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)