The Patient Centered Primary Care Collaborative has been working for years to build evidence and knowledge about how to improve healthcare by providing a medical "home" for each of us - a place where all our records reside, where the staff know us, etc. This April 2010 by Executive Director Edwina Rogers shows the phenomenal range of results they've produced.

1. Patient Centered Primary Care Collaborativeand the National Patient Centered Medical Home Movement Edwina Rogers Executive Director Patient Centered Primary Care Collaborative 601 Thirteenth St., NW, Suite 400 North Washington, D.C. 20005 Direct: 202.724.3331 Mobile: 202.674.7800 erogers@pcpcc.net 1

3. 44 States and the District of Columbia Have Passed over 330 Laws and/or Have PCMH Activity

4. Medicaid and Medicare Activity2

5. 3 Blue Cross Blue Shield Plan Pilots (As of March 2010) Pilots in planning phase for 2010 implementation Pilots in progress Pilot activity in early stages of development Multi-Stakeholder demonstration

6. AK VA There are 37 States Working to Advance Medical Homes for Medicaid or CHIP Beneficiaries WA ME ND MT OR VT ID MN NH MA WI NY SD MI WY RI CT PA IA NJ NE NV OH UT IN DE IL MD CO CA WV DC KS MO KY NC TN AZ OK SC AR NM GA AL MS TX LA FL HI States with at least one effort that met criteria for analysis SOURCE: NASHP analysis

7. Patient-Centered Medical Home Overview of Pilot Activity and Planning Discussions RI Multi-Payer pilot discussions/activity Identified pilot activity No identified pilot activity – 5 States 5

9. 54 Executive Committee Members

10. 20 Advisory Board Members

11. 5 Centers

12. 7 Task Forces

13. 3 Annual Conferences & Summits

14. Monthly Calls (National PCMH Movement Briefings, CMD, CPPI, CCE)

15. Bi-Weekly Calls (CEE, CeHIA)

16. National Weekly Call (Thursday, 11AM EDT)

17. Phone number: 712.432.3900

18. Passcode: 471334

19. Host Regular Webinars6

21. AAP

22. IBM

23. Ohio

24. AAFP

25. AOA

26. Iowa

27. FedEx

28. General Electric

29. ABIM

30. ACC

31. Dow

32. ACOI

33. AHI

36. AFL-CIO

37. BCBSA

38. Aetna

39. National Consumers League

40. United

41. Humana

42. CIGNA

43. Kaiser Permanente

44. SEIU

45. Foundation for Informed Decision Making

47. PCPCC Center and Task ForceRecent Deliverables Value Based Insurance Design Report Payment Reform Task Force Report PCMH Transformation Resource Guide Medication Management Guide Emmi Solutions PCMH Video (soon to be available in Spanish) Pilot Activity Tracking from CMD website Letters to Congress Letters Regarding Meaningful Use 9

48. History of the Medical Home Concept The first known documentation of the term “medical home”: Standards of Child Health Care, AAP in 1967 by the AAP Council on Pediatric Practice -- “medical home -- one central source of a child’s pediatric records” History of the Medical Home Concept Calvin Sia, Thomas F. Tonniges, Elizabeth Osterhus and Sharon TabaPediatrics 2004;113;1473-1478 Patient Centered – IOM “I would strongly urge the adoption of the Danish model of the Patient Centered Medical Home” -- Karen Davis, Commonwealth Fund 2010 Medical Home Wikipedia page: http://en.wikipedia.org/wiki/Medical_home PCPCC Facebook Page 10

49. Joint Principles of the PCMH (February 2007) The following principles were written and agreed upon by the four Primary Care Physician Organizations – the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. Principles: Ongoing relationship with personal physician Physician directed medical practice Whole person orientation Coordinated care across the health system Quality and safety Enhanced access to care Payment recognizes the value added 11

