The Colorado Multi-Payer, Multi-State Patient-Centered Medical Home Pilot

Region Within State: 
Front Range
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Friday, May 1, 2009
Pilot/Demo Length: 
2-3 years

Colorado is the site of a multi-payer, multi-state PCMH pilot that includes multiple participants at both the local and national levels. The PCMH model will be tested in 16 family medicine and internal medicine practices selected from across the Colorado Front Range as well as practices in Cincinnati, our partner region. Following an initial preparation period, payment for the two-year PCMH pilot will begin May 2009, once practices have met specific requirements to achieve at least a Level 1 NCQA Medical Home designation. Practices will receive modified payments for up to 30,000 patients covered by the participating health plans.

HealthTeamWorks will serve as the convening organization and provide technical assistance for the PCMH pilot practices in Colorado, including in-office coaching, learning communities and innovative technology. The pilot will be evaluated by Meredith Rosenthal, PhD from Harvard School of Public Health to determine the effect on quality, cost trends, and satisfaction for patients and their health care team. Funding for the pilot is generously provided by The Colorado Trust and the Commonwealth Fund.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
HealthTeamWorks
Primary Contact: 
Elaine Skoch RN, MN, EMBA, NEA-BC
E-mail: 
[email protected]
Phone: 
720/297-1681
Additional Contact
Name: 
Marije Harbrecht, MD
Kari Loken
Phone: 
720/297-1681
303-962-8987
Participating Stakeholders: 

Aetna, Anthem-Wellpoint, CIGNA, Colorado Medicaid, CoverColorado, Humana, UnitedHealthcare, Colorado Business Group on Health, Centura Health, IBM, McKesson Corporation, PCPCC, State of Colorado, American Academy of Family Physicians, American College of Physicians, Colorado Academy of Family Physicians, Colorado Medical Society, Colorado Department of Health & Public Environment, University of Denver Health Science Center, Colorado Hospital Association, Centura Health, Exempla Healthcare, HealthONE Hospitals,Memorial Health System, iPN, PHP, MedSouth, NCIPA.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
16
Number of Participating Physicians: 
51
Physicians per practice: 
1-9
Types of Practices: 
Internal Medicine, Family Medicine
Health Plan Lines of Business Included: 
Commercial, Medicare Advantage, Medicaid Managed Care, Other: Safety Net Insurer
Overall Number of Covered Lives: 
100000
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: >95%
Estimated % of practices with electronic medical record: >95%
Estimated % of practices with registry software: >95%
Other: Patient portal, e-prescribing, HIPAA compliant e-mail communication, home monitoring devices

Consumer Involvement: 

Formal patient advisory panel(s); consumer organization input incorporated in the project design process

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
Other: Self-management support, decision support, health care organization

Technology that participating practices have added as a result of their participation: 

The Colorado pilot practices with the assistance of HealthTeamWorks are maximizing their technology and/or adding new technology to support the PCMH model. Pilot practices are required to have registry functionality and reporting for population management. Fifteen of our 16 practices had an EMR prior to the pilot. Practices are required to have a care coordinator; many of the practices have either hired or restructured their work force to support this integral role. The Colorado pilot practices have and use e-prescribing functionality.

Payment Model: 

• Fee for Service • Per Member Per Month (PMPM) care management/coordination fee • Pay for Performance (P4P)

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality
Cost/Efficiency
Patient Experience/Satisfaction
Provider Experience/Satisfaction

Which of the data types are being shared?: 

The pilot practices are submitting their pilot measures to HealthTeamWorks monthly.

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

Yes, Demonstration project convening organization;
Practice transformation consultant(s).

Relevant links: 

http://www.healthteamworks.org/medical-home/pcmh-pilot.html