1. Edwina Rogers Executive Director Patient Centered Primary Care Collaborative 601 Thirteenth St., NW, Suite 400 North Washington, D.C. 20005 Direct: 202.724.3331 Mobile: 202.674.7800 [email_address] Patient Centered Medical Home

3. Pilots in planning phase for 2009 implementation Multi-Stakeholder demonstration Pilot activity in early stages of development Pilots in progress Blue Cross Blue Shield Plan Pilots (as of January 2009)

5. State Initiatives to Advance Medical Homes in Medicaid/SCHIP = Identified to have a medical home initiative Source: National Academy for State Health Policy State Scan, November 2008

6. Patient-Centered Medical Home 2009 Overview of Pilot Activity and Planning Discussions RI Multi-Payer pilot discussions/activity Identified pilot activity No identified pilot activity – 6 States

8. PCPCC: 2008-2009 4 Key Organizations Joining PCPCC Since April 28 th Stakeholder Meeting

9. How do you start to fix the foundational issue around why our healthcare system is so expensive and yet so broken? Average health spend per capita ($US PPP)

10. The World Health Organizations ranks the U.S. as the 37 th best overall healthcare system in the world

12. Collaborative Principles The Patient Centered Primary Care Collaborative is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians and many others who have joined together to develop and advance the patient centered medical home. The Collaborative believes that, if implemented, the patient centered medical home will improve the health of patients and the viability of the health care delivery system. In order to accomplish our goal, employers, consumers, patients, clinicians and payers have agreed that it is essential to support a better model of compensating clinicians. Compensation under the Patient-Centered Medical Home model would incorporate enhanced access and communication, improve coordination of care, rewards for higher value, expand administrative and quality innovations and promote active patient and family involvement. The Patient-Centered Medical Home model will also engage patients and their families in positive ongoing relationships with their clinicians. Further, the Patient-Centered Medical Home will improve the quality of care delivered and help control the unsustainable rising costs of healthcare for both individuals and plan-sponsors. If you agree, please visit us at www.pcpcc.net and join today!

18. PCPCC Payment Model May 2007 Key physician and practice accountabilities/ value added services and tools Proactively work to keep patients healthy and manage existing illness or conditions Coordinate patient care among an organized team of health care professionals Utilize systems at the practice level to achieve higher quality of care and better outcomes Focus on whole person care for their patients Performance Standards Incentives Incentives Incentives 16

21. NC Savings (FY04) Simple Cost Avoidance Category of Service Estimated Savings from Benchmark Inpatient $142,085,680 Outpatient $51,865,028 Emergency Room $25,944,553 Primary Care, Specialist $45,498,709 Pharmacy $(15,526,996) Other $(5,065,238) Totals $244,801,735

22. North Carolina Pilot Project Details AccessCare Network Counties Access II Care of Western NC Access III of Lower Cape Fear Central Care Health Network Community Care of Wake and Johnston Counties AccessCare Network Sites Community Care Plan of Eastern NC Community Health Partners Northern Piedmont Community Care Partnership for Health Management Sandhills Community Care Network Carolina Collaborative Comm. Care Carolina Community Health Partnership Comm. Care Partners of Gtr. Mecklenburg Northwest Community Care Network Southern Piedmont Community Care Plan

23. Pilot: Geisinger Health System Lewisburg Pennsylvania Pre-Test period Jan - Oct 2006 First pilot year Jan – Oct 2007 Percent reduction Hospital Admission 365/1000 291/1000 - 20% Hospital readmissions 15.2% 7.9% - 48% Cost 7% less

24. At least 14 Independent Evaluations in 11 States . . . And Growing RI CMS will select 8 states for the Medicare Medical Home Demonstration