51. The American Academy of Hospice and Palliative Medicine

52. The American Academy of Neurology

53. The American College of Cardiology

54. The American College of Osteopathic Family Physicians

55. The American College of Osteopathic Internists

56. The American Geriatrics Society

57. The American Medical Directors Association

58. The American Society of Addiction Medicine

59. The American Society of Clinical Oncology

60. The Society for Adolescent Medicine

61. The Society of Critical Care Medicine

62. The Society of General Internal Medicine

63. American Medical Association

64. Association of Professors of Medicine

65. Association of Program Directors in Internal Medicine

66. Clerkship Directors in Internal Medicine

67. Infectious Diseases Society of Medicine12

69. Accountable Care Organizations Source: Premier Healthcare Alliance 14

70. PCPCC Payment ModelMay 2007 Key physician and practice accountabilities/ value added services and tools Proactively work to keep patients healthy and manage existing illness or conditions Incentives Coordinate patient care among an organized team of health care professionals Incentives Performance Standards Utilize systems at the practice level to achieve higher quality of care and better outcomes Incentives Focus on whole person care for their patients (including behavioral health) 16 15

71. At least 14 Independent Evaluations in 11 States . . . And Growing RI CMS will select 8 states for the Medicare Medical Home Demonstration 16

72. Several PCMH Evaluations Underway… 17

73. PCMH Evaluations (cont.) 18

74. Community Implications - Published Results of PCMH Projects to Date Source: PCPCC Pilot Guide, 2009 19

75. Community Implications – Published Results of PCMH Projects (cont.) Source: PCPCC Pilot Guide, 2009 20

76. Community Implications – Published Results of PCMH Projects (cont.) Source: Metcare Press Release, February 23, 2010 21

77. Community Implications – PreliminaryFindings of Other PCMH Projects (cont.) Source: PCPCC Pilot Guide, 2009 22

78. Community Implications – PreliminaryFindings of Other PCMH Projects (cont.) Source: PCPCC Pilot Guide, 2009 23

79. Simple Cost Avoidance NC Savings (FY04) 24

80. Case Example: Louisiana Greater New Orleans Primary Care Access and Stabilization Grant Thirteen of the 25 organizations achieved recognition by NCQA as PCMHs at 36 clinic locations (ranging from levels 1-3), and more clinics are expected to achieve the recognition in 2009. All organizations have implemented 24/7 access to clinician by phone and same day appointments for urgent care. The total system volume (number of individuals served) has increased by 15% every six-month period starting March 2007 for outpatient primary and behavioral health care. The 25 participating organizations have expanded the number of service delivery sites from 67 pre-grant to 91 today. Source: PCPCC 2009 Pilot Guide 25

81. Recognition Programs for PCMH Developed or Under Development Quality Organizations PCMH Standards Activity 2010 26

82. 27 NCQA PPC-PCMH Content and Scoring **Must Pass Elements

83. Scoring: Building a Ladder to Excellence Level 3: 75+ Points; 10/10 Must Pass Level 2: 50-74 Points; 10/10 Must Pass Level 1: 25-49 Points; 5/10 Must Pass Increasing Complexity of Services

84. 29 Source: NCQA, December 2009

85. PCMH Implementation Tools- Report Release“Aligning Incentives and Systems”Promoting Synergy Between Value-Based Insurance Design and the Patient Centered Medical Home” Makes the business value case for PCMH showing link to VBID Case studies: Whirlpool Company, the State of Washington, the City of Battle Creek, Mich., IBM, Roy O. Martin Lumber, CIGNA, Universal American, Geisinger Health System/Health Plan, Aetna and the State of Minnesota. Authored by the Center for Employer Engagement in partnership with the National Business Coalition on Health and the University Michigan’s Center for Value-Based Insurance Design 30

86. Meaningful Use: Meaningful Connections Defines health IT capabilities essential to PCMH. Crosswalks capabilities with functional priorities supporting PCMH. Explores how patients/consumers are currently using health IT to connect. Representative sample of 19 case example responses from primary care providers. Appendices include Guidelines for PCMH Demonstration Projects Consumer Principles Consumer Toolkit 31

87. Patient Centered Primary Care Collaborative“Purchaser Guide” Released July, 2008 Developed by the PCPCC Center for Benefit Redesign and Implementation in partnership with NBCH and the Center’s multi-stakeholder advisory panel. Guide offers employers and buyers actionable steps as they work with health plans in local markets - over 6000 copies downloaded and/or distributed. Includes contract language, RFP language and overview of national pilots. Includes steps employers can take to involve themselves now in local market efforts. The PCPCC is holding a series of Webinars, sponsored by Pfizer, on the Purchaser Guide. 11 32

