EmblemHealth Medical Home High Value Network Project

1
EmblemHealth Medical Home High Value Network
Project

• William Rollow, MD MPH
• PCPCC Presentation
• December 2, 2008

2
Project Objectives

• To create a subnetwork of high performing FFS
  adult PCPs
• To position EmblemHealth as an innovative force
  with providers, purchasers, and the community
• To test ability of physician practices to become
  medical homes and resulting impact on quality,
  efficiency, and patient experience

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Project Design

• 460,000 Commonwealth Fund grant to Ethel
  Donaghue Center for Translating Research Into
  Practice (TRIPP) at the University of Connecticut
• Evaluation questions
• Can supported practices achieve medical homeness?
• Does medical homeness result in high performance
  on quality, efficiency, and patient experience
  measures?
• Practices signing letter of commitment were
  randomly assigned to Supported or Comparison
  Group
• Groups will be compared at baseline, end of 2008,
  and end of 2009 on medical homeness and at end of
  2009 on quality, efficiency, and patient
  experience measures

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Supported v. Comparison Groups

• Both groups
• Complete NCQA PPC-PCMH survey and supplementary
  questions to assess medical homeness
• Report blood pressure values for diabetics and
  hypertensives using CPT codes on claims
• Provide contact information on patients receiving
  services for purposes of telephonic and web-based
  patient experience survey
• Supported Group
• Receives revised payment methodology (potential
  for 15 additional earning beyond FFS base
  payment)
• Receives technical support for redesign and
  onsite care manager
• Comparison Group
• Receives participation payment of 5000/year

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Revised Payment Methodology

• FFS no change in underlying payment
• P4P opportunity for 2.50 pmpm award based on
  performance on
• Quality measures
• Patient experience measures
• Efficiency measure
• Care management fee opportunity for 2.50 pmpm
  based on
• Medical homeness (three levels)
• Risk level of patient population (three levels)

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Quality Measures(HEDIS )

• Process
• Cervical cancer screening
• Chlamydia screening
• Mammography
• Diabetic HbA1c testing
• Diabetic lipid testing
• Appropriate use of antibiotics for patients with
  bronchitis
• Outcomes
• Diabetic HbA1c control
• Diabetic lipid control
• Diabetic blood pressure control
• Hypertensive blood pressure control
• CAD LDL control

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Efficiency Measure

• Based on the percentage of savings that is
  achieved when actual costs for members are
  compared against projected costs based on prior
  year results, using either an episode- or
  population- based methodology
• Outlier patients will be removed, and hospital
  costs may also be excluded from individual
  scoring and included on the basis of performance
  for the entire Supported Group

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Patient Experience Measures(CAHPS Clinician)

• Overall satisfaction
• Accessibility
• Physician communication
• Self-care ability
• Measurement using telephonic and web-based
  surveys conducted by DocInsight

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Medical Homeness

• PPC-PCMH used for study purposes
• For payment purposes
• Must have EHR to get to payment level 2 or 3
• Can meet care management requirements for care
  management related to EmblemHealth-only patients

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Redesign and Care Management Support

• Enhanced Care Initiatives (ECI) provides
• Redesign facilitator who works with the practice
  on EHR adoption and redesign of appointment
  systems, electronic clinical information,
  e-prescribing, lab results and referrals
  tracking, etc
• Onsite care manager who coordinates hospital and
  specialist care, arranges services needed for
  quality measures, develops care plans and
  supports patient self-management, etc

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Current Project Status

• 38 practices recruited 35 currently
  participating
• 8 NYC and surrounding counties
• Average size 3 physicians average HIP/GHI
  membership 500
• Supported group has largely met initial
  requirements comparison group still has
  stragglers
• First performance measure results (quality,
  efficiency, patient experience) will be provided
  to practices in November to February

12
Challenges

• Recruitment
• PPC-PCMH submission
• Performance measurement
• Practice transformation
• Care management