1

The Medical Home:A Model for Health Reform?February 17, 2009

• James F. Coan– Project Officer, Medicare Medical Home

Demonstration, Centers for Medicare & Medicaid Services

• Dr. Chad Boult– Professor of Public Health, Director, Lipitz

Center for Integrated Health Care, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University

• Dr. Barbara Walters– Senior Medical Director, Dartmouth-Hitchcock

Medical Center

• Moderator: Laurel Sweeney– Sr. Director, Reimbursement & Legislative

Affairs, Philips Healthcare

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MEDICARE MEDICAL HOME MEDICARE MEDICAL HOME DEMONSTRATION (MMHD):DEMONSTRATION (MMHD):

OVERVIEW OVERVIEW

James Coan, Project OfficerJames Coan, Project Officer

Centers for Medicare & Centers for Medicare & Medicaid ServicesMedicaid Services

Baltimore, MDBaltimore, MD

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AuthorizationAuthorization

Tax Relief and Health Care Act Tax Relief and Health Care Act (TRHCA) of 2006, Section 204 (TRHCA) of 2006, Section 204

Medicare Improvements for Patients Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, and Providers Act (MIPPA) of 2008, Section 133 Section 133

Tax Relief and Health Care Act Tax Relief and Health Care Act (TRHCA) of 2006, Section 204 (TRHCA) of 2006, Section 204

Medicare Improvements for Patients Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, and Providers Act (MIPPA) of 2008, Section 133 Section 133

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SpecificsSpecifics3-Year Demonstration3-Year DemonstrationNo more than 8 StatesNo more than 8 StatesPhysician-Based PracticesPhysician-Based PracticesHigh-Need PopulationHigh-Need Population

Individuals with chronic illnesses that Individuals with chronic illnesses that require regular medical monitoring, require regular medical monitoring, advising, or treatment.advising, or treatment.

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Demonstration DesignDemonstration Design Reviewed statutes, literature (especially of the American Reviewed statutes, literature (especially of the American

Academy of Family Physicians (AAFP), American Academy of Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA)), and experiences of American Osteopathic Association (AOA)), and experiences of othersothers

CMS consulted with ACP, AAFP, and American Geriatrics CMS consulted with ACP, AAFP, and American Geriatrics Society (AGS) and othersSociety (AGS) and others

Medicare Medical Home Demonstration designMedicare Medical Home Demonstration design

Physician Practice Connection (PPC-PCMH-CMS)Physician Practice Connection (PPC-PCMH-CMS)

AMA/Specialty Society Relative Value Scale Update AMA/Specialty Society Relative Value Scale Update Committee (RUC) estimated work, office, and professional Committee (RUC) estimated work, office, and professional liability insuranceliability insurance expenses to establish relative value units expenses to establish relative value units (RVU) (RVU)

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2 Main Parts of the Medical 2 Main Parts of the Medical HomeHome

The PracticeThe Practice

The PhysicianThe Physician

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Medical Home DesignationMedical Home Designation

Medical Home is a term that applies Medical Home is a term that applies to a physician-based practice.to a physician-based practice.• Has necessary capabilities in placeHas necessary capabilities in place• Practice culture supports Medical Practice culture supports Medical

Home type careHome type care• Is committed to coordinating/managing Is committed to coordinating/managing

all patient careall patient care

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Tier StructureTier Structure

Two tiers of medical homesTwo tiers of medical homes

Tier 1: “Typical” medical home servicesTier 1: “Typical” medical home services

Tier 2: “Enhanced” medical home servicesTier 2: “Enhanced” medical home services

Both Tiers are fully functional and qualifiedBoth Tiers are fully functional and qualified

Two tiers of medical homesTwo tiers of medical homes

Tier 1: “Typical” medical home servicesTier 1: “Typical” medical home services

Tier 2: “Enhanced” medical home servicesTier 2: “Enhanced” medical home services

Both Tiers are fully functional and qualifiedBoth Tiers are fully functional and qualified

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Tier 1 RequirementsTier 1 Requirements

14 required capabilities, for example: 14 required capabilities, for example:

• Discuss with patients the role of the medical homeDiscuss with patients the role of the medical home

• Establish written standards for patient accessEstablish written standards for patient access

