Edwina Rogers

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Patient Centered Primary Care CollaborativeJuly
16th Stakeholders Working MeetingPublic and
Private Initiatives Advancing the PCMH
Welcome and Overview July 16th 2009
PCPCCStakeholders Working Meeting

• Edwina Rogers
• Executive Director
• Patient Centered Primary Care Collaborative
• 601 Thirteenth St., NW, Suite 400 North
• Washington, D.C. 20005
• Direct 202.724.3331
• Mobile [phone]
• erogers_at_pcpcc.net

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Patient Centered Medical Home Pilot Activity
Blue Cross Blue Shield Plan Pilots (as of January
2009)

• Overview of PCPCC Activity
• 27 Multi-stakeholder Pilots in 20 States
• 8 State Medicare Pilots Planned for 2009
• 44 States and the District of Columbia Have
  Passed over 330 Laws and/or Have PCMH Activity

Pilots in planning phase for 2009 implementation
Pilots in progress
Sample State PCMH Example
Pilot activity in early stages of development
Multi-Stakeholder demonstration

• Sample Medical Home Pilot Sites
• Marillac Clinic
• Geisinger Medical Home Pilot
• Southeast Pennsylvania Learning Collaborative

• CMS will select 8 states for the Medicare Medical
  Home Demonstration

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Some New 2009 Single-Payer Health Plan
Demonstration Pilots

• Key PCMH Pilot Programs Either in Place or in
  Development
• Cigna PCMH Pilot in New Hampshire
• Aetna has PCMH Pilots in
• Colorado
• Maine
• Mid-Hudson Valley
• Pennsylvania
• Central New Jersey
• Priority Health PCMH Pilot Program in Michigan
• Wellpoint, Inc. PCMH Pilot in New York City
• UnitedHealth Medical Home Pilot in Arizona
  (Tucson Phoenix)
• Blue Cross Blue Shield PCMH Pilot in Nebraska in
  early stages of development

New Demonstration Pilots Taking Place or in the
Process of Being Enacted
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State Initiatives to Advance Medical Homes in
Medicaid/ SCHIP
Identified to have a medical home initiative
Source National Academy for State Health Policy
State Scan, November 2008
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State Policy PCMH Implementation

• Introduced Legislation in 2009
• California
• New Jersey
• Hawaii
• Maryland
• Nebraska
• West Virginia
• Texas
• Washington
• Wyoming

• Introduced Legislation in 2008
• Iowa
• Kansas
• Massachusetts
• New Hampshire
• New York
• Oklahoma
• Minnesota
• Washington
• Maryland
• Maine
• Vermont
• Utah

• Enacted Legislation in 2007 and 2008
• Colorado
• Louisiana
• Minnesota
• Iowa
• Washington
• Oklahoma
• Maine
• New York

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Patient-Centered Medical Home 2009 Overview of
Pilot Activity and Planning Discussions
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Multi-Payer pilot discussions/activity
Identified pilot activity
No identified pilot activity 6 States
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PCPCC 2008-2009
Key Organizations Joining PCPCC Since April 28th
Stakeholder Meeting

• Cleveland Clinic
• Department of Veterans Affairs
• Minnesota Department of Health
• National Council on Aging
• Harvard Medical School
• Medical Home News
• Thomas Group
• Robert Bosch Healthcare

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Patient Centered Primary Care Collaborative
Four Centers - Over 770 volunteer members

• Center for Multi-Stakeholder Demonstration
  Identify community-based pilot sites in order to
  test and evaluate the concept offer hands-on
  technical assistance, share best practices, and
  identify funding sources to advance adoption.
• Center to Promote Public Payer Implementation
  Assist state Medicaid agencies and other public
  payers as they implement and refine programs to
  embed the Patient Centered Medical Home model by
  offering technical assistance sharing best
  practices and giving guidance on the development
  of successful funding models.
• Center for Health Benefit Redesign and
  Implementation Create standards and buying
  criteria to serve as a guide and tool for large
  and small employers/purchasers in order to build
  the market demand for adoption of the Medical
  Home model.
• Center for eHealth Information Adoption and
  Exchange Evaluate use and application of
  information technology to support and enable the
  development and broad adoption of information
  technology in private practice and among
  community practitioners.

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PCPCC Payment Model
Key physician and practice accountabilities/
value added services and tools
Proactively work to keep patients healthy and
manage existing illness or conditions
Incentives
Coordinate patient care among an organized team
of health care professionals
Incentives
Performance Standards
Utilize systems at the practice level to achieve
higher quality of care and better outcomes
Incentives
Focus on whole person care for their patients
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Statement on the PCMH President Obama
I support the concept of a patient-centered
medical home, and as part of my health care plan,
I will encourage and provide appropriate payment
for providers who implement the medical home
model, including physician-directed,
interdisciplinary teams, care management and care
coordination programs, quality assurance
mechanisms, and health IT systems which
collectively will help to improve
care. President Barack Obama
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PCMH - HOUSE of representatives activity

• The House Tri-Committee Health Reform Draft
• On June 19, 2009 the Chairmen of the three
  committees with jurisdiction over health policy
  in the U.S. House of Representatives unveiled
  their discussion draft for health care reform. 
  The draft would reduce out-of-control costs,
  improve choices and competition for consumers and
  expand access to quality, affordable health care
  for all Americans.
• Included in this draft is language on the Patient
  Centered Medical Home (PCMH).  The draft bill
  includes funding of 350 million for PCMH pilot
  programs, which include Independent PCMHs and
  Community-based Medical Homes.
• 'The Secretary shall establish a medical home
  pilot program (in this section referred to as the
  pilot program) for the purpose of evaluating
  the feasibility and advisability of reimbursing
  qualified patient-centered medical homes for
  furnishing medical home services (as defined
  under subsection (b)(2)) to high need
  beneficiaries (as defined in subsection
  (b)(1)).' 
• Sec.1822. Medical Home Pilot Program. Establishes
  a 5-year pilot program to test the medical home
  concept with high-need Medicaid beneficiaries.
  The federal government would match costs of
  community care workers at 90 for the first two
  years and 75 for the next 3 years, up to a total
  of 1.235 billion.

