January – June 2014From Abstraction to

Action:A Brief Recap of CPCC Activity

Goal for Convenings: Build the public will for medical homes to improve

health care in Colorado

Steering Committee Determines Four Areas of Focus

1. Payment Reform

2. Engaging the Public

3. Buying Health Insurance for Employees

4. Delivery Reform

Stakeholders Use Convening toDefine and Prioritize

1) Payment Reform: Cover All Services Needed

2) Engaging the Public:Education and Community Culture

Stakeholders Use Convening toDefine and Prioritize

3) Buying Health Insurance for Employees:Build a business case for, and explain

a clear ROI for the PCMH

4) Delivery Reform:Build equitable facilitator systems for practice transformation.

Work Groups Clarify and Add Details

Points considered:

Who is doing what, where, and well?What isn’t being done? Can we really do it?

Can we augment or support existing efforts?What value add does CPCC uniquely offer?

What audiences are more likely to respond to PCMH?How can existing relationships and resources be helpful?

What does target audience want and/or need?Among other questions…

Payment ReformCissy Kraft, MD

Cover all services needed

Focus on Primary Care

Desired outcome: Collaborate with key stakeholders to create top-down

support and call for specific payment changes for primary care across all payers.

Target:

Payers1) Direct payers: health plans, employers, and government

2) Indirect Payers: ACOs, IPAs

Partners, conduits, messengers:Policymakers

Providers

Strategy 1:Build on relationships with policymakers, providers and organized medical groups

a. Collaboration

b. Seek support and buy-in

c. Legislation as last resort 

Strategy 2:Outreach and follow up with payers (i.e. health plans, employers, and government)

a. Leverage relationships to support the State Innovation Model (SIM)

b. Meet payers where they are at: understand and address motivation and incentives

c. Refine and promote message to resonate with all different models of care delivery

Tactic 1: Use specific data outcomes to make the point:

a. Research to include actionable and missing data including but not limited to behavioral

and dental

b. Identify and assess existing models (e.g. Direct Primary Care, Bundling, Concierge, etc.)

 

 

Tactic 1: Use specific data outcomes to make the point:

c. Analyze existing data outcome, value, validate medical home approach, what would work for Primary Care, how can

other professionals on the team/professional organizations be included.

d. Actual cost to transform: reality check to be a primary care practice

 

 

Tactic 2: Assert leadership through “bold demonstration of worth”

a. Would doctors be willing to take stand “This is a model that benefits us all and we can’t do it any other way – the need is to be paid differently to reflect the value proposition.”

 

Tactic 3: Create and disseminate report to payers with request for action

a. Provide payers data that emphasizes value, benefit, etc. and ask for specific payment reform amount (once determined)

b. Seek concrete support from payers to implement payment reform.

 

Tactic 4: Secure meetings

a. Meet with policymakers (i.e. Governor, Insurance Commissioner, etc) to create support and use their help as needed.

 

Engaging the Public Rick Budensiek, DO

Education and Recognizing Community Culture

Desired Outcome:

Empower consumers to use their influence to raise awareness and create change through calls

to action.

Target: Consumers who are likely advocates for PCMH and who will influence plans and providers who is bought in, who is not, who is paying?

a. Age 50 and up (i.e. Medicare)

b. Women of childbearing age/ “Sandwich Generation”

c. Chronic illnesses

Partners, conduits, messengers:a. AARP, employers, providers (ages 50 to 60)

b. MOPS and other faith based organizations

c. Social media, Planned Parenthood, Ob/Gyn Society, etc. (Women of childbearing age/Sandwich Gen).

e. Colorado Chronic Illness Committee, advocacy groups such as MS Society, Epilepsy, etc (Chronic Illness)

f. Advocacy organizations with focus on patient empowerment (grassroots groups such as Aurora Health Access)

Strategy 1:Outreach and collaboration with partners and trusted messengers, such as RCCO, Chambers, CPCI to understand needs of and best ways to reach/empower target population. 

Strategy 2:Dissemination of information thru existing channels and efforts, newsletter articles, health and wellness fairs, Exchange website, WebMD, Wikipedia, etc. May also include PR tactics efforts such as PSAs, media stories, etc.