• Use data to identify/track patientsUse data to identify/track patients

• Use integrated care planUse integrated care plan

• Provide patient education/supportProvide patient education/support

• Track tests/referralsTrack tests/referrals

14 required capabilities, for example: 14 required capabilities, for example:

• Discuss with patients the role of the medical homeDiscuss with patients the role of the medical home

• Establish written standards for patient accessEstablish written standards for patient access

• Use data to identify/track patientsUse data to identify/track patients

• Use integrated care planUse integrated care plan

• Provide patient education/supportProvide patient education/support

• Track tests/referralsTrack tests/referrals

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Tier 2 RequirementsTier 2 Requirements

All Tier 1 requirementsAll Tier 1 requirements

Plus 4 more including;Plus 4 more including;

• Use electronic health record (EHR), certified by the Use electronic health record (EHR), certified by the Certification Commission on Health Information Certification Commission on Health Information Technology (CCHIT), to capture clinical information Technology (CCHIT), to capture clinical information (for example, blood pressure, lab results, status of (for example, blood pressure, lab results, status of preventive services)preventive services)

All Tier 1 requirementsAll Tier 1 requirements

Plus 4 more including;Plus 4 more including;

• Use electronic health record (EHR), certified by the Use electronic health record (EHR), certified by the Certification Commission on Health Information Certification Commission on Health Information Technology (CCHIT), to capture clinical information Technology (CCHIT), to capture clinical information (for example, blood pressure, lab results, status of (for example, blood pressure, lab results, status of preventive services)preventive services)

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Practices That Start as Tier 1 Can Practices That Start as Tier 1 Can Later Apply for Tier 2Later Apply for Tier 2

Practices that choose to qualify asPractices that choose to qualify as Tier 1 initially may apply to qualify Tier 1 initially may apply to qualify as Tier 2 practices in subsequent yearsas Tier 2 practices in subsequent years

• Complete the PPC-PCMH-CMSComplete the PPC-PCMH-CMS

• Provide documentation of Tier 2 capabilitiesProvide documentation of Tier 2 capabilities

Upgrade applications accepted during the last 3-months of year 1 and Upgrade applications accepted during the last 3-months of year 1 and year 2year 2

Additional documentation will reviewed as before Additional documentation will reviewed as before

Once Tier 2 qualification is established, the practice can receive the Once Tier 2 qualification is established, the practice can receive the Tier 2 care management feeTier 2 care management fee

Practices that choose to qualify asPractices that choose to qualify as Tier 1 initially may apply to qualify Tier 1 initially may apply to qualify as Tier 2 practices in subsequent yearsas Tier 2 practices in subsequent years

• Complete the PPC-PCMH-CMSComplete the PPC-PCMH-CMS

• Provide documentation of Tier 2 capabilitiesProvide documentation of Tier 2 capabilities

Upgrade applications accepted during the last 3-months of year 1 and Upgrade applications accepted during the last 3-months of year 1 and year 2year 2

Additional documentation will reviewed as before Additional documentation will reviewed as before

Once Tier 2 qualification is established, the practice can receive the Once Tier 2 qualification is established, the practice can receive the Tier 2 care management feeTier 2 care management fee

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Which Practices Are Qualified?Which Practices Are Qualified?

Physician-Based practicePhysician-Based practice

• First point of contact and main source of primary careFirst point of contact and main source of primary care

Must be able to provide medical home servicesMust be able to provide medical home services

• Oversee development & implementation of plan of careOversee development & implementation of plan of care

• Use evidence-based medicine & decision-support toolsUse evidence-based medicine & decision-support tools

• Use health information technology to monitor & track Use health information technology to monitor & track health status of patientshealth status of patients

• Encourage patient self-managementEncourage patient self-management Capabilities qualify Capabilities qualify as Tier 1 or Tier 2 as measured by PPC-PCMH-CMS Versionas Tier 1 or Tier 2 as measured by PPC-PCMH-CMS Version

Physician-Based practicePhysician-Based practice

• First point of contact and main source of primary careFirst point of contact and main source of primary care

Must be able to provide medical home servicesMust be able to provide medical home services

• Oversee development & implementation of plan of careOversee development & implementation of plan of care

• Use evidence-based medicine & decision-support toolsUse evidence-based medicine & decision-support tools

• Use health information technology to monitor & track Use health information technology to monitor & track health status of patientshealth status of patients

• Encourage patient self-managementEncourage patient self-management Capabilities qualify Capabilities qualify as Tier 1 or Tier 2 as measured by PPC-PCMH-CMS Versionas Tier 1 or Tier 2 as measured by PPC-PCMH-CMS Version

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Participating PhysiciansParticipating Physicians

Work within the Medical Home Work within the Medical Home practice structurepractice structure

Provide healthcare management Provide healthcare management services beyond regular medical careservices beyond regular medical care

““Quarterback” of the healthcare Quarterback” of the healthcare management teammanagement team

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Which Physicians Are Eligible?Which Physicians Are Eligible?

