Montefiore Medical Group’s PCMH Coaching Model November 12, 2013.
Patient Centered Medical Home (PCMH) Performance Measures May 2012 Office of the Chief Medical...
-
Upload
edgar-williams -
Category
Documents
-
view
217 -
download
0
Transcript of Patient Centered Medical Home (PCMH) Performance Measures May 2012 Office of the Chief Medical...
Patient Centered Medical Home (PCMH)Performance Measures
May 2012
Office of the Chief Medical OfficerTRICARE Management Activity
Overview
• Strategy Review
• Governance
• Current Performance Measures
• Opportunities
• Constraints
2
Strategy Review
• Major drivers– Rising Costs – more beneficiaries, more entitlements and higher utilization– Persistently low satisfaction relative to private sector care
• Foundational step to MHS’ transformation to an ]Accountable Care Organization
• Goal – Implement PCMH model of care at all 470+ primary care practices– Near term – improve PCM continuity, access to care and patient satisfaction– Mid term – manage demand, reduce primary care leakage and ED/primary
care/specialty care utilization, improve HEDIS measures and medically readiness
– Longer-term impacts – Improve beneficiary health status, increase MTF capacity and enrollment and improve MTF resource optimization
3
PCMH Governance
Senior Military MedicalAdvisory Council
Clinical ProponencySteering Committee
Clinical Quality Forum
PCMH Advisory Board
Joint HealthOperations Council
MHS Strategy ManagementWorking Group
Tri-Service PCMH Working Group
Tri-Service PCMH Sub-Working Groups (SWG)
PerformanceMeasures
PMPM AccessTo Care
IM/IT Private SectorCare PCMH
Ad Hoc(Staff Satisfaction,4th Letter MEPRS)
Tri-Service PCMH Performance Measures Sub-Working Group
• Multi-disciplinary, Tri-Service and JTF CAPMED– Gina Julian and Dylan Stearns (TMA/PCMH)
– CDR Chris Hunter (TMA/Behavioral Health)
– Justin Sweetman (TMA/Office of Strategy Management)
– LTC Sharon Pacchiana (TMA/HPA&E)
– Army, Navy, AF and JTF CAPMED Service leads and analysts
• Track, monitor and verify measures– Aggregate into PCMH/Non-PCMH practices
– Develop target and range recommendations
• Recommend new performance measures• Outreach – 600 clinical leaders trained so far (another
500 scheduled for 2d half of FY12)– PCMH, Recognition and PMPM Guidebooks– Practice/real-world experience5
Strategic Imperative
Exec
Sponsor Performance Measure
Development
Status
PreviousPerformanc
eCurrent
Performance Change
FY2011
Target
FY2012
Target
FY2014
Target Strategic Initiatives
Readiness
Improve Individual and Family Medical Readiness
FHPC Medically Ready to Deploy 75% 75% - 81% 82% 85%
Implement Policies, Procedures & Partnerships to Meet Individual Medical Readiness GoalsTBD Measure of Family Readiness (i.e., PHA for families)
Enhance Psychological Health & Resiliency
FHPC PTSD Screening, Referral and Engagement (R/T) 48%/64% 42%/71% -6%/+7% 50%/75% 50%/75% 50%/75%Integrate & Optimize Psychological Health Programs to Increase Resilience, Wellness & Readiness
Implement DoD/VA Joint Strategic Plan for Mental Health to Improve Coordination
FHPC Depression Screening, Referral & Engagement (R/T) 63%/69% 62%/74% -1%/+5% 50%/75% 50%/75% 50%/75%
Population
Health
Engage Patients in Healthy Behaviors
CPSC MHS Cigarette Use Rate (Active Duty 18-24) 26% 21% -5% 19% 18% 16%
Support the National Prevention Strategy to Promote Healthy Behaviors & Total Fitness
CPSCPercent of Overweight/Obese Adults with Documented Weight Issue
17%/54% - 30%/75% 50%/90% 100%/100%
CPSC Percent of Overweight/Obese Adolescents/Children with Documented Weight Issue
11%/33% - 30%/50% 50%/75% 100%/100%
CPSC Exclusive Breastfeeding During Newborn Hospitalization 56% 62% +6% 65% 70% 80%
CPSC HEDIS Index: Preventive Cancer Screens & Well Child Visits (DC/PC)
7/6 8/6 +1/- 10/10 12/14 15/20
Experience of C
are
Deliver Evidence-Based Care
CPSCHEDIS Index: Cardiovascular, Diabetic & Mental Health Care (DC/PC)
23/6 24/5 +1/-1 29/18 36/24 50/35Support the National Partnership for Patients Effort to Improve Care, Transitions and Prevent Harm During Treatment
Wounded Warrior Programs
Disability Evaluation System Redesign
Optimize Pharmacy Practices to Improve Quality and Reduce Cost
Implement Patient Centered Medical Home Model of Care to Increase Satisfaction, Improve Care and Reduce Per Capita Healthcare Costs
Create Alternative Strategy for Purchasing Care to Improve Performance in Achieving the Quadruple Aim.
