ibm healthcare and life sciences patient-centered medical home pilots landscape as of 06/19/2008

IBM Healthcare and Life Sciences

Patient-Centered Medical Home Pilots Landscape as of 06/19/2008

2 © 2007 IBM Corporation


PCMH Pilots Map

Multi-Payer pilot discussions/activity

RI

Identified pilot activity

No identified pilot activity

Note: this chart is from Carol Flamm, who leads the PCPCC Center for Multistakeholder Demonstrations. It doesn’t bear any one-to-one relationship to the PCMH pilot details included in this deck, but is offered as an example of how the state and local activities might be summarized.



PCMH Pilots Summary (multi-payer and significant single payer projects)

State Region Convening Authority Slide Notes

New York Mid-Hudson Valley THINC RHIO 5

Colorado Statewide Colorado Clinical Guidelines Collaborative

6

New York New York City Group Health & Health Plan of NY

7

Rhode Island Statewide RI Office of Health Insurance Commissioner

8

Washington Statewide Wash. State Dept. of Health

9

Pennsylvania Southeast Governor’s Office of Health Reform

10

New York Albany CDPHP 11

Tennessee Memphis Memphis Business Group on Health

12

New Hampshire Dartmouth-Hitchcock patients

CIGNA and Dartmouth-Hitchcock

13

Texas Dallas, Houston, San Antonio, Austin

Texas Academy of Internal Medicine

14

Michigan Statewide Michigan Primary Care Initiative

15

Ohio Southwest Greater Cincinnati Health Improvement Collaborative

16



PCMH Pilots Summary (multi-payer and significant single payer projects)

State Region Convening Authority Slide Notes

North Carolina Statewide North Carolina Division of Medical Assistance

(Medicaid)

17

Washington Seattle – Everett – Renton Area

Boeing Company 18

Vermont Statewide BCBS of Vermont 19

Michigan Statewide BCBS of Michigan 20



PCMH Pilots Detail

State:New York

Region:Mid-Hudson Valley

Convening Authority:THINC RHIO

Payer(s):Aetna, CDPHP, United HealthCare, MVP, Wellpoint, Hudson Health

Overview:

Providers and covered lives:500 providers; 1M lives

PCMH components:

Project contact(s):

Link to press release: Notes:

2-5 year pilot to demonstrate improved cost and quality of care. P4P / Medical Home project funded by $1.5M grant from NYDOH.

John [email protected] (845) 897-6359

Asha [email protected]

(845) 896-4726, Ext. 3205

EHR (eClinical Works); ePrescribing (RxHub and SureScripts); provider portals (HealthVision); data aggregation & analytics (IPRO and VIPS); Continuity of Care Document for interoperable data elements between ambulatory care practices & other health entities (e.g., hospitals); Masspro support for practice assessment and redesign; multi-disciplinary approach



PCMH Pilots Detail

State:Colorado

Region:Statewide, but primarily Front Range and Denver centered

Convening Authority:Colorado Clinical Guidelines Collaborative (CCGC)

Payer(s):Aetna, Anthem-WellPoint, Cigna, Humana, Rocky Mtn Health Plan, United, and Medicaid

Overview:

Providers and covered lives: PCMH components:

Project contact(s):

Link to press release:

XXXXXXXXXXXXXXXX

Notes:6/17/08: Seeking Funding for Technical Assistance and Evaluation. The Commonwealth Fund will choose Pilot Evaluator.

2-year pilot to reduce fragmentation and implement systems and processes, using evidence-based clinical guidelines and improve healthcare in Colorado.

Marjie [email protected](720) 297-1681

Julie [email protected]

(720) 297-1681

Guiding Principles: Joint Principles, NCQA PPC-PCMH, 3-Tiered Reimbursement (FFS, Care Management Fee and P4P)

Use of disease registries;Reach My Doctor; Technical support for Practice Transformation and achievement of NCQA PPC-PCMH. Measurement on Cost, Quality (Chronic Disease and Prevention) and Provider Office/Patient Satisfaction. Evaluation Methodology-Matched Comparison Group



PCMH Pilots Detail

State:New York

Region:New York City

Convening Authority:Group Health Inc. and Health Plan of New York

Payer(s):Group Health Inc. and Health Plan of New York

Overview:

Providers and covered lives:50 practices; 100 providers; 20k covered lives

PCMH components:

Project contact(s):


XXXXXXXXXX

XXXXXXXXXXXXXXXX

Notes:

2-year demo of PCMH model by Group Health Inc. (GHI), a New York State health insurer, and Health Plan (HP) of New York, a large HMO.