MD/DO board-certifiedMD/DO board-certified

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) practices Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) practices providing ambulatory health care, including federally qualified health centers providing ambulatory health care, including federally qualified health centers (FQHCs) and small-, medium-, and large-sized practices(FQHCs) and small-, medium-, and large-sized practices

Provide first contact, continuous care, main source of primary careProvide first contact, continuous care, main source of primary care

Eligible: General internist, family practice, geriatrics, some specialtiesEligible: General internist, family practice, geriatrics, some specialties

Not eligible: Radiology, pathology, anesthesiology, dermatology, Not eligible: Radiology, pathology, anesthesiology, dermatology, ophthalmology, emergency medicine, chiropractors, psychiatry, and surgery ophthalmology, emergency medicine, chiropractors, psychiatry, and surgery

MD/DO board-certifiedMD/DO board-certified

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) practices Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) practices providing ambulatory health care, including federally qualified health centers providing ambulatory health care, including federally qualified health centers (FQHCs) and small-, medium-, and large-sized practices(FQHCs) and small-, medium-, and large-sized practices

Provide first contact, continuous care, main source of primary careProvide first contact, continuous care, main source of primary care

Eligible: General internist, family practice, geriatrics, some specialtiesEligible: General internist, family practice, geriatrics, some specialties

Not eligible: Radiology, pathology, anesthesiology, dermatology, Not eligible: Radiology, pathology, anesthesiology, dermatology, ophthalmology, emergency medicine, chiropractors, psychiatry, and surgery ophthalmology, emergency medicine, chiropractors, psychiatry, and surgery

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Physician ResponsibilitiesPhysician Responsibilities Each physician in the Medical Home is Each physician in the Medical Home is

expected to provide specific services to expected to provide specific services to each patient as necessaryeach patient as necessary

• Provide ongoing support, oversight, and Provide ongoing support, oversight, and guidance through a health care team guidance through a health care team

• Provide integrated coherent planning for Provide integrated coherent planning for ongoing medical care including communication ongoing medical care including communication and coordination with other physicians and and coordination with other physicians and healthcare professionals furnishing carehealthcare professionals furnishing care

• Provide development and/or revision of Provide development and/or revision of documented care plans, including integration of documented care plans, including integration of new information and/or adjustment of medical new information and/or adjustment of medical therapytherapy

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Physician ResponsibilitiesPhysician Responsibilities(cont.)(cont.)

• Track hospital, and other facility admissions, Track hospital, and other facility admissions, with appropriate follow-up after dischargewith appropriate follow-up after discharge

• Oversee and track medication changes Oversee and track medication changes initiated by pharmacy benefit plansinitiated by pharmacy benefit plans

• Provide reconciliation of medications to avoid Provide reconciliation of medications to avoid interactions or duplications. interactions or duplications.

• Review medication changes occurring outside Review medication changes occurring outside of their own E/M visit, including all of their own E/M visit, including all prescriptions and related communication with prescriptions and related communication with other physicians and health care professionals.other physicians and health care professionals.

• Review reports of patient status from other Review reports of patient status from other physicians or health care professionalsphysicians or health care professionals

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Physician ResponsibilitiesPhysician Responsibilities(cont.)(cont.)

• Review results of laboratory and other studiesReview results of laboratory and other studies• Monitor staff to ensure the use of evidence-Monitor staff to ensure the use of evidence-

based medicine and clinical decision support based medicine and clinical decision support tools to facilitate diagnostic test tracking, pre-tools to facilitate diagnostic test tracking, pre-visit planning, and after-visit/test follow-up visit planning, and after-visit/test follow-up

• Maintain communication (including telephone Maintain communication (including telephone calls, secure web sites, etc.) with the patient, calls, secure web sites, etc.) with the patient, family, and caregivers for purposes of family, and caregivers for purposes of assessment or care decisionsassessment or care decisions

• Use patient self-management plan (including Use patient self-management plan (including end-of-life planning, home monitoring)end-of-life planning, home monitoring)

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Which Patients are Which Patients are Eligible/Ineligible?Eligible/Ineligible?

