Pennsylvania Chronic Care Initiative

Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Tuesday, May 13, 2008
Pilot/Demo Length: 
3+ years

The Chronic Care Commission created by Governor Rendell crafted a strategic plan that calls for implementing the chronic care model developed by Dr. Ed Wagner and the MacColl Institute in all primary care practices across the Commonwealth. This initiative is being implemented in stages throughout regions of the state. The efforts are being led by the Governor’s Office of Health Care Reform and involve strong collaboration by providers, payers, and professional organizations. The initiative incorporates the PCMH standards as a validation tool that practices are transforming their care delivery to effectively manage chronically ill patients. There are seven regional learning collaboratives underway across the Commonwealth.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Governor’s Office of Health Care Reform
Primary Contact: 
Philip Magistro
E-mail: 
[email protected]
Phone: 
717/214-8174
Additional Contact
Name: 
Michael Bailit
Phone: 
781/453-1166
Participating Stakeholders: 

Governor's Office of Health Care Reform; Aetna; AmeriChoice; AmeriHealth Mercy; Capital Blue Cross; Geisinger Health Plan; Health Partners; Keystone Mercy; Highmark BC/BS; Independence Blue Cross; Northeast PA Blue Cross; Unison; University of Pittsburgh Health Plan; University of Pennsylvania Health System; Jefferson Health System; American Board of Internal Medicine; American College of Physicians; Pennsylvania Association of Family Physicians; Improving Performance in Practice (IPIP); Pennsylvania Department of Public Welfare.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
170
Number of Participating Physicians: 
780
Physicians per practice: 
1-10
Types of Practices: 
Internal Medicine, Family Medicine, Pediatrics
Health Plan Lines of Business Included: 
Commercial, Medicare Advantage, Medicaid Managed Care
Overall Number of Covered Lives: 
1093246
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: >95%
Estimated % of practices with electronic medical record: 51-75%
Estimated % of practices with registry software: 26-50%

Consumer Involvement: 

Consumer organization input incorporated in the project design process and in evaluation 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: Implementing all aspects of the Chronic Care Model.

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

A Web-based patient registry is available to practices that do not have an electronic medical record or that have an EMR without registry functions.

Payment Model: 

There are payments to the practices to help offset practice management costs, the cost of hiring or contracting for care management, and incentives to achieve Level 1 Plus, Level 2, and Level 3 recognition in the PCMH standards. There is also a shared savings payment of up to 50 percent based on performance to identified measures.

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?: 

Clinical data, quality measures

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

Yes, Practice transformation consultant(s).

Relevant links: 

http://www.rxforpa.com/chroniccare.html