DESIGNING SYSTEMS

THAT DELIVER

PATIENT-CENTERED CARE

Mary Takach MPH RN

Council of State Governments Leadership Forum

Medicaid Policy Academy

June 19 2014

Washington DC

Health System Reform 2

Why do we need health system reform

What kind of models can help meet health system

goals

What role can you play

NASHP 3

27-year-old non-profit non-partisan organization

Offices in Portland Maine and Washington DC

Academy members

Peer-selected group of state health policy leaders

No duesmdashcommitment to identify needs and guide work

Working together across states branches and agencies to

advance accelerate and implement workable policy

solutions that address major health issues

4

4

5

0

05

1

15

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

Pri

ma

ry C

are

Sco

re

US

NTH

CAN AUS

SWE JAP

BEL FR

GER

SP

DK

FIN

UK

Source Dr Barbara Starfield Presentation at the Blekinge Conference

Ronneby Sweden September 19 2007

6

US Lags on Primary Care Score vs

Health Care Expenditures

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

Health System Reform 2

Why do we need health system reform

What kind of models can help meet health system

goals

What role can you play

NASHP 3

27-year-old non-profit non-partisan organization

Offices in Portland Maine and Washington DC

Academy members

Peer-selected group of state health policy leaders

No duesmdashcommitment to identify needs and guide work

Working together across states branches and agencies to

advance accelerate and implement workable policy

solutions that address major health issues

4

4

5

0

05

1

15

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

Pri

ma

ry C

are

Sco

re

US

NTH

CAN AUS

SWE JAP

BEL FR

GER

SP

DK

FIN

UK

Source Dr Barbara Starfield Presentation at the Blekinge Conference

Ronneby Sweden September 19 2007

6

US Lags on Primary Care Score vs

Health Care Expenditures

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

NASHP 3

27-year-old non-profit non-partisan organization

Offices in Portland Maine and Washington DC

Academy members

Peer-selected group of state health policy leaders

No duesmdashcommitment to identify needs and guide work

Working together across states branches and agencies to

advance accelerate and implement workable policy

solutions that address major health issues

4

4

5

0

05

1

15

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

Pri

ma

ry C

are

Sco

re

US

NTH

CAN AUS

SWE JAP

BEL FR

GER

SP

DK

FIN

UK

Source Dr Barbara Starfield Presentation at the Blekinge Conference

Ronneby Sweden September 19 2007

6

US Lags on Primary Care Score vs

Health Care Expenditures

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

4

4

5

0

05

1

15

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

Pri

ma

ry C

are

Sco

re

US

NTH

CAN AUS

SWE JAP

BEL FR

GER

SP

DK

FIN

UK

Source Dr Barbara Starfield Presentation at the Blekinge Conference

Ronneby Sweden September 19 2007

6

US Lags on Primary Care Score vs

Health Care Expenditures

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

5

0

05

1

15

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

Pri

ma

ry C

are

Sco

re

US

NTH

CAN AUS

SWE JAP

BEL FR

GER

SP

DK

FIN

UK

Source Dr Barbara Starfield Presentation at the Blekinge Conference

Ronneby Sweden September 19 2007

6

US Lags on Primary Care Score vs

Health Care Expenditures

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

0

05

1

15

2

1000 1500 2000 2500 3000 3500 4000

Per Capita Health Care Expenditures

Pri

ma

ry C

are

Sco

re

US

NTH

CAN AUS

SWE JAP

BEL FR

GER

SP

DK

FIN

UK

Source Dr Barbara Starfield Presentation at the Blekinge Conference

Ronneby Sweden September 19 2007

6

US Lags on Primary Care Score vs

Health Care Expenditures

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

7

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

8

Primary Care Spending As A Percentage Of Total Medical Spending

Rhode Island Average (Baseline) And Benchmarks From Six Large

Insurers

Koller C F et al Health Aff 201029941-947

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

Why health system reform

Burden of Chronic Illness 9

Responsible for 7 out of every 10 deaths in the United States

On average presence of a chronic disease increases annual costs for a disabled Medicaid-only patient by approximately $8400

Super-additive effect increase in cost rises with additional comorbidities

Behavioral health comorbidities increase costs and worsen outcomes

Depression in diabetics increases mortality (30) and treatment costs (50-75)

Medicaid disproportionately affected

25 of Medicaid-only beneficiaries with disabilities had both a psychiatric and a cardiovascular condition (40 of most expensive 5)