Medicare fee-for-service beneficiariesMedicare fee-for-service beneficiaries

At least one eligible chronic condition (86% of beneficiaries) At least one eligible chronic condition (86% of beneficiaries)

• Based on the adapted Hwang et al. list (Based on the adapted Hwang et al. list (Health AffairsHealth Affairs 2001) on CMS website 2001) on CMS website

At Enrollment:At Enrollment:

• Part A and Part B coveragePart A and Part B coverage

• Medicare is primary insurance providerMedicare is primary insurance provider

Ineligible: Ineligible:

Medicare AdvantageMedicare Advantage HospiceHospice Long-term nursing homeLong-term nursing home Treatment for end-stage renal diseaseTreatment for end-stage renal disease

Medicare fee-for-service beneficiariesMedicare fee-for-service beneficiaries

At least one eligible chronic condition (86% of beneficiaries) At least one eligible chronic condition (86% of beneficiaries)

• Based on the adapted Hwang et al. list (Based on the adapted Hwang et al. list (Health AffairsHealth Affairs 2001) on CMS website 2001) on CMS website

At Enrollment:At Enrollment:

• Part A and Part B coveragePart A and Part B coverage

• Medicare is primary insurance providerMedicare is primary insurance provider

Ineligible: Ineligible:

Medicare AdvantageMedicare Advantage HospiceHospice Long-term nursing homeLong-term nursing home Treatment for end-stage renal diseaseTreatment for end-stage renal disease

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Location and Sample SizeLocation and Sample Size

8 sites (A site is a state or a part of a state.)8 sites (A site is a state or a part of a state.)

• Will include urban, rural, medically underserved sitesWill include urban, rural, medically underserved sites

• CMS announce sites following approvalCMS announce sites following approval

Sample across all 8 sites (not each site):Sample across all 8 sites (not each site):

• 400 practices (small, med. large, FQHC, RHC, CHC)400 practices (small, med. large, FQHC, RHC, CHC)• 2,000 physicians2,000 physicians• 400,000 Medicare beneficiaries400,000 Medicare beneficiaries

8 sites (A site is a state or a part of a state.)8 sites (A site is a state or a part of a state.)

• Will include urban, rural, medically underserved sitesWill include urban, rural, medically underserved sites

• CMS announce sites following approvalCMS announce sites following approval

Sample across all 8 sites (not each site):Sample across all 8 sites (not each site):

• 400 practices (small, med. large, FQHC, RHC, CHC)400 practices (small, med. large, FQHC, RHC, CHC)• 2,000 physicians2,000 physicians• 400,000 Medicare beneficiaries400,000 Medicare beneficiaries

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What Are the Benefits to What Are the Benefits to Practices?Practices?

Care management feeCare management fee

Share in savingsShare in savings

Ability to provide better quality care to patientsAbility to provide better quality care to patients

Improved practice work flow Improved practice work flow

Improved job satisfactionImproved job satisfaction

Care management feeCare management fee

Share in savingsShare in savings

Ability to provide better quality care to patientsAbility to provide better quality care to patients

Improved practice work flow Improved practice work flow

Improved job satisfactionImproved job satisfaction

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What Is the Care Management What Is the Care Management Fee?Fee?

Based on RUC relative value units for physician work, practice expenses, and professional liability insurance

In addition to activities already reimbursed by Medicare

Risk-adjusted, based on hierarchical condition categories (HCC) score of the patient

Based on RUC relative value units for physician work, practice expenses, and professional liability insurance

In addition to activities already reimbursed by Medicare

Risk-adjusted, based on hierarchical condition categories (HCC) score of the patient

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What Is the Care Management What Is the Care Management Fee?Fee?

