West Virginia Medical Home Initiative Through the Health Improvement Institute

AAFP Southeast Family Medicine ForumBriefing and OverviewAugust, 2008

Medicaid Transformation GrantsCenters for Medicare & Medicaid Services (CMS) initiative under DRA providing grants to states for innovative improvement of Medicaid program WV DHHR received 5 awards Each award is focused on a different aspect of Medicaid RedesignEach grant has 24 month timeline

Advanced Medical Home

Medicaid Transformation GrantsFive CMS grants awards: Personal ResponsibilityHealth System ImprovementApplied TechnologyStronger Medicaid ProgramEnhanced Medication Management

Health System Improvement Grant focused on:Improving primary care delivery systemCreating patient-centered medical homesLaunching Health Improvement Institute to help facilitate enhancement of primary care system of care

Activities in this area are coordinated by project management team

Delays & Waits for access 1-12 weeks3:1 Staffing RatioTHE PREVALENT SYSTEM OF CARE DELIVERYReimbursementPiecemealFee for Service

The Potential-The PioneersTime with doctor has gone from 8.2 minutes to 12.5 minutesTotal visit time has gone from 90 minutes to 42 minute averageHbA1c for their population of focus came down from 11 to 8Encounters and revenue for behavioral health services skyrocketed (in Medicaid cost based reimbursed and Medicare is 60% of the cap for behavioral counseling services)There are several key clinical indicators where they have reversed the health disparities and outcomes for minority populations are better Third available appointment has gone from 140 to 0 daysWent from breakeven/deficit spending to 7% positive marginTotal average aggregate costs of care for people with Diabetes 30-70% less than all other providersGrew from 16,000 patients to 40,000

CareSouth CarolinaSource: Ann Lewis, CEO CareSouth Carolina

PLANNED CARE IN THE NEW ENVIRONMENTM.D. N..P. N.P. R.N. R.N. M.A. DIETICIAN EXTERNALTEAMGuidelinesIn exam roomWith PDAs

EMR eliminateAll paper

Registry usedFor Master Scheduling

Community ResourcesPart of care teamOpen AccessNo shows decrease to2-5%Group VisitsUsed 25%

17% visits by EmailReimbursementAligned to supportPlanned careCare Team Work Spread 8:1 RatioContinuousFlow minimizeOn-site time

Informed,ActivatedPatient

ProductiveInteractions:

Evidence-based clinical managementCollaborative treatment planEffective therapiesSelf-management supportSustained follow-up

Prepared,ProactivePractice Team

Functional and Clinical Outcomes

Health System

Resources and Policies

Community

Organization of Health Care

Self-Mgt Support

Delivery System Design

Decision support

Clinical Information Systems

Diabetes Outcome MeasuresOctober 2005 September 2006All MCI diabetes patients n = 8631

Chart4

Sheet1

SECAT Performance Reports

MCI Network Level

Aug 1, 2005 - July 31, 2006

DiabetesMCI WellmarkMCI-allSouth-allSouth WellmarkWest-allWest WellmarkNHANES 2002Wellmark 2005HEDIS 2004 90%ileHEDIS 2004 Mean

Total Patients19348873694175702210998

Process goals:

HgAlc last 12 mo.94%95%95%95%90%95%87%91%85%

LDL last 12 mo.88%79%91%93%89%95%75%

SBP last 12 mo.96%86%95%94%94%96%

Microalb last 12 mo.79%69%86%87%80%87%38%62%48%

Outcome goals:

% HgAlc < 9.090%90%93%90%93%90%79%69%

% HgAlc < 8.080%80%84%80%85%80%70%

% HgAlc < 7.054%57%63%59%64%59%50%

% LDL < 13087%87%93%93%86%86%70%61%

% LDL < 10061%63%72%68%57%59%36%42%35%

% SBP < 14085%82%87%93%83%85%

% SBP < 13059%56%61%68%65%69%

HypertensionWellmark HTN

Total Patients4576

Process goals:

SBP last 12 mo.77%

Lipids last 12 mo.64%

Glucose last 12 mo.62%

Microalb last 12 mo.53%

Outcome goal:

% SBP < 14080%81%88%86%34%71%62%

% SBP < 13052%

Sheet2

SECAT Performance Reports

MCI Network Level

Aug 1, 2005 - July 31, 2006

DiabetesMCISouth WellmarkWellmark 2005NHANES 2002MCI-all patientsHEDIS 2004 MeanSouth-allSouth WellmarkWest-allWest WellmarkNHANES 2002Wellmark 2005HEDIS 2004 90%ileHEDIS 2004 Mean

Total Patients19341759988873694175702210998

Process goals:

HgAlc last 12 mo.94%95%87%95%85%95%95%90%95%87%91%85%

LDL last 12 mo.88%93%75%79%91%93%89%95%75%

Microalb last 12 mo.79%87%38%69%48%86%87%80%87%38%62%48%

Outcome goals:

% HgAlc < 9.090%90%69%93%90%93%90%79%69%

% HgAlc < 8.080%70%80%84%80%85%80%70%

% HgAlc < 7.054%50%57%63%59%64%59%50%

% LDL < 13087%87%61%93%93%86%86%70%61%

% LDL < 10061%36%63%35%72%68%57%59%36%42%35%

% SBP < 14085%82%87%93%83%85%

% SBP < 13059%56%61%68%65%69%

HgAlc

HypertensionWellmark HTNLDL

Total Patients4576Microalbumin

Process goals:

SBP last 12 mo.77%

Lipids last 12 mo.64%

Glucose last 12 mo.62%

Microalb last 12 mo.53%

Outcome goal:

% SBP < 14080%34%81%62%88%86%34%71%62%

% SBP < 13052%

Sheet2

00

00

00

MCI

Wellmark 2005

% with test done in the last year

Sheet3

0.950.865

0.930.754

0.870.378

South Wellmark

Wellmark 2005

000

000

000

000

000

NHANES 2002

MCI-all patients

HEDIS 2004 Mean

Chart2

0.920.880.64

0.790.730.49

0.690.650.4

MCI

HEDIS 2005 (90%ile)

HEDIS 2005 (mean)

Sheet1

MCIHEDIS 2005 (90%ile)HEDIS 2005 (mean)

% HgA1c < 9.092%79%69%

% LDL < 13088%73%65%

% LDL < 10064%49%40%

Sheet1

000

000

000

MCI

HEDIS 2005 (90%ile)

HEDIS 2005 (mean)

Sheet2

Sheet3

CMS Profit = $8.00 / testYields $100,000 / yr.

Chart1

86

436

762

959

892

1035

1294

1241

1416

1613

2439

2717

MCI Microalbumin Tests (per Qtr.)

