Q4 Learning Session: National, State, and Local Briefing

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Patient-Centered Primary Care Collaborative of Central Ohio Q4 Learning Session Patient-centered medical home teams from central Ohio sharing actionable best practices to improve care coordination Please save the following dates for 2013 Quarterly Learning Sessions from 7:30-10:30AM: February 22, May 31, September 27, December 6 Coordinated by:

Lead Support

Major Support

Additional Support 100% Access HealthColumbus Board & Staff Individual & Corporate Donations


Patient-Centered Primary Care Briefing on National, State & Local Activity = strong potential for negative implications = uncertain implications at this time = strong potential for positive implications


Activity Monitor A.

CMMI: Comprehensive Primary Care Initiative (CPCI)

B.

CMMI: State Innovation Models (SIM)

C.

Medicare: Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration

D.

Medicare: Physician Payment Formula (27% reduction in Medicare reimbursements effective 1/1/2013)

E.

Medicaid: Medicare rates for primary care services in 2013 & 2014

F.

Ohio: Medicaid Health Homes

G.

Ohio: Medicare-Medicaid Integrated Care Delivery System (ICDS)

H.

Ohio: Patient-Centered Primary Care Collaborative

I.

Ohio: Medicaid Expansion

J.

Ohio: Health Insurance Exchange

K.

Local: Commercial Plans Shifting Resources to Primary Care

Dec


Activity Monitor A.

CMMI: Comprehensive Primary Care Initiative (CPCI)

B.

CMMI: State Innovation Models (SIM)

C.

Medicare: Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration

D.

Medicare: Physician Payment Formula (27% reduction in Medicare reimbursements effective 1/1/2013)

E.

Medicaid: Medicare rates for primary care services in 2013 & 2014

F.

Ohio: Medicaid Health Homes

G.

Ohio: Medicare-Medicaid Integrated Care Delivery System (ICDS)

H.

Ohio: Patient-Centered Primary Care Collaborative

I.

Ohio: Medicaid Expansion

J.

Ohio: Health Insurance Exchange

K.

Local: Commercial Plans Shifting Resources to Primary Care

Dec


CMMI: Comprehensive Primary Care Initiative (CPCI)


CMMI: Comprehensive Primary Care Initiative (CPCI)

Testing two models simultaneously: a service delivery model and a payment model

7 regions • 500 primary care practices • 2,144 providers • 313,000 Medicare beneficiaries

Ohio & Kentucky: Cincinnati-Dayton Region • 75 Primary Care Practices • 261 Providers • 10 Payers • Estimated 44,500 Beneficiaries Served • Aetna CareSource (Ohio only), Centene Corporation (Ohio only), Amerigroup (Ohio only), Anthem Blue Cross Blue Shield of Ohio, Humana, HealthSpan, Medical Mutual, Ohio Medicaid, UnitedHealthcare


State Innovation Model Grant Opportunity • $275 million competitive funding opportunity for states to design and test multi-payer payment and delivery models that deliver high-quality care and improve health system performance • $50 million for up to 25 Model Design Awards to support state payment reform planning and design efforts • $225 million for up to 5 Model Testing Awards to test and evaluate multi-payer health system transformation models • Ohio applied for a $3 million Model Design Award (plus $4.1 million in-kind from the state and participating health plans) to develop and submit a Model Testing Application in June 2013 • www.healthtransformation.ohio.gov/CurrentInitiatives/Payforhe althcarebasedonvaluenotvolume.aspx SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.


Ohio’s State Innovation Model Proposal 1. Expand the capacity and availability of qualified medical homes to most Ohioans across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe

2. Define and administer episode-based payments for a majority of acute medical events across Medicaid, Medicare, and commercially insured patients in a 3-5 year timeframe SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.


Payment Reform Project Plan and Timeline Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Preparation Stakeholder engagement

Model 1: PCMH/medical homes design Model 2: Episode-based payments design Infrastructure planning Model testing proposal

SOURCE: State Innovation Model Design Grant Application, Ohio Office of Health Transformation, September 21, 2012.


Medicaid Health Home for SPMI Implementation Schedule

Implementation Schedule Green - October 2012 Blue - April 2013 Yellow - July 2013

10


Ohio ICDS Regions NE Ottawa

NW

Integrated Care Delivery for Individuals Enrolled in both Medicare and Medicaid

Aetna Buckeye

Lake

United CareSource Buckeye

Lucas

Fulton

Geauga

NEC United CareSource

Cuyahoga Wood

Trumbull

Lorain

Medina

Summit

Portage Mahoning

Wayne

EC United CareSource Union

Delaware

WC

Central

Molina Buckeye

Franklin Clark

Madison

Molina Aetna

Montgomery Greene Pickaway

Butler

Warren

Clinton

SW

Hamilton

Molina Clermont Aetna

ICDS Regions and Demo Counties

NEC- Northeast Central

Central

NW - Northwest

EC - East Central

SW - Southwest

NE - Northeast

WC - West Central

Stark

Columbiana


LOCAL: Collaborative Approach for Improving Patient-Centered Primary Care

Why?