88. Patient Centered Primary Care Collaborative“Proof in Practice– A Compilation of Patient Centered Medical Home Pilot and Demonstration Projects” Released October 2009 Developed by the PCPCC Center for Multi-stakeholder Demonstration through a grant from AAFP offering a state-by-state sample of key pilot initiatives. Offers key contacts, project status, participating practices and market scan of covered lives; physicians. Inventory of : recognition program used, practice support (technology), project evaluation, and key resources. Begins to establish framework for program evaluation/ market tracking. 12 33

89. 34 Patient Centered Primary Care Collaborative“A Collaborative Partnership – Resources to Help Consumers Thrive in the Medical Home” Released October 2009 Included in the Guide: 1. PCPCC activities and initiatives supporting consumer engagement; 2. Research and examples surrounding consumer engagement in PCMH demonstrations; 3. Tools for consumers and other stakeholders to assist with PCMH education, engagement and partnerships; and 4. A catalogue of resources that provides descriptions of and the means to obtain potential resources for consumers, providers and purchasers seeking to better engage consumers.

90. Information Flow- Consumer Materials Four minute video for waiting room viewing; deep-dive on PCMH (Flash) Promotes Primary Care (brochure) Deep-dive focus on PCMH (brochure) What consumers can expect- PCMH consumer principles (brochure) Guidance to create your own practice brochure in support of PCMH model (paper) 35

92. Private insurers work in cooperation with Medicaid to set uniform standards for “Advanced Primary Care (APC) models”

94. Demonstrate a commitment from a majority of their primary care doctors to join the program;

95. Meet a stringent set of qualifications for doctors who participate; and

96. Integrate public health services to emphasize wellness and prevention strategies.36

98. Pediatric Accountable Care Organization demonstration project. Establishes a demonstration project that allows qualified pediatric providers to be recognized and receive payments as Accountable Care Organizations (ACO) under Medicaid.

99. Establishment of Center for Medicare and Medicaid Innovation within CMS. The purpose of the Center will be to research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patients in each program.

100. Training in family medicine, general internal medicine, general pediatrics, and physician assistantship. Provides grants to develop and operate training programs, provide financial assistance to trainees and faculty, enhance faculty development in primary care and physician assistant programs, and to establish, maintain, and improve academic units in primary care.

101. Expanding access to primary care services and general surgery services. Beginning in 2011, provides primary care practitioners, as well as general surgeons practicing in health professional shortage areas, with a 10 percent Medicare payment bonus for five years.

103. Enhancing Health Care Workforce Education and Training -. Priority is given to programs that educate students in team-based approaches to care, including the patient-centered medical home. Authorization is set at $125 million.37

104. CMS Activity and the PCMH Planned Demonstrations Medicare Medical Home Demo Status - on hold pending recent health care reform legislation Multi-Payer Advanced Primary Care Practice Demo Status - invitation to states and solicitation in clearance Federally Qualified Health Centers Advanced Primary Care Practice Demo Status - under development 38

105. Test Drive the New PCPCC Website ! Soft Launch 3.18.2010 Membership Webinar 4.08.2010 -Recorded Major features include Master calendar listing all PCPCC events On-line and interactive Pilot Guide User portals (consumer & patients, employer & health plans, providers & clinicians, federal & state government Center portals and updates http://www.pcpcc.net 39

106. Upcoming Collaborative Events Thursday, July 22, 2010 - Washington D.C., Stakeholder Meeting - Ronald Reagan Building and International Trade Center Thursday, October 21, 2010- Washington D.C., Annual Summit - Ronald Reagan Building and International Trade Center 40

107. Contact Information Visit our website – http://www.pcpcc.net To request any additional information on the PCMH or the Patient Centered Primary Care Collaborative please contact: Edwina Rogers Patient Centered Primary Care Collaborative Executive Director 202.724.3331 202.674.7800 (cell) erogers@pcpcc.net The Homer Building 601 Thirteenth St., NW, Suite 400 North Washington, DC 20005 41