maine aap ~ asthma pilot ~ learning session april 2010

Maine AAP ~ Asthma Pilot ~ Learning Session

April 2010

Lisa M. Letourneau MD, MPHQuality Counts

I have no relevant financial relationships with the manufacturers(s) of any commercial products(s)

and/or provider of commercial services discussed in this CME activity.

Disclosure Statement

Objectives

• Describe Maine PCMH Pilot

• Understand how asthma fits into PCMH– Role of care managers – Role of patients in improving asthma

• Asthma quality measures moving forward

Defining Medical Home

“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.”

American Academy Pediatrics

The Stalemate that Blocks Change

Providers unable to transform practice without

viable & sustainable payment for desired

services

Employers & payers unwilling to pay for desired

services unless primary care demonstrates value AND create potential to

save money

BUT

The Medical Home: A Model for Change!

Providers transform practice, create value with

viable & sustainable payment for desired

services

= Practice Transformation

Employers & payers pay for desired services

because primary care demonstrates value AND

saves money

= Payment Reform

AND

AAFP-AAP-ACP-AOA-AMAPCMH Joint Principles

1. Every patient has a personal physician 2. Care is provided by a physician-directed team who

collectively care for patient3. Personal physician is responsible for providing all patient’s

needs, or arranging for services to be provided by others4. Care is coordinated and integrated across all aspects of

healthcare system5. Quality and safety are hallmarks6. Patients are offered enhanced access to care (e.g.

expanded hours, enhanced communication )7. Payment appropriate recognizes added value of PCMH

Maine PCMH Pilot Key elements:

– 3-year multi-payer PCMH pilot– Collaborative effort of key stakeholders, all major payers– Adopted common mission & vision, guiding principles for Maine

PCMH model– Selected 22 adult / 4 pedi PCP practices across state – Supporting practice transformation & shared learnings beyond pilot

practices– Committed to engaging consumers/ patients at all levels– Planning rigorous outcomes evaluation (clinical, cost, patient

experience of care)

Maine PCMH Pilot Leadership

Quality Counts

Maine Quality Forum

Maine Health Management

Coalition

Maine PCMH Pilot - Timeline• Jan 2009: Call for practice applications

• May 2009: Practices notified – start of 6mo “ramp-up period”

• Sept 2009: NCQA PPC-PCMH applications completed

• Sept-Dec: practices contracted with payers

• Jan 2010: Start date for PCMH payments

• Jan 2010- Dec 2012: 3-year PCMH Pilot

Maine PCMH – Pediatric Practices

• 6 applicants; 4 selected– Demonstrated commitment to PCMH – High MaineCare populations

• Participating practices:– EMMC / Husson Pediatrics– Maine Med Partners / Westbrook Peds– PCHC / Penobscot Pediatrics– Winthrop Peds & Adolescent Medicine

Maine PCMH Pilot – Payment Model

• All four private payers & Medicaid participating (??Medicare – APC demo)

• Using “standard” 3-component payment: Prospective (pmpm) care management

payment – approx $3pmpm Ongoing FFS payments Performance payment for meeting quality

targets (existing P4P programs)

Maine PCMH Pilot Practice “Core Expectations”

1. Demonstrated physician leadership2. Team-based approach3. Population risk-stratification and management4. Practice-integrated care management5. Same-day access6. Behavioral-physical health integration7. Inclusion of patients & families8. Connection to community / local HMP9. Commitment to waste reduction10.Patient-centered HIT

Support for Practice Transformation

• PCMH Learning Collaborative– IHI “BTS” model; 3 Learning Sessions/yr

• Practice QI Coaches– Most from existing PHOs, med groups– Using microsystems approach to QI

• Technical assistance “experts”– BH integration, work with consumers, HIT

• Ongoing feedback reports – Clinical, claims data

PCMH & Improving Asthma Care1. Demonstrated physician leadership2. Team-based approach3. Population risk-stratification and management4. Practice-integrated care management5. Same-day access6. Behavioral-physical health integration7. Inclusion of patients & families8. Connection to community / local HMP9. Commitment to waste reduction10.Patient-centered HIT

PCMH Evaluation

• Patient experience of care– CG-CAHPS patient surveys

• Clinical quality measures– Adult & pedi

• Cost & resource use– Hosp’s, readmissions, ED use, imaging

• Practice changes

Pedi Quality Measures

• Align with other state, national programs– Pathways to Excellence– CHIPRA– ARRA/ “Meaningful Use” measures

• Likely asthma measures– ED use– Controller use– ?Symptom assessment

Lessons Learned Maine PCMH Pilot

• Change starts with effective leadership– Primary selection criteria for Pilot– Don’t assume physician leadership skills - need

ongoing support

• Change happens through effective teams

• NCQA PPC-PCMH “medical home”

• It’s all about relationships – with patients AND within teams

• Recognize value of “outside” coaching

Where We’re Aiming: Medical Home Is Where…

• Patients feel welcomed

• Staff takes pleasure in working

• Physicians feel energized every day

Maine PCMH Pilot - Issues TBD

• Will new payment be enough to support true practice transformation?

• How best to engage specialists, hospitals in shared goals, shared cost savings?

• How to engage patients in new partnership?

• How to spread learnings to other “non-Pilot” practices

• And more??

PCMH Creating Hope for a Better System

With thanks to Dr. Tom Bodenheimer, Dept. Family & Community Med, UCSF

“I cannot say whether things will get better if we change; what I can say is they must change if we are to get better”

- Georg Christoph Lichtenberg ( 1742-1799)

www.mainequalitycounts.org

Contact Info / Questions Lisa Letourneau MD, MPH• Letourneau.lisa@gmail.com• 207.415.4043

Sue Butts Dion• sbutts@maine.rr.com

Maine PCMH Pilot• www.mainequalitycounts.org

(See “Resource Library” & “News” sections)

Additional info on PCMH model, pilots• www.pcpcc.net