maine aap ~ asthma pilot ~ learning session april 2010
DESCRIPTION
Lisa M. Letourneau MD, MPH Quality Counts. Maine AAP ~ Asthma Pilot ~ Learning Session April 2010. Disclosure Statement. 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. - PowerPoint PPT PresentationTRANSCRIPT
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)
Contact Info / Questions Lisa Letourneau MD, MPH• [email protected]• 207.415.4043
Sue Butts Dion• [email protected]
Maine PCMH Pilot• www.mainequalitycounts.org
(See “Resource Library” & “News” sections)
Additional info on PCMH model, pilots• www.pcpcc.net