Sources httpwwwcdcgovchronicdiseaseresourcespublicationsaagpdfchronicpdf

httpwwwchcsorgmediaFull_Report_Faces_IIpdf httpwfmhcomwp-

contentuploads201402WMHDAY2010pdf

httpwwwchcsorgmediaFaces_of_Medicaid_IIIpdf

Why health system reform

Unmet Behavioral Health Needs 10

Most primary care visits driven by behavioral health

Primary care providers prescribe most psychoactive medications and anti-depressants

Primary care system is not equipped to handle behavioral health concerns alone

Primary care providers often miss behavioral health conditions

Most individuals with mental health conditions do not receive treatment

Two-thirds of physicians reported difficulty referring patients to outpatient mental health services

Sources httpswwwapaorghealthbriefsprimary-carepdf

httpwwwncmedicaljournalcomwp-contentuploadsNCMJMay-Jun-09Collinspdf

httpwwwpsychosomaticmedicineorgcontent693270fullpdf

httpwwwnejmorgdoipdf101056NEJMsa043266

httpcontenthealthaffairsorgcontent283w490full

11

Background Image by Dave Cutler Vanderbilt

Medical Center

(httpwwwmcvanderbiltedulensarticleid=2

16amppg=999)

What kind of

models can

help meet

health system

goals

12

Medicaid PCMH Payment Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

Making medical home payments (30)

Payments based on provider qualification standards (28)

Payments based on provider qualification standards making payments in a multi-payer initiative (19)

Participating in MAPCP Demonstration (8 ME MI MN NY NC PA RI VT)

Participating in CPC Initiative (7 AR CO NJ NY OH OK OR)

AK

As of May 2014

httpwwwnashporgmed-home-map

Patient Centered Medical Homes

Key model features

Multi-stakeholder

partnerships

Qualification standards

aligned with new payments

Practice teams

Health Information

Technology

Data amp feedback

Practice Education

13

Graphic Source Ed Wagner Presentation entitled ldquoThe Patient-centered Medical Home Care Coordinationrdquo Available at wwwimprovingchroniccareorgdownloadscare_coordinationppt

12

Medicaid PCMH Payment Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

Making medical home payments (30)

Payments based on provider qualification standards (28)

Payments based on provider qualification standards making payments in a multi-payer initiative (19)

Participating in MAPCP Demonstration (8 ME MI MN NY NC PA RI VT)

Participating in CPC Initiative (7 AR CO NJ NY OH OK OR)

AK

As of May 2014

httpwwwnashporgmed-home-map

Patient Centered Medical Homes

Key model features

Multi-stakeholder

partnerships

Qualification standards

aligned with new payments

Practice teams

Health Information

Technology

Data amp feedback

Practice Education

13

Graphic Source Ed Wagner Presentation entitled ldquoThe Patient-centered Medical Home Care Coordinationrdquo Available at wwwimprovingchroniccareorgdownloadscare_coordinationppt

Patient Centered Medical Homes

Key model features

Multi-stakeholder

partnerships

Qualification standards

aligned with new payments

Practice teams

Health Information

Technology

Data amp feedback

Practice Education

13

Graphic Source Ed Wagner Presentation entitled ldquoThe Patient-centered Medical Home Care Coordinationrdquo Available at wwwimprovingchroniccareorgdownloadscare_coordinationppt

Raising Standards of Care

MainemdashModified NCQA

NCQA criteria plus 10 additional standards such as

Behavioral health integration

Population risk-stratification and management

Same-day access

Team-based care

Inclusion of patients amp families in redesign

Focus on cost containment and waste reduction in QI activities

Integration of health IT

Connection to community resources

OklahomamdashState Developed

Tier One 8 requirements such as

Providescoordinates all primary and preventive care

Organizes clinical data in electronic or paper format

Maintains a system to track referrals tests and follow-up results

Tier Two additional 9 requirements such as

Open access scheduling

Limited after-hours coverage

Tier Three 5 more requirements such as

Work in teams

Medication reconciliation

14

Sources wwwmainequalitycountsorg

wwwokhcaorgprovidersaspxid=8470ampmenu=74ampparts=

8482_10165

Minnesota Health Care Homes 15

Legislatively mandated all-payer program (Chapter 358 2008 Session Laws) serving over 3 million Minnesotans statewide

Payment ($1014-$7905 per-member per-month) tiered by patient complexity primary language other than English and presence of severe and persistent mental illness)

Intensive certification process using state-developed standards including on-site practice validation

