CDPHP Patient-Centered Medical Home Pilot

Region Within State: 
Albany
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Thursday, May 22, 2008
Pilot/Demo Length: 
3+ years

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.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Capital District Physician’s Health Plan (CDPHP)
Primary Contact: 
Lisa Sasko
E-mail: 
[email protected]
Phone: 
518/641-3217
Additional Contact
Name: 
Dr. Bruce Nash
Phone: 
518/641-3211
Participating Stakeholders: 

Capital District Physician's Health Plan; Community Care Physicians, P.C.; Capital Care Medical Group; TransforMED.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
3
Number of Participating Physicians: 
18
Physicians per practice: 
3-10
Types of Practices: 
Internal Medicine, Family Medicine
Health Plan Lines of Business Included: 
Commercial Medicare Advantage Medicaid Managed Care
Overall Number of Covered Lives: 
13500
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: 51-75%
Estimated % of practices with electronic medical record: >95%
Estimated % of practices with registry software: 51-75%

Consumer Involvement: 

Comments: Patients have been involved in practice focus groups and learning collaboratives. Family members have also been involved in learning collaboratives.

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Care Coordination
Increased Access Information Technology (e.g., registries, patient portals)
New Pay for Performance Models
Team approach to care

Services participating practices have added as a result of their participation: 

Practices incorporated the use of population management tools (CINA), patient registries, and altered existing staff structures to incorporate PCMH focused care coordination roles/responsibilities and a patient-centric team-based approach to care.

Payment Model: 

The CDPHP payment model is a capitation plus bonus incentive (based on quality and efficiency) model, which began January 2009 for the three practice sites.

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality—Practices will be measured on 18 HEDIS Quality Metrics at the practice level.
Cost/Efficiency—Practices will be measured on three efficiency domains, specifically:
(1) Utilization-based hospital and ED rates (ambulatory case sensitive conditions);
(2) Population-based efficiency metrics; and
(3) Episode-based medical costs for eight clinical conditions.
Patient Experience/Satisfaction—CG CAHPS+ PCMH specific survey questions.
Provider Experience/Satisfaction—Survey

Which of the data types are being shared?: 

Clinical quality/performance and cost/efficiency

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Yes, Health insurance providers involved in the demonstration Practice transformation consultant(s)

Results to Share: 

We expect to have results to share in 2010.

Relevant links: 

www.cdphp.com