Edwina RogersExecutive Director

Patient-Centered Primary Care Collaborative601 Thirteenth St., NW, Suite 400 North

Washington, D.C. 20005Direct: 202.724.3331Mobile: 202.724.3332

erogers@pcpcc.net

Patient Centered Primary Care Collaborative

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Overview of Activity

•22 Multi-stakeholder Pilots in 16 States•8 State Medicare Pilots Planned for 2009•44 States and the District of Columbia Have Passed over 330 Laws and/or Have PCMH Activity

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Pilots in planning phase for 2009 implementation

Multi-Stakeholder demonstrationPilot activity in early stages of development

Pilots in progress

Blue Cross Blue Shield Plan Pilots

(as of January 2009)

Overview of the PCPCC

Now in our 3rd year Over 475 signing members Advancing the Patient Centered Medical Home

(PCMH) concept in the public and private sectors Hosting Meetings, Summits and Congressional

Briefings Weekly Call Thursday at 11:00 AM EST

Call-in Number: 712.432.3900 Passcode: 471334#

Weekly “Center” calls established to operationalize work of PCPCC

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Collaborative PrinciplesThe Patient Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and many others who have joined together to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, clinicians and payers have agreed that it is essential to support a better model of compensating clinicians.

Compensation under the Patient-Centered Medical Home model would incorporate enhanced access and communication, improve coordination of care, rewards for higher value, expand administrative and quality innovations and promote active patient and family involvement. The Patient-Centered Medical Home model will also engage patients and their families in positive ongoing relationships with their clinicians. Further, the Patient-Centered Medical Home will improve the quality of care delivered and help control the unsustainable rising costs of healthcare for both individuals and plan-sponsors.

If you agree, please visit us at www.pcpcc.net and join today!

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The Patient-Centered Primary Care Collaborative

ACP

Providers 333,000

primary carePurchasers –Most of the Fortune 500

Payers Patients

AAP AAFP AOA

ABIM ACC ACOI AHI

IBM General Motors General Electric FedEx Microsoft Pfizer

Merck & Co.

Business Coalitions

BCBSA

United

Aetna

CIGNA

Humana

WellPoint

HCSC

NCQA AFL-CIO National Partnership

for Women and Families

SEIU

Foundation for Informed Decision Making

Examples of Broad Stakeholder Support & Participation

The Patient-Centered Medical Home 80 Million lives

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Patient Centered Primary Care Collaborative

Four ‘Centers’

Center for Multi-Stakeholder Demonstration: Identify community-based pilot sites in order to test and evaluate the concept; offer hands-on technical assistance, share best practices, and identify funding sources to advance adoption.

Center to Promote Public Payer Implementation: Assist state Medicaid agencies and other public payers as they implement and refine programs to embed the Patient Centered Medical Home model by offering technical assistance; sharing best practices and giving guidance on the development of successful funding models.

Center for Health Benefit Redesign and Implementation: Create standards and buying criteria to serve as a guide and tool for large and small employers/purchasers in order to build the market demand for adoption of the Medical Home model.

Center for eHealth Information Adoption and Exchange: Evaluate use and application of information technology to support and enable the development and broad adoption of information technology in private practice and among community practitioners.

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JOINT PRINCIPLES OF THE PCMH (FEBRUARY

2007)The following principles were written and agreed upon by the four Primary Care Physician Organizations – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.

Principles:Ongoing relationship with personal physicianPhysician directed medical practiceWhole person orientationCoordinated care across the health systemQuality and safety Enhanced access to carePayment recognizes the value added

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ENDORSEMENTS

The PCMH Joint Principles have received endorsements from 13 specialty health care organizations:The 13 organizations endorsing the Joint Principles are: •The American Academy of Chest Physicians •The American Academy of Hospice and Palliative Medicine •The American Academy of Neurology •The American College of Cardiology •The American College of Osteopathic Family Physicians •The American College of Osteopathic Internists •The American Geriatrics Society •The American Medical Directors Association •The American Society of Addiction Medicine •The American Society of Clinical Oncology •The Society for Adolescent Medicine •The Society of Critical Care Medicine •The Society of General Internal Medicine

The PCMH Joint Principles have recently also received an endorsement from the American Medical Association.

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Publically available

information

•Patients have accurate, standardized information on physicians to help them choose a practice that will meet their needs.