2014 report found

Statistically significant improvement in colorectal cancer screening asthma care diabetes care and vascular care

Significantly fewer emergency department visits

92 net cost savings

2014 Report

httpwwwhealthstatemnushealthreformhomesoutcomesdocumentsevalu

ationreportsevaluationhch20102012pdf

Expanding Medical Home Capacity through

Multi-disciplinary Teams

Key model features

Practice teamsmdashoften shared among primary care practices (PCPs)

Payments to teams and qualified PCPs

Teams are based in a variety of settings

Community developed teams vary from region to region

16

Whorsquos on the Team

New or Expanded Roles for

Nurses

Behavioral Health Specialists

Community Health Workers

Social Workers

Peer Specialists

Pharmacists

Health Coaches

17

Shared Support Teams

IA

MT

ME

NY

AL

OK

MN

NC

MI

Making Payments to Shared Support Teams

Pursuing similar models through State Innovation Model Grants

ID

IL

PA

18

WA

OR

CA

AK

ND

SD WY

CO

NV

AZ

UT

NE

TX

NM

KS MO

AR

LA

HI

WI

IN

GA

FL

SC

TN

MS

KY

OH

VA WV

NJ CT

MA

NH

DE

VT VT

RI

MD

19

Michigan

Maine Alabama

Scope Payer(s) Payment Strategy Core Team Composition

Alabama

Patient Care

Networks of

Alabama

4 networks

170000 eligible

patients

Medicaid (Health

Home SPA)

Networks receive $950

PMPM for each Health

Home patient

Must include clinical director or

medical director clinical

pharmacist chronic care clinical

champion (nurse) care managers

(nurse or social worker)

Vermont

Community

Health Teams

14 teams

514000 eligible

patients

Medicaid Medicare

private plans some

self-insured

Teams receive $350000 for

5 FTE team costs divided

proportionately among

payers

Staffing structures are flexible

most include nurse care

managers behavioral health

specialistssocial workers health

coaches panel managers and

tobacco cessation counselors

Michigan

Physician

Organizations

(POs)

37 physician

organizations

(POs) 11

million eligible

patients

Medicaid Medicare

private plans some

self-insured

POs receive $350 PMPM

($450 from Medicare) for

care coordination and up to

$060 PMPM incentive

payment from all payers

Funding passed through to

providers as appropriate

POs may staff care managers

staffing requirement (25000

patient ratio) Originally included 1

complex and 1 moderate care

manager modified to

accommodate hybrid care

managers

New York

Adirondack

Region Medical

Home Pilot Pods

3 pods

106000 eligible

patients

Medicaid Medicare

private plans some

self-insured employers

including state

employees

Pods receive $7 PMPM

payment to PCPs who

contract with pods for

support services Average

payment to pod

approximately $350 PMPM

No specific staffing requirements

structures vary across pods

Shared Practice Team Snapshot

Building ldquoHealth Homerdquo Neighborhoods

using ACA Sec 2703 20

Medical Homes vs Health Homes

Designed for

everybody

Primary care provider-

led

Primary care focus

No enhanced federal

Medicaid match

Designed for eligible individuals with a serious mental illness andor specific chronic physical conditions

Primary care provider is key but not necessarily the lead

Focus on linking primary care with behavioral health and long-term care

Eight-quarter 90 percent federal Medicaid match

Significant increase in financial support to providers

Medical Homes Health Homes

21

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

Whorsquos on the Team

New or Expanded Roles for

Nurses

Behavioral Health Specialists

Community Health Workers

Social Workers

Peer Specialists

Pharmacists

Health Coaches

17

Shared Support Teams

IA

MT

ME

NY

AL

OK

MN

NC

MI

Making Payments to Shared Support Teams

Pursuing similar models through State Innovation Model Grants

ID

IL

PA

18

WA

OR

CA

AK

ND

SD WY

CO

NV

AZ

UT

NE

TX

NM

KS MO

AR

LA

HI

WI

IN

GA

FL

SC

TN

MS

KY

OH

VA WV

NJ CT

MA

NH

DE

VT VT

RI

MD

19

Michigan

Maine Alabama

Scope Payer(s) Payment Strategy Core Team Composition

Alabama

Patient Care

Networks of

Alabama

4 networks

170000 eligible

patients

Medicaid (Health

Home SPA)

Networks receive $950

PMPM for each Health

Home patient

Must include clinical director or

medical director clinical

pharmacist chronic care clinical

champion (nurse) care managers

(nurse or social worker)