27. **Must Pass Elements NCQA PPC-PCMH Content and Scoring Standard 1: Access and Communication A. Has written standards for patient access and patient communication** B. Uses data to show it meets its standards for patient access and communication** Pts 4 5 9 Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information (mostly non-clinical data) B. Has clinical data system with clinical data in searchable data fields C. Uses the clinical data system D. Uses paper or electronic-based charting tools to organize clinical information** E. Uses data to identify important diagnoses and conditions in practice** F. Generates lists of patients and reminds patients and clinicians of services needed (population management) Pts 2 3 3 6 4 3 21 Standard 3: Care Management A. Adopts and implements evidence-based guidelines for three conditions ** B. Generates reminders about preventive services for clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans, assessing progress, addressing barriers E. Coordinates care//follow-up for patients who receive care in inpatient and outpatient facilities Pts 3 4 3 5 5 20 Standard 4: Patient Self-Management Support A. Assesses language preference and other communication barriers B. Actively supports patient self-management** Pts 2 4 6 Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety checks C. Has electronic prescription writer with cost checks Pts 3 3 2 8 Standard 6: Test Tracking A. Tracks tests and identifies abnormal results systematically** B. Uses electronic systems to order and retrieve tests and flag duplicate tests Standard 7: Referral Tracking A. Tracks referrals using paper-based or electronic system** Pts 7 6 13 Pts 4 4 Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by physician or across the practice** B. Survey of patients’ care experience C. Reports performance across the practice or by physician ** D. Sets goals and takes action to improve performance E. Produces reports using standardized measures F. Transmits reports with standardized measures electronically to external entities Pts 3 3 3 3 2 1 15 Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support Pts 1 2 1 4

28. NCQA PPC-PCMH Scoring Levels: If there is a difference in Level achieved between the number of points and “Must Pass”, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 “Must Pass” Elements, the practice will achieve at Level 1. Practices with a numeric score of 0 to 24 points or less than 5 “Must Pass” Elements are not Recognized. Level of Qualifying Points Must Pass Elements at 50% Performance Level Level 3 75-100 10 of 10 Level 2 50-74 10 of 10 Level 1 25-49 5 of 10 Not recognized 0-24 <5

33. TODAY’S CARE MEDICAL HOME CARE My patients are those who make appointments to see me Our patients are those who are registered in our medical home Patients’ chief complaints or reasons for visit determines care We systematically assess all our patients’ health needs to plan care Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet patient needs without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it It’s up to the patient to tell us what happened to them We track tests & consultations, and follow-up after ED & hospital Clinic operations center on meeting the doctor’s needs A multidisciplinary team works at the top of our licenses to serve patients Acute care is delivered in the next available appointment and walk-ins Acute care is delivered by open access and non-visit contacts Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma

34. Information Flow- Consumer Materials What consumers can expect- PCMH consumer principles (brochure) Guidance to create your own practice brochure in support of PCMH model (paper) Four minute video for waiting room viewing; deep-dive on PCMH (Flash) Promotes Primary Care (brochure) Deep-dive focus on PCMH (brochure)

35. Inclusion of the Medical Home Concept in Health Reform Efforts Employer Trade Associations Think Tanks Executive Branch Plans developed by Congressional Representatives The Patient-Centered Medical Home

36. Statement on the PCMH: President Obama “ I support the concept of a patient-centered medical home, and as part of my health care plan, I will encourage and provide appropriate payment for providers who implement the medical home model, including physician-directed, interdisciplinary teams, care management and care coordination programs, quality assurance mechanisms, and health IT systems which collectively will help to improve care.” President Barack Obama

39. UPCOMING COLLABORATIVE EVENTS Thursday October 22, 2009 - Washington D.C., Annual Summit - Washington Convention Center Tuesday, March 30, 2010 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center Thursday, July 22, 2010 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center Thursday, October 21, 2010 - Washington D.C., Annual Summit - Ronald Reagan Building and International Trade Center

41. CONTACT INFORMATION Visit our website – http://www.pcpcc.net To request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact: Edwina Rogers Patient Centered Primary Care Collaborative Executive Director 202.724.3331 202.674.7800 (cell) erogers@pcpcc.net, 601 Thirteenth St., NW, Suite 400 North Washington, DC 20005