MEDICAL HOMES Arkansas Hospital Association Framing our discussion Environmental snapshot of health care Hospitals and the PCMH Arkansas Medical Homes Patients/Consumers 2 1
Health Policy is changing Budget Challenges Health Care Reform 3 Health Care Is changing Access to providers is a major concern Rural Arkansas is aging and with that trend comes health care challenges including chronic disease management Fragmented Care Improving outcomes 4 2
Impact of Health Care Reform 2014 Anticipate increased enrollments 5 AHA Research Synthesis Report * 5 ways hospitals can support PCMH Strengthen affiliated physician relationships Help facilitate use of health information technology Offer staff support and resources Offer management expertise Administrator of bundled payment * Source: American Hospital Association Committee on Research, Sept 2010 6 3
Primary focus Can t lose sight of the person the patient is the center! emphasis on medical management rewarding quality patient centered care improving the patient experience and reducing cost 7 What is a Medical Home? a team based health care delivery model that facilitates communication and shared decision making between the patient, their primary care providers, other providers, and the patient s family. GOAL: Continuity of care to obtain maximized health outcomes 8 4
CPCI Comprehensive Primary Care Initiative Multi payer initiative Collaboration between public and private payers Goal: strengthen primary care Offer bonus $$$ for better coordination of care Access to resources to help coordinate 9 CPCI Comprehensive Primary Care Initiative ARKANSAS has been selected to be included in CPCI Arkansas Four Payers: 1. Arkansas Blue Cross and Blue Shield 2. Arkansas Medicaid 3. Humana 4. QualChoice of Arkansas 10 5
CPCI Details Manage Care for Patients with High Health Care Needs Serious or multiple conditions deliver intensive care management create a care plan unique to each patient Ensure Access to Care: People need 24/7 access emergencies don t keep clinic hours Use EHR real time, personal health care information to patients in need 11 Deliver Preventive Care CPCI Details (cont.) proactively assess patients Engage Patients and Caregivers Coordinate Care Across the Medical Neighborhood Primary care is the center of patients experiences with medical care Access to and meaningful use of EHR 12 6
Service Delivery Model Designed to test comprehensive primary care including: Risk stratified Care Management Access and Continuity Planned Care for Chronic Conditions and Preventative Care; Patient and Caregiver Engagement Coordination of Care Across the Medical Neighborhood. 13 Payment Model A monthly care management fee (for their FFS Medicare beneficiaries) Potential to share in any savings to the Medicare program (years 2 4) Multi payer funding streams Other payers participating in the initiative will pay PCPs Strengthen their capacity to implement practice wide quality improvement 14 7
Influence Patients Change behavior 15 Influence Patients Increase compliance 16 8
Purposeful Decisions Coordination across the medical neighborhood 17 Purposeful Decisions Reduce errors 18 9
Purposeful Decisions Control costs 19 Purposeful Outcomes Improve outcomes Have healthier communities 20 10
So now what? We ve heard a lot of information from varying perspectives relating to Patient Centered Medical Homes Let s ask some questions of our panel 21 Thank you! 11