Vermont

Community

Health Teams

14 teams

514000 eligible

patients

Medicaid Medicare

private plans some

self-insured

Teams receive $350000 for

5 FTE team costs divided

proportionately among

payers

Staffing structures are flexible

most include nurse care

managers behavioral health

specialistssocial workers health

coaches panel managers and

tobacco cessation counselors

Michigan

Physician

Organizations

(POs)

37 physician

organizations

(POs) 11

million eligible

patients

Medicaid Medicare

private plans some

self-insured

POs receive $350 PMPM

($450 from Medicare) for

care coordination and up to

$060 PMPM incentive

payment from all payers

Funding passed through to

providers as appropriate

POs may staff care managers

staffing requirement (25000

patient ratio) Originally included 1

complex and 1 moderate care

manager modified to

accommodate hybrid care

managers

New York

Adirondack

Region Medical

Home Pilot Pods

3 pods

106000 eligible

patients

Medicaid Medicare

private plans some

self-insured employers

including state

employees

Pods receive $7 PMPM

payment to PCPs who

contract with pods for

support services Average

payment to pod

approximately $350 PMPM

No specific staffing requirements

structures vary across pods

Shared Practice Team Snapshot

Building ldquoHealth Homerdquo Neighborhoods

using ACA Sec 2703 20

Medical Homes vs Health Homes

Designed for

everybody

Primary care provider-

led

Primary care focus

No enhanced federal

Medicaid match

Designed for eligible individuals with a serious mental illness andor specific chronic physical conditions

Primary care provider is key but not necessarily the lead

Focus on linking primary care with behavioral health and long-term care

Eight-quarter 90 percent federal Medicaid match

Significant increase in financial support to providers

Medical Homes Health Homes

21

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

Shared Support Teams

IA

MT

ME

NY

AL

OK

MN

NC

MI

Making Payments to Shared Support Teams

Pursuing similar models through State Innovation Model Grants

ID

IL

PA

18

WA

OR

CA

AK

ND

SD WY

CO

NV

AZ

UT

NE

TX

NM

KS MO

AR

LA

HI

WI

IN

GA

FL

SC

TN

MS

KY

OH

VA WV

NJ CT

MA

NH

DE

VT VT

RI

MD

19

Michigan

Maine Alabama

Scope Payer(s) Payment Strategy Core Team Composition

Alabama

Patient Care

Networks of

Alabama

4 networks

170000 eligible

patients

Medicaid (Health

Home SPA)

Networks receive $950

PMPM for each Health

Home patient

Must include clinical director or

medical director clinical

pharmacist chronic care clinical

champion (nurse) care managers

(nurse or social worker)

Vermont

Community

Health Teams

14 teams

514000 eligible

patients

Medicaid Medicare

private plans some

self-insured

Teams receive $350000 for

5 FTE team costs divided

proportionately among

payers

Staffing structures are flexible

most include nurse care

managers behavioral health

specialistssocial workers health

coaches panel managers and

tobacco cessation counselors

Michigan

Physician

Organizations

(POs)

37 physician

organizations

(POs) 11

million eligible

patients

Medicaid Medicare

private plans some

self-insured

POs receive $350 PMPM

($450 from Medicare) for

care coordination and up to

$060 PMPM incentive

payment from all payers

Funding passed through to

providers as appropriate

POs may staff care managers

staffing requirement (25000

patient ratio) Originally included 1

complex and 1 moderate care

manager modified to

accommodate hybrid care

managers

New York

Adirondack

Region Medical

Home Pilot Pods

3 pods

106000 eligible

patients

Medicaid Medicare

private plans some

self-insured employers

including state

employees

Pods receive $7 PMPM

payment to PCPs who

contract with pods for

support services Average

payment to pod

approximately $350 PMPM

No specific staffing requirements

structures vary across pods

Shared Practice Team Snapshot

Building ldquoHealth Homerdquo Neighborhoods

using ACA Sec 2703 20

Medical Homes vs Health Homes

Designed for

everybody

Primary care provider-

led

Primary care focus

No enhanced federal

Medicaid match

Designed for eligible individuals with a serious mental illness andor specific chronic physical conditions

Primary care provider is key but not necessarily the lead

Focus on linking primary care with behavioral health and long-term care

Eight-quarter 90 percent federal Medicaid match

Significant increase in financial support to providers

Medical Homes Health Homes

21

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

19

Michigan

Maine Alabama

Scope Payer(s) Payment Strategy Core Team Composition

Alabama

Patient Care

Networks of

Alabama

4 networks

170000 eligible

patients

Medicaid (Health

Home SPA)

