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Edwina RogersExecutive Director
Patient Centered Primary Care Collaborative601 Thirteenth St., NW, Suite 400 North
Washington, D.C. 20005Direct: 202.724.3331Mobile: 202.674-7800
Patient Centered Primary Care Collaborative
July 16th Stakeholder’s Working Meeting
Public and Private Initiatives: Advancing the PCMH
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Welcome and OverviewJuly 16th 2009 PCPCCStakeholder’s Working Meeting
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Pilots in planning phase for 2009 implementation
Multi-Stakeholder demonstrationPilot activity in early stages of development
Pilots in progress
Patient Centered Medical Home Pilot Activity
Overview of PCPCC Activity
•27 Multi-stakeholder Pilots in 20 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
Blue Cross Blue Shield Plan Pilots
(as of January 2009)
• CMS will select 8 states for the Medicare Medical Home Demonstration
• Sample Medical Home Pilot Sites
• Marillac Clinic
• Geisinger Medical Home Pilot
• Southeast Pennsylvania Learning Collaborative
Sample State PCMH Example
= New Demonstration Pilots Taking Place or in the Process of Being Enacted
Key PCMH Pilot Programs Either in Place or in Development
•Cigna PCMH Pilot in New Hampshire•Aetna has PCMH Pilots in
•Colorado•Maine•Mid-Hudson Valley•Pennsylvania•Central New Jersey
•Priority Health PCMH Pilot Program in Michigan•Wellpoint, Inc. PCMH Pilot in New York City•UnitedHealth Medical Home Pilot in Arizona (Tucson & Phoenix)•Blue Cross Blue Shield PCMH Pilot in Nebraska in early stages of development
Some New 2009 Single-Payer Health Plan Demonstration Pilots
= Identified to have a medical home initiative
Source: National Academy for State Health Policy State Scan, November
2008
State Initiatives to Advance Medical Homes in Medicaid/ SCHIP
State Policy PCMH Implementation
Introduced Legislation in 2009
1.California2.New Jersey3.Hawaii4.Maryland5.Nebraska6.West Virginia7.Texas8.Washington 9.Wyoming
Introduced Legislation in 2008
1.Iowa2.Kansas3.Massachusetts4.New Hampshire5.New York6.Oklahoma7.Minnesota8.Washington9.Maryland10.Maine11.Vermont12.Utah
Enacted Legislation in 2007 and 2008
1.Colorado2.Louisiana3.Minnesota4.Iowa5.Washington6.Oklahoma7.Maine8.New York
Patient-Centered Medical Home2009 Overview of Pilot Activity and Planning Discussions
RI
Multi-Payer pilot discussions/activity
Identified pilot activity
No identified pilot activity – 6 States
PCPCC: 2008-2009
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100
200
300
400
500
600
Membership Tripled
Membership
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
Revenue Doubled
Revenue
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Key Organizations Joining PCPCC Since April 28th Stakeholder Meeting
Patient Centered Primary Care Collaborative
Four ‘Centers’ - Over 770 volunteer members 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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PCPCC Payment Model
Key physician and practice accountabilities/ value added
services and tools
Proactively work to keep patients healthy and manage existing illness or conditions
Coordinate patient care among an organized team of health care professionals
Utilize systems at the practice level to achieve higher quality of care and better outcomes
Focus on whole person care for their patients
Perfo
rman
ce S
tan
dard
s
Incentiv
es
Incentives
Incentives
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Statement on the PCMH: President Obama
“I support the concept of a patient-centered medical home, and as part of my health care plan, I will encourage and provide appropriate payment for providers who implement the medical home model, including physician-directed, interdisciplinary teams, care management and care coordination programs, quality assurance mechanisms, and health IT systems which collectively will help to improve care.”
President Barack Obama
PCMH - HOUSE OF REPRESENTATIVES ACTIVITY
The House Tri-Committee Health Reform Draft
On June 19, 2009 the Chairmen of the three committees with jurisdiction over health policy in the U.S. House of Representatives unveiled their discussion draft for health care reform. The draft would reduce out-of-control costs, improve choices and competition for consumers and expand access to quality, affordable health care for all Americans.Included in this draft is language on the Patient Centered Medical Home (PCMH). The draft bill includes funding of $350 million for PCMH pilot programs, which include Independent PCMHs and Community-based Medical Homes.
•'The Secretary shall establish a medical home pilot program (in this section referred to as the ‘pilot program’) for the purpose of evaluating the feasibility and advisability of reimbursing qualified patient-centered medical homes for furnishing medical home services (as defined under subsection (b)(2)) to high need beneficiaries (as defined in subsection (b)(1)).'
•Sec.1822. Medical Home Pilot Program. Establishes a 5-year pilot program to test the medical home concept with high-need Medicaid beneficiaries. The federal government would match costs of community care workers at 90% for the first two years and 75% for the next 3 years, up to a total of $1.235 billion.
