Edwina Rogers

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• 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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MEDICARE-MEDICAID ADVANCED PRIMARY CARE
DEMONSTRATION INITIATIVE

• On September 16, 2009 HHS Secretary Sebelius,
  along with Director of White House Office of
  Health Reform Nancy-Ann DeParle and Vermont
  Governor Jim Douglas, announced that the Centers
  for Medicare and Medicaid Services (CMS) will
  establish a demonstration program that will
  enable Medicare to join Medicaid and private
  insurers in innovative state-based advanced
  primary care initiatives.
• New Medicare Demonstration
• Design will include mechanisms to assure it
  generates savings for the Medicare trust funds
  and the federal government
• Private insurers work in cooperation with
  Medicaid to set uniform standards for Advanced
  Primary Care (APC) models
• Provide incentives for doctors to spend more time
  with their patients and offer better coordinated
  higher-quality medical care
• States Wishing to Participate in the New
  Demonstration Must
• Certify they have already established similar
  cooperative agreements between private payer and
  their Medicaid program
• Demonstrate a commitment from a majority of their
  primary care doctors to join the program
• Meet a stringent set of qualifications for
  doctors who participate and
• Integrate public health services to emphasize
  wellness and prevention strategies.

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PCMH - HOUSE of representatives activity

• The House Tri-Committee Health Reform Proposal
• 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)).' 
• Medical Home Pilot Program for Medicaid.
  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.
• Payment incentive for selected primary care
  services. Increases the Medicare payment rate by
  5 for primary care services of physicians
  specializing in primary care. Eligible
  practitioners practicing in health professions
  shortage areas receive an additional 5.

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PCMH - Senate Activity

• Senate HELP Committee
• Grants to Establish Community Health Teams to
  Support a Medical Home Model 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 -. 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.
• Health Literacy and Shared Decision Making.
• Senate Finance Committee
• Create a new Medicaid state plan option where
  enrollees with at least two chronic conditions,
  or those with one chronic condition who are at
  risk of developing another chronic condition,
  could designate a provider as their health home.
  Qualifying providers would have to meet certain
  standards established by the Secretary.
• Require the Secretary to create a CMS
  Innovation Center, a new office authorized to
  test, evaluate, and expand different payment
  structures and methodologies that aim to foster
  patient-centered care, improve quality, and slow
  the rate of Medicare cost growth.
• Provide a new ten percent bonus for certain
  primary care practitioners beginning January 1,
  2011.
• Provide Medicare direct and indirect Graduate
  Medical Education funding for Teaching Health
  Centers.

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Evidence of cost Savings Quality Improvement
This briefing document summarizes key findings
from recent PCMH evaluation studies. Across these
diverse settings and patient populations,
evaluation findings consistently indicate that
investments to redesign the delivery of care
around a primary care PCMH yield an excellent
return on investment Quality of care, patient
experiences, care coordination, and access are
demonstrably better. Investments to strengthen
primary care result within a relatively short
time in reductions in emergency department visits
and inpatient hospitalizations that produce
savings in total costs. These savings at a
minimum offset the new investments in primary
care in a cost-neutral manner, and in many cases
appear to produce a reduction in total costs per
patient.
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Summary of Key Data on Cost Outcomes from Patient Centered Medical Home Interventions
Group Health Cooperative of Puget Sound 29 Reduction in ER visits and 11 reduction in ambulatory sensitive care admissions. Additional investment in primary care of 16 per patient per year was associated with offsetting cost reductions, with the net result being no overall increase in total costs for pilot clinic patients.
Community Care of North Carolina 40 decrease in hospitalizations for asthma and 16 lower ER visit rate total savings to the Medicaid and SCHIP programs are calculated to be 135 million for TANF-linked populations and 400 million for the aged, blind and disabled population.
Genesee Health Plan HealthWorks PCMH Model 50 decrease in ER visits and 15 fewer inpatient hospitalizations, with total hospital days per 1,000 enrollees now cited as 26.6 lower than competitors.
Colorado Medicaid and SCHIP Median annual costs 785 for PCMH children compared with 1,000 for controls, due to reductions in ER visits. and hospitalizations. In an evaluation specifically examining children in Denver with chronic conditions, PCMH children had lower median costs (2,275) than those not enrolled in a PCMH practice (3,404).
Johns Hopkins Guided Care PCMH Model 24 reduction in total hospital inpatient days, 15 fewer ER visits, 37 decrease in skilled nursing facility days. Annual net Medicare savings of 1364 per patient and 75,000 per Guided Care nurse deployed in a practice.
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PCPCC PAYMENT MODEL (MAY 2007)PAYMENT REFORM
TASK FORCE (SEPTEMBER 2009)
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
(including behavioral health)
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PROOF IN PRACTICE A COMPILATION OF PATIENT
CENTERED MEDICAL HOME PILOT AND DEMONSTRATION
PROJECTS RELEASED OCTOBER 2009

• Developed by the PCPCC Center for
  Multi-stakeholder Demonstration offering a
  state-by-state sample of key pilot initiatives.
• Offers key contacts, project status,
  participating practices and market scan of
  covered lives and 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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A COLLABORATIVE PARTNERSHIP RESOURCES TO HELP
CONSUMERS THRIVE IN THE MEDICAL HOME RELEASED
OCTOBER 2009

• PCPCC activities and initiatives supporting
  consumer engagement
• Research and examples surrounding consumer
  engagement in PCMH demonstrations
• Tools for consumers and other stakeholders to
  assist with PCMH education, engagement and
  partnerships and
• A catalogue of resources that provides
  descriptions of and the means to obtain potential
  resources for consumers,
• providers and purchasers seeking to better engage
  consumers.

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ALIGNING INCENTIVES AND SYSTEMS PROMOTING
SYNERGY BETWEEN VALUE-BASED INSURANCE DESIGN AND
THE PATIENT CENTERED MEDICAL HOME

• This White Paper, authored by
• The National Business Coalition on Health
• The Patient Centered Primary Care Collaborative
  (PCPCC) and
• University Michigan Center for Value Based
  Insurance Design
• Presents
• the conceptual foundation
• previews the available clinical and economic
  evidence and
• explores how the integration of these
  innovative health care strategies impact quality
  of care and health care costs.
• Case studies of health plans, employers, and
  public purchasers who have adopted one or both
  strategies include
• Battle Creek, MI
• IBM
• Geisinger Health Plan
• Roy O. Martin and
• Whirlpool Corporation

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PCPCC STRATEGIC OVERVIEW

• Mission Statement The PCPCC will promote the
  widespread implementation of patient-centered
  medical homes, which will in turn improve the
  effectiveness, quality, and value of health care
  in the United States.
• In pursuit of this mission, there are five main
  strategies that the PCPCC will follow
• Strengthen the health professions training
  pipeline to increase the production of highly
  trained primary care clinicians needed for the
  nations PCMH
• Build the infrastructure for modernized, 21st
  Century PCMHs
• implement systems of interoperable EMRs and
  related health IT in all PCMHs,
• provide technical assistance for practice
  innovation and reengineering of PCMHs,
• support the training and deployment of team-based
  care models in the PCMH.
• Reform payment policies in the private and
  public sector to support PCMH
• increase primary care fees to appropriately value
  the work of primary care,
• compensate medical home for care coordination and
  other work outside face-to-face encounters, and
• promote and reward high value in the delivery of
  services by the PCMH.
• Engage consumers as active partners in the PCMH
  
• Engage employers as active partners in the
  PCMH

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PATIENT CENTERED PRIMARY CARE COLLABORATIVES
FOCUS AREAS 2009-2010