Networks receive $950

PMPM for each Health

Home patient

Must include clinical director or

medical director clinical

pharmacist chronic care clinical

champion (nurse) care managers

(nurse or social worker)

Vermont

Community

Health Teams

14 teams

514000 eligible

patients

Medicaid Medicare

private plans some

self-insured

Teams receive $350000 for

5 FTE team costs divided

proportionately among

payers

Staffing structures are flexible

most include nurse care

managers behavioral health

specialistssocial workers health

coaches panel managers and

tobacco cessation counselors

Michigan

Physician

Organizations

(POs)

37 physician

organizations

(POs) 11

million eligible

patients

Medicaid Medicare

private plans some

self-insured

POs receive $350 PMPM

($450 from Medicare) for

care coordination and up to

$060 PMPM incentive

payment from all payers

Funding passed through to

providers as appropriate

POs may staff care managers

staffing requirement (25000

patient ratio) Originally included 1

complex and 1 moderate care

manager modified to

accommodate hybrid care

managers

New York

Adirondack

Region Medical

Home Pilot Pods

3 pods

106000 eligible

patients

Medicaid Medicare

private plans some

self-insured employers

including state

employees

Pods receive $7 PMPM

payment to PCPs who

contract with pods for

support services Average

payment to pod

approximately $350 PMPM

No specific staffing requirements

structures vary across pods

Shared Practice Team Snapshot

Building ldquoHealth Homerdquo Neighborhoods

using ACA Sec 2703 20

Medical Homes vs Health Homes

Designed for

everybody

Primary care provider-

led

Primary care focus

No enhanced federal

Medicaid match

Designed for eligible individuals with a serious mental illness andor specific chronic physical conditions

Primary care provider is key but not necessarily the lead

Focus on linking primary care with behavioral health and long-term care

Eight-quarter 90 percent federal Medicaid match

Significant increase in financial support to providers

Medical Homes Health Homes

21

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

Building ldquoHealth Homerdquo Neighborhoods

using ACA Sec 2703 20

Medical Homes vs Health Homes

Designed for

everybody

Primary care provider-

led

Primary care focus

No enhanced federal

Medicaid match

Designed for eligible individuals with a serious mental illness andor specific chronic physical conditions

Primary care provider is key but not necessarily the lead

Focus on linking primary care with behavioral health and long-term care

Eight-quarter 90 percent federal Medicaid match

Significant increase in financial support to providers

Medical Homes Health Homes

21

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

Medical Homes vs Health Homes

Designed for

everybody

Primary care provider-

led

Primary care focus

No enhanced federal

Medicaid match

Designed for eligible individuals with a serious mental illness andor specific chronic physical conditions

Primary care provider is key but not necessarily the lead

Focus on linking primary care with behavioral health and long-term care

Eight-quarter 90 percent federal Medicaid match

Significant increase in financial support to providers

Medical Homes Health Homes

21

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

Health Home (2703) Provider Standards

22

Culturally effective patient centered care

Evidence-based clinical guidelines

Preventive amp health promotion services

Mental health amp substance abuse services

Care management care coordination amp transitional care

Chronic disease management including self-management

Individual and family supports

Long-term care supports amp services

Person-centered care plan

HIT to link services facilitate communication provide practice feedback

Continuous quality improvement program

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

23

23

ACA Section 2703 Health Home Activity

WA

OR

TX

CO

NC

LA

PA

NY

IA

VA

NE

OK

AL

MD

MT

ID

KS

MN

NH

ME

AZ

VT

MO CA

WY

NM

IL

WI

MI

WV

SC

GA

FL

UT NV

ND

SD

AR

IN OH

KY

TN

MS

DE

RI

NJ CT

MA

HI

At Least One Approved State Plan Amendment(s) (15 States)

Planning Grant (18 States and Washington DC)

AK

As of May 2014

httpwwwnashporgmed-home-map

Note States with stripes have both

Missouri Health Homes

Eligible Entities

Federally Qualified Health Center

Rural Health Clinics

Hospital Clinic

Requires Behavioral Health Consultant on Team

$5887 Per-Member Per-Month

In first year reduced of patients with at least 1 hospitalization from 239 to 157