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PCMH - SENATE ACTIVITY
•The Senate HELP Committee released the ‘Affordable Health Choices Act’ on June 9, 2009 outlining the committee’s option for health care reform.
Section 212 of the draft legislation - ‘Grants to Establish Community Health Teams to Support a Medical Home Model’ stated that:
•The Secretary of HHS would establish a grant program to creating the “community health team which is community-based, multi disciplinary, interprofessional teams (on the model of medical home) to increase access to comprehensive coordinated care.
Enhancing Health Care Workforce Education and Training - There is language in the bill also aimed to enhance health care workforce education and training in Family Medicine, General Internal Medicine, General Pediatrics, and Physician Assistantship by providing grants to develop and operate training programs, financial assistance of trainees and faculty, and faculty development in primary care and physician assistant programs. This bill would provide grants to establish, maintain and improve academic units in primary care. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home. Authorization is set at $125 million.
•The Senate Finance Committee is working on its own health care reform legislation. Their focus on primary care and the medical home model includes:
Primary Care Bonus Payment - Certain Medicare providers being eligible for a primary care services bonus payment of at least 5 percent over the fee schedule amount for providing certain evaluation and management services.Chronic Care Management Innovation Center (CMIC) - The establishment of the CMIC at CMS for Medicare by the Secretary of HHS for the purpose of testing and disseminating payment innovations that foster patient-centered care coordination, with advancing PCMHs at the top of their list.Potential Items- The Committee would also look to reimburse states that use the PCMH model in their Medicaid programs.
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THE DAY AHEAD…
Morning Session
PCMH: Leaps Forward Through Federal Initiatives (Panel 1) At our April conference we heard from CMS about their PCMH planned Medicare demonstration, but there are numerous other federal agencies that are charging ahead with PMCH activities; we will hear from three such agencies.
The Big Picture: Focus on Health Care Reform (Panel 2) With extensive activity happening in Congress and the Obama administration, now is the time to seriously focus on federal healthcare reform. Three experts will give us the big picture overview and include in-depth discussions on relevant topics like workforce supply and primary care payment reform.
Consumers Speak: A First-Hand PCMH Experience (Panel 3) In the PCMH model, there is nothing more important than continued focus on consumer involvement. During this session, we will discuss important topics such as integration of families, cultural competence, prevention and access, among other issues.
The Nuts and Bolts of a Successful PCMH - How it Works (Panel 4) This panel will focus on numerous important topics pertaining to medium and small-sized practice; including transformation, behavioral health, the team approach, return on investment, among other important components.
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THE DAY AHEAD…
Networking Lunch
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THE DAY AHEAD…
Afternoon SessionsEach Center will present their unique accomplishments to date and their draft goals/mission for the upcoming Fiscal Year. In addition, each Center will bring their own topics into discussion,
which include, among other things:
Center for Public Payer Implementation – The CPPI will detail current health reform legislation including Senate Finance Committee, Senate HELP committee and House leadership proposals; PCMH and the full spectrum of behavioral health issues; update on State Medicaid activities; health plans and PCMH activity; growing PCMH and federal programs; Medicare demonstration pilots; and PCMH and the integration of medication management.
Center for eHealth Information Adoption and Exchange– The CeHIA will discuss the progress of creating an eHealth and PCMH web-based resource center; we will hear reports from the center taskforces which includes participatory engagement, meaningful use, and decision support; and review case studies on HIT integration and the medical home.
Center for Multi-Stakeholder Demonstrations – The CMD will discuss the landscape of the current multi-stakeholder demonstration projects with particular attention to recently started pilot projects.
Center for Benefit Redesign and Implementation– The CBRI will discuss its progress on a value based benefit design white paper; needed employer-to- employee communication on PCMH; onsite primary care clinics and the PCMH universe; the new mental health parity legislation (behavioral health and productivity); and the need for policy changes concerning high deductible health plans so that primary care and pharmaceuticals for chronic conditions receive first dollar coverage.
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House bill limit Medical Home pilots to “High need” beneficiaries?
• -- this will not build a sustainable system of primary care where the focus is on preventing a person from becoming a “High need” beneficiaries.
The Patient Centered Medical Home agreed on set of principles between providers and buyers of health care that serve as foundation of health-care system.
Personal Relationship: Each Patient has an ongoing relationship with a personal clinician trained to provide first contact, continuous and comprehensive care.
Expanded Access:
Team Approach:
Comprehensive: The personal clinician is responsible for providing for all the patient’s health care needs at all stages of life or taking responsibility for appropriately arranging care with other qualified professionals.
Coordination:
Quality and Safety:
Added Value: Payment that appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home
A Medical School, a Funeral and a Hospital
Patient Centered Primary Care Collaborative
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