Health Quality Innovation

West Virginia Medical Home Pilot

"The pilot project is being undertaken by the WV Health Improvement Institute and is a multi-payer initiative intended to determine the impact of implementation of the medical home model on clinical outcomes and health resource utilization, and to inform possible reimbursement changes in West Virginia. The first phase of the pilot includes a six month intense collaborative learning experience for care teams of all participating practices.

Practices will receive coaching and technical assistance throughout the pilot, will apply for NCQA recognition, and will report monthly on a standard set of clinical outcomes measures. These measures, along with patient experience and utilization metrics, will be used as the basis for future incentive payments. The incentive pool will be comprised of contributions from each of the participating payers based on savings realized in a 12-month period."

Learn more at the Patient-Centered Primary Care Collaborative

Texas Medical Home Initiative

"The project attempts to facilitate increased clinical quality and efficiency, improved patient and physician experience of care, and overall care coordination and integration within and among the participating practices. The project will begin with a small scale implementation. Based upon 'lessons learned' during the first 12-18 months of this implementation, the project will be expanded. During Stage One, the focus will be primarily on adults; however, the project will also include patients younger than 18 with severe asthma.

In addition, there will be a focus on young adults with special health care needs aged 14-24 if transferring from pediatric practices. Stage One will be limited to practices that treat adult patients or both child and adult patients in which the medical home team leader is a primary care physician within one of three practice types: one large primary care practice, two small to medium (2-7 practitioners) primary care practices or one multi-specialty and/or integrated practice. Selected practices will have a six month 'ramp up' period to achieve the qualifications required to initiate payment: • NCQA Level 1 recognition • 24 hour/7 day access • Establishment of a patient registry • Implementation of evidence-based protocols • Establishment of service agreements with defined specialty practices and at least one frequently referred-to hospital • Agreement to assist in providing relevant patient claims and defined additional clinical information to the TMHI project • Participation in the special needs transition program."

Learn more at the Patient-Centered Primary Care Collaborative

Pennsylvania Chronic Care Initiative

"The Chronic Care Commission created by Governor Rendell crafted a strategic plan that calls for implementing the chronic care model developed by Dr. Ed Wagner and the MacColl Institute in all primary care practices across the Commonwealth. This initiative is being implemented in stages throughout regions of the state. The efforts are being led by the Governor’s Office of Health Care Reform and involve strong collaboration by providers, payers, and professional organizations. The initiative incorporates the PCMH standards as a validation tool that practices are transforming their care delivery to effectively manage chronically ill patients. There are seven regional learning collaboratives underway across the Commonwealth."

Learn more at the Patient-Centered Primary Care Collaborative

Oklahoma: OU School of Community Medicine - Patient-Centered Medical Home Project

"The project is designed to transform the teaching clinics of the University of Oklahoma School of Community Medicine into the PCMH. This pilot was initiated in response to the Oklahoma Health Care Authority’s (Medicaid) change from pure capitation to fee-for-service plus a capitated fee for care management. OU intends to shape its teaching clinics on the medical home model. We wish to demonstrate that patients will have better access to primary and specialty care, increased access to medical advice, more efficient and effective treatment for chronic care, improved support and education for meaningful lifestyle changes and proactive, holistic health care instead of reactive responses to symptoms.

The Tulsa and Northeast Oklahoma community will benefit by having fewer ER admissions for acute primary care, fewer relapses of chronic conditions, and improved mental and physical health-related behaviors that will result in better overall health trends. OU Physicians practices will provide proactive instead of reactive care, form integrated health care teams, improve communications between care teams, prevent conflicting treatment plans or missed services, and permit all professionals to practice at the top of their license."

Learn more at the Patient-Centered Primary Care Collaborative

Ohio: TriHealth Physician Practices/Humana Patient-Centered Medical Home

"Continue to evaluate the PCMH model of care and the impact on outcomes, quality and cost for commercial and 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 focuses on a comparison of quarterly data with baseline data for both the test group and the control group."

Learn more at the Patient-Centered Primary Care Collaborative

Ohio: Queen City Physicians/Humana Patient-Centered Medical Home

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

Learn more at the Patient-Centered Primary Care Collaborative

Greater Cincinnati Aligning Forces for Quality Medical Home Pilot

"Evaluating the effectiveness of the PCMH."

Learn more at the Patient-Centered Primary Care Collaborative

New York: Hudson Valley P4P - Medical Home Project

"The Hudson Valley is implementing innovative programs to potentially improve quality and reduce the cost of health care delivered. First, THINC is facilitating diffusion of electronic health record (EHR) implementation in office practices of the Hudson Valley. Second, THINC RHIO is also offering a strategic approach to pay for performance (P4P) and medical home implementation among payers and providers across the Hudson Valley that will serve as a model for New York State.

The THINC P4P-Medical Home project brings together multiple health plans that service the Hudson Valley region. Using standardized measures agreed upon by providers and payers, the project will provide performance incentives from multiple payers to providers. Third, the THINC P4P project will provide an added financial incentive for private practice physicians who implement and reach Level 2 of Physician Practice Connections-Patient Centered Medical Home (PPC-PCMH), NCQA’s national recognition system for physician practices."

Learn more at the Patient-Centered Primary Care Collaborative

New York: CDPHP Patient-Centered Medical Home Pilot

"The primary focus of the CDPHP Medical Home Pilot is to create a new primary care reimbursement methodology that is sustainable and scalable. The hypothesis we are testing is whether the aggregate savings associated with better health outcomes and lower utilization is sufficient to fund the enhanced compensation/reimbursement model and support practice adoption of the medical home."

Learn more at the Patient-Centered Primary Care Collaborative

NH Multi-Stakeholder Medical Home Pilot

"The goal of the NH Multi-Stakeholder Medical Home Pilot is to prescribe, value and reward medical care that is tightly coordinated, patient-centered, and of superior quality and efficiency. Our research questions are as follows: • If payers and providers make the investment in PCMHs, can it create value (as defined by cost savings or higher quality of care)? • Will there be sufficient value created to cover costs of investment? and • What are the metrics that are best correlated to value creation? Our focus is on the adult populations in primary care settings that range from rural to urban populations and in independent, hospital-owned, and community health center practices."

Learn more at the Patient-Centered Primary Care Collaborative