UnitedHealth Group PCMH Demonstration Program

Region Within State: 
Phoenix, Tucson
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Wednesday, April 1, 2009
Pilot/Demo Length: 
2-3 years

The intent of the program is to demonstrate the value of a PCMH primary care practice. The “medical home” physician will be responsible for the primary care of the individual patient as well as managing and arranging care collaboratively with United for those patients. Though the emphasis will be on primary disease prevention and improving quality of care for chronically ill patients, the program includes an outreach to members to become more engaged in their overall health and wellness. United is committed to participate and work cooperatively with the medical group in furtherance of these goals.

Type of Practices: 
Other
CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
UnitedHealthcare
Primary Contact: 
Eric Sullivan
E-mail: 
[email protected]
Phone: 
410/956-6182
Additional Contact
Name: 
Gary Rieks
Phone: 
952/992-5043
Participating Stakeholders: 

IBM, other self-insured employers.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
7
Number of Participating Physicians: 
25
Physicians per practice: 
1-7
Types of Practices: 
Internal Medicine, Family Medicine
Health Plan Lines of Business Included: 
Commercial, Medicare Advantage, Medicaid Managed Care
Overall Number of Covered Lives: 
14000
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: 51-75%
Other: 40% have a Web presence.

Consumer Involvement: 

Consumer focus groups and employer collaboration.

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: Care Management, Practice Culture/Teaming.

Payment Model: 

Prospective Care Management PMPM Fee and retrospective Performance Bonus PMPM.

PROJECT EVALUATION
Types of data to be collected : 

Practices compared to market on basic cost and quality metrics. Satisfaction surveys for providers, staff, and patients.