Delaware PCMH Delaware PCMH InitiativeInitiative

October 2010October 2010

Rationale for PCMHRationale for PCMH

Better health quality and outcomesBetter health quality and outcomes Lower health care costsLower health care costs Increased patient satisfactionIncreased patient satisfaction Increased provider satisfactionIncreased provider satisfaction

Rationale for PCMHRationale for PCMH

The Dartmouth Atlas recently The Dartmouth Atlas recently demonstrated unacceptable demonstrated unacceptable variations in cost and health care variations in cost and health care utilization are associated with the utilization are associated with the ineffective use of primary care.ineffective use of primary care.

Rationale for PCMHRationale for PCMH

Timely, acuity-stratified care Timely, acuity-stratified care delivered via a health care team's delivered via a health care team's coordinated efforts could save coordinated efforts could save 100,000 lives yearly and control 100,000 lives yearly and control costs, according to a Geisinger study costs, according to a Geisinger study published in the September published in the September Annals Annals of Surgeryof Surgery. .

What is a Patient-Centered Medical What is a Patient-Centered Medical HomeHome

The PCMH concept aims to provide continuous, The PCMH concept aims to provide continuous, comprehensive, coordinated care through a comprehensive, coordinated care through a partnership between patients and their personal partnership between patients and their personal healthcare team.healthcare team.

PCMH practices provide care through:PCMH practices provide care through: Evidence-based medicine;Evidence-based medicine; Expanded access and communication;Expanded access and communication; Wellness and prevention;Wellness and prevention; Care coordination and integration; and,Care coordination and integration; and, Culturally and linguistically sensitive care.Culturally and linguistically sensitive care.

Practices are incentivized through payment Practices are incentivized through payment reform to be a PCMH.reform to be a PCMH.

Example from MarylandExample from MarylandPayment and Incentive Model for Payment and Incentive Model for

ProvidersProviders Carriers would use their traditional fee Carriers would use their traditional fee

structure, plus-structure, plus- A fixed per patient per month (PPPM) A fixed per patient per month (PPPM)

payment for enhanced care payment for enhanced care coordination and practice coordination and practice transformation.transformation.

A fixed PPPM plus possible additional A fixed PPPM plus possible additional incentives based on shared savings and incentives based on shared savings and quality improvements/performancequality improvements/performance

PhasesPhases

Pre-planning – Planting the SeedsPre-planning – Planting the Seeds Planning – Building the FoundationPlanning – Building the Foundation ImplementationImplementation

Pre-planning – Planting Pre-planning – Planting the Seedsthe Seeds

Medical Society of DE Task ForceMedical Society of DE Task Force A number of existing related efforts A number of existing related efforts Great momentumGreat momentum Establishment of principlesEstablishment of principles

Multi-payerMulti-payer All individuals regardless of age or chronic All individuals regardless of age or chronic

conditioncondition Payment reform – 3 prongsPayment reform – 3 prongs Defined primary care as family practice, Defined primary care as family practice,

general internal medicine and general pediatric general internal medicine and general pediatric practicespractices

Planning – Building the Planning – Building the FoundationFoundation

Governance and operating structure, roles and Governance and operating structure, roles and responsibilities;responsibilities;

Vision, goals, objectives, scope, patient and Vision, goals, objectives, scope, patient and practice level outcomes;practice level outcomes;

Partnership building (including written Partnership building (including written agreements);agreements);

Identification of needs, including acquisition of Identification of needs, including acquisition of funds, IT and policy needsfunds, IT and policy needs

Plans for payment reform Plans for payment reform Practice engagementPractice engagement Family/patient engagement Family/patient engagement Evaluation planEvaluation plan

Implementation – PilotImplementation – Pilot

Optimistic goal to begin in the Fall of Optimistic goal to begin in the Fall of 20112011

Details yet to be worked out – (e.g. Details yet to be worked out – (e.g. duration, number of practices)duration, number of practices)

Building systems of care for after the Building systems of care for after the pilotpilot

GovernanceGovernance Co-leadership of the MSD and DHSS/DPHCo-leadership of the MSD and DHSS/DPH MSD – MSD –

