NH MultiStakeholder Medical Home Pilot

1
NH Multi-Stakeholder Medical Home Pilot
February, 2009
2
NH Multi-Stakeholder Pilot Origins

• Dialogue began within the Reimbursement Work
  Group, which was tasked with addressing
  reformation of the reimbursement system to
• Improve the quality of care
• Mitigate the increasing trend in cost of care
• Align reimbursement to obtain the kind of care we
  wanted
• Act in consideration of workforce challenges that
  are exacerbated by the current system.

3
Reimbursement Composition

• Reimbursement work group is comprised of
  leadership from
• NH Medical Society and AMA Delegation
• Commercial Carriers (Anthem Wellpoint, CIGNA and
  Harvard Pilgrim)
• State Insurance Department and NH Medicaid
• CMS
• Center for Medical Home Improvement
• Behavioral Health Association
• Hospital Association
• Primary Care and Independent Multi-Specialty
  Practices
• NH QIO

4
NH Multi-Stakeholder Pilot Origins

• In order to achieve its goals, the Reimbursement
  Work Group felt that it must first define the
  right care
• Clinical and carrier leadership put forth the
  concept of Medical Homes as the right way to
  deliver care
• Rich history of implementation and success with
  pediatric medical homes by the Center for Medical
  Home Improvement
• Timely publications from the Commonwealth Fund on
  medical homes (Beal, et al, June 2007) and
  reimbursement (Miller, September 2007)
• Alignment with work effort by the Quality Team in
  definitions

5
Medical Home Project Team

• The NH Multi-Stakeholder Medical Home Project was
  initiated in January of 2008 as a joint effort of
  all NH Payers and representatives of the clinical
  communities.
• The pilot will commence on 01/01/2009, payment
  will begin 06/01/2009 and will run until
  5/30/2011.
• It is our desire and intent to offer uniformity
  in patient attribution, reimbursement, technical
  support and outcomes measurement to deliver the
  greatest effectiveness possible in program
  design.

6
Why Medical Homes?

• It is about the transformation of primary care
• Putting the patient not just at the fore, but at
  the center
• Enforces, and requires, a team approach to care
  delivery, both within and across practices and
  sites of care
• Is just as much about care, coordination and
  services when the patient isnt there as when
  they are
• National movements, employer interest and payer
  support in the pilots now provide the
  reimbursement vehicle to pay for the essential
  services that should and do occur outside of an
  office visit

7
Patient-Centered Medical Home Joint Principles

• Personal Physician
• Physician directed medical practice
• Whole person orientation
• Care is coordinated and/or integrated
• Quality and safety are hallmarks
• Enhanced access

8
Joint Principles

• 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

9
Pilot Decisions

• Selection Criteria
• Geographic Diversity
• Demonstrated Medical Home Readiness
• Able to reach a minimum of NCQA Level-1
• Organizational Commitment

10
NCQA PPC-PCMH
11
NCQA PPC-PCMH
12
Pilot Decisions

• Pilot Size
• 11 practices with approximately 39k total members
• Family Practice, Internal Medicine and General
  Practitioners
• Infrastructure Practice Support Model
• Initial vetting and training
• Collaboration

13
Pilot Decisions

• Attribution Method (United Colorado Model)
• Derived
• Retrospective view of Medical EM and Rx for 18
  months
• Algorithm will select most recent date and will
  break ties with visit volume and spend
• Semi-Annual reporting

14
Pilot Decisions

• Reimbursement
• Per member per month care management fee
• Fee for service
• Pay for performance through existing carrier
  programs
• Evaluation
• Proposal for evaluation design is in the process
  of review

15
Practices Selected

• Practice Name City/Town Practice Type
• Ammonoosuc Community Health Services Littleton H
  ealth Center
• Cheshire Medical Center Dartmouth Hitchcock
  Keene Keene Ind Multi-Specialty Practice
• Concord Hospital Family Health Center
  Concord Hospital Owned/ Residency
• COOS County Family Health Services Berlin Healt
  h Center
• Derry Medical Center Derry Independent MD
  Practice
• Elliot Family Medicine at Bedford
  Commons Bedford Hospital Owned Practice
• Lamprey Health Care Newmarket Health Center
• Life Long Care New London Independent ARNP
  Practice
• Manchester Community Health Center Manchester He
  alth Center
• Mid-State Health Center Plymouth Health Center
• Westside Healthcare Franklin Hospital Owned
  Practice

16
Evaluation

• Cost Utilization
• Avoidable in-patient stays
• ED utilization
• Office visits (specialty, primary care)
• Pharmacy
• Outpatient procedures and diagnostics
• Total cost
• Should include risk adjustment

17
Evaluation

• Quality
• Claims and chart based
• Modeled after CMS Group Practice Demo
• Diabetes
• Coronary Heart Disease
• Congestive Heart Failure
• Prevention
• Infrastructure
• Patient and family satisfaction
• Practice culture, teamwork and satisfaction