West Virginia Medical Home Pilot

Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Sunday, November 1, 2009
Pilot/Demo Length: 
1.5-2 years

The pilot project is being undertaken by the WV Health Improvement Institute and is a multi-payer initiative intended to determine the impact of implementation of the medical home model on clinical outcomes and health resource utilization, and to inform possible reimbursement changes in West Virginia. The first phase of the pilot includes a six month intense collaborative learning experience for care teams of all participating practices.

Practices will receive coaching and technical assistance throughout the pilot, will apply for NCQA recognition, and will report monthly on a standard set of clinical outcomes measures. These measures, along with patient experience and utilization metrics, will be used as the basis for future incentive payments. The incentive pool will be comprised of contributions from each of the participating payers based on savings realized in a 12-month period.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
West Virginia Health Improvement Institute
Primary Contact: 
Christine St. Andre
E-mail: 
[email protected]
Phone: 
435/649-6439
Additional Contact
Name: 
Carl Callison
Participating Stakeholders: 

West Virginia Health Improvement Institute; WV Bureau of Medical Services (Medicaid); WV Public Employees Insurance Association; Mountain State Blue Cross; UniCare; WVCHIP; WV Academy of Family Practice; WV Academy of Pediatrics; WV Medical Institute; WV State Medical Association; WV Primary Care Association; Health Plan of Upper Ohio Valley; Coventry.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
25
Number of Participating Physicians: 
50
Types of Practices: 
Internal Medicine, Family Medicine, Pediatrics
Health Plan Lines of Business Included: 
Commercial, Medicaid Managed Care
Overall Number of Covered Lives: 
20000
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: >95%
Estimated % of practices with electronic medical record: 26-50%
Estimated % of practices with registry software: 5-25%

Consumer Involvement: 

Consumer organization input incorporated in evaluation process (planned)

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: general QI and process improvement approaches

Payment Model: 

Pilot includes an incentive system but no initial changes to ongoing reimbursement

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 process and outcomes measures initially; cost/ efficiency as they become available

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

Yes, Other demonstration practices; Health insurance providers involved in the demonstration; Demonstration project convening organization; Practice transformation consultant(s).

Relevant links: 

www.wvhealthimprovement.org