Patient Centered Medical Home (PCMH) The Wisconsin Perspective by wlx15873

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									Patient Centered Medical Home (PCMH)
       The Wisconsin Perspective




             210 Green Bay Road, Thiensville, WI 53092
                      Phone: (262) 512-0606
                                                         1
                    Email: academy@wafp.org
                       www.wafp.org/pcmh
  Background: What is a PCMH?
A Patient Centered Medical Home (PCMH) is a
more effective and efficient model of health care
delivery that produces:
• Better health outcomes
• Lower costs
• Greater equity in health



                  210 Green Bay Road, Thiensville, WI 53092
                           Phone: (262) 512-0606
                                                              2
                         Email: academy@wafp.org
                            www.wafp.org/pcmh
 Background: What is a PCMH?
Joint principles from AAFP, AAP, ACP and AOA
outline the model, attributes, and payment
structure




                210 Green Bay Road, Thiensville, WI 53092
                         Phone: (262) 512-0606
                                                            3
                       Email: academy@wafp.org
                          www.wafp.org/pcmh
  Background: What is a PCMH?
In a Patient Centered Medical Home:
• Patients have a relationship with a personal physician.
• A practice-based care team takes collective
  responsibility for the patient’s ongoing care.
• The care team is responsible for providing or arranging
  all the patient’s health care needs.




                     210 Green Bay Road, Thiensville, WI 53092
                              Phone: (262) 512-0606
                                                                 4
                            Email: academy@wafp.org
                               www.wafp.org/pcmh
  Background: What is a PCMH?
In a Patient Centered Medical Home:
• Patients can expect care that is coordinated across
  care settings and disciplines.
• Quality is measured and improved as part of daily work
  flow.
• Patients experience enhanced access and
  communication.
• The practice uses electronic health records, registries
  & other clinical support systems.


                     210 Green Bay Road, Thiensville, WI 53092
                              Phone: (262) 512-0606
                                                                 5
                            Email: academy@wafp.org
                               www.wafp.org/pcmh
210 Green Bay Road, Thiensville, WI 53092
         Phone: (262) 512-0606
                                            6
       Email: academy@wafp.org
          www.wafp.org/pcmh
                  Why PCMH?
A Patient Centered Medical Home delivers:
• Improved patient care and satisfaction
   – In the US, studies show patients with a primary care
     physician had 33% lower costs of care and were 19%
     less likely to die – than patients who worked solely with
     specialists.
   – Recent studies estimate that if every American had access
     to a Medical Home, national health care expenditures
     would drop by 5.6% – translating into a national savings
     of at least $67 billion per year.



                      210 Green Bay Road, Thiensville, WI 53092
                               Phone: (262) 512-0606
                                                                  7
                             Email: academy@wafp.org
                                www.wafp.org/pcmh
                 Why PCMH?
A Patient Centered Medical Home delivers:
• Enhanced payment in a fee-for-service and pay-for-
  performance environment
• Better organized and more efficient office processes
• Higher physician and staff satisfaction




                    210 Green Bay Road, Thiensville, WI 53092
                             Phone: (262) 512-0606
                                                                8
                           Email: academy@wafp.org
                              www.wafp.org/pcmh
How is a Practice Recognized as a PCMH?

NCQA has developed a scored criteria set of standards
(PPC-PCMH™) for medical practices to demonstrate that
they are functioning as PCMHs
• Includes a tiered recognition system based upon score
   (see www.ncqa.org)

TransforMED has a MHIQ tool to assess a practice’s
readiness



                    210 Green Bay Road, Thiensville, WI 53092
                             Phone: (262) 512-0606
                                                                9
                           Email: academy@wafp.org
                              www.wafp.org/pcmh
         PCMH in Wisconsin
An increasing number of WI practices are in the
process of obtaining NCQA recognition as a
Patient Centered Medical Home.
The Wisconsin Academy of Family Physicians
(WAFP) is making the advancement of PCMH
its #1 priority.



                  210 Green Bay Road, Thiensville, WI 53092
                           Phone: (262) 512-0606
                                                              10
                         Email: academy@wafp.org
                            www.wafp.org/pcmh
           PCMH in Wisconsin
The WAFP Goals, over the next 3-5 years, are:
• To help our members understand, embrace and
  implement PCMH
• To educate payers and legislators about the benefits of
  the medical home concept and achieve payment reform
• To reform the health care payment system to recognize
  PCMH
We believe the Patient Centered Medical Home is
our best hope for meaningful health care reform
as evidenced by other successful implementations.

                     210 Green Bay Road, Thiensville, WI 53092
                              Phone: (262) 512-0606
                                                                 11
                            Email: academy@wafp.org
                               www.wafp.org/pcmh
     Payment Structure Reform
Fee for service for face-to-face visits

Care management fee to recognize added value

Additional payment for achieving measurable and
continuous quality improvement




                       210 Green Bay Road, Thiensville, WI 53092
                                Phone: (262) 512-0606
                                                                   12
                              Email: academy@wafp.org
                                 www.wafp.org/pcmh
    Payment Structure Reform
Payment reform must recognize the added value
provided to patients with Patient Centered Medical
Home




                  210 Green Bay Road, Thiensville, WI 53092
                           Phone: (262) 512-0606
                                                              13
                         Email: academy@wafp.org
                            www.wafp.org/pcmh
            PCMH in Practice
North Carolina: 2003 – 2006
Patient Centered Medical Home implementation saves
the state of North Carolina more than $200 Million
each year in health care costs.