Per Member Per Month PaymentsPer Member Per Month Payments

Medical Medical Home TierHome Tier

Patients Patients with HCC with HCC

Score <1.6Score <1.6

Patients Patients with HCC with HCC

Score ≥1.6Score ≥1.6 Blended Blended

RateRate

1 1 $27.12$27.12 $80.25$80.25 $40.40$40.40

2 2 $35.48$35.48 $100.35$100.35 $51.70$51.70

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Next StepsNext Steps

RecruitmentRecruitment• Notify all practices in demo sitesNotify all practices in demo sites

ApplicationApplication• Submission of initial applicationSubmission of initial application

QualificationQualification• PPC-PCMH-CMSPPC-PCMH-CMS

Beneficiary EnrollmentBeneficiary Enrollment• Beneficiary education and agreementBeneficiary education and agreement

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Additional Additional Information/QuestionsInformation/Questions

James F. Coan, Project Officer

www.cmsmedicalhome.org

medhomedemo@cms.hhs.gov

James F. Coan, Project Officer

www.cmsmedicalhome.org

medhomedemo@cms.hhs.gov

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Technical Assistancefor the Medicare Medical Home

Demonstration Project

Dr. Chad BoultJohns Hopkins Bloomberg School of Public Health

February 17, 2009

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Technical Assistance

• Guided Care implementation manual• On-line course for Guided Care nurses• On-line course for physicians• Guidance in selecting HIT• Online practice self-assessment (“MHIQ”)• Webinars, learning collaboratives, networks• Information by Internet and telephone• Consultation

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Pay for Performance at DHPay for Performance at DH“Your Medical Home”“Your Medical Home”

Barbara Walters DO, MBABarbara Walters DO, MBA

Senior Medical DirectorSenior Medical Director

Dartmouth - HitchcockDartmouth - Hitchcock

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Dartmouth-HitchcockDartmouth-Hitchcock

• Dartmouth- Hitchcock clinic

•Mary Hitchcock Memorial Hospital

•Dartmouth Medical School

•VA Medical Center in White River Junction

•Dartmouth-Hitchcock Alliance

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Dartmouth-Hitchcock OperationsDartmouth-Hitchcock Operations

1,500,000 outpatient 1,500,000 outpatient visits per yearvisits per year

21,000 inpatients21,000 inpatients 1000+ physicians1000+ physicians 7500 employees7500 employees 900+ medical 900+ medical

students, residents & students, residents & fellowsfellows

Reimbursement Reimbursement environment – All FFSenvironment – All FFS

EMR’s & data EMR’s & data warehousewarehouse

3030

CMS Physician Group Practice CMS Physician Group Practice Demonstration ProjectDemonstration Project

The Pre-work ?The Pre-work ?

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CMS Demonstration ProjectCMS Demonstration Project

10 multispecialty groups10 multispecialty groups FFS Medicare EnvironmentFFS Medicare Environment Assignment of patients Assignment of patients

done retrospectively based done retrospectively based on preponderance of careon preponderance of care

Responsibility for total cost Responsibility for total cost of careof care

Bonus allocated for cost Bonus allocated for cost savings first – then qualitysavings first – then quality

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CMS ResultsCMS Results We achieved savings in year We achieved savings in year

1 , but did not meet the 1 , but did not meet the threshold for bonus threshold for bonus paymentpayment

We achieved all quality We achieved all quality metrics in year one metrics in year one

We achieved savings and We achieved savings and passed the threshold in year passed the threshold in year 2, so received 6.8 million 2, so received 6.8 million dollars of bonus payoutsdollars of bonus payouts

We achieved 98% of the We achieved 98% of the quality metrics , so part of quality metrics , so part of the above payout was for the above payout was for qualityquality

3333

Most Important Clinical Most Important Clinical InterventionsInterventions

ICD 9 Coding TrainingICD 9 Coding Training Transform the role of the RN – health coaches, Transform the role of the RN – health coaches,

and pre-visit planningand pre-visit planning Registry DevelopmentRegistry Development Post Discharge Phone CallPost Discharge Phone Call

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Where did we see a difference?Where did we see a difference? Our risk adjusted total cost Our risk adjusted total cost

was lower than the was lower than the comparison group – we comparison group – we had significantly sicker had significantly sicker patients who we cared for patients who we cared for more efficientlymore efficiently

Our admission rate for all Our admission rate for all of our patients was lower of our patients was lower than our comparison groupthan our comparison group