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PCMH - Senate Activity

• The Senate HELP Committee released the
  Affordable Health Choices Act on June 9, 2009
  outlining the committees option for health care
  reform.
• Section 212 of the draft legislation - Grants to
  Establish Community Health Teams to Support a
  Medical Home Model stated that
• The Secretary of HHS would establish a grant
  program to creating the community health team
  which is community-based, multi disciplinary,
  interprofessional teams (on the model of medical
  home) to increase access to comprehensive
  coordinated care.
• Enhancing Health Care Workforce Education and
  Training - There is language in the bill also
  aimed to enhance health care workforce education
  and training in Family Medicine, General Internal
  Medicine, General Pediatrics, and Physician
  Assistantship by providing grants to develop and
  operate training programs, financial assistance
  of trainees and faculty, and faculty development
  in primary care and physician assistant programs.
  This bill would provide grants to establish,
  maintain and improve academic units in primary
  care. Priority is given to programs that educate
  students in team-based approaches to care,
  including the patient-centered medical home.
  Authorization is set at 125 million.
• The Senate Finance Committee is working on its
  own health care reform legislation. Their focus
  on primary care and the medical home model
  includes
• Primary Care Bonus Payment - Certain Medicare
  providers being eligible for a primary care
  services bonus payment of at least 5 percent over
  the fee schedule amount for providing certain
  evaluation and management services.
• Chronic Care Management Innovation Center (CMIC)
  - The establishment of the CMIC at CMS for
  Medicare by the Secretary of HHS for the purpose
  of testing and disseminating payment innovations
  that foster patient-centered care coordination,
  with advancing PCMHs at the top of their list.
• Potential Items- The Committee would also look to
  reimburse states that use the PCMH model in their
  Medicaid programs.

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The Day ahead

• Morning Session
• PCMH Leaps Forward Through Federal Initiatives
  (Panel 1)
• At our April conference we heard from CMS about
  their PCMH planned Medicare demonstration, but
  there are numerous other federal agencies that
  are charging ahead with PMCH activities we will
  hear from three such agencies.
• The Big Picture Focus on Health Care Reform
  (Panel 2)
• With extensive activity happening in Congress and
  the Obama administration, now is the time to
  seriously focus on federal healthcare reform.
  Three experts will give us the big picture
  overview and include in-depth discussions on
  relevant topics like workforce supply and primary
  care payment reform.
• Consumers Speak A First-Hand PCMH Experience
  (Panel 3)
• In the PCMH model, there is nothing more
  important than continued focus on consumer
  involvement. During this session, we will
  discuss important topics such as integration of
  families, cultural competence, prevention and
  access, among other issues.
• The Nuts and Bolts of a Successful PCMH - How it
  Works (Panel 4)
• This panel will focus on numerous important
  topics pertaining to medium and small-sized
  practice including transformation, behavioral
  health, the team approach, return on investment,
  among other important components.

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The Day ahead
Networking Lunch
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The Day ahead
Afternoon Sessions Each Center will present their
unique accomplishments to date and their draft
goals/mission for the upcoming Fiscal Year. In
addition, each Center will bring their own topics
into discussion, which include, among other
things Center for Public Payer Implementation
The CPPI will detail current health reform
legislation including Senate Finance Committee,
Senate HELP committee and House leadership
proposals PCMH and the full spectrum of
behavioral health issues update on State
Medicaid activities health plans and PCMH
activity growing PCMH and federal programs
Medicare demonstration pilots and PCMH and the
integration of medication management. Center for
eHealth Information Adoption and Exchange The
CeHIA will discuss the progress of creating an
eHealth and PCMH web-based resource center we
will hear reports from the center taskforces
which includes participatory engagement,
meaningful use, and decision support and review
case studies on HIT integration and the medical
home. Center for Multi-Stakeholder
Demonstrations The CMD will discuss the
landscape of the current multi-stakeholder
demonstration projects with particular attention
to recently started pilot projects. Center for
Benefit Redesign and Implementation The CBRI
will discuss its progress on a value based
benefit design white paper needed employer-to-
employee communication on PCMH onsite primary
care clinics and the PCMH universe the new
mental health parity legislation (behavioral
health and productivity) and the need for policy
changes concerning high deductible health plans
so that primary care and pharmaceuticals for
chronic conditions receive first dollar
coverage.
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House bill limit Medical Home pilots to High
need beneficiaries?

• -- this will not build a sustainable system of
  primary care where the focus is on preventing a
  person from becoming a High need beneficiaries.

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The Patient Centered Medical Home agreed on set
of principles between providers and buyers of
health care that serve as foundation of
health-care system. Personal Relationship Each
Patient has an ongoing relationship with a
personal clinician trained to provide first
contact, continuous and comprehensive care.
Expanded Access Team Approach
Comprehensive The personal clinician is
responsible for providing for all the patients
health care needs at all stages of life or taking
responsibility for appropriately arranging care
with other qualified professionals.
Coordination Quality and Safety Added
Value Payment that appropriately recognizes the
added value provided to patients who have a
Patient-Centered Medical Home
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A Medical School, a Funeral and a Hospital
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Patient Centered Primary Care Collaborative
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