Tactic 1: Inventory and promotion of existing medical home messaging among supporters (consistency); review messaging from PCPCC, Colorado PCMH practices, TransforMed, NCQA, RCCO, CAHP, CDPHE, etc

 

Tactic 2: Use CPCI (trusted source) focus groups to tailor messaging to target groups does PCMH as a term resonate, if not, then what? Can PCMH messaging be tied into current ACA efforts?

 

Tactic 3: Craft materials such as practice level resource, one-pager, q and a, testimonials/stories make connection to “hot topics”, address elephant in the room, include call to action

 

Buying Health Insurance for Employees:Dan Burke, MD

Build a business case for, and explain a clear ROI for the PCMH

Desired Outcome:

Business leaders who advocate for appropriate support of primary care.

Target:

“Innovative Employers” such as Boulder Valley School District (BVSD), St. Vrain Valley School District, and Elward Systems Corp. (possibly hospitals that are self-insured)

Partners, conduits, messengers:a. Colorado Business Group on Healthb. Providers – local; grassrootsc. Chambers of Commerced. Brokerse. Society for Human Resource Management f. Colorado Hospital Association

Strategy 1:

Identify opportunity and next steps through collaborative conversations.

Strategy 2:

Create alliance with local providers and businesses in community

Tactic 1: Work with Donna Marshall to set up a strategy session with Bob Jamison from BVSD.

a. Understand motivation and incentive, identify lessons learned, could employees be engaged?

b. Test existing messaging such as “happier, healthier employees” and “pay less”

c. Refine messages based on conversation

 

Tactic 2: Implement next steps in collaboration with “innovative business” and community providers.

 

Delivery Reform:Brian Hill, MD

Build equitable facilitator systems for practice transformation

Desired Outcome:

Understand current landscape of primary care practices in Colorado (including those owned and operated by hospital), sas well as practice transformation needs. Then, identify opportunities for meetings to address key issues.

Target:

All primary care practices in Colorado

Partners, conduits, messengers:a. CDPHE (has existing work group researching work force issues)b. AAFP’s Robert Graham Center and Ben Miller (recent paper geo-coded providers)c. Research firms, med students, other existing resourcesd. Colorado Rural Health Centere. CCMUf. Colorado Health Instituteg. CCHAP (Colorado Children’s Healthcare Access Program)

Partners, conduits, messengers:h. CCHNi. HealthTeamWorksj. CU Dept of Family Medicinek. SIMl. AHRQm. Regional Extension Centersn. TransforMED

Strategy 1:

Inventory current practice transformation efforts, challenges, and gaps.

(use current efforts under way such as SIM and existing data such as CMS and CAFP surveys from 2009 and 2011)

Strategy 2:

Convene providers and other stakeholders in solution-oriented, accessible, statewide meetings (not just in metro area) to address key issues related to practice transformation.

Tactic 1: Conduct needs assessment to the extent possible given challenges and limitations regarding available data (inventory, assessment, readiness); consider using National Provider Identifiers (NPI data)

-Define denominator (who are the practices, what is a “practice”)-Other questions include:

-Who is doing what; who is involved-How to move from primary care to PCMH?-What is the need and where (gaps)-Who is the population; how much do they want-Who is not doing anything; why?-Is there a need for building a case for small practices-What are data challenges and needs (include children)-What measures reflect value and quality?

 

Tactic 2:

Leverage relationships to assist with research and create engagement opportunities for providers

 

Tactic 3: Use research to identify/validate convening topics such as:

“Should a group be formed to create common measures to standardize data” – look at CPCI

or

“Should a convening be held around data use and analysis?”

 

Q and A

 

Next Steps:Join an Action Team

(sign up sheets at your table)

Meeting July 30th9:30 am: Payment Reform

10:30 am: Engaging the Public12:30 pm: Delivery Reform

July 7th9:30 am: Buying Health Insurance for Employees

Next Steps:Action Teams Update Steering Committee:

September 2014December 2014

 

Next Steps:Steering Committee Meets

July 21, 2014September 22, 2014