Medical Home Pilot
Business Plan
Florida Academy of Family Physicians
E. Coy Irvin Jr., M.D., M.B.A.
Senate Health Regulation Committee
March 4, 2010
Proposed Partners
Florida Academy of Family Physicians
Florida Association of Community
Health Centers
Florida Medical Association
Florida Osteopathic Medical Association
Health First Network
Prestige Health Choice PSN
Business Plan for:
1. Escambia and Santa Rosa Counties
2. Okaloosa and Walton Counties
There are NO managed care
plans in area one
AHCA Report Area 1: Medicaid February 2010
Program Enrollment Totals (Including Medikids population)
Feb-10
Area 01
STATE TOTAL
PCCM
TOTAL
Total Medicaid
MPN
MEDIPASS TOTAL
MHC *
MEDIPASS NHD
FFS
59,299
565,238 624,537 1,252,330
565,238 15,827 825,916
2,659,311
Escambia
4
26,523
26,527
4
26,523
0
25,188
51,715
Okaloosa
5
9,195
9,200
5
9,195
0
10,268
19,468
Santa Rosa
2
8,544
8,546
2
8,544
0
7,349
15,895
Walton
0
4,190
4,190
0
4,190
0
1,862
6,052
Total
11
48,452
48,463
11
48,452
0
44,667
93,130
5
Medicaid Savings can be achieved
with the support of Community
Providers
1. To achieve savings any Medicaid initiative must be in partnership
with the Provider Community who focus on
a. Care coordination
b. Chronic disease management
c. Reduction of emergency room visits and in patient days
d. Utilize health information technology
2. To engage this Community, Providers must have;
a. Input into the process
b. Transparency of information, and
c. Partnerships with a risk entity they trust
d. Increase Medicaid provider reimbursement
6
It is estimated that
no new money
will need to be
appropriated for this Pilot
MediPass Enrollment Measures
Escambia and Santa Rosa Counties
Patients
Patients Age 18 and Over
Patients Under 18
Escambia
Santa Rosa
Total
26,523
7,436
19,087
8,544
2,314
6,230
35,067
9,750
25,317
MediPass Expenditures for 2009
Escambia and Santa Rosa Counties
Patients 18 and Over
Patients Under 18
Escambia
Santa Rosa
Total
$38,189,432.25
$9,984,736.66
$48,174,168.91
$18,261,336.42
$7,094,708.23
$25,356,044.65
Medical Home Pilot Project Business Plan for
Escambia and Santa Rosa Counties

Coverage of MediPass participants in two county area


35,067 individuals
Develop a network of physicians for medical homes


70 physicians
Network will be composed of private practice physicians,
hospital employed and community health center physicians






Family Practice
Geriatrics
Internal Medicine
Pediatrics
Psychiatric care will be carved out to Lakeview Center ( Already in
Place )
Team will also include ARNPs, pharmacists, PAs, case
managers as well as nurse managers
Participating Facilities
Escambia and Santa Rosa Counties
Baptist Hospital
Gulf Breeze Hospital
Sacred Heart Hospital
Santa Rosa Medical Center
Data Driven Care Coordination
for the Model

Data collection from
EMRs
 Claims Data from Risk Entity
 Pharmacy Data
 Chart Review
 Patient Satisfaction and Provider Satisfaction surveys
 Health Analytics Data Base
 Pensacola Network (waiting for name)

Provider Payment Elements
for the Model


Revenue: Estimated cap payment per member per
month will be determined by AHCA blended rate
Provider Payments:
 Participating physicians will be paid on a fee for
service basis closer to Medicare rates
 Physician will also receive a management fee of $3
per member per month for level I care. Fee will be
adjusted higher for level II or III care.
 Provider incentive package for capacity, outcomes,
cost
Hospital Rate
Escambia and Santa Rosa Counties
Hospitals will receive a
per diem rate of $1,300
MediPass Enrollment Measures
Okaloosa and Walton Counties
Patients
Patients Age 18 and Over
Patients Under 18
Okaloosa
Walton
Total
9,195
1,203
7,992
4,190
1,112
3,078
13,385
2,315
11,070
MediPass Expenditures for 2009
Okaloosa and Walton Counties
Okaloosa
Walton
Total
Patients 18 and Over
$9,288,752
$6,984,721
$16,273,473
Patients Under 18
$10,397,237
$3,981,513
$14,378,750
Medical Home Pilot Project Business Plan for
Okaloosa and Walton Counties

Coverage of MediPass participants in two county area


13,385 individuals
Develop a network of physicians for medical homes


___ physicians
Network will be composed of private practice physicians,
hospital employed and community health center physicians






Family Practice
Geriatrics
Internal Medicine
Pediatrics
Psychiatric care will be carved out to Lakeview Center ( Already in
Place )
Team will also include ARNPs, pharmacists, PAs, case
managers as well as nurse managers
Participating Facilities
Okaloosa and Walton Counties
North Okaloosa Medical Center
Twin Cities Hospital
White-Wilson Medical Center
Building a Sustainable Medical Home Model
ensures reduction in costs & improved patient
outcomes
1.
2.
3.
4.
Transparency of Data means improvement of patient
outcomes
Community recognizes the benefits of a medical home
and it’s continuation
AHCA Quality and Reporting Requirements are met
Primary care physicians & staff are valued for their
care coordination
When these criteria are met, the evidence
demonstrates that the Medical Home Model
grows in a community
19
Medicaid Expenditures
Escambia
Santa Rosa
Okaloosa
Walton
07-08
08-09
$219,892,680
$249,705,832
$56,075,048
$75,425,759
$23,239,218
$63,105,437
$90,077,154
$25,975,848
Florida Medicaid Fee For Service
Expenditures for Drug and Non-Drug
Services FY2008-2009
Non-Drug
Drug
Escambia
$154320547
$9480115
Santa Rosa
$36316180
$3356324
Okaloosa
$63680445
$4857026
Walton
$15051399
$1062525
Estimated Dollar Savings
(Medicaid)
Pilot will achieve at least an 8% savings for the
State for each member enrolled in the program.
Based upon experience in other Areas
Savings through reduction in Fraud and Abuse as
well as AHCA administrative costs associated with
Fee for Service Medicaid are not estimated
Risk Bearing Entity
Prestige Health Choice, LLC
What Is Prestige Health Choice, LLC




A capitated Provider Service Network serving
Medicaid members
Owned and controlled by Health Choice Network
and its member FQHC centers
Approximately 41,600 Members
Accredited by AAAHC
23
Three Year Pilot Project





Start – upon authorization being signed into law
Organization of care network & Implementation
of operation plan (1st Quarter)
Acceptance of enrollees (2nd Quarter)
Comply with AHCA meds encounter data, QI
compliance, and other requirements - ongoing
Final report submitted to the Governor &
Legislature July 1, 2013