CPSC Hospital Readmission Rate - - - - - -
CPSC Patient Safety - Wrong Site Surgery - - - - - -
CPSC Antibiotic Received Within 1 Hour Prior to Surgical Incision 94% 95% +1% 98% 98% 98%
Excel in Wounded, Ill and Injured Care
CPSCPercentage of Medical Boards Completed Within 30 Days (DAR & IDES)
53%/67% 41%/53%-12%/-14%
60%/60% TBD TBD
CPSCPercent of Service Members Rating Medical Evaluation Board Experience as Favorable
51% 52% +1% 65% 70% 75%
Optimize Access to Care
JHOC Primary Care 3rd Available Appointment (Routine/Acute) 72%/50% 66%/52% -6%/+2% 91/68% 92%/70% 94%/75%
JHOC Satisfaction with Getting Timely Care Rate 76% 77% +1% 78% 80% 82%
JHOCPotentially Recapturable Primary Care Workload for MTF Enrollment Sites
30% 34% +4% 26% 24% 22%
Promote Patient-Centeredness
JHOC Percent of Visits Where MTF Enrollees See Their PCM 51% 51% - 60% 65% 70%
JHOC Satisfaction with Health Care 59% 59% - 61% 62% 64%
Per
Capita
Cost
Manage Health Care Costs
CFOIC Annual Percent Increase in Per Capita Costs 5.8% 4.3% -1.5% 3.1% - -Implement Alternative Payment Mechanisms to Pay for Value
CFOIC Emergency Room Visits Per 100 Enrollees Per Year 47/100 50/100 +3 35/100 30/100 25/100
Learning & G
rowth
Enable Better Decisions
CPSC EHR UsabilityImplement Modernized iEHR to Improve Outcomes and Enhance Interoperability
Centers of Excellence
Improve Governance to Achieve Better Quadruple Aim Performance in Multi-Service Markets
Foster Innovation CFOIC Effectiveness in Going from Product to Practice (Translational Research)
Develop Our People CFOIC Human Capital Readiness / Build Skills & Currency
CFOIC Primary Care Staff Satisfaction
MHS Strategic Imperatives Scorecard
6Design Phase Approved Funded
Performance Review
• PCMH is accountable for performance• PCMH and Behavioral Health (BH) POM Funding tied to
Performance against set targets• PCMH – one of MHS’ Portfolio of Initiatives (GAO Review)• Key measures
– NCQA Recognition– Enrollees in MTF PCMHs– PCM Continuity– Access to Care– ED Utilization– Recapturable Primary Care (Leakage)– Patient Satisfaction– Staff Satisfaction
NCQA PCMH Recognition
• FY11– 46 Level 3 PCMHs– 1 Level 2 PCMH
• FY12– Army: 50– Navy: 53– Air Force: 25– JTF CapMed: 2
• Support– 7 training events– MHS Guide to Recognition
• Practice Feedback
8
PCMH MTF Enrollment
• POM performance measure• Limited by amount of NCQA recognition funding• Tri-Service PCMH Criteria
– Enrollees in NCQA Recognized PCMHs: 540K– Tri-Service PCMH practices: 1.78M
9
Service Total Prime + Plus# Enrollees in NCQA
or Tri-Svc PCMHs% MTF Enrollment
Army 1,455,375 900,000 62%Navy 724,805 573,228 79%Air Force 1,140,886 808,641 71%JTF CapMed 89,682 33,096 37%Total Direct Care 3,410,748 2,314,965 68%
Source: Services and TOC
PCM Continuity
• Leading indicator of change• The “Provider Accountability”
metric• Improving steadily since Aug
11– AF highest overall– Army most improved: +16%
• NCQA-recognized PCMHs 11% higher than MHS overall in Mar 12– PCMH Average 62%– Above FY12 target of 60%
10
20%
30%
40%
50%
60%
70%
80%
Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
Perc
ent P
CM C
ontin
uity
12 Percent Increase in PCM Continuity Overall
AF Army Navy JTF Goal
20
30
40
50
60
70
80
Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
Aver
age
% P
CM C
ontin
uity
PCMH PCM Continuity 9 percent higher than Overall
NCQA PCMHs MHS OverallSource: TOC
Access to Care – Acute and Routine• Access to Care key to fixing satisfaction and leakage• No Third Next Available data provided
– Inaccurate/sample size too small – resolution pending
• “Days to” better in PCMHs– Acute: 0.5 days vs 0.8 in Mar 12 (36% better in PCMHs than overall)– Routine: 6.3 days vs 6.5 in Mar 12 (5% better in PCMHs than overall)
11Source: TOC
0
1
2
3
4
5
6
7
8
9
Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
Avg
Day
s to
Rou
tine
Avg Days to Routine Appointments
PCMH MHS Overall2 FY12 Goal MHS Std
0
0.2
0.4
0.6
0.8
1
1.2
Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12
Avg
Day
s to
Acut
e
Avg “Days to” Acute Appointments
MHS Overall PCMH PCMH Goal MHS Standard
ED Utilization
• ED Utilization is declining as access/PCM continuity improves
• MHS/PCMH averages in the yellow range
• PCMHs have lower ED utilization than direct care overall– Lowest: AF 41.9/Navy 42.3
• Large MTFs with emergency rooms (ERs) have significantly higher utilization than PCMHs in small MTFs with no ERs– Madigan is exception at 36.8
visits/100 enrollees (green)
12Source: HPA&E
30
35
40
45
50
55
60
FY10Q3 FY10Q4 FY11Q1 FY11Q2 FY11Q3 FY11Q4 FY12Q1
