west virginia medical home incentive pilot
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WEST VIRGINIA MEDICAL HOME INCENTIVE PILOT
Presented to:PCPCC Center for Multi-payer DemonstrationsApril 6, 2010Christine St. AndreRoger Chaufournier
BACKGROUND Medicaid Transformation Grants---conceptual
support for medical home model Project management contract through West Virginia
University/ CSI Solutions, LLC to implement the grants
Development of West Virginia Health Improvement Institute as a forum for multiple stakeholders to collaborate in improving the health status of the citizens of WV
Evolved from Medicaid-sponsored to independent 501(c)3 with broad stakeholder board
WEST VIRGINIA HEALTH IMPROVEMENT INSTITUTE
Stakeholder Advisory GroupMeets Quarterly
Virtual Engagement On-Going
ProviderEducation
Self Management
Adoption ofHIT
Measurement/Reimbursement/
Reporting
Innovation Community300+ Primary Care Providers
Pilots Pilots Pilots
Coordinating Committee
Evaluation& Innovation
AIM: To improve the health status of all West Virginians through aligned initiatives focusing on improved access; prevention; promotion of wellness and healthy lifestyle choices; and optimal evidence based chronic illness management
INSTITUTE DESIGN ELEMENTS Broad participation across professional
organizations, payers, advocacy groups, providers Work groups to focus on specific topics of interest
and importance Use of pilot projects to test changes/ intervention on
a small scale prior to decisions on full state-wide implementation
Creation of an Innovation Community of interested providers committed to the medical home model and willing to participate in pilot initiatives
INNOVATION COMMUNITY
Virtual community of primary care providers committed to improving the health of the population
Voluntary process 300+ primary care providers Access to opportunities for training and pilot
participation and supported by a virtual office
PILOTS CURRENTLY UNDERWAY A pediatric obesity pilot A pilot on training in the Stanford Self-Management program A pilot focused on empowering young Medicaid mothers with
health literacy skills so as to better utilize the health care system
Testing of a provider incentive program for adoption of technology
Pilot to explore interest and scalability of an open source EMR A pilot to test the ability of providers to report on a key set of
quality measures A pilot focused on the chronically sick and disabled using an
expanded care team and pharmacist A pilot to test sharing a care coordinator among several small
private practices A Medical Home Performance Incentive pilot using a shared
savings incentive model
MEDICAL HOME PERFORMANCE INCENTIVE PILOT-PILOT BASICS Developed by Measurement Work Group to test
effectiveness of the Patient-Centered Medical Home model in WV and to inform future reimbursement
Uses NCQA PCMH Recognition criteria Outcomes assessment to include:
Clinical process measuresClinical outcome measuresUtilizationCostAlignment with evolving definition of “Meaningful Use”
PILOT BASICS Beginning with 6 month readiness phase
Practice assessmentModified collaborative approach—face to face
learning session for the care team, webcasts, monthly team calls
Training and coaching on NCQA standards and practice redesign
Preparation for measures reporting 12 month assessment phase following the
readiness period
PILOT BASICS Payer participation:
UniCare (managed Medicaid)Mountain State BlueCross Blue ShieldPEIA (state employee plan)
Shared savings incentive model-up to 2.5% of total claims cost based on comparison of assessment period to 2009 claims
No change in ongoing reimbursement Twelve month savings pooled across all providers
and patients; distribution to be based on physician performance on process and outcomes measures
Payout targeted for Fall, 2011
PARTICIPATING PRACTICES Targeted 50 physicians; have 33 Limited the number of physicians from each
organization7 FQHC’s9 free clinics---all in the stateOne large IPA2 academic practices2 small private practicesOne rural health clinic
All have an EMR in place, but this was not a requirement
EXPECTATIONS OF PRACTICES Make a commitment: participation agreement,
business associate agreements Apply for NCQA recognition within 9 months Care team participation in the face to face
session, webcasts, and monthly calls Monthly reporting the aggregate clinical
measures for all patients using the measures required for CMS EMR incentives
Provide patient lists for attribution
EXPECTATIONS OF PARTICIPATING PAYERS
Verify patient lists for attribution Agree to share savings up to 2.5% of total 2009 claims
cost for the participating patients/ members and contribute this amount to the overall incentive pool
Agree on a uniform approach to calculation of savings Agree on incentive pool distribution methodology Provide cost and utilization feedback where possible
based on claims data Use results to inform future reimbursement changes
PATIENT ATTRIBUTION Practices use practice management or EMR system to
look back 18 months and identify any patient that has been seen during that time.
Exclude any people seen as a result of cross-coverage and others that were known to be one-time occurrences
Provide a list of all patients, with their designated payer to the WVHII staff
Lists are aggregated by payer for confirmation of coverage during the entire 2009 period
HOW DID WE SELL PARTICIPATION TO PRACTICES? Financial upside from the incentive component Best practice models they will be exposed to could
help drive internal efficiencies and throughput Market value of TA offered (estimated at
approximately $25k per practice) Participation will jump start the practice down the
pathway of meaningful use This is a showcase demonstration project of
national significance Intend to influence the remaining reimbursement
system if we all succeed
ROLE AND SUPPORT FROM WVHII Project management Training, technical assistance, and coaching Reporting site that will aggregate data and track
individual as well as group performance Virtual office and listserv for sharing resources Compensation for lost revenue resulting from
attendance at all day learning session Payment for NCQA assessment tool and
application
CHALLENGES WE’VE FACED Not all payers are participating
Medicaid need for plan amendment in order to compensate differently
Medicare Several smaller payers in the state
Providers take the full riskDifficulty in recruitment
Measurement strategy not yet finalMeaningful use and CMS incentives must be
considered to avoid re-work and duplication
CURRENT STATUS In readiness phase with face to face learning
session held in February Practices completing practice assessments Compiling patient lists for attribution Expect 12 month assessment phase to begin July
1 Payers meeting next month to establish savings
calculation Now that we have started, more people want to
get involved!
CONTACT INFORMATION
www.wvhealthimprovement.org
Christine St. Andrécstandre@spreadinnovation.com
Roger Chaufournier rchaufournier@spreadinnovation.com
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