HIMSS Pa(ent- Centered Payer Roundtable. December 16, 2010
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1 HIMSS Pa(ent- Centered Payer Roundtable December 16, 2010
2 Agenda Welcome Call to Order and Roll Call (Paul Oates, Shelley Price) Topic discussion Medical Home: Rochester, NY Pilot (Marty Lus(ck, M.D.) Topic discussion ONC Privacy & Security Tiger Team: Issue and review of tes(mony (Paul Oates) Topic discussion PCAST Report: Summary and review HIMSS comment process (Tom Leary, HIMSS) Topic discussion HIMSS11: Payer program overview (Shelley Price) Housekeeping (Shelley Price) Adjournment 2
3 Agenda Welcome Call to Order and Roll Call (Paul Oates, Shelley Price) Topic discussion Medical Home: Rochester, NY Pilot (Marty Lus(ck, M.D.) Topic discussion ONC Privacy & Security Tiger Team: Issue and review of tes(mony (Paul Oates) Topic discussion PCAST Report: Summary and review HIMSS comment process (Tom Leary, HIMSS) Topic discussion HIMSS11: Payer program overview (Shelley Price) Housekeeping (Shelley Price) Adjournment 3
4 Rochester Medical Home Initiative (RMHI) Marty Lustick, M.D.
5 Why pursue a Medical Home? Primary Care adds value Signs of an emerging crisis in primary care 5
6 General Practitioners Per 10,000 and Quality Rank in
7 Primary Care and Cost 8% increase in PCP s drives 1% decrease in cost 7
8 Current State - Diminishing Supply of PCP s % Graduates choose primary care % Graduates choose primary care % Medical Students contemplate primary care PCP average age in 2007 : 54 8
9 W-2 Differential 9
10 Pilot Goals Increase PCP Quality of Life & Income Increase Patient Satisfaction Decrease Costs / Improve Quality Understand Needs Beyond Pilot Demonstrate Innovation and Leadership 10
11 MVP/Excellus BCBS Rochester Medical Home Initiative (RMHI) Three year pilot 8/1/09 thru 7/31/12 Carefully selected physician practices 21 physicians at 7 practice sites Excellus BCBS and MVP are providing financial support and administrative resources Every patient in each practice is included in the pilot, regardless of their insurance status Harvard School of Public Health to oversee data analysis 11
12 RMHI Participating Practices(# of Physicians): 1. Unity Family Medicine at St. Bernard's (3) 2. Unity Chili Family Medicine (4) 3. Jefferson Family Medicine, P.C. (1) 4. Finger Lakes Family Care (1) 5. Lifetime Health - Perinton (3) 6. Pulsifer Medical Associates (3) 7. Ridgeview Internal Medicine Group LLP (6) 12
13 Essential Elements of Pilot Culture and Workflow Changes Access and Communication Standards Care Management (on site nurse managers) Patient Tracking and Registry (using data aggregator) Patient Registries Gaps in Care Point Of Service Reminders Performance Reporting and Improvement 13
14 Pilot: Payment Model Administrative Costs : Measurement Training (office staff and practitioners) NCQA Certification as PCMHs Patient Care Costs Additional Payments for Care Coordination Each payer uses its own model for this and P4P Pay-for-Performance (P4P) for Meeting Quality, Cost, Member Satisfaction Goals Continued FFS for Necessary Face to Face Care 14
15 Payment model (con t) Upfront $16,000 grant Continue FFS $25 pmpm for members with chronic disease Opportunity for Performance based increase 15
16 How can we afford it? On average 1000 Health plan members cost $3,200,000 annually Historically about $130,000 goes to primary care A 3% reduction in overall costs would fund a 70% increase for primary care 16
17 RMHI Planned Outcome Measures: Quality/Effectiveness Measures Diabetes, hypertension, CAD, CHF, Asthma, Depression Breast cancer, cervical cancer, colorectal cancer screening, immunizations Satisfaction Member/patient, Physician, Staff Efficiency Measures ER visits, Hospitalizations, Re-admissions, Procedures per month (MRI, CT, back surgery, lab tests, etc.) Non-MD referrals Practice activity (# of MD and non-md visits by specific E & M codes) 17
