Medical Home: Next Steps in the Neighborhood. David Kelley MD, MPH Chief Medical Officer Office of Medical Assistance Programs

Transcription

1 Medical Home: Next Steps in the Neighborhood David Kelley MD, MPH Chief Medical Officer Office of Medical Assistance Programs Outline Pennsylvania s medical home initiatives RDPS Care Collaboration for Consumers with Serious Mental Illness - multi payer collaborative Current activity in HealthChoices managed care and Access Plus PCCM programs Future directions Embedded care management BH-PH coordination Transition of care (TOC) HIT 1

2 RDPS Small practices High volume Medicaid High opportunity for quality improvement Floating nurse provided to 8 practices RN multiple roles of practice redesign, quality improvement and care coordination Free registry provided to practices Results Minor practice redesign Minimal i uptake of HIT Improvement in quality processes for diabetes Cost savings- TBD SMI Project Consumers with SMI in Pittsburgh and 3 counties surrounding Philadelphia Collaboration between BH-PH MCOs, counties, providers and consumers Focus Combined stratification of BH-PH consumers Shared care plans Hospital notification within 24 hours Pharmacy non-adherence Reduced hospitalizations/readmissions/ ED visits PH navigators part of BH team Preliminary results first year Slight reduction in admissions/readmissions Program being expanded into rural counties 2

3 Multi-payer initiative in 5 different regions started in 2007 Involves over 150 practices, 780 providers and over 1 million patients Initial focus on practice redesign, use of HIT to report quality data, and learning networks Clinical focus on adult diabetes and pediatric asthma Minimal focus on embedded care management or TOC Results Improved quality, uptake of HIT, NCQA recognition i Cost savings- TBD In NEPA, shared savings model yielded income for providers Multi-payer CMS grant including Medicare awarded 2010 Multi-payer CMS grant including Medicare Involves three regions with over 80 practices Payment for infrastructure $1.50 pmpm Payment of age based care management pmpm ($.60- $7.00) Required collection of and monthly reporting of quality data Required embedded care management in practices Gain share based on cost savings model Must hit quality thresholds to participate in gain share Medicaid MCOs and FFS program required to participate 3

4 Activity in HealthChoices and Access Plus HealthChoices All MCOs participate in CCI $1 pmpm P4P money can be used to fund CCI UPMC for You- fully developed TOC program at 16 hospitals and embedded nurses in 50 practices Other MCOs primarily telephonic care management (180 FTEs) but starting to fund 1-5 high volume practices with embedded nurses; minimal TOC programs BH-PH collaboration Access Plus Over 30 floating nurses covering 42 rural counties Dedicated set of nurses for improving quality TOC program in 20 hospitals Minimal use of HIT Improvement in quality, over $87 million dollars of cost savings in first 4 years Future Directions for Medicaid HealthChoices All MCOs required to participate in CCI MCOs required to Embed nurse care managers (CMs) in high volume practices Encourage practices to obtain NCQA certification Develop TOC programs MCOs encouraged to Develop TOC and CM programs with large health systems Develop gain share arrangements with large health systems Develop floater CM programs with smaller practices Expand BH-PH programs 4

5 Future Directions for Medicaid Access Plus CCI in 29 practices- involves embedding dedicated CMs owned by the practices in NEPA Continue floater CM model on in other regions Expand BH-PH navigator model Expand TOC program to additional hospitals HIT High volume Medicaid eligible providers and hospitals targeted for HIT incentives hospitals targeted for HIT incentives Over 1,000 providers have received HIT incentives Over $54 million sent to providers since June 2011 Meaningful use of EHRs essential to success of care management and transitions of care programs Conclusions Focus High volume providers Embed nurse CMs Develop TOC programs Coordinate BH-PH Integrate with HIT/EHR program Fund through existing capitation payments Align incentives Outcomes Improve quality and consumer satisfaction Reduce admissions/readmissions Reduce ED visits Questions? Contact 5