Edwina Rogers

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Patient Centered Primary Care Collaborative

• 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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• Overview of Activity
• 22 Multi-stakeholder Pilots in 16 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

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Overview of the PCPCC

• Now in our 3rd year
• Over 440 signing members
• Advancing the Patient Centered Medical Home
  (PCMH) concept in the public and private sectors
• Hosting Meetings, Summits and Congressional
  Briefings
• Weekly Call Thursday at 1100 AM EST
• Call-in Number 712.432.3900
• Passcode 471334
• Weekly Center calls established to
  operationalize work of PCPCC

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Collaborative Principles

• The Patient Centered Primary Care Collaborative
  is a coalition of major employers, consumer
  groups, patient quality organizations, health
  plans, labor unions, hospitals, clinicians and
  many others who have joined together to develop
  and advance the patient centered medical home.
  The Collaborative believes that, if implemented,
  the patient centered medical home will improve
  the health of patients and the viability of the
  health care delivery system. In order to
  accomplish our goal, employers, consumers,
  patients, clinicians and payers have agreed that
  it is essential to support a better model of
  compensating clinicians.
• Compensation under the Patient-Centered Medical
  Home model would incorporate enhanced access and
  communication, improve coordination of care,
  rewards for higher value, expand administrative
  and quality innovations and promote active
  patient and family involvement. The
  Patient-Centered Medical Home model will also
  engage patients and their families in positive
  ongoing relationships with their clinicians.
  Further, the Patient-Centered Medical Home will
  improve the quality of care delivered and help
  control the unsustainable rising costs of
  healthcare for both individuals and
  plan-sponsors.
• If you agree, please visit us at www.pcpcc.net
  and join today!

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The Patient-Centered Primary Care Collaborative
Examples of Broad Stakeholder Support
Participation
Providers 333,000 primary care
Purchasers Most of the Fortune 500

• ACP

• AAP

• IBM

• General Motors

• AAFP

• AOA

• General Electric

• FedEx

• ABIM

• ACC

• Microsoft

• Pfizer

• ACOI

• AHI

• Business Coalitions

The Patient-Centered Medical Home

• Merck Co.

80 Million lives
Payers
Patients

• NCQA

• AFL-CIO

• BCBSA

• Aetna

• National Partnership for Women and Families

• Humana

• United

• HCSC

• CIGNA

• Foundation for Informed Decision Making

• WellPoint

• SEIU

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Patient Centered Primary Care CollaborativeFour
Centers

• 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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Joint Principles of the PCMH (February 2007)

• The following principles were written and agreed
  upon by the four Primary Care Physician
  Organizations the American Academy of Family
  Physicians, the American Academy of Pediatrics,
  the American College of Physicians, and the
  American Osteopathic Association.
• Principles
• Ongoing relationship with personal physician
• Physician directed medical practice
• Whole person orientation
• Coordinated care across the health system
• Quality and safety
• Enhanced access to care
• Payment recognizes the value added

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Endorsements

• The PCMH Joint Principles have received
  endorsements from 13 specialty health care
  organizations
• The 13 organizations endorsing the Joint
  Principles are
• The American Academy of Chest Physicians
• The American Academy of Hospice and Palliative
  Medicine
• The American Academy of Neurology
• The American College of Cardiology
• The American College of Osteopathic Family
  Physicians
• The American College of Osteopathic Internists
• The American Geriatrics Society
• The American Medical Directors Association
• The American Society of Addiction Medicine
• The American Society of Clinical Oncology
• The Society for Adolescent Medicine
• The Society of Critical Care Medicine
• The Society of General Internal Medicine
• The PCMH Joint Principles have recently also
  received an endorsement from the American Medical
  Association.