The need to improve patient-centered primary care as the foundation of accountable health care delivery to achieve: • better care • better health • better value

What?

Catalyze and coordinate the spread of: 1. patient-centered medical homes 2. primary care quality reporting 3. provider-based patient education & engagement 4. value-based purchasing

How?

Coordinate local health care improvement projects in collaboration with: • consumers • providers • purchasers • payers


LOCAL: Collaborative Approach for Improving Patient-Centered Primary Care

Why?

The need to improve patient-centered primary care as the foundation of accountable health care delivery to achieve: • better care • better health • better value

What?

Catalyze and coordinate the spread of: 1. patient-centered medical homes 2. primary care quality reporting 3. provider-based patient education & engagement 4. value-based purchasing

How?

Coordinate local health care improvement projects in collaboration with: • consumers • providers • purchasers • payers


SPREAD: Patient-Centered Medical Homes (PCMH)

In coordination with Access HealthColumbus: Coordinated by others: Recognized PCMHs

Recognized PCMHs

Emerging PCMHs


SPREAD: Patient-Centered Medical Homes (PCMH)

1200

450,000 400,000

1000

350,000 800 600

1,205

400 146 200 238

Total PCPs

300,000

250,000 Emerging PCMHs

200,000

Recognized PCMHs

150,000

0 Recognized Total Primary PCMH Care Practitioners* Practitioners (PCPs)** Sources * National Committee for Quality Assurance (NCQA) ** Practicing PCPs in Franklin County provided by Columbus Medical Association

Emerging PCMHs

Recognized PCMHs

100,000 50,000 0 Estimated Patients Served by PCMHs


SPREAD PRIMARY CARE QUALITY REPORTING: PCMH Improvement Dashboard

Outcome Measures from 3 PCMHs 100 90 80 70 60 50 40 30 20 10 0

2010 AVG 2012 AVG


SPREAD VALUE-BASED PURCHASING: Participating Organizations

The following health plans and employers are participating in our local Collaborative and have implemented value-based purchasing starting with patient-centered medical homes:  Aetna  Anthem Blue Cross & Blue Shield  Franklin County Cooperative Health Benefits Program  Humana  Medical Mutual of Ohio  MediGold  Nationwide Insurance  Ohio Public Employees Retirement System  School Employees Retirement System of Ohio  State Teachers Retirement System of Ohio  The Dispatch Printing Company  The Ohio State University  The Ohio State University Health Plan  UnitedHealthcare We anticipate additional purchasers will be joining our collaborative effort in 2013


New 2013 project: SPREAD PRIMARY CARE QUALITY REPORTING

What could happen that would make quality reporting of patient-centered primary care available and transparent in Central Ohio?

What could be different? Physicians and providers have accurate information to identify areas for quality improvement

Purchasers provide incentives to high-value primary care teams to accelerate transformation of care

Primary care teams improve quality of care and demonstrate increased value by measuring performance and care outcomes

More patients have improved health status and economic productivity


New 2013 project: SPREAD PROVIDER-BASED PATIENT ENGAGEMENT

Is Patient Engagement the next “Blockbuster Drug�? What could happen that would make effective patient engagement a standard of care in Central Ohio? What could be different? Patient and caregiver voices and perspectives embedded in quality improvement initiatives

Purchasers provide incentives to primary care teams to accelerate patient engagement as a standard of care

Clinicians fully utilizing their potential as the three most trusted* professions: Nurses, Pharmacists, Doctors (*Gallup poll)

More patients have improved health status and economic productivity


New 2013 project: SPREAD PROVIDER-BASED PATIENT ENGAGEMENT

Is Patient Engagement the next “Blockbuster Drug”? What could happen that would make effective patient engagement a standard of care in Central Ohio? What could be different?

Provider-based patient engagement will be focus Purchasers provide incentives 2013 Learning session to primary care teams to

Patient and caregiver voices of our February 22, and perspectives embedded in quality improvement initiatives

accelerate patient engagement as a standard of care

We will be inviting you and your colleagues to join us as….

Clinicians fully utilizing their PATIENTS/CONSUMERS potential as the three most More patients have improved trusted* professions: Nurses, health status and economic More details to be announced shortly! Pharmacists, Doctors productivity (*Gallup poll)


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