Pennsylvania Statewide
Implementation
p
of Multi-payer
p y
Supported PCMH Improves Diabetes
Care
Robert Gabbay MD, PhD
Director, Penn State Institute for Diabetes and Obesity
Professor of Medicine
Penn State College of Medicine
rgabbay@psu edu
rgabbay@psu.edu
1
The PA Chronic Care
Commission
• Established by Executive Order by Gov.
Rendell
• Guided by Gov Office of Health Care Reform
• Strategic plan to implement the Chronic Care
Model across the Commonwealth
• Implementation incremental by region
• Diabetes (with co-morbidities) and to a lesser
extent asthma primary focus of the initial rollout
with spread to other chronic illnesses
2
Partner Organizations
• Governors Office for Health Care Reform
• Governor’s Chronic Care Commission
• Payers
– Independence Blue Cross
Cross, Highmark
Highmark, Capital
Blue Cross, Aetna, Keystone Mercy, Health
Partners Geisinger,
Partners,
Geisinger Cigna
Cigna, UPMC
UPMC, others (17
Total)
• Professional
P f
i
lO
Organizations/Societies
i ti
/S i ti
– Improving Performance in Practice (IPIP)
– ABIM, ACP, PAFP
3
The Intervention
1.
2
2.
3.
4.
Learning Collaboratives
IPIP Practice Coaches
Registry Reporting
Reimbursement/infrastructure payments
4
Reimbursement
• 17 leading insurers involved but no
Medicare
• GOHCR ‘convener’ avoiding anti-trust
• Reimburse for time away from practice at
learning collaboratives
• Benchmark payments based on NCQA
PCMH C
Certification
ifi i ((requires
i
care
management)
g
)
• In NEPA- Shared savings with practices
• Can
C b
be ~$30-50
$30 50 K /FTE/ yr
5
Focus on Chronic Care
Model
But reimbursement tied to PCMH
NCQA Certification
6
Implementation of the Chronic
Care Model in PA
• Southeastern PA was the first regional rollout
May 2008
• Rollouts in South Central PA followed byy SW,,
NE PA and then throughout the State
• Rollouts persist for at least three years
• Now 3 more funded regions have started
• To
T dated t 780 providers
id
across the
th state
t t
involved with population of 1 million patients
7
A Look at the Numbers
Region
Number of
Practices
Total
Providers
FTE'S
Total
Reported
Patients
Average
FTE's/Practice
Average
g
Patients/FT
E
Year 1
Payments
Total
Estimated
Payments By
Insurers
SEPA
32
236
150.5
209,354
5
1,391
SCPA
25
78
65.5
136,317
3
2,081
$4,711,210
SWPA
23
86
64.0
154,435
3
2,413
$6,219,842
NEPA
37
103
89.0
216,049
2
2,428
$6,159,615
Total
117
503
369
716,155
3
1,941
$1,965,982
NWPA
16
37
37
,
73,964
2
2,026
,
$192,000
$
,
NCPA
14
81
81
75,049
6
927
$168,000
SEPA 2
23
159
159
228,078
7
1,434
$276,000
Total
53
277
277
377 091
377,091
5
1 364
1,364
$636 000
$636,000
170
780
646
1,093,246
4
1,694
$2,601,982
Grand Total
8
$1,965,982
$13,599,231
$30,689,898
$30,689,898
Strengths of the PA Approach
•
•
•
•
•
•
•
Government Convener
Multi Payer
Multi-Payer
Teaching practices to change
Chronic Care Model Focus
Lots of small practices
All Practices Reporting Monthly
Scope
9
Preliminary Results:
Southeastern PA
•
•
•
•
•
25 practices working on Diabetes
143 providers and 10,000 patients
First year outcomes
NCQA certification
Improvement in complication screening,
evidence based medication use
use, and
clinical outcomes
10
11
Evidence Based Treatment
70
60
50
40
Baseline Mean
30
Value at One Year
20
10
0
Aspirin
Statin*
ACE/ARB*
SM Goal
A Few Lessons Learned
•
•
•
•
•
One Size Never Fits All
Need to be More Prescriptive
Money Matters
NCQA
Focus on High
High, Middle
Middle, or
or. Low
Performers
• Key: Leadership, Communication and and
Team care
13
It Takes a Team…..
• Governor’s Office of Health Care Reform –
Ann Torregrossa,
Torregrossa Phil Magistro
Magistro, Brian
Ebersole, Gregory Howe and of course the
Governor
• Ed Wagner, Michael Bailit, Connie Sixta,
Linda Siminerio, the brave practices, and
many many more
many,
• PA Association of Family
Practice/Improving Performance in
Practice (IPIP)
(IPIP)- Pat Bricker and practice
coaches