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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Overview of the PCPCC

Now in our 3rd year Over 440 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

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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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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Patient Centered Primary Care Collaborative

“Consumers & Patients”

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

i. Center for Advancement of Health Consumer Guide

ii. Consumer Guide to E-Prescribing

iii. Family Centered Care Resources

iv. Measuring Patient Experience

v. ABIM Foundation Brief - Patient Charter

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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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Employer Value Based Benefit Design

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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

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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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