Judith [email protected](860) 679-3815

"advanced health information technology" to direct services to patients and coordinate services from other physician; care coordination services and technical support to redesign physician offices and management systems



PCMH Pilots Detail

State:Rhode Island

Region:Statewide

Convening Authority:RI Office of Health Insurance Commissioner

Payer(s):BCBSRI, United, Neighborhood Health Plan, Medicaid

Overview:


Project contact(s):


XXXXXXXXXX

XXXXXXXXXXXXXXXX

Notes:

2-year pilot to demonstrate that PCMH model is sustainable, i.e. provides better care, provides more cost-effective care, enhances patient satisfaction with medical care received and provides improved professional satisfaction for primary care physicians

Deidre [email protected]

Lynn [email protected](401) 528-3222

Practices must satisfy nine NCQA PPC standards for a PCMH (access and communication, patient tracking and registry, care management, patient self-management support, electronic prescribing, test tracking, referral tracking, performance reporting and improvement and advanced electronic communications).

Insurers providing or funding dedicated nurse for practice support. $3PMPM funding for practices NCQA PPC-PCMH recognized (Level 1 in 6 mos, Level 2 in 18 mos)



PCMH Pilots Detail

State:Washington

Region:Statewide

Convening Authority:Wash. State Dept. of Health, Children with Special Health Care Needs Program

Payer(s):Public sector project

Overview:

Providers and covered lives:All WA state children age birth to 17 years

PCMH components:

Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Coalition to promote and provide practical support for medical homes -- family-centered, comprehensive coordinated primary health care -- for children and youth with special health care needs. Provide medical home for every WA State CSHCN by 2010

MaryAnne [email protected](360) 725-1786

Developing performance indicators to identify whether children have an effective medical home. Identifying stakeholder representatives who can formulate performance measures to be used starting in 2009 to link quality improvement measures with provider rate increases.



PCMH Pilots Detail

State:Pennsylvania

Region:Southeast

Convening Authority:Governor’s Office of Health Reform

Payer(s):Aetna, AmeriChoice (Medicaid), Health Partners (Medicaid), Independence Blue Cross, Keystone Mercy Health Plan (Medicaid)

Overview:

Providers and covered lives:33 practices; 165 clinician FTE’s; 176k patients

PCMH components:

Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Statewide implementation of the Chronic Care Model (a PCMH-like model) involving learning collaboratives, practice coaches, an incentive alignment strategies for providers and consumers.

Phil [email protected](717) 214-8174

Michael [email protected](781) 453-1166

Practice coaches, consumer self-management training, patient registries, statewide pooled claims database, practice certification process, performance measures, evaluation plan and public reporting, communication plan



PCMH Pilots Detail

State:New York

Region:Albany

Convening Authority:Capital District Physicians’ Health Plan, Inc. (CDPHP)

Payer(s):CDPHP

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Pilot supported with a 1 million grant from CDPHP. Will look at the Allen Goroll payment reform model. Three practices will all have support with an on the ground transformation model. Facilitators are being provided by TransforMED and paid for by CDPHP.

Brian J. [email protected](518) 641-5220

The practices will be paid for PCMH services whether or not the patient is a CDPHP member. So, 100% of the patients are in the pilot. The breakout is 40% CDPHP members, a mixture of ASO and commercial. About 17 % are Medicare, 30 % Blues, 8% MVP.



PCMH Pilots Detail

State:Tennessee

Region:Memphis

Convening Authority:Memphis Business Group on Health

Payer(s):BCBSTN, Humana

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Several phone discussions and two face-to-face meetings with potential stakeholders in a multi-payer pilot of PCMH; led primarily by ACP and Memphis Business Group on Health. Agreement on 5/7/08 to form Steering Committee of interested stakeholders.

to be determined

Cristie Travis (MBGH)[email protected](901) 767-9585

Shari Erickson (ACP)[email protected](202) 261-4551



PCMH Pilots Detail

State:New Hampshire

Region:Statewide

Convening Authority:CIGNA and Dartmouth-Hitchcock

Payer(s):CIGNA

Overview:

Providers and covered lives:17k CIGNA members receiving primary care from Dartmouth-Hitchcock providers

PCMH components:

Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

In the pilot, patients, especially those with chronic illness or ongoing medical needs, will have access to enhanced care coordination, communications, appointment availability and education to help them navigate their health care system, while physicians will receive additional reimbursement for providing these enhanced services and supportive infrastructure. Dartmouth-Hitchcock has a tradition of pursuing these objectives; both organizations say the new pilot program will help to accelerate existing efforts.

Dick Salmon (CIGNA)[email protected](901) 767-9585

Barbara Walters (Dartmouth-Hitchcock)

Primary care providers affiliated with Dartmouth-Hitchcock will be paid for the medical services they provide, reimbursed an additional amount for enhanced services such as care management they provide and be rewarded through a “pay for performance” structure for improving quality and appropriate health care.