18 RMHI Current Status: All sites have embedded Care Managers Aggregated patient care data available through the MDInsight Portal All practices are now accredited as NCQA Patient Centered Medical Homes: Level 3: Pulsifer, Jefferson, Ridgeview, Finger Lakes Level 2: St. Bernard's and Chili Level 1: Perinton Ongoing meetings at all levels of the pilot, including Physician Leadership, Care Managers, and entiregroup Collaboratives Baseline satisfaction surveys are complete P4P Bonus component ready for year 2 18
19 RMHI Current Status 19
20 RMHI: What s Next? Improvement in quality indicators Quality Improvement Projects Satisfaction Surveys Efficiency Measures as part of P4P ER Utilization Rate Hospitalization Rate Re-admission Rate 20
21 Thank you Marty Lustick, M.D. Senior Vice President, Corporate Medical Director Excellus BCBS
22 Agenda Welcome Call to Order and Roll Call (Paul Oates, Shelley Price) Topic discussion Medical Home: Rochester, NY Pilot (Marty Lus(ck, M.D.) Topic discussion ONC Privacy & Security Tiger Team: Issue and review of tes(mony (Paul Oates) Topic discussion PCAST Report: Summary and review HIMSS comment process (Tom Leary, HIMSS) Topic discussion HIMSS11: Payer program overview (Shelley Price) Housekeeping (Shelley Price) Adjournment 22
23 ONC Privacy & Security Tiger Team Hearing: December 9, 2010 Link: hup://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objid=2833&pageid=19477 Health plans were asked to comment at the hearing Key points raised included: 1. Importance of data quality and completeness 2. Standards are less likely. Best prac(ces and learning systems are more valuable 3. Linking/matching discussion needs to be extended to the en(re health ecosystem..."consumer linking" 23
24 Agenda Welcome Call to Order and Roll Call (Paul Oates, Shelley Price) Topic discussion Medical Home: Rochester, NY Pilot (Marty Lus(ck, M.D.) Topic discussion ONC Privacy & Security Tiger Team: Issue and review of tes(mony (Paul Oates) Topic discussion PCAST Report: Summary and review HIMSS comment process (Tom Leary, HIMSS) Topic discussion HIMSS11: Payer program overview (Shelley Price) Housekeeping (Shelley Price) Adjournment 24
25 PCAST Report President's Council of Advisors on Science and Technology (PCAST) released a report on Health IT Path Forward Report & video at: hup:// HIMSS Summary RFI issued for public comment; due by January 17th. HIMSS providing comments Looking for PCP Roundtable members to digest the report and assist in making comments 25
26 Agenda Welcome Call to Order and Roll Call (Paul Oates, Shelley Price) Topic discussion Medical Home: Rochester, NY Pilot (Marty Lus(ck, M.D.) Topic discussion ONC Privacy & Security Tiger Team: Issue and review of tes(mony (Paul Oates) Topic discussion PCAST Report: Summary and review HIMSS comment process (Tom Leary, HIMSS) Topic discussion HIMSS11: Payer program overview (Shelley Price) Housekeeping (Shelley Price) Adjournment 26
27 HIMSS11 Payer Program HIMSS11: February 20-24, 2010 in Orlando, FL Pre- conference events Symposia: Secondary Use of Data, 5010/ICD- 10 Medical Banking Bootcamp and Ins(tute Conference events Educa(on sessions Payer Breakfast and PCP Roundtable ACO conference HIMSS11 Payer Program Agenda available at hup:// _HIMSS11_MainBrochureContent2011_Pay er.pdf 27
28 Agenda Welcome Call to Order and Roll Call (Paul Oates, Shelley Price) Topic discussion Medical Home: Rochester, NY Pilot (Marty Lus(ck, M.D.) Topic discussion ONC Privacy & Security Tiger Team: Issue and review of tes(mony (Paul Oates) Topic discussion PCAST Report: Summary and review HIMSS comment process (Tom Leary, HIMSS) Topic discussion HIMSS11: Payer program overview (Shelley Price) Housekeeping (Shelley Price) Adjournment 28
29 Wrap- up Web page hup:// Next mee(ng 3rd Thursday of the month from 4-5pm EST Thursday, January 20,
30 Leadership and Contact Informa(on Chairperson: Paul Oates Senior Enterprise Architect CIGNA Healthcare Vice Chairperson: Jeffrey Pankow Director, IT Excellus BCBS HIMSS Staff Liaison: Shelley Price Director, Payer and Life Sciences HIMSS 30
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