Health Quality Innovation

New Hampshire: CIGNA and Dartmouth-Hitchcock Patient-Centered Medical Home Pilot

"CIGNA and Dartmouth-Hitchcock (D-H) launched a PCMH pilot program June 1, 2008 with the goal of improving the quality, affordability and patient satisfaction with care through collaboration and aligned incentives. The program has three key components: clinical information, clinical collaboration, and a blended payment model.

Along with a member roster, CIGNA provides D-H with lists of identified high risk patients according to mutually agreed upon criteria. D-H provides 'embedded case management services,' i.e., a nurse who helps to coordinate the care of the patient with the goal of improving quality and reducing avoidable ER visits and hospitalizations for this high risk group and others identified. CIGNA also provides D-H with electronic feeds of 'gaps in care' where identified issues such as medication compliance or needed preventive health care can be addressed at the time of the patient’s next visit. Clinical collaboration between CIGNA and D-H encourages patient access to key programs."

Learn more at the Patient-Centered Primary Care Collaborative

Michigan: Priority Health PCMH Grant Program

"The Priority Health pilot seeks to demonstrate the value of specific attributes of the PCMH: access, care coordination and patient engagement. However, other PCMH attributes are impacted and are recognized. The emphasis is on improving population health, improving patient experience and reducing per capita costs. Priority Health provided grants to a limited number of PHO/PO or independent practices proposing to achieve the triple aim and allowing us to study their practice re-design around PCMH.

Grantee sites receive plan-provided case management resources and reporting specific to outcomes, along with member stratification reports to assist in care delivery. Grantees have access to an external evaluator to assist in building capacity to identify and measure the process and clinical changes. Priority Health is also aligning reimbursement by providing enhanced reimbursement to all Priority Health primary care providers and significant transformation support to a subset of practices."

Learn more at the Patient-Centered Primary Care Collaborative

Maryland: National Naval Medical Center Medical Home Program

"The NNMC Patient Centered Medical Home Pilot Program is the only existing PCMH pilot program in Military Health System (MHS). An enrolled pilot group of 11,500 patients will be compared to the remaining 11,000 beneficiaries along quality, cost, and satisfaction parameters. A health care team, or “Clinical Micropractice” (CM), forms the fundamental unit of care, consisting of three providers, one registered nurse, three licensed practical nurses/ corpsmen, and two administrative assistants.

The CM is responsible for managing acute, chronic and preventive care as well as coordinating studies and subspecialty care for all assigned patients. Clinical decision support tools, evidence-based practice guidelines and realtime performance monitoring are incorporated into the daily practice. Teams use an Oracle based dashboard to proactively schedule appointments and manage diabetes, CHF, asthma, COPD, as well as arrange preventive services to include cervical cancer screening, mammography, and colon cancer screening. The CM also encourages patients to engage in the management of their own health by providing them with resources, education and skills via improvements in information technology and the implementation of a self management program. Patients can schedule same-day acute appointments with their primary provider and can schedule routine appointments within 2-3 days. Subspecialty appointments are booked upon discharge from the clinical visit by the PCMH team. The model includes integration of behavioral health consultants and nutrition therapists at the point of care."

Learn more at the Patient-Centered Primary Care Collaborative

Maine Patient-Centered Medical Home Pilot

"The Maine Patient-Centered Medical Home Pilot is the first step in achieving statewide implementation of the PCMH model. We are working with participating practices to support their continued transformation to a more patient-centered model of care, and are working with all major private payers in the state and Medicaid (MaineCare) to pilot an alternative payment model that recognizes and rewards practices for demonstrating high quality and efficient care.

We will evaluate the pilot using a comprehensive approach that includes nationally recognized measures of quality, efficiency, and patient centered measures of care that reflect the six aims of quality care identified by the Institute of Medicine (i.e. safe, effective, timely, efficient, equitable, and patientcentered). The ultimate goal of this effort is to sustain and revitalize primary care both to improve health outcomes for all Maine people and to reduce overall health care costs. The Pilot is committed to undertaking a rigorous evaluation and plan to compare outcomes from intervention and controls groups using a quasiexperimental design with interrupted timer series."