Eligible Entities

Community Mental Health Centers

Requires Primary Care Physician Consultant on Team

$7874 Per-Member Per-Month

In first year reduced of patients with at least 1 hospitalization from 337 to 246

Estimated $8326 per-member per-month net savings

24

Physical Health Program

Behavioral Health Program

Preliminary Outcomes

httpwwwintegrationsamhsagovabout-usCIHS_Presentation_Slides_062713pdf

Integrated System Models

Key model features

High-performing primary care

providers

Emphasis on coordination across

providers in the health care system

Shared goals amp risk

Population health management tools

Health information technology amp

exchange

Engaged patients

25

NASHPrsquos State Accountable

Care Activity Map 26

httpwwwnashporgstate-accountable-care-activity-map

NASHPrsquos State Accountable

Care Activity Map 26

httpwwwnashporgstate-accountable-care-activity-map

Oregon Coordinated Care Organizations

(CCOs) Payment Model

Authorized by the legislature in 2012 via SB 1580

Each CCO receives a fixed global budget for physicalmental(ultimately) dental care for each Medicaid enrollee

CCOs must have the capacity to assume risk

Implement value-based alternatives to traditional FFS reimbursement methodologies

CCOs to coordinate care and engage enrollees amp providers in health promotion

16 CCOs are currently operating in communities around Oregon serving around 90 percent of Medicaid members

Expected to meet key quality measurements while reducing the growth in spending by 2 over the next 2 year

httpsccohealthoregongovPagesHomeaspx

27

What role can you play

States have demonstrated a commitment and a unique role in advancing primary care

Unmet behavioral health needs is driving poor outcomes and high costs in our health system

Team-based care provides small rural practices with essential infrastructure including behavioral health support

Practice transformation takes time and resources

Data challenges are significant

ACA provides important health systems funding

Multi-payer financing opportunities are increasing

28

29

Please visit

wwwnashporg

httpnashporgmed

-home-map

wwwstatereforumorg

Contact

mtakachnashporg

bullHome | bullAbout NASHP | bullNewsroom | bullE-News signup | bullEmployment |

bullContact Us

Search this site

bullChronic amp Long Term Care bullComprehensive Health Reform bullCoverage amp Access bullHealth System Improvement

bullSpecific Services amp Populations

bullABCD Resource Center bullMaximizing Enrollment for Kids bullMedicaid and the DRA bullPatient Safety Toolbox

bullState Quality Improvement Partnership Toolbox

bullNASHP Projects amp Programs bullNASHP Publications by Category bullNASHP Publications by Date bullNASHP Authors Publications

bullNASHP Publications by Related Topics

bullPreconference Sessions bullConference Sessions bullConference Speakers

bullSession Speakers

New NASHP Publications bullA State Policymakersrsquo Guide to Federal Health Reform - Part I Anticipating How Federal Health Reform will Affect State Roles Many critical aspects of federal health reform will be implemented by the states Through program design regulations policies and practices state decisions and actions already play a profound role in shaping the American health care system Both the House and Senate reform proposals would dramatically change the federal structure within which state health policy operates Part I of this State Policymakersrsquo Guide provides a high-level view of existing state roles in the health care system and how federal reform will affect those roles Download the file Policymakers Guide Part 1 November 2009 bullState Policymakersrsquo Priorities for Improving the Health System This State Health Policy Briefing presents the issues identified by NASHPrsquos state leadership as their most significant priorities for improving their health systems As Academy members discussed their priorities a set of broader themes emerged These larger policy goals are Connect People to Needed Services Promote Coordination and Integration in the Health System Improve Care for Populations with Complex Needs Orient the Health System toward Results Increase Health System Efficiencies This briefing also provides a more detailed list of statesrsquo priorities presented in four major categories of state health policy Coverage and Access Health Systems Improvement Special Services and Populations and Long Term and Chronic Care Download the file Policymakers Priorities November 2009 bullSupporting State Policymakersrsquo Implementation of Federal Health Reform States will have enormous short-term and long-term needs for assistance as they grapple with federal health reform legislation Significant federal and private resources to support state-level implementation will be necessary Implementation support must be defined and coordinated quickly Technical assistance must be provided in a manner that corresponds with state needs State officials should be involved in the design of technical assistance so that it is most effective given varied state circumstances needs and capacities Technical assistance should inspire innovation among leaders even as it helps all states meet minimum standards of performance Download the file Supporting Implementation of Federal Reform