The cost of care of our CHF The cost of care of our CHF patients was less than out patients was less than out comparison groupcomparison group

Our quality was better than Our quality was better than the comparison groupthe comparison group

3535

Cigna ProjectCigna Project The CMS project The CMS project

was successful so was successful so we began looking we began looking for a Commercial for a Commercial plan to partner plan to partner with to apply our with to apply our clinical model to clinical model to that populationthat population

3636

Improve on the CMS modelImprove on the CMS model

Attribution was for primary care providers onlyAttribution was for primary care providers only First dollar savingsFirst dollar savings Quality metrics for clinical conditions in control of Quality metrics for clinical conditions in control of

the primary care dept.the primary care dept. Ongoing payment for care management – biggest Ongoing payment for care management – biggest

issue for implementation!issue for implementation! Bonus methodology needs to include employer Bonus methodology needs to include employer

groups – especially self-funded, so most of the groups – especially self-funded, so most of the practice ‘s patients are included..practice ‘s patients are included..

Create a preferred environment for primary care Create a preferred environment for primary care doctors to practicedoctors to practice

3737

Commercial Plans Additional Commercial Plans Additional ConcernsConcerns

Access-Access-AccessAccess-Access-Access– ER usage still highER usage still high– Gaps in care , especially Gaps in care , especially

for preventative visitsfor preventative visits Employer Groups and self-Employer Groups and self-

funded plans need early funded plans need early results to sign onresults to sign on

Health plans have disease Health plans have disease management initiatives – how management initiatives – how to collaborate?to collaborate?

3838

Design and Negotiate the PilotDesign and Negotiate the Pilot

3939

Adopted the Joint Principles for Adopted the Joint Principles for Medical Home Designation Medical Home Designation

Personal Physician

Physician directed medical practice

Whole person orientation

Care is coordinated and/or integrated

Quality and safety are hallmarks

Enhanced access

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Adopted Reimbursement Adopted Reimbursement PrinciplesPrinciples

Reimbursement should Reflect the value of non-face time

Pay for care coordination

Support adoption and use of HIT for QI

Support enhanced communication such as secure email and telephone consultation

Allow for separate fee-for-service visit payment

Recognize case mix differences in patient population

Allow for physicians to share in savings from reduced hospitalizations

Allow for additional payments for achieving measureable quality improvements

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4242

NCQA PPC-PCMHNCQA PPC-PCMH

4343

NCQA PPC-PCMHNCQA PPC-PCMH

4444

Patient Centered Medical Home Bonus ModelPatient Centered Medical Home Bonus ModelAssess Bonus Eligibilityquality assessment -greater than or equal

to market average

Does practicemeet criteria?

Provide analysiswith rationale for

no bonusYes

compare medicalcost trend to

market, must beatmarket tmc trend

Does practicemeet criteria?

No

Yes

Bonus Pool FundingSavings minus X% ofcare coordination fee

Pool Split EmployerX% PCMH-potential

of Y%

MH Cost Pool1/3 of bonus pooldistribute 100%

include analysis forbonus

MH Quality poolmaximum 2/3 of bonus

pool distributionbased on degree of

meeting EBMmeasures

End

No

Apply Payment cap -Compare total paid tothe PCMH - any amountabove the cap goes tothe customer, amountsbelow will go to thePCMH

PCMH Pool Split

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Results to dateResults to date

Began 4-1-09Began 4-1-09 Data clean up – our docs?, our patients?Data clean up – our docs?, our patients? Steering Committee and Operational Committee Steering Committee and Operational Committee

structurestructure Received Baseline performance year dataReceived Baseline performance year data

– Working on gaps in careWorking on gaps in care– Identifying patients who need case Identifying patients who need case

managementmanagement Continue enhancing the Medical Home Practice Continue enhancing the Medical Home Practice

Model in each of our 48 sitesModel in each of our 48 sites GREAT collaboration !! – too early for resultsGREAT collaboration !! – too early for results

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Questions

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Tell us what you think…

Please go to http://www.tinyurl.com/philips217 to complete a quick survey on this session.

If you have suggestions for new webinars, please note them on the survey.