8Source: Health2 Resources 9.30.08

Defining the Medical Home

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The Patient-Centered Primary Care Collaborative recommends a three-part payment methodology,

Including:

A) A monthly care coordination payment for the physician’s work that falls outside of a face-to face visit and for the health information technologies needed to achieve better outcomes,

B) A visit-based fee-for-service component that is recognized for services that are currently paid under the present fee-for-service payment system, and

C) A performance-based component that recognizes achievement of service, patient centeredness, quality and efficiency goals.

PCPCC Payment Model(May 2007)

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EVIDENCE OF COST SAVINGS & QUALITY

IMPROVEMENT•Barbara Starfield of Johns Hopkins UniversityWithin the United States, adults with a primary care physician rather than a specialist had 33 percent lower costs of care and were 19 percent less likely to die.In both England and the United States, each additional primary care physician per 10,000 persons is associated with a decrease in mortality rate of 3 to 10 percent.

• In the United States, an increase of just one primary care physician is associated with 1.44 fewer deaths per 10,000 persons.

• A medical home can reduce or even eliminate racial and ethnic disparities in access and quality for insured persons.

•Commonwealth Fund has reported:Denmark has organized its entire health care system around patient-centered medical homes, achieving the highest patient satisfaction ratings in the world. Denmark has among the lowest per capita health expenditures and highest primary care rankings.

•Center for Evaluative Clinical Sciences at Dartmouth, states in the US relying more on primary care have:lower Medicare spending,lower resource inputs, lower utilization,and better quality of care.

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EVIDENCE OF COST SAVINGS & QUALITY

IMPROVEMENTChronic Care for Diabetes – BCBS of ND Reported

•6% decrease in hospital admissions•24 % decrease emergency room•$500, Per member per years savings

The state of North Carolina reported savings of $244 million for FY04 for their 720,000 Medicaid recipient program.

Horizon BCBS of NJ reported that the cost per patient, complying with diabetes testing in engaged medical homes, was substantially less than those in non-engaged medical homes.

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NC Savings (FY04)

Category of Service Estimated Savings from Benchmark

Inpatient $142,085,680

Outpatient $51,865,028

Emergency Room $25,944,553

Primary Care, Specialist $45,498,709

Pharmacy $(15,526,996)

Other $(5,065,238)

Totals $244,801,735

Simple Cost Avoidance

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North Carolina Pilot Project Details

AccessCare Network CountiesAccess II Care of Western NCAccess III of Lower Cape Fear

Community Care Plan of Eastern NC

Community Health Partners Northern Piedmont Community Care

Partnership for Health Management

Sandhills Community Care Network

Carolina Collaborative Comm. CareCarolina Community Health Partnership

Comm. Care Partners of Gtr. MecklenburgNorthwest Community Care Network

Central Care Health Network

Southern Piedmont Community Care Plan Community Care of Wake and Johnston Counties

AccessCare Network Sites

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Standard 1: Access and CommunicationA. Has written standards for patient access and patient communication**B. Uses data to show it meets its standards for patient access and communication**

Pts

459

Standard 2: Patient Tracking and Registry FunctionsA. Uses data system for basic patient information(mostly non-clinical data)B. Has clinical data system with clinical data insearchable data fieldsC. Uses the clinical data systemD. Uses paper or electronic-based charting tools to organize clinical information**E. Uses data to identify important diagnoses and conditions in practice**F. Generates lists of patients and reminds patients and clinicians of services needed (population management)

Pts

2

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64

321

Standard 3: Care ManagementA. Adopts and implements evidence-based guidelines for three conditions **B. Generates reminders about preventive services forcliniciansC. Uses non-physician staff to manage patient careD. Conducts care management, including care plans,assessing progress, addressing barriersE. Coordinates care//follow-up for patients whoreceive care in inpatient and outpatient facilities

Pts

3

43

55

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Standard 4: Patient Self-Management SupportA. Assesses language preference and othercommunication barriersB. Actively supports patient self-management**

Pts

246

Standard 5: Electronic PrescribingA. Uses electronic system to write prescriptionsB. Has electronic prescription writer with safety checksC. Has electronic prescription writer with cost checks

Pts3328

Standard 6: Test TrackingA. Tracks tests and identifies abnormal resultssystematically**B. Uses electronic systems to order and retrieve tests and flag duplicate tests