November 2009

Will Medicare Join State Multi-Payer Medical Home Initiatives A Conversation with States Regarding Medicarersquos Proposed Advanced Primary Care Demonstration

ABCD III Using Data Integration and Information Technology to Improve Care Coordination for Young Children

bullRWJF Blog Preparing for health reform in the states with Alan Weil

bullHome | bullAbout NASHP | bullNewsroom | bullE-News signup | bullEmployment |

bullContact Us

Search this site

bullChronic amp Long Term Care bullComprehensive Health Reform bullCoverage amp Access bullHealth System Improvement

bullSpecific Services amp Populations

bullABCD Resource Center bullMaximizing Enrollment for Kids bullMedicaid and the DRA bullPatient Safety Toolbox

bullState Quality Improvement Partnership Toolbox

bullNASHP Projects amp Programs bullNASHP Publications by Category bullNASHP Publications by Date bullNASHP Authors Publications

bullNASHP Publications by Related Topics

bullPreconference Sessions bullConference Sessions bullConference Speakers

bullSession Speakers

New NASHP Publications bullA State Policymakersrsquo Guide to Federal Health Reform - Part I Anticipating How Federal Health Reform will Affect State Roles Many critical aspects of federal health reform will be implemented by the states Through program design regulations policies and practices state decisions and actions already play a profound role in shaping the American health care system Both the House and Senate reform proposals would dramatically change the federal structure within which state health policy operates Part I of this State Policymakersrsquo Guide provides a high-level view of existing state roles in the health care system and how federal reform will affect those roles Download the file Policymakers Guide Part 1 November 2009 bullState Policymakersrsquo Priorities for Improving the Health System This State Health Policy Briefing presents the issues identified by NASHPrsquos state leadership as their most significant priorities for improving their health systems As Academy members discussed their priorities a set of broader themes emerged These larger policy goals are Connect People to Needed Services Promote Coordination and Integration in the Health System Improve Care for Populations with Complex Needs Orient the Health System toward Results Increase Health System Efficiencies This briefing also provides a more detailed list of statesrsquo priorities presented in four major categories of state health policy Coverage and Access Health Systems Improvement Special Services and Populations and Long Term and Chronic Care Download the file Policymakers Priorities November 2009 bullSupporting State Policymakersrsquo Implementation of Federal Health Reform States will have enormous short-term and long-term needs for assistance as they grapple with federal health reform legislation Significant federal and private resources to support state-level implementation will be necessary Implementation support must be defined and coordinated quickly Technical assistance must be provided in a manner that corresponds with state needs State officials should be involved in the design of technical assistance so that it is most effective given varied state circumstances needs and capacities Technical assistance should inspire innovation among leaders even as it helps all states meet minimum standards of performance Download the file Supporting Implementation of Federal Reform

November 2009

Will Medicare Join State Multi-Payer Medical Home Initiatives A Conversation with States Regarding Medicarersquos Proposed Advanced Primary Care Demonstration

ABCD III Using Data Integration and Information Technology to Improve Care Coordination for Young Children

bullRWJF Blog Preparing for health reform in the states with Alan Weil

For More Information on Medical Homes

Searchform-f8cf0search_theSearchform-f8cf0search_the

29

Please visit

wwwnashporg

httpnashporgmed

-home-map

wwwstatereforumorg

Contact

mtakachnashporg

bullHome | bullAbout NASHP | bullNewsroom | bullE-News signup | bullEmployment |

bullContact Us

Search this site

bullChronic amp Long Term Care bullComprehensive Health Reform bullCoverage amp Access bullHealth System Improvement

bullSpecific Services amp Populations

bullABCD Resource Center bullMaximizing Enrollment for Kids bullMedicaid and the DRA bullPatient Safety Toolbox

bullState Quality Improvement Partnership Toolbox

bullNASHP Projects amp Programs bullNASHP Publications by Category bullNASHP Publications by Date bullNASHP Authors Publications

