North Carolina Multi-Payer Advanced Primary Care Demonstration

Transcription

1 North Carolina Multi-Payer Advanced Primary Care Demonstration

2 Community Care of the Lower Cape Fear One of 14 CCNC Networks Headquartered in Wilmington, NC Geographic Footprint: Bladen, Brunswick, Columbus, New Hanover, Onslow and Pender Counties Partnership of 154 Primary Care Practices / 490+ Providers; seven Regional Hospitals; six local health departments; six departments of social services; other local healthcare stakeholders including AHEC and LMEs. Patient Enrollment: 95,000 MAPCP Attribution: Ø Medicare: 7,633 Ø BCBSNC: 2,060 2

3 MAPCP Overview q CMS awards NC $11.8 million for 3-year demonstration to pilot the expansion of the Patient Centered Medical Home and Care Management Services to improve health outcomes and reduce care costs across multiple payers in 7 rural North Carolina counties. q Partners include: Community Care of North Carolina (CCNC) CMS Blue Cross Blue Shield of North Carolina (BCBSNC) State Employees Health Plan q 4 CCNC Networks covering Ashe, Avery, Bladen, Columbus, Granville, Transylvania and Watauga Counties q Participation Eligibility: Practices must be enrolled with local CCNC Network and achieve NCQA PCMH (level I, II or III) Recognition q Incentives: Financial and CCNC Benefits 3

4 What is PCMH? q A model of primary care recognized by the National Committee for Quality Assurance (NCQA). q A PCMH is a health care setting that emphasizes the relationship between patient, provider, and when appropriate, the patient's family. q Integrates evidence-based practices, clinical decision-support tools, disease registries, and health information technology to improve population management and preventive care. v Medicare reimbursements scalable based on level of NCQA PCMH recognition and attribution. BCBSNC and State Health Plan negotiated at the practice level. 4

5 Planning & Implementation q Almost half of MAPCP eligible practices in Bladen & Columbus Counties q Targeted communications campaign to recruit eligible practices q All but a few eligible practices made the commitment to join & undergo PCMH transformation q The Practice Commitment: q PCMH Dedicated Team, Provider-led q 100+ hours 5

6 Technical Assistance & Practice Support q CCNC Webinar Series with templates, examples and tools to support transformation q PCMH Project Timeline q Dedicated QI team member for every practice, providing regularly scheduled educational and technical assistance meetings q Collaboration with SEAHEC q CCNC discounted submission rate (20% off $450 provider fee) Today, 23 CCLCF practices have achieved NCQA PCMH recognition. 6

7 Staffing, Trainings, Meetings and More CCLCF Staffing: QI team trained on PPC-PCMH 2008 and 2011 Guidelines (NCQA conferences, webinars, and conference call trainings) Internal MAPCP team meetings Regularly scheduled CCNC MAPCP conference calls and meetings Ramped-up staffing to meet project needs: additional QI support, Care Management and Pharmacy Provider Meetings: Kick-off evening meetings Columbus Regional Provider Trainings After-hours trainings at individual practices In-person technical assistance BCBS BQPP Educational Meetings 7

8 The Challenges of Taking on New Populations SHP and BCBS contracts are set up with warm hand-offs Limited patient data across populations Care Managers challenged with learning new resources and benefits covered under different insurers Pharmacy staff challenged with learning medication benefits of new insurers Patients are not linked to a medical home impacting practice efforts, patient behaviors and CCLCF QI efforts. Care Management Information System (CMIS) needed significant development to incorporate and analyze the data from multiple insurers 8

9 Lessons Learned: New Populations Medicare: Finances and a lack of supportive resources are a challenge; Multi-morbidity and frailty drive recurrent hospitalizations; Most high-risk Medicare beneficiaries take more than 15 medications; Prefer face-to-face visits over phone encounters. Blue Cross Blue Shield NC / SHP Working populations / hours adjustment Not as receptive to cold calling 9

10 Lessons Learned at a Practice: Bladen Medical Intense undertaking to achieve PCMH recognition (approx. 150 hours) Increased patient access with new after-hours clinics Increased efficiencies (policies and procedures in place; staffing framework) Meaningful financial incentives from different insurers Stronger partnership with CCLCF Desire to increase in-house quality improvement efforts 10

11 CMS Site Visit 11

12 Questions?