ACP: Medical Homes & Patient-Centered Care - Pennsylvania – Southeastern Pennsylvania Rollout of the Chronic Care Initiative

Advocacy

Pennsylvania – Southeastern Pennsylvania Rollout of the Chronic Care Initiative

Project Location, Timeframe, and Scope:

The Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission (CCC) and members of the Patient-Centered Primary Care Collaborative (PCPCC) have collaborated to implement the Chronic Care Model, including the Patient-Centered Medical Home concepts, with approximately over 30 primary care practice teams in metropolitan Philadelphia and to measure the impact. Each participating insurer and primary care practice will commit to a minimum of 3 years of participation and the project will be replicated (likely with some variation) throughout the entire state of Pennsylvania, via a regional roll-out approach.

Practice Recognition and Payment:

There is commitment to use the PPC-PCMH – participating practices will be expected to achieve Level 1 recognition within 12 months. Health plans will pay for the NCQA PPC-PCMH application fee, a patient registry, some first-year office administrative costs, practice coaches and time for practice participation in a learning collaborative, as well as a supplemental fee for attainment of NCQA PPC-PCMH level 1 (or higher).

Practice Support:

Practice support will come from various sources, including:

Participating insurers will provide members with coverage of community-based services to develop self-management support skills.
The Pennsylvania Governor’s Office of Health Care Reform (GOHCR) will organize, staff and fund a Southeast PA learning collaborative—the learning collaborative will use treatment of diabetes (and its co-morbidities) and pediatric asthma as the conditions around which the general model concepts will be taught and first applied.
The Pennsylvania Improving Performance in Practice (IPIP) Program will provide two trained practice coaches to assist participating practices; facilitate providing IPIP trainers for the learning collaborative; and provide primary care practice training on registry use

Project Measurement and Evaluation:

Governor’s Office of Health Care Reform (GOHCR) will fund and coordinate measurement and evaluation activities. The evaluation method remains to be designed, but is likely to include a matched pair methodology, and will not include a randomized controlled test design.