Learn more at the Patient-Centered Primary Care Collaborative

Maryland: CareFirst BlueCross BlueShield Patient-Centered Medical Home Demonstration Program

"CareFirst partnered with 11 primary care practices in the MidAtlantic Region to pilot the effectiveness of the PCMH. Demonstration includes the provision of transformation consultants and use of data intermediary for the collection of clinical data from the practices. Incentives include: care coordination fee, technology grants, accreditation reimbursement if successful, outcomes rewards."

Learn more at the Patient-Centered Primary Care Collaborative

Louisiana Health Care Quality Forum Medical Home Initiative

"The LHCQF is a multi-stakeholder, nonprofit organization whose mission is to lead evidence-based quality improvement initiatives to improve the health of the people of Louisiana. The LHCQF’s Medical Home Committee was formed to promote the adoption of the PCMH model of care. In January 2008, the LHCQF board adopted the Joint Principles of the PCMH and the NCQA standards.

Currently the committee is focusing its efforts in three areas: (1) serving as a learning collaborative for clinics and practices in LA working to meet the NCQA standards for a medical home; (2) addressing payment reforms that will support the PCMH model of care; and (3) serving on the Department of Health and Hospitals Technical Advisory Group and advising the Department on development of Medicaid PCMHs."

Learn more at the Patient-Centered Primary Care Collaborative

Greater New Orleans Primary Care Access and Stabilization Grant

"The PCASG is a $100 million federal grant program designed to meet the increasing demand for health care services in Greater New Orleans area post-hurricane Katrina. This is seen as an opportunity to realize a new vision for health care delivery in the area. Twenty-five public and private nonprofit organizations providing primary and mental health care were eligible for funding through the grant to stabilize, improve, and expand their services. Outcomes at the patient, practice, and system levels are sought and will be measured in the evaluation funded by the Commonwealth Fund.

Grant funds are distributed every six months according to number of patients served in the previous six-month period. Funds available each period are divided according to patient panels which are weighted according to age, payor class, and service provided. $3.8 million were reserved for incentive payments to organizations achieving NCQA PPC-PCMH in three rounds over a one-year period. A three-year prospective study of all 25 PCASG grantee organizations and their 67 delivery sites will be conducted to evaluate progress towards the key goals of the PCASG."

Learn more at the Patient-Centered Primary Care Collaborative

Metcare of Florida/Humana Patient-Centered Medical Home

"Continue to evaluate the PCMH model of care and the impact on outcomes, quality, and cost for Medicare Advantage members. We will be evaluating the performance and success of the project on key clinical, financial, satisfaction and patient-centeredness measures. The evaluation will focus on comparing quarterly data with baseline data for both the test group and control group."

Learn more at the Patient-Centered Primary Care Collaborative

Georgia: WellStar Health System/Humana Patient-Centered Medical Home

"Continue to evaluate the PCMH model of care and the impact on outcomes, quality, and cost for members in commercially insured products. We will be evaluating the performance and success of the project on key clinical, financial, satisfaction, and patient centeredness measures. The evaluation will involve a comparison of quarterly data with baseline data for both the test group and a control group."

Learn more at the Patient-Centered Primary Care Collaborative

The Colorado Multi-Payer, Multi-State Patient-Centered Medical Home Pilot

"Colorado is the site of a multi-payer, multi-state PCMH pilot that includes multiple participants at both the local and national levels. The PCMH model will be tested in 16 family medicine and internal medicine practices selected from across the Colorado Front Range as well as practices in Cincinnati, our partner region. Following an initial preparation period, payment for the two-year PCMH pilot will begin May 2009, once practices have met specific requirements to achieve at least a Level 1 NCQA Medical Home designation. Practices will receive modified payments for up to 30,000 patients covered by the participating health plans.

The Colorado Clinical Guidelines Collaborative (CCGC) will serve as the convening organization and provide technical assistance for the PCMH pilot practices in Colorado, including in-office coaching, learning communities and innovative technology. The pilot will be evaluated by Meredith Rosenthal, PhD from Harvard School of Public Health to determine the effect on quality, cost trends, and satisfaction for patients and their health care team. Funding for the pilot is generously provided by The Colorado Trust and the Commonwealth Fund."

Learn more at the Patient-Centered Primary Care Collaborative