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Defining the Medical Home
Source Health2 Resources 9.30.08
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TODAYS CARE
MEDICAL HOME CARE
My patients are those who make appointments to
see me
Our patients are those who are registered in our
medical home
Patients chief complaints or reasons for visit
determines care
We systematically assess all our patients health
needs to plan care
Care is determined by todays problem and time
available today
Care is determined by a proactive plan to meet
patient needs without visits
Care varies by scheduled time and memory or skill
of the doctor
Care is standardized according to evidence-based
guidelines
Patients are responsible for coordinating their
own care
A prepared team of professionals coordinates all
patients care
I know I deliver high quality care because Im
well trained
We measure our quality and make rapid changes to
improve it
Acute care is delivered in the next available
appointment and walk-ins
Acute care is delivered by open access and
non-visit contacts
Its up to the patient to tell us what happened
to them
We track tests consultations, and follow-up
after ED hospital
Clinic operations center on meeting the doctors
needs
A multidisciplinary team works at the top of our
licenses to serve patients
Slide from Daniel Duffy MD School of Community
Medicine Tulsa Oklahoma
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PCPCC Payment Model (May 2007)
The Patient-Centered Primary Care Collaborative
recommends a three-part payment
methodology, Including A) A monthly care
coordination payment for the physicians work
that falls outside of a face-to face visit and
for the health information technologies needed to
achieve better outcomes, B) A visit-based
fee-for-service component that is recognized for
services that are currently paid under the
present fee-for-service payment system, and C)
A performance-based component that recognizes
achievement of service, patient centeredness,
quality and efficiency goals.
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Evidence of Cost Savings quality improvement

• Barbara Starfield of Johns Hopkins University
• Within the United States, adults with a primary
  care physician rather than a specialist had 33
  percent lower costs of care and were 19 percent
  less likely to die.
• In both England and the United States, each
  additional primary care physician per 10,000
  persons is associated with a decrease in
  mortality rate of 3 to 10 percent.
• In the United States, an increase of just one
  primary care physician is associated with 1.44
  fewer deaths per 10,000 persons.
•  A medical home can reduce or even eliminate
  racial and ethnic disparities in access and
  quality for insured persons.
• Commonwealth Fund has reported
• Denmark has organized its entire health care
  system around patient-centered medical homes,
  achieving the highest patient satisfaction
  ratings in the world. Denmark has among the
  lowest per capita health expenditures and highest
  primary care rankings.
• Center for Evaluative Clinical Sciences at
  Dartmouth, states in the US relying more on
  primary care have
• lower Medicare spending,
• lower resource inputs,
• lower utilization,
• and better quality of care.

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Evidence of cost Savings Quality Improvement

• Chronic Care for Diabetes BCBS of ND Reported
• 6 decrease in hospital admissions
• 24 decrease emergency room
• 500, Per member per years savings
• The state of North Carolina reported savings of
  244 million for FY04 for their 720,000 Medicaid
  recipient program.
• Horizon BCBS of NJ reported that the cost per
  patient, complying with diabetes testing in
  engaged medical homes, was substantially less
  than those in non-engaged medical homes.

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Simple Cost Avoidance
NC Savings (FY04)
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North Carolina Pilot Project Details
AccessCare Network Sites
AccessCare Network Counties
Access II Care of Western NC
Access III of Lower Cape Fear
Community Care of Wake and Johnston Counties
Central Care Health Network
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(No Transcript)
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Patient Centered Primary Care CollaborativeConsu
mers Patients

• The PCPCC currently has a section on our website
  dedicated to Consumer and Patient issues.
• i. Center for Advancement of Health Consumer
  Guide
• ii. Consumer Guide to E-Prescribing
• iii. Family Centered Care Resources
• iv. Measuring Patient Experience
• v. ABIM Foundation Brief - Patient Charter

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Patient Centered Primary Care CollaborativePurch
aser Guide Released July, 2008

• Developed by the PCPCC Center for Benefit
  Redesign and Implementation in partnership with
  NBCH and the Centers multi-stakeholder advisory
  panel.
• Guide offers employers and buyers actionable
  steps as they work with health plans in local
  markets - over 6000 copies downloaded and/or
  distributed.
• Includes contract language, RFP language and
  overview of national pilots.
• Includes steps employers can take to involve
  themselves now in local market efforts.
• The PCPCC is holding a series of Webinars,
  sponsored by Pfizer, on the Purchaser Guide.

