:

1. Share and Gain Feedback on Project Goals

• Make care better through added capabilities such as…

• Change the way primary care is paid for to increase spending on PCP care

and give providers the money and flexibility they need to take care of

patients

• What changes do you think would be most beneficial to those you serve?

• Do you have any concerns?

2. Tap into Participant Knowledge, Experience

• Dive deep into 1-2 advocate specific subtopics or other relevant content

most aligned with their work

3. Revisiting the Big Picture

• As we wrap up, can you each share with us one thing you want to make

sure we understand and don’t forget?

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Input from Consumers

Employers

Advanced Networks

Primary Care Practices

Federally Qualified Health Centers

Individual Payers

Hospitals/Health Systems

Health care provider and professional training

programs

Consumers Representing Various

Perspectives

Consumers Advocate Organizations

Initial Consumer Listening Sessions

Listening Session Goals:

1. Share and Gain Feedback on Primary Care in Connecticut

• For example, I really like it when my doctor or his/her

office does xyz

• If you could fix one thing it should be…

2. Use Narratives to Explain and Gain Input on Specific

Changes

• Use up to three short stories – on slides with pictures – to

explain how a few relevant, specific changes might be

implemented.

• As you listened to this story: (repeat for each story)

- What was different from how your doctor’s office

works for you today?

- What was better?

- Anything that worried you?

3. Wrap Up

Can you each share with us one thing you want to make sure

we understand and don’t forget?

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New Services or Capabilities Being Considered Increasing Patients’ Access and

Engagement

Expanding Primary Care Capacity System Supports and Resources

1. Diverse Care Teams

• Community health workers

• Pharmacists

• Care coordinators

• Navigators

• Health coaches

• Nutritionists

• Interpreters

• Nurse managers

2. Alternative Ways to Connect to

Primary Care

• Phone/text/email

• Home Visits

• Shared visits

• Telemedicine

1. Capacities

• Practice specialization

• Pain management and MAT

• Infectious diseases

• Geriatrics (complex older

adults)

• Persons with disabilities

• Genomic medicine

• Subspecialists as PCPs

• Pediatrics considerations

2. Health Information Technology

• E-consults

• Remote patient monitoring

1. BH Integration (adult)

2. BH Integration (pediatric)

3. Community Integration

• Social determinants of health

• Purchased community services

4. Oral Health Integration

Social determinants of health and health equity will be considered across capabilities

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Approach to Evaluating Possible New

Services/Capabilities

Evidence and literature

Expert opinion and experience

Experience in other states

CT Consumer Experience

Skeleton Capabilities

Includes consumer needs and health equity sections

PTTF recommendations

Design group recommendations

Stakeholder and consumer input

Draft Capabilities Statements

PTTF recommendations

Design group recommendations

Stakeholder and consumer input

Final Capabilities Statements

How the PTTF Will Review Capabilities

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Does the evidence support including this capability in the PCM payment bundle?

Based on health promotion/prevention, quality and outcomes, patient experience, provider satisfaction, lower cost

Should this be a core (universal/required) or an electivecapability?

Should this capability be deployed in all practice sites, or provided by a subset of docs or practices within each primary care network?

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Example Design Group Slide:

Consumer Needs and Health Equity Lens

Consumer Needs:

• Need for optimized preventive care for cancer

• Need for optimized preventive care for cardiovascular disease

Health Equity Lens:

• Genomic screening is currently available as a “concierge” opportunity for those who

seek it and can self-pay. This screening would be offered to a more diverse and

representative population.

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Payment Reform Council

What will it do?

Determine a way to pay for care differently so primary care providers can make the investments

necessary to provide the new capabilities and services.

What will be some of the key questions it considers?

• How to make payments enough and fair, particularly for providers taking care of the sickest patients

• How to invest more in primary care and in way that long term costs decrease not increase