                   210 Green Bay Road, Thiensville, WI 53092
                            Phone: (262) 512-0606
                                                               14
                          Email: academy@wafp.org
                             www.wafp.org/pcmh
             PCMH in Practice
North Carolina: 2003 – 2006
Category of Service                                 Estimated Annual Savings
Inpatient                   $142,085,680
Outpatient                  $ 51,865,028
Emergency Room              $ 25,944,553
Primary Care, Specialist    $ 45,944,553
Pharmacy                    $ (15,526,996)
Other                  $ (5,065,238)
Total                                               $ 244,801,735

                      210 Green Bay Road, Thiensville, WI 53092
                               Phone: (262) 512-0606
                                                                           15
                             Email: academy@wafp.org
                                www.wafp.org/pcmh
           PCMH in Practice
North Carolina: 2003 – 2006
Savings are achieved because physicians:
• Proactively assist their patients in staying
  healthy and managing existing illnesses or
  conditions
• Coordinate patient care among an organized
  team of health care professionals
• Utilize systems at the practice level to achieve
  higher quality care and better outcomes
• Focus on whole person care for their patients

                   210 Green Bay Road, Thiensville, WI 53092
                            Phone: (262) 512-0606
                                                               16
                          Email: academy@wafp.org
                             www.wafp.org/pcmh
                WAFP Efforts
What WAFP is doing for Members:
• We’ve compiled tools you can use to better understand
  PCMH and its benefits to your patients and your
  practice.
• We’ll begin soon to conduct monthly phone/web
  conferences, open to all members, staff and colleagues.
  Each conference will feature a PCMH topic and will be
  followed by Q&A.




                    210 Green Bay Road, Thiensville, WI 53092
                             Phone: (262) 512-0606
                                                                17
                           Email: academy@wafp.org
                              www.wafp.org/pcmh
                 WAFP Efforts
What WAFP is doing on the Policy front:
• Our lobbyist is actively talking with Wisconsin state
  legislators about the benefits of PCMH.
• In November, 2008, we testified before the Wisconsin
  Legislative Council in favor of a PCMH pilot program in
  the state.
• We developed a proposed PCMH Medicaid Payment
  Program.




                     210 Green Bay Road, Thiensville, WI 53092
                              Phone: (262) 512-0606
                                                                 18
                            Email: academy@wafp.org
                               www.wafp.org/pcmh
               WAFP Efforts
What WAFP is doing on the Policy front:
WAFP has proposed a blended payment plan for Medical
Assistance incorporating:
• Enhanced fee for service fees
• A care management fee
• Pay for Performance (P4P) bonuses




                   210 Green Bay Road, Thiensville, WI 53092
                            Phone: (262) 512-0606
                                                               19
                          Email: academy@wafp.org
                             www.wafp.org/pcmh
                        WAFP Efforts
What WAFP is doing on the Policy front:
Both fee-for-service and care management fees would
be increased according to the PCMH recognition level
achieved by the practice:

 Level of         FFS Primary Care Fee
                                                          PMPM Care Management Fee
 Recognition      Schedule Increase

 No recognition   0%                                      $0 PMPM
 Level 1          %                                      $ PMPM
 Level 2          %                                     $ PMPM
 Level 3          %                                    $ PMPM


                            210 Green Bay Road, Thiensville, WI 53092
                                     Phone: (262) 512-0606
                                                                                     20
                                   Email: academy@wafp.org
                                      www.wafp.org/pcmh
                                WAFP Efforts
Under a blended payment plan, projected
savings in Wisconsin could be as follows:
   Patient Centered Medical Home Wisconsin Projections

   Medicaid       % in   Monthly       Annual        Annual Savings     Monthly        Projected Cost    Net Savings
   Participants   PCMH   Savings       Savings                          Cost per       (paid to PCMHs)
                         per           per                              Participant
                         Participant   Participant                      PMPM


   45,650         5%     $29.05        $348.57       $15,912,286        $12.00         $6,573,600        $9,338,686

   91,300         10%    $29.05        $348.57       $31,824,571        $12.00         $13,147,200       $18,677,371

   228,250        25%    $29.05        $348.57       $79,561,429        $12.00         $32,868,000       $46,693,429

   456,500        50%    $29.05        $348.57       $159,122,857       $12.00         $65,736,000       $93,386,857




                                           210 Green Bay Road, Thiensville, WI 53092
                                                    Phone: (262) 512-0606
                                                                                                                       21
                                                  Email: academy@wafp.org
                                                     www.wafp.org/pcmh
              WAFP Efforts
For a Wisconsin practice of 5000 patients at Level
1 PCMH recognition, that means a potential of
$300,000 annually in PMPM payments.




                  210 Green Bay Road, Thiensville, WI 53092
                           Phone: (262) 512-0606
                                                              22
                         Email: academy@wafp.org
                            www.wafp.org/pcmh
               WAFP Efforts
What You Can Do:
• Discuss the concept with your peers and within your
  clinic.
• Take the MHIQ, found at this web
  addresshttp://www.transformed.com/MHIQ/welcome.cfm
  ,
  and compare your answers to the NCQA PPCPCMH™
  Standards — a national recognition program based on
  the Patient Centered Medical Home.
• Develop a work plan to become a Patient Centered
  Medical Home.
                   210 Green Bay Road, Thiensville, WI 53092
                            Phone: (262) 512-0606
                                                               23
                          Email: academy@wafp.org
                             www.wafp.org/pcmh
         For More Information
Visit: www.wafp.org/pcmh
Call: Wisconsin Academy of Family Physicians
       Larry Pheifer, Exec. Dir. (262) 512-0606
E-mail: Larry@wafp.org




                  210 Green Bay Road, Thiensville, WI 53092
                           Phone: (262) 512-0606
                                                              24
                         Email: academy@wafp.org
                            www.wafp.org/pcmh
Thank You




210 Green Bay Road, Thiensville, WI 53092
         Phone: (262) 512-0606
                                            25
       Email: academy@wafp.org
          www.wafp.org/pcmh

								
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