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Patient Centered Primary Care CollaborativeBuild
ing Evidence and Momentum Compendium of PCMH
Pilots Released October 2008

• Developed by the PCPCC Center for
  Multi-stakeholder Demonstration through a grant
  from AAFP offering a state-by-state sample of key
  pilot initiatives.
• Offers key contacts, project status,
  participating practices and market scan of
  covered lives physicians.
• Inventory of recognition program used, practice
  support (technology), project evaluation, and key
  resources.
• Begins to establish framework for program
  evaluation/ market tracking.

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Employer Value Based Benefit Design
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Inclusion of the Medical Home Concept in Health
Reform Efforts
Employer Trade Associations
Think Tanks
Executive Branch
The Patient-Centered Medical Home
Plans developed by Congressional
Representatives
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Baucus- Health Care Reform Proposal (November
2008)

• Expanding Medicares role in testing the medical
  home model in which practitioners are paid
  explicitly for comprehensive care management
  services
• Medical home expansions in Medicare should focus
  only on providers who are committed to ensuring
  that patients truly receive the primary care and
  care management services...
• Providers seeking to participate in a Medicare
  medical home should meet a set of stringent
  service and capacity criteria in order to
  qualify and be willing to have additional
  payments
• based in part on the quality of care they
  deliver.

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Other Legislative Initiatives

• Senator Durbin (D-IL) and Senator Burr (R-NC) are
  working together on Patient Centered Medical Home
  Legislation
• The Healthy Americans Act, sponsored by Senator
  Rob Wyden (D-Oregon) and Senator Bob Bennett
  (R-Utah) is the first bipartisan health reform
  proposal in more than a decade to guarantee
  affordable, healthcare quality for all and
  includes PCMH.
• Senator Baucus White Paper is very favorable for
  Medical Homes.
• Economic Stimulus Package includes funding for
  Health IT infrastructure and primary care
  workforce shortages.
• North Carolina received a 646 waiver to take the
  Patient Centered Medical Home program to all of
  Medicare, with estimated savings by the CBO of
  1.4 billion.

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2009 Upcoming Collaborative Events
Tuesday, April 28, 2009 - Washington D.C.,
Stakeholder Meeting - Ronald Reagan Building and
International Trade Center, 1300 Pennsylvania
Avenue, NW Washington D.C. 20004 Thursday, July
16, 2009 - Washington D.C., Stakeholder Meeting -
Ronald Reagan Building and International Trade
Center, 1300 Pennsylvania Avenue, NW Washington
D.C. 20004 Thursday October 22, 2009 -
Washington D.C., Annual Summit
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• www.pcpcc.net
• About the PCPCC
• History
• Members
• Brochure
• Executive Committee
• Advisory Board
• Officers
• Executive Bios
• The Patient Centered Medical Home
• Joint Principles
• Endorsements by Specialists
• Employer Perspectives
• Evidence of Quality
• Health Reform Proposal
• Reimbursement Model

• Collaborative Centers
• Center to Promote Public Payer Implementation
• Center for Multi-Stakeholder Demonstration
• Center for Benefits Redesign and Implementation
• Center for eHealth Information Exchange and
  Adoption
• Other PCMH Resources
• Pilot Project Guide
• Purchasers Guide
• Evidence Documents
• Consumer Materials
• Events
• National Weekly Call
• Thursday, 1100AM EST

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Contact Information

• Visit our website http//www.pcpcc.net
• To request any additional information on the PCMH
  or the Patient Centered Primary Care
  Collaborative please contact
• Edwina Rogers
• Patient Centered Primary Care Collaborative
• Executive Director
• 202.724.3331
• 202.674.7800 (cell)
• erogers_at_pcpcc.net,
• 601 Thirteenth St., NW, Suite 400 North
• Washington, DC 20005