september 2010 lisa m. letourneau md, mph quality counts
TRANSCRIPT
September 2010
Lisa M. Letourneau MD, MPHQuality Counts
Objectives
• Review key aspects, goals for Maine PCMH Pilot
• Provide updates on Maine Pilot
• Share lessons learned to date
Maine PCMH Pilot Key elements:
– 3-year multi-payer PCMH pilot– Collaborative effort of key stakeholders, all major payers– Adopted common mission & vision, guiding principles for Maine
PCMH model– Selected 22 adult / 4 pedi PCP practices across state – Supporting practice transformation & shared learnings beyond pilot
practices– Committed to engaging consumers/ patients at all levels– Planning rigorous outcomes evaluation (clinical, cost, patient
experience of care)
Maine PCMH Pilot Leadership
Quality Counts
Maine Quality Forum
Maine Health Management
Coalition
Maine PCMH Pilot - Timeline• Jan 2009: Call for practice applications
• May 2009: Practices notified – start of 6mo “ramp-up period”
• Sept 2009: NCQA PPC-PCMH applications completed
• Sept-Dec: practices contracted with payers
• Jan 2010: Start date for PCMH payments
• Jan 2010- Dec 2012: 3-year PCMH Pilot
Maine PCMH Pilot Practice “Core Expectations”
1. Demonstrated physician leadership2. Team-based approach3. Population risk-stratification and management4. Practice-integrated care management5. Same-day access6. Behavioral-physical health integration7. Inclusion of patients & families8. Connection to community / local HMP9. Commitment to waste reduction10.Patient-centered HIT
Maine PCMH Pilot – Payment Model
• Anthem, Aetna, HPHC & MaineCare participating
• Common 3-component payment model:1. Prospective (pmpm) care management
payment (approx $3 pmpm)2. Ongoing FFS payments3. Use existing payer P4P programs
• Practices expected to make changes across all populations
Medicare Med Home Demo• CMS “Multi-Payer Advanced Primary Care”
(MAPCP) demonstration• States with multi-payer pilots invited to apply – must
meet eligibility criteria– Majority of payers must participate– Pilot must be consistent with natl PCMH defn’s– Must connect with community resources & supports
• CMS to select 6 states – Medicare to participate as payer in state PCMH pilots
• Maine well-positioned, but stiff competition!
Medicare Med Home Demo
Timeline:
• Applications due Aug 15
• CMS decision by fall
• Demo to start Jan 2011
• Demo runs 2011-2013
PCMH Evaluation & Data for Improvement
• Patient experience of care– CG-CAHPS patient surveys
• Clinical quality measures– Adult & pedi
• Cost & resource use (HealthDialog rpts)– Hosp’s, readmissions, ED use, imaging
• Practice changes
Data Feedback: Clinical Quality
• Pilot expectation that practices report clinical quality measures quarterly
• Started with 2008 (baseline), then Q1 2010 onward
• Adult: 31 clinical quality measures, aligned with meaningful use
• Using online data reporting system developed by OnPoint
Clinical Data Feedback
X
Clinical Data Feedback
Data Feedback: Cost & Resource Use
• Use claims from Maine All-Claims Paid Database, via MHDO
• MQF contracts with Health Dialog to produce reports
• First reports delivered to practices mid-August, using 2008 claims data
• Anticipate ongoing, q6mos reports
Provider Performance Measurement ReportsAugust 2010
Performance SummaryPerformance summary includes:• Demographics about
practice’s panel• Overall practice performance
compared to peers in 3 areas of unwarranted variation
• Evaluation of overall effectiveness and efficiency
• Practice’s score on 6 key utilization measures
• Best opportunities for improvement in the practice
Performance Summary• Practice’s overall score is
compared to peer norm in each of 3 categories of unwarranted variation:– Effective care
(evidence based treatment or intervention to improve health status or quality of life)
– Supply sensitive care (services that strongly correlate with resource supply)
– Preference sensitive care (conditions that have multiple treatment options and the treatment decision should reflect the patient’s preferences
Effectiveness and Efficiency
• Looks at overall supply sensitive cost score compared to the overall effective care gap score
• Practice is compared to other practices on a scatter plot with four quadrants based on the population medians
Utilization Measures
• Utilization measures look at overall admissions, emergency department visits, and PCP and specialist visits per 1000 patients per year
• Summary measures on prescription count per 1,000 patients and generic fill rate are included
• Colored triangles indicate where practice is significantly different from peers
Best Opportunities for Improvement
• Shows where practice is significantly different from peers AND where the total impact of improving is highest
Performance Impact
• Lists all measures where practice is significantly different from peer norm
Total Impact estimates the number of opportunities or the total dollars that could be impacted if your practice were to perform at the same level as the peer norm.
Effective, Supply Sensitive, Preference Sensitive Care
• Each section contains 3 components:
1. Cover page with table of contents
2. Overall measure for care type3. Overall and detail information
for individual measures
Lessons Learned Maine PCMH Pilot
• Change starts with effective leadership– Primary selection criteria for Pilot
– Don’t assume physician leadership skills - need ongoing support
• Change happens through effective teams
• NCQA PPC-PCMH “medical home”
• It’s all about relationships – with patients AND within teams
• Recognize value of “outside” coaching
Where We’re Aiming: Medical Home Is Where…
• Patients feel welcomed
• Staff takes pleasure in working
• Physicians feel energized every day
Maine PCMH Pilot - Issues TBD
• Will new payment be enough to support true practice transformation?
• How best to engage specialists, hospitals in shared goals, shared cost savings?
• How to engage patients in new partnership?
• How to spread learnings to other “non-Pilot” practices
• And more??
Contact Info / Questions Lisa Letourneau MD, MPH• [email protected]• 207.415.4043
Sue Butts Dion• [email protected]
Maine PCMH Pilot• www.mainequalitycounts.org
(See “Major Programs” “PCMH Pilot”)