bullNASHP Publications by Related Topics

bullPreconference Sessions bullConference Sessions bullConference Speakers

bullSession Speakers

New NASHP Publications bullA State Policymakersrsquo Guide to Federal Health Reform - Part I Anticipating How Federal Health Reform will Affect State Roles Many critical aspects of federal health reform will be implemented by the states Through program design regulations policies and practices state decisions and actions already play a profound role in shaping the American health care system Both the House and Senate reform proposals would dramatically change the federal structure within which state health policy operates Part I of this State Policymakersrsquo Guide provides a high-level view of existing state roles in the health care system and how federal reform will affect those roles Download the file Policymakers Guide Part 1 November 2009 bullState Policymakersrsquo Priorities for Improving the Health System This State Health Policy Briefing presents the issues identified by NASHPrsquos state leadership as their most significant priorities for improving their health systems As Academy members discussed their priorities a set of broader themes emerged These larger policy goals are Connect People to Needed Services Promote Coordination and Integration in the Health System Improve Care for Populations with Complex Needs Orient the Health System toward Results Increase Health System Efficiencies This briefing also provides a more detailed list of statesrsquo priorities presented in four major categories of state health policy Coverage and Access Health Systems Improvement Special Services and Populations and Long Term and Chronic Care Download the file Policymakers Priorities November 2009 bullSupporting State Policymakersrsquo Implementation of Federal Health Reform States will have enormous short-term and long-term needs for assistance as they grapple with federal health reform legislation Significant federal and private resources to support state-level implementation will be necessary Implementation support must be defined and coordinated quickly Technical assistance must be provided in a manner that corresponds with state needs State officials should be involved in the design of technical assistance so that it is most effective given varied state circumstances needs and capacities Technical assistance should inspire innovation among leaders even as it helps all states meet minimum standards of performance Download the file Supporting Implementation of Federal Reform

November 2009

Will Medicare Join State Multi-Payer Medical Home Initiatives A Conversation with States Regarding Medicarersquos Proposed Advanced Primary Care Demonstration

ABCD III Using Data Integration and Information Technology to Improve Care Coordination for Young Children

bullRWJF Blog Preparing for health reform in the states with Alan Weil

bullHome | bullAbout NASHP | bullNewsroom | bullE-News signup | bullEmployment |

bullContact Us

Search this site

bullChronic amp Long Term Care bullComprehensive Health Reform bullCoverage amp Access bullHealth System Improvement

bullSpecific Services amp Populations

bullABCD Resource Center bullMaximizing Enrollment for Kids bullMedicaid and the DRA bullPatient Safety Toolbox

bullState Quality Improvement Partnership Toolbox

bullNASHP Projects amp Programs bullNASHP Publications by Category bullNASHP Publications by Date bullNASHP Authors Publications

bullNASHP Publications by Related Topics

bullPreconference Sessions bullConference Sessions bullConference Speakers

bullSession Speakers

New NASHP Publications bullA State Policymakersrsquo Guide to Federal Health Reform - Part I Anticipating How Federal Health Reform will Affect State Roles Many critical aspects of federal health reform will be implemented by the states Through program design regulations policies and practices state decisions and actions already play a profound role in shaping the American health care system Both the House and Senate reform proposals would dramatically change the federal structure within which state health policy operates Part I of this State Policymakersrsquo Guide provides a high-level view of existing state roles in the health care system and how federal reform will affect those roles Download the file Policymakers Guide Part 1 November 2009 bullState Policymakersrsquo Priorities for Improving the Health System This State Health Policy Briefing presents the issues identified by NASHPrsquos state leadership as their most significant priorities for improving their health systems As Academy members discussed their priorities a set of broader themes emerged These larger policy goals are Connect People to Needed Services Promote Coordination and Integration in the Health System Improve Care for Populations with Complex Needs Orient the Health System toward Results Increase Health System Efficiencies This briefing also provides a more detailed list of statesrsquo priorities presented in four major categories of state health policy Coverage and Access Health Systems Improvement Special Services and Populations and Long Term and Chronic Care Download the file Policymakers Priorities November 2009 bullSupporting State Policymakersrsquo Implementation of Federal Health Reform States will have enormous short-term and long-term needs for assistance as they grapple with federal health reform legislation Significant federal and private resources to support state-level implementation will be necessary Implementation support must be defined and coordinated quickly Technical assistance must be provided in a manner that corresponds with state needs State officials should be involved in the design of technical assistance so that it is most effective given varied state circumstances needs and capacities Technical assistance should inspire innovation among leaders even as it helps all states meet minimum standards of performance Download the file Supporting Implementation of Federal Reform

November 2009

Will Medicare Join State Multi-Payer Medical Home Initiatives A Conversation with States Regarding Medicarersquos Proposed Advanced Primary Care Demonstration

ABCD III Using Data Integration and Information Technology to Improve Care Coordination for Young Children

bullRWJF Blog Preparing for health reform in the states with Alan Weil

For More Information on Medical Homes

Searchform-f8cf0search_theSearchform-f8cf0search_the