ED
Vis
its/
100
En
roll
ees
ED Utilization Direct Care vs. NCQA PCMHs
NCQA PCMHs Direct Care Overall
Potentially Recapturable Primary Care Workload for MTF Enrollment Sites
• Primary Care leakage has improved for three consecutive months– ED utilization declined 12.5% as a
percent of all care– PC by others and UCC utilization
remained steady
• Overall, leakage decreased from 33% in Dec 11 to 27%
• NCQA-recognized PCMH leakage averaged 23% – Achieved FY12 target of 24%– Retrospective data analysis
underway
13Source: HPA&E
0
5
10
15
20
25
30
35
40
Previous Performance Current Performance
% R
ecap
tura
ble
Care
% Total Recapturable Care
MHS Overall NCQA PCMHs FY12 Goal
Patient Satisfaction
• Overall Patient Satisfaction with healthcare is lower than civilian benchmark
• Satisfaction is higher in NCQA-recognized PCMHs– Army has highest satisfaction– Navy has greatest difference between
NCQA recognized PCMHs and non-recognized
• Tri-Service PCMH Advisory Board working with DHCAPE to refine metric down to satisfaction with Primary Care– Best measure is 3QC– Average is 83% for both cohorts
14Source: DHCAPE/TROSS
0102030405060708090
100
MHS Total Army Navy Air Force
% S
atisfi
ed
Percent Satisfaction with Overall Healthcare
Overall PCMHs Civ. Benchmark
0102030405060708090
100
MHS Total Army Navy Air Force
% S
atisfi
ed
Percent Satisfaction with Primary Care
Overall PCMHs
Primary Care Staff Satisfaction
• Dec 11 MHS R&A approved twice yearly survey
• Just completed first FY12 survey (Mar 12)– Lower response rate than in Sep
11 (34 vs 26%)– Satisfaction 2% lower overall at
58% (vs. 59% in Sep)• Service satisfaction rates similar
• Correlation and cohort analysis underway
15Source: DHCAPE/Zogby
3426
05
101520253035404550
Response Rate
% Primary Care Staff Responding
Sep-11 Mar-12
0
10
20
30
40
50
60
70
80
90
100
Army Navy Air Force JTF CapMed Overall
% S
atisfi
ed O
vera
ll
Overall Satisfaction by Service Sep 11 vs. Mar 12
Direct-Care Specific Demonstrations/Studies
• MHS Performance Planning Demonstration• Dr. Jonathon Gruber Study – MIT Economist/chief architect
of the Massachusetts and Obama Administration Healthcare Reform Legislation
– Study PCMH performance impact retro and prospectively
• WRAMC - CMS Healthcare Innovation Challenge Grant Finalist
– Data-driven team care to keep people healthy – assess risk, personalize prevention plan and use risk reduction interventions
– Focus on Outcome Measures - Impact of chronic conditions, increased well-being, reduced ER visits and hospitalizations, improved patient experience, + return on investment
Private Sector Proposed Demonstrations
• Maryland Demo– TRO North to participate in Maryland Demo to test if PCMH model of care
provides higher quality/less costly care and leads to higher patient/staff satisfaction
– Measures: costs, satisfaction, 21 quality measures, admissions, primary care visits, ED visits
– In SACCP coordination
• Other proposed demonstrations with our federal partners in development
Opportunities• PCMH transformation is a process
– We need continued leadership support and emphasis– MHS decisions should align with strategy
• Staff Communication and Outreach• Beneficiary Communication and Outreach
– Increase presence in beneficiaries’ “virtual space”• Focus on performance
– Best Practice proliferation– MTF Cost and Utilization Guidance (PMPM, etc.)– Access to Care Guidance– Focus on High Utilizers/Chronically Ill
• Expanding patient-centered spectrum of care through specialty care optimization and standardization
18
Constraints• Nurse Advice Line implementation delay• 4th Letter MEPRS – embedded specialists• IM/IT and Business Intelligence
– Tri-Service PCMH IM/IT Sub-working Group developed and coordinated High Level Requirements (HLR)
– First PCMH/IMIT Summit held 26-27 Apr 12
• Needs Identified: – Alignment and decision-making between PCMH and IM/IT – $9-13M Secure Messaging unfunded requirements– More reliable, relevant, timely and actionable data– Need to make or buy tools to enhance patient-centered care
• Get rid of what doesn’t work to fund what can– HLR can inform development of iEHR
• Need better cost impact data/tool– Have access to access, continuity and satisfaction but lagging on cost impact data
19
Summary
• PCMH being implemented across not only the MHS but US government, states and private sector
• Foundation of MHS’ move to an accountable care organization
• Most measured, mature and supported MHS Initiative• PCMH concept of care is data-driven
– More/better data and tools needed