WEST VIRGINIA MEDICAL HOME INCENTIVE PILOT

Presented to:PCPCC Center for Multi-payer DemonstrationsApril 6, 2010Christine St. AndreRoger Chaufournier

BACKGROUND Medicaid Transformation Grants---conceptual

support for medical home model Project management contract through West Virginia

University/ CSI Solutions, LLC to implement the grants

Development of West Virginia Health Improvement Institute as a forum for multiple stakeholders to collaborate in improving the health status of the citizens of WV

Evolved from Medicaid-sponsored to independent 501(c)3 with broad stakeholder board

WEST VIRGINIA HEALTH IMPROVEMENT INSTITUTE

Stakeholder Advisory GroupMeets Quarterly

Virtual Engagement On-Going

ProviderEducation

Self Management

Adoption ofHIT

Measurement/Reimbursement/

Reporting

Innovation Community300+ Primary Care Providers

Pilots Pilots Pilots

Coordinating Committee

Evaluation& Innovation

AIM: To improve the health status of all West Virginians through aligned initiatives focusing on improved access; prevention; promotion of wellness and healthy lifestyle choices; and optimal evidence based chronic illness management

INSTITUTE DESIGN ELEMENTS Broad participation across professional

organizations, payers, advocacy groups, providers Work groups to focus on specific topics of interest

and importance Use of pilot projects to test changes/ intervention on

a small scale prior to decisions on full state-wide implementation

Creation of an Innovation Community of interested providers committed to the medical home model and willing to participate in pilot initiatives

INNOVATION COMMUNITY

Virtual community of primary care providers committed to improving the health of the population

Voluntary process 300+ primary care providers Access to opportunities for training and pilot

participation and supported by a virtual office

PILOTS CURRENTLY UNDERWAY A pediatric obesity pilot A pilot on training in the Stanford Self-Management program A pilot focused on empowering young Medicaid mothers with

health literacy skills so as to better utilize the health care system

Testing of a provider incentive program for adoption of technology

Pilot to explore interest and scalability of an open source EMR A pilot to test the ability of providers to report on a key set of

quality measures A pilot focused on the chronically sick and disabled using an

expanded care team and pharmacist A pilot to test sharing a care coordinator among several small

private practices A Medical Home Performance Incentive pilot using a shared

savings incentive model

MEDICAL HOME PERFORMANCE INCENTIVE PILOT-PILOT BASICS Developed by Measurement Work Group to test

effectiveness of the Patient-Centered Medical Home model in WV and to inform future reimbursement

Uses NCQA PCMH Recognition criteria Outcomes assessment to include:

Clinical process measuresClinical outcome measuresUtilizationCostAlignment with evolving definition of “Meaningful Use”

PILOT BASICS Beginning with 6 month readiness phase

Practice assessmentModified collaborative approach—face to face

learning session for the care team, webcasts, monthly team calls

Training and coaching on NCQA standards and practice redesign

Preparation for measures reporting 12 month assessment phase following the

readiness period

PILOT BASICS Payer participation:

UniCare (managed Medicaid)Mountain State BlueCross Blue ShieldPEIA (state employee plan)

Shared savings incentive model-up to 2.5% of total claims cost based on comparison of assessment period to 2009 claims

No change in ongoing reimbursement Twelve month savings pooled across all providers

and patients; distribution to be based on physician performance on process and outcomes measures

Payout targeted for Fall, 2011

PARTICIPATING PRACTICES Targeted 50 physicians; have 33 Limited the number of physicians from each

organization7 FQHC’s9 free clinics---all in the stateOne large IPA2 academic practices2 small private practicesOne rural health clinic

All have an EMR in place, but this was not a requirement

EXPECTATIONS OF PRACTICES Make a commitment: participation agreement,

business associate agreements Apply for NCQA recognition within 9 months Care team participation in the face to face

session, webcasts, and monthly calls Monthly reporting the aggregate clinical

measures for all patients using the measures required for CMS EMR incentives

Provide patient lists for attribution

EXPECTATIONS OF PARTICIPATING PAYERS

Verify patient lists for attribution Agree to share savings up to 2.5% of total 2009 claims

cost for the participating patients/ members and contribute this amount to the overall incentive pool

Agree on a uniform approach to calculation of savings Agree on incentive pool distribution methodology Provide cost and utilization feedback where possible

based on claims data Use results to inform future reimbursement changes

PATIENT ATTRIBUTION Practices use practice management or EMR system to

look back 18 months and identify any patient that has been seen during that time.

Exclude any people seen as a result of cross-coverage and others that were known to be one-time occurrences

Provide a list of all patients, with their designated payer to the WVHII staff

Lists are aggregated by payer for confirmation of coverage during the entire 2009 period

HOW DID WE SELL PARTICIPATION TO PRACTICES? Financial upside from the incentive component Best practice models they will be exposed to could

help drive internal efficiencies and throughput Market value of TA offered (estimated at

approximately $25k per practice) Participation will jump start the practice down the

pathway of meaningful use This is a showcase demonstration project of

national significance Intend to influence the remaining reimbursement

system if we all succeed

ROLE AND SUPPORT FROM WVHII Project management Training, technical assistance, and coaching Reporting site that will aggregate data and track

individual as well as group performance Virtual office and listserv for sharing resources Compensation for lost revenue resulting from

attendance at all day learning session Payment for NCQA assessment tool and

application

CHALLENGES WE’VE FACED Not all payers are participating

Medicaid need for plan amendment in order to compensate differently

Medicare Several smaller payers in the state

Providers take the full riskDifficulty in recruitment

Measurement strategy not yet finalMeaningful use and CMS incentives must be

considered to avoid re-work and duplication

CURRENT STATUS In readiness phase with face to face learning

session held in February Practices completing practice assessments Compiling patient lists for attribution Expect 12 month assessment phase to begin July

1 Payers meeting next month to establish savings

calculation Now that we have started, more people want to

get involved!

CONTACT INFORMATION

www.wvhealthimprovement.org

Christine St. Andrécstandre@spreadinnovation.com

Roger Chaufournier rchaufournier@spreadinnovation.com