Standard 7: Referral TrackingA. Tracks referrals using paper-based or electronicsystem**

Pts

7613Pts44

Standard 8: Performance Reporting andImprovementA. Measures clinical and/or service performanceby physician or across the practice**B. Survey of patients’ care experienceC. Reports performance across the practice or byphysician **D. Sets goals and takes action to improveperformanceE. Produces reports using standardized measuresF. Transmits reports with standardized measureselectronically to external entities

Pts

3

33

321

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Standard 9: Advanced Electronic CommunicationsA. Availability of Interactive WebsiteB. Electronic Patient IdentificationC. Electronic Care Management Support

Pts1214

**Must Pass Elements

NCQA PPC-PCMH Content and Scoring

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NCQA PPC-PCMH Scoring

Level of Qualifying

Points Must Pass Elementsat 50% Performance Level

Level 3 75-100 10 of 10

Level 2 50-74 10 of 10

Level 1 25-49 5 of 10

Not recognized 0-24 <5

Levels: If there is a difference in Level achieved between the number of points and “Must Pass”, the practice will be awarded the lesser level; for example, if a practice has 65 points butpasses only 7 “Must Pass” Elements, the practice will achieve at Level 1.

Practices with a numeric score of 0 to 24 points or less than 5 “Must Pass” Elements are not Recognized.

How NCQA PPC-PCMH Recognition Works

Physician/practice• Self-assess, collect data using Web-based software• Submit documentation to NCQA when ready• May be asked to submit more data if needed

NCQA• Evaluates and scores all applications• Checks licensure of physician• Audits a sample of applications• Posts Recognized physicians on web• Distributes list of Recognized physicians monthly to health plansand others• Physicians sent media kit, press releases, letter & certificate

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Meaningful Use: Meaningful Connections Why this report- Why now?

Unprecedented urgency to change our health care “system.”

American Recovery and Reinvestment Act – over $19B for health IT infrastructure.

Natural synergy between PCMH and health IT.

Offer needed guidance to the industry.

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What is included in the Resource Guide?

Defines health IT capabilities essential to PCMH.

Crosswalks capabilities with functional priorities supporting PCMH.

Explores how patients/consumers are currently using health IT to connect.

Representative sample of 19 case example responses from primary care providers.

Appendices include Guidelines for PCMH Demonstration

Projects Consumer Principles Consumer Toolkit

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“Boots-on-the-Ground” Case Examples – Over 100

Primary care providers in private practice – we asked them: What kind of health IT systems do you use? In what way does health IT and exchange support your practice

or organization? How do you use health IT to improve patient engagement? What have your results been in terms of improved care

processes, clinical outcomes, or increased patient satisfaction as a result of health IT?

What objective evidence do you have that using health IT has achieved positive impacts?

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Patient Centered Primary Care Collaborative

“Purchaser Guide” Released July, 2008

Developed by the PCPCC Center for Benefit Redesign and Implementation in partnership with NBCH and the Center’s multi-stakeholder advisory panel.

Guide offers employers and buyers actionable steps as they work with health plans in local markets - over 6000 copies downloaded and/or distributed.

Includes contract language, RFP language and overview of national pilots.

Includes steps employers can take to involve themselves now in local market efforts.

The PCPCC is holding a series of Webinars, sponsored by Pfizer, on the Purchaser Guide.

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Patient Centered Primary Care Collaborative

“Building Evidence and Momentum – Compendium of PCMH Pilots” Released October 2008

Developed by the PCPCC Center for Multi-stakeholder Demonstration through a grant from AAFP offering a state-by-state sample of key pilot initiatives.

Offers key contacts, project status, participating practices and market scan of covered lives; physicians.

Inventory of : recognition program used, practice support (technology), project evaluation, and key resources.

Begins to establish framework for program evaluation/ market tracking.

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There has been significant interest and activity in the development of demonstration projects regarding the Patient Centered Medical Home (PCMH) care model over the past several years. These public, private or public/private projects combine the efforts of payers, providers and other health care stakeholders to test elements of the PCMH care model.  A set of guidelines to help ensure that demonstration projects purporting to test the PCMH model are broadly consistent with the joint principles was developed by the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians and the American Osteopathic Association. In addition, the standardization promoted by the acceptance of these guidelines will help facilitate more meaningful interpretation and understanding of the “lessons learned” from the results of the different PCMH demonstration projects.