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Jim CoanSocial Science Research AnalystOffice of Research Development and InformationCenters for Medicare and Medicaid Demonstrations

Jim Coan is a Social Science Research Analyst in the Demonstrations Program Group of the Office of Research Development and Information in the Centers for Medicare and Medicaid Services. The majority of Jim’s experience, however, comes from the world of public health as a Senior Public Health Advisor for 22 years with the Centers for Disease Control and Prevention. During that time Jim has worked extensively in the areas of communicable disease prevention, vaccine preventable diseases, and chronic disease prevention at the local, state, and national levels. He also has worked abroad in Southeast Asia with Indochinese refugees.

Throughout his career, Jim has developed an extensive background in research design methodologies and coverage and payment systems, as well as in social marketing and health promotion and disease prevention approaches. Jim came to CMS in 1995 and now devotes his skills and experience to conducting research demonstration projects for Medicare and Medicaid populations. Jim is the Project Officer for the Medicare Medical Home Demonstration Project.

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Chad Boult, MD, MPH, MBAEugene and Mildred Lipitz ProfessorDirector of the Roger C. Lipitz Center for Integrated Health CareDepartment of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health

Dr. Chad Boult is the Eugene and Mildred Lipitz Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. He directs the Roger C. Lipitz Center for Integrated Health Care and holds joint appointments on the faculties of the Johns Hopkins University Schools of Medicine and Nursing. The mission of the Lipitz Center is to improve thehealth and quality of life for people with complex health care needs by conducting research and disseminating new knowledge. The Center is also committed to preparing the next generation of leaders in this field. Dr. Boult advises multiple masters, doctoral, and post-doctoral students and teaches two graduate-level courses: “Innovations in Health Care for Aging Populations,” and“New Frontiers in Gerontology.”

A geriatrician for more than 17 years, he has extensive experience in developing, testing, evaluating, and diffusing new models of health care for older persons. His current research includes Guided Care, a novel, multi-disciplinary model of primary care for older people with multiple chronic conditions. Guided Care is designed to improve the quality and outcomes of complex health care by improving the delivery system’s design, decision support, access to clinical information, support for self-management, and by facilitating patients’ access to community services. Dr. Boult is the Principal Investigator of a multi-site, cluster-randomized controlled trial of Guided Care involving 48 physicians, 933 older patients, and 319 family members in the Baltimore-Washington DC area. The study is funded by a public-private partnership of the Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation, and the Jacob and Valeria Langeloth Foundation.

As an expert on chronic care, Dr. Boult has spoken at meetings and conferences throughout the world. He has published projections of the number of disabled older Americans in the 21st century and numerous studies of the outcomes of innovative models of health care for older persons. He created the first validated instrument for identifying high-risk older persons (the Pra) and co-edited a book entitled “New Ways to Care for Older People: Building Systems Based on Evidence: Springer Publishing Company, 1999.” He received the Excellence in Research Award from the American Geriatrics Society in 2000. From 2000-2005 he edited the “Models and Systems of Geriatric Care” Section of the Journal of the American Geriatrics Society. He has reviewed manuscripts submitted to many scientific journals and grant proposals submitted to the National Institute on Aging, the Agency for Healthcare Research and Quality, and several foundations. When time allows, he provides consultation to health care organizations that seek to improve health care for persons with chronic conditions. Additional information is available at www.jhsph.edu/LipitzCenter and www.GuidedCare.org

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Barbara A. Walters, D.O., M.B.A.Senior Medical DirectorSouthern NH Community Group PracticesDartmouth-Hitchcock 603-629-1101Barbara.A.Walters@Hitchcock.org

Dr. Barbara Walters, Senior Medical Director for Dartmouth-Hitchcock’s Southern New Hampshire Community Group Practices, is responsible for management of ambulatory practice operations located in 15 locations, employing 1,200 employees, 300 providers, and providing 1,000,000 visits per year. In addition she is responsible for commercial payor contracting for the Dartmouth-Hitchcock system and is the principal investigator for the CMS PGP Demonstration Project. Board certified in psychiatry and neurology, Dr. Walters came to Dartmouth-Hitchcock in 1998 from the Carolina Permanente Medical Group in Chapel Hill, North Carolina, with extensive experience in group practice and managed care.

She earned her medical degree from Michigan State University, completed her internship in Family Practice at Lansing General Hospital in Lansing, Michigan, and her psychiatric residency at the University of North Carolina, Chapel Hill. Dr. Walters received her M.B.A. degree from Duke University in 1998.