PCMH Pilots Detail

State:Texas

Region:Dallas, San Antonio, Houstin, Austin

Convening Authority:Texas Academy of Internal Medicine

Payer(s):

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Meeting on 6/27/2008 in Austin to inform and assess local stakeholder interest. The Texas Academy of Internal Medicine is also seeking business groups that may be interested in participating in the effort.

to be determined

Neil Kirschner (ACP)[email protected](202) 261-4535



PCMH Pilots Detail

State:Michigan

Region:Statewide

Convening Authority:Michigan Primary Care Consortium

Payer(s):BCBSMI, United, Humana, Aetna

Overview:


Project contact(s):

Link to press release:http://michigan.gov/som/0,1607,7-192-26847-184896--,00.html

Notes:

Through collaboration between public health and primary care, by 2010, key system level barriers will be resolved; by 2015, every consumer of primary care services in Michigan will consistently receive evidence-based preventive and chronic disease care, and changes to assure quality care will have been embedded in primary care practices across the state

Initial focus areas will be: prevention(aligned with RX for Healthier MI and MI Steps Up), Physical Inactivity, Poor Nutrition, Tobacco Use and Exposure; Chronic Disease Care & Management: Asthma & Diabetes

Janet Olzekski, MD - [email protected](517) 373-3740

Donald Nease, MD – vice chair (734) 936-4660



PCMH Pilots Detail

State:Ohio

Region:Southwest

Convening Authority:Greater Cincinnati Health Improvement Collaborative

Payer(s):Anthem, United (Managed Medicare and Commercial), Humana

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Initial stages of discussion. $1.7M grant from R.W. Johnson Foundation under Aligning Forces for Quality initiative to focus on improved healthcare messaging for patients with diabetes.

Medical Home forum held at Univ. of Cincinnati on March 17; presenters included Michael Sherman, Corp. Medical Director of Physician Strategies at Humana.

PCMH pilot kick-off meeting may be held sometime in summer 2008. Paul Grundy has been contacted as a potential speaker.

Craig Brammer, [email protected](202) 261-4535



PCMH Pilots Detail

State:North Carolina

Region:Statewide

Convening Authority:N. Carolina Division of Medical Assistance (Medicaid)

Payer(s):Medicaid

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Started 1998-1999 as way to manage Medicaid patients in rural area—medical home model –particularly targeted at small practices that did not have a lot of resources—goal was to link them with a local hospital and other safety net providers – gave payment to providers and to networks for them to put resources into the community (e.g. case managers, recently added a clinical pharmacist) -goal is organizing MDs

Allen Dobson [email protected](704) 721-2073

Jeffrey [email protected](919) 855-4100



PCMH Pilots Detail

State:Washington

Region:Seattle – Everett – Renton areas

Convening Authority:Boeing Company

Payer(s):Medicaid

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

A dedicated core primary care team of 1-2 physicians and a nurse case manager sees enrolled patients.

Boeing is actively involved in the pilot’s day-to-day management and is paying a PMPM payment to each MD in addition to the providers’ regular FFS reimbursement. The practice-embedded nurse case manager is thought to be the key to the model’s success.

Theresa [email protected](704) 721-2073

Ambulatory Intensive Caring Unit model, similar to that being employed by UNITE HERE. In 2nd year of pilot targeted to serving the top 20% of employees and dependents projected to be greatest need of future health care.



PCMH Pilots Detail

State:Vermont

Region:Statewide

Convening Authority:BCBS of Vermont

Payer(s):BCBSVT

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

MD participation in the P4Q program requires the proactive adoption of the following practice infrastructure changes, derived from the Health System component of The Chronic Care Model.

Increased reimbursement is available for office-based E & M, consultations, preventive medicine and counseling codes. The enhanced reimbursement applies to all of the practices patients, not just those with select chronic conditions.

Practices may utilize some BCBSVT tools and services to satisfy program entry requirements, or use enhanced funding to support development of their own infrastructure and systems.

Sharon [email protected](802) 371-3230

Pilot Pay for Quality Program is aligned with The Chronic Care Model and the VT Blueprint for Health. P4Q pilot program started in 2005 with diabetes and was roughly built off of the structure of the NCQA Diabetes Physician Recognition Program



PCMH Pilots Detail

State:Michigan

Region:Statewide

Convening Authority:Blue Cross Blue Shield of Michigan

Payer(s):BCBSM

Overview:


Project contact(s):


XXXXXXXXXXXXXXXX

Notes:

Initial stages of discussion,

BCBSM Physician Group Incentives will embody elements of chronic care model and PC-MH. 2008 initiatives will focus on: individual care management, extended access, test tracking, patient registry, performance reporting and patient-provider agreement. Implementation of differential reimbursement for PGIP physicians who meet criteria for BCBSM designation as a PC-MH will begin mid-2009Thomas Simmer (BCBSM CMO)

[email protected]

Margaret [email protected]

ibm healthcare and life sciences patient-centered medical home pilots landscape as of 06/19/2008

Documents

ibm corporation ibm

health entities

hudson health overview

pcmh pilot details

united healthcare

life sciences patient

lives pcmh components

rocky mtn health plan