RecommendationsA.Collaboration and LeadershipB.Practice RecognitionB.Practice SupportC.Reimbursement ModelD.Assessment and Reporting of Results

A full description of the Guidelines can be found on the Patient Centered Primary Care Collaborative website. 25

Guidelines for Patient Centered Medical Home (PCMH) Demonstration Projects

TODAY’S CARE MEDICAL HOME CARE

My patients are those who make appointments to see me

Our patients are those who are registered in our medical home

Patients’ chief complaints or reasons for visit determines care

We systematically assess all our patients’ health needs to plan care

Care is determined by today’s problem and time available today

Care is determined by a proactive plan to meet patient needs without visits

Care varies by scheduled time and memory or skill of the doctor

Care is standardized according to evidence-based guidelines

Patients are responsible for coordinating their own care

A prepared team of professionals coordinates all patients’ care

I know I deliver high quality care because I’m well trained

We measure our quality and make rapid changes to improve it

It’s up to the patient to tell us what happened to them

We track tests & consultations, and follow-up after ED & hospital

Clinic operations center on meeting the doctor’s needs

A multidisciplinary team works at the top of our licenses to serve patients

Acute care is delivered in the next available appointment and walk-ins

Acute care is delivered by open access and non-visit contacts

Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

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Patient Centered Primary Care Collaborative

“Consumers & Patients”

The PCPCC currently has a section on our website dedicated to Consumer and Patient issues.

i. PCMH Consumer Education Material

ii. Emmi Solutions Video

iii. PCMH Primary Care Brochure

iv. National Partnership for Women and Families Resources

v. The Center for the Advancement of Health Resources

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Inclusion of the Medical Home Concept in Health Reform

Efforts

Employer Trade Associations

Think Tanks

ExecutiveBranch

Plans developed by Congressional Representatives

The Patient-Centered Medical Home

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Baucus- Health Care Reform Proposal (November 2008)

Expanding Medicare’s role in testing the medical home model — in which practitioners are paid explicitly for comprehensive care management services…

Medical home expansions in Medicare should focus only on providers who are committed to ensuring that patients truly receive the primary care and care management services...

Providers seeking to participate in a Medicare medical home… should meet a set of stringent service and capacity criteria in order to qualify… and be willing to have additional paymentsbased in part on the quality of care they deliver.

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•Senator Durbin (D-IL) and Senator Burr (R-NC) are working together on Patient Centered Medical Home Legislation

•The Healthy Americans Act, sponsored by Senator Rob Wyden (D-Oregon) and Senator Bob Bennett (R-Utah) is the first bipartisan health reform proposal in more than a decade to guarantee affordable, healthcare quality for all and includes PCMH.

•Senator Baucus’ White Paper is very favorable for Medical Homes.

•Economic Stimulus Package includes funding for Health IT infrastructure and primary care workforce shortages.

•North Carolina received a 646 waiver to take the Patient Centered Medical Home program to all of Medicare, with estimated savings by the CBO of $1.4 billion.

Other Legislative Initiatives

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2009 UPCOMING COLLABORATIVE EVENTS

Tuesday, April 28, 2009 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center, 1300 Pennsylvania Avenue, NW Washington D.C. 20004

Thursday, July 16, 2009 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center, 1300 Pennsylvania Avenue, NW Washington D.C. 20004

Thursday October 22, 2009 - Washington D.C., Annual Summit, Washington Convention Center

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www.pcpcc.net

About the PCPCC History Members Brochure Executive Committee Advisory Board Officers Executive Bios

The Patient Centered Medical Home

Joint Principles Endorsements by Specialists Employer Perspectives Evidence of Quality Health Reform Proposal Reimbursement Model

Collaborative Centers Center to Promote Public Payer

Implementation Center for Multi-Stakeholder

Demonstration Center for Benefits Redesign and

Implementation Center for eHealth Information

Exchange and Adoption

Other PCMH Resources Pilot Project Guide Purchasers Guide Evidence Documents Consumer Materials Events

National Weekly Call Thursday, 11:00AM EST

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CONTACT INFORMATION

Visit our website – http://www.pcpcc.netTo request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact:

Edwina RogersPatient Centered Primary Care CollaborativeExecutive Director202.724.3331 202.674.7800 (cell)erogers@pcpcc.net, 601 Thirteenth St., NW, Suite 400 NorthWashington, DC 20005

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