NH Multi-Stakeholder
Medical Home Pilot
February, 2009
NH Multi-Stakeholder Pilot Origins
 Dialogue began within the Reimbursement Work
Group, which was tasked with addressing
reformation of the reimbursement system to:
 Improve the quality of care;
 Mitigate the increasing trend in cost of care;
 Align reimbursement to obtain the kind of care we
wanted;
 Act in consideration of workforce challenges that
are exacerbated by the current system.
Reimbursement Composition
Reimbursement work group is comprised of leadership
from:

NH Medical Society and AMA Delegation

Commercial Carriers (Anthem Wellpoint, CIGNA and Harvard
Pilgrim)

State Insurance Department and NH Medicaid

CMS

Center for Medical Home Improvement

Behavioral Health Association

Hospital Association

Primary Care and Independent Multi-Specialty Practices

NH QIO
NH Multi-Stakeholder Pilot Origins
 In order to achieve its goals, the Reimbursement Work
Group felt that it must first define the “right” care
 Clinical and carrier leadership put forth the concept of
Medical Homes as the right way to deliver care
 Rich history of implementation and success with
pediatric medical homes by the Center for Medical
Home Improvement
 Timely publications from the Commonwealth Fund
on medical homes (Beal, et al, June 2007) and
reimbursement (Miller, September 2007)
 Alignment with work effort by the Quality Team in
definitions
Medical Home Project Team
 The NH Multi-Stakeholder Medical Home Project was
initiated in January of 2008 as a joint effort of all NH
Payers and representatives of the clinical communities.
 The pilot will commence on 01/01/2009, payment will
begin 06/01/2009 and will run until 5/30/2011.
 It is our desire and intent to offer uniformity in patient
attribution, reimbursement, technical support and
outcomes measurement to deliver the greatest
effectiveness possible in program design.
Why Medical Homes?
• It is about the transformation of primary care:
 Putting the patient not just at the fore, but at the
center
 Enforces, and requires, a team approach to care
delivery, both within and across practices and sites
of care
 Is just as much about care, coordination and
services when the patient isn’t there as when they
are
• National movements, employer interest and
payer support in the pilots now provide the
reimbursement vehicle to pay for the essential
services that should and do occur outside of an
office visit
Patient-Centered Medical Home
Joint Principles
 Personal Physician
 Physician directed medical practice
 Whole person orientation
 Care is coordinated and/or integrated
 Quality and safety are hallmarks
 Enhanced access
Joint Principles
Reimbursement should

Reflect the value of non-face time

Pay for care coordination

Support adoption and use of HIT for QI

Support enhanced communication such as secure email and
telephone consultation

Allow for separate fee-for-service visit payment

Recognize case mix differences in patient population

Allow for physicians to share in savings from reduced
hospitalizations

Allow for additional payments for achieving measureable quality
improvements
Pilot Decisions
1.Selection Criteria
 Geographic Diversity
 Demonstrated Medical Home Readiness
 Able to reach a minimum of NCQA Level-1
 Organizational Commitment
NCQA PPCPCMH
NCQA PPC-PCMH
Pilot Decisions
2. Pilot Size
1. 11 practices with approximately 39k total members
2. Family Practice, Internal Medicine and General
Practitioners
3. Infrastructure & Practice Support Model
 Initial vetting and training
 Collaboration
Pilot Decisions
4.Attribution Method (United & Colorado
Model)
 Derived
 Retrospective view of Medical E&M and Rx
for 18 months
 Algorithm will select most recent date and
will break ties with visit volume and spend
 Semi-Annual reporting
Pilot Decisions
5.Reimbursement
 Per member per month care management
fee
 Fee for service
 Pay for performance through existing
carrier programs
6.Evaluation
 Proposal for evaluation design is in the
process of review
Practices Selected
Practice Name
Ammonoosuc Community Health Services
Cheshire Medical Center Dartmouth Hitchcock Keene
Concord Hospital Family Health Center
COOS County Family Health Services
Derry Medical Center
Elliot Family Medicine at Bedford Commons
Lamprey Health Care
Life Long Care
Manchester Community Health Center
Mid-State Health Center
Westside Healthcare
City/Town
Littleton
Keene
Concord
Berlin
Derry
Bedford
Newmarket
New London
Manchester
Plymouth
Franklin
Practice Type
Health Center
Ind Multi-Specialty Practice
Hospital Owned/ Residency
Health Center
Independent MD Practice
Hospital Owned Practice
Health Center
Independent ARNP Practice
Health Center
Health Center
Hospital Owned Practice
Evaluation
• Cost & Utilization
•
•
•
•
•
•
•
Avoidable in-patient stays
ED utilization
Office visits (specialty, primary care)
Pharmacy
Outpatient procedures and diagnostics
Total cost
Should include risk adjustment
Evaluation
• Quality
 Claims and chart based
• Modeled after CMS Group Practice Demo
• Diabetes
• Coronary Heart Disease
• Congestive Heart Failure
• Prevention
 Infrastructure
 Patient and family satisfaction
 Practice culture, teamwork and satisfaction