Provider engagement and advocacyProvider engagement and advocacy Leadership and previous experienceLeadership and previous experience Dr. Gill – expertise and experienceDr. Gill – expertise and experience

SOD/DHSS/DPH-SOD/DHSS/DPH- Safe HarborSafe Harbor Funding streamsFunding streams Existing infrastructureExisting infrastructure Prevention-focusedPrevention-focused Integration of public health and primary careIntegration of public health and primary care Dr Rattay – expertise and experienceDr Rattay – expertise and experience

Management Services to Management Services to Support Pilot PlanningSupport Pilot Planning

Secured WAMS Secured WAMS Professional expertise:Professional expertise:

Design, implementation and management of health Design, implementation and management of health service delivery programsservice delivery programs

Ambulatory care operations managementAmbulatory care operations management Planning and staffing multi-stakeholder initiatives and Planning and staffing multi-stakeholder initiatives and

consortium; e.g. the Delaware Cancer Consortium, consortium; e.g. the Delaware Cancer Consortium, CHAP, VIP, the Delaware Covering Kids & Families CHAP, VIP, the Delaware Covering Kids & Families ProgramProgram

Physician education and residency training programsPhysician education and residency training programs Deliverables:Deliverables:

Assistance with stakeholder engagementAssistance with stakeholder engagement Communication and meeting supportCommunication and meeting support Written Materials and ResearchWritten Materials and Research Pilot Project Plan and TimelinePilot Project Plan and Timeline

Many StakeholdersMany Stakeholders

Executive Team – small and nimbleExecutive Team – small and nimble Steering Group – varied Steering Group – varied

representation, advisoryrepresentation, advisory Subcommittees – focused on Subcommittees – focused on

topical/operational issues (e.g. topical/operational issues (e.g. payment reform, evaluation, practice payment reform, evaluation, practice improvements, policy)improvements, policy)

Learning From OthersLearning From Others Collaboration is key to successCollaboration is key to success

Example - Involvement of the employer community Example - Involvement of the employer community is criticalis critical

A collaborative learning approach works wellA collaborative learning approach works well Whole-practice transformation is necessary Whole-practice transformation is necessary

Multi-payerMulti-payer All ages and diseasesAll ages and diseases Prevention-focusedPrevention-focused

Adequate practice incentives and technical Adequate practice incentives and technical assistance is importantassistance is important

HIT – HIE and EHR/EMR is a huge advantageHIT – HIE and EHR/EMR is a huge advantage

Timeline, Deliverables and Timeline, Deliverables and Cost: Cost:

Quarter 1Quarter 1 Bring stakeholders together as a Bring stakeholders together as a

Steering Committee as well as Steering Committee as well as defining functional subcommitteesdefining functional subcommittees

ID the goals and objectivesID the goals and objectives Assess whether legislation is needed Assess whether legislation is needed

and prepare for proposaland prepare for proposal Technical Assistance from the Patient-Technical Assistance from the Patient-

Centered Primary Care Collaborative Centered Primary Care Collaborative (PCPCC)(PCPCC)

Timeline, Deliverables and Timeline, Deliverables and Cost: Cost:

Quarter 2Quarter 2 Form workgroups to address key operational Form workgroups to address key operational

and strategic considerations for the pilot.and strategic considerations for the pilot. Draft an operating structure and budgetDraft an operating structure and budget Define the roles of government and other Define the roles of government and other

partnerspartners Prepare written proposal and other materials Prepare written proposal and other materials

needed to elicit support from partners (e.g. needed to elicit support from partners (e.g. funders and payers).funders and payers).

Promote legislation if neededPromote legislation if needed Begin funding recruitmentBegin funding recruitment

Timeline, Deliverables and Timeline, Deliverables and Cost: Cost:

Quarters 3 and 4Quarters 3 and 4 Agreements in place (e.g. MOU’s)Agreements in place (e.g. MOU’s) Finalize payment reform Finalize payment reform

methodologymethodology Secure funding commitmentsSecure funding commitments Recruit practicesRecruit practices Finalize evaluation planFinalize evaluation plan Support personnel capacity (e.g Support personnel capacity (e.g

hiring of care coordinators)hiring of care coordinators)