Patient-Centered Medical Home & Multi-Payer Demo

Training Webinar # 1

David Halpern, MD, MPHMay 18th, 2011

Nice To “Meet” You

David Halpern, MD, MPHPractice 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

Today’s Agenda

• What is a Patient-Centered Medical Home?

• What is the Multi-Payer Demo Project?

• What are the Benefits for Me and My Practice?

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

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

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

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

Medical Home “Joint Principles”

1) Personal Physician

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

Medical Home “Joint Principles”

2) Physician-Directed Practice

The physician is responsible for directing a team that takes collective responsibility for patient care.

Medical Home “Joint Principles”

3) 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.

Medical Home “Joint Principles”

4) Care Coordination/Integration

A patient’s 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.

Medical Home “Joint Principles”

5) 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.

Medical Home “Joint Principles”

6) 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.

Medical Home “Joint Principles”

7) Payment

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

Benefits of the PCMH Model

PCMH practices provide care that is:

Higher Quality– Improves Patient Outcomes

More Efficient– More Timely and Cost-Effective

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

Benefits of the PCMH Model

Efficiency – Cost– Lower total costs of care

– Shorter patient wait times

– Less staff burnout/turnover

– Higher staff satisfaction/productivity

What is the Multi-Payer Advanced Primary Care Practice Demonstration

Project (MAPCP)?

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

Source: Anderson. Health Affairs 27, no. 6 (2008): 1718–1727

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

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

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

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

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.

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

What are the Benefits for

Me and My Practice?

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)

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

CMS Incentives – Example(per physician per year)

% 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

PC

MH

Le

vel

(calculated using a panel of 2,500 patients per provider)

BCBS Incentives – Example (per physician per year)

% 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

PC

MH

Le

vel

(calculated using an annual revenue of $400K per provider)

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

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)

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?

Next Steps (Homework)

Get the EMR ball rolling today…

– Sign up for AHEC’s REC services (free) by completing an application at

www.ncahecrec.net

Community Care PCMH Team

• David Halpern, MD, MPHCommunity Care of North Carolina (CCNC)

• R.W. “Chip” Watkins, MD, MPH, FAAFPCommunity Care of North Carolina (CCNC)

• Brent Hazelett, MPANorth Carolina Academy of Family Physicians (NCAFP)

• Elizabeth Walker Kasper, MSPHNorth Carolina Healthcare Quality Alliance (NCHQA)

Partners

Questions?

Feel free to contact me:

David Halpern, MD, MPH

(215) 498-4648

dhalpern@n3cn.org