Charts 7-04

Charts 7-04

86

436

762

959

892

1035

1294

MCI Total Microalbumin Tests per Quarter

Chart by Clinic 7-04

00871008396158

BeaverdaleBeaverdale50132928275

105811211597104130

4112037555845

FMUFMU037585365

423955517978

02131166

0258210164129248347

67102100156137137143

0098112129141183

Capital IMCapital IM01129

0365620

103942432755

8643676295989210351294

3rd 2002

1st 2003

2nd 2003

3rd 2003

4th 2003

1st 2004

2nd 2004

MCI Microalbumin Tests per Quarter by Clinic

Charts Oct. 05

00871008396158

BeaverdaleBeaverdale50132928275

105811211597104130

4112037555845

FMUFMU037585365

423955517978

02131166

0258210164129248347

67102100156137137143

0098112129141183

Capital IMCapital IM01129

0365620

103942432755

8643676295989210351294

3rd 2002

1st 2003

2nd 2003

3rd 2003

4th 2003

1st 2004

2nd 2004

MCI Microalbumin Tests per Quarter by Clinic

Data

Data

008710083961588512470152211

BeaverdaleBeaverdale5013292827584100125131159

105811211597104130199179276281371

4112037555845496177104168

FMUFMU03758536589110123214231

4239555179787258676371

02131166871075

0258210164129248347233215277503491

67102100156137137143187158151197189

0098112129141183158260280538560

Capital IMCapital IM011293697110164180

036562009194241

1039424327554138284340

3rd 2002

1st 2003

2nd 2003

3rd 2003

4th 2003

1st 2004

2nd 2004

3rd 2004

4th 2004

1st 2005

2nd 2005

3rd 2005

Quarterly Microalbumin Test by Clinic7/02 - 7/05

Charts 12-03

86

436

762

959

892

1035

1294

1241

1416

1613

2439

2717

MCI Microalbumin Tests (per Qtr.)

MicroAlbumin Tests (82044 & 82043) per quarter (calendar year)

3rd 20021st 20032nd 20033rd 20034th 20031st 20042nd 20043rd 20044th 20041st 20052nd 20053rd 2005Total

North0087100839615885124701522111166

Beaverdale50132928275841001251311591030

Campus1058112115971041301991792762813711932

East4112037555845496177104168689

FMU03758536589110123214231980

Indianola4239555179787258676371639

Johnston0213116687107566

South02582101641292483472332152775034913075

Urbandale671021001561371371431871581511971891724

West00981121291411831582602805385602459

Capital IM011293697110164180600

Central IM036562009194241133

West IM1039424327554138284340397

Total86436762959892103512941241141616132439271714890

008710083

BeaverdaleBeaverdale5013292

105811211597

411203755

FMUFMU03758

42395551

021311

0258210164129

67102100156137

0098112129

Capital IMCapital IM011

03656

10394243

3rd 2002

1st 2003

2nd 2003

3rd 2003

4th 2003

Microalbumin Tests per Quarter by Clinic

86

436

762

959

892

MCI MicroAlbumin Tests per Quarter

Transformational change:In the Health Care Delivery SystemFor Medicaid patients with Diabetes receiving these services 2000-2002Source: South Carolina Office of Budget and Control 2004

IndicatorCareSouthAll Family Practice Physicians (Median)Avg. total annual payment per patient$1, 340$1,778Avg. annual drug payment per patient*$502$576Avg. office visit payment per patient*$441$168Avg. inpatient hospitalization payment*$172$634Average emergency room payment*$15$22

West Virginia Health Improvement InstituteStakeholder Advisory GroupMeet QuarterlyVirtual Engagement On-GoingProviderEducationSelf ManagementAdoption ofHITMeasurement/Reimbursement/ReportingInnovation Community150+ PracticesPilotsPilotsPilots Measures& PilotsSteering Committee

Medical Home Learning CommunityWV Health Improvement InstituteResultsRecruitment CohortDemonstrations120-150 Practice TeamsTeam-based learning around a care teamLearn elements of Medical HomeTest practice changesShare ideas, successes and failures with each otherMonitor and report common measures of performanceEvolve the practice into a patient-centered medical homeProvider Training and Support WorkgroupCoaching and technical assistanceMeasures for monthly reportingTopic-specific webcastsMonthly team callsVirtual short-cycle learning sessionsSelf-Management WorkgroupCoaching and technical assistanceTopic-specific webcastsMeasurement andReimbursement WorkgroupMeasures for monthly reportingAdoption of Electronic Health Records WorkgroupCoaching and technical assistanceSelf-Management DemonstrationPayer Pay for Performance DemonstrationElectronic Health Records DemonstrationPerformance measuresClinical outcomes measuresNew reimbursement modelsEconomic indicators reflected in Medicaid claims and health status of overall Medicaid populationsIncreased successful adoption of EHRsNew care models to spread to providers across the stateMedical Home penetration

Communication VehiclesQuarterly Meetings

www.wvhealthimprovement.org

Newsletter

RCHAUFOURNIER@SPREADINNOVATION.COM301-529-7858Roger Chaufournier

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