ACP: Medical Homes & Patient-Centered Care - New York City

Advocacy

New York City – Emblem Health Project

Project Location, Timeframe, and Scope:

The Emblem Health project, taking place in New York City and the immediate surrounding counties, is scheduled to begin during the first quarter of 2008 (practice recruitment) and will be concluded by 2010. The study will include a total of 50 adult primary care practices—the majority of which will be solo/small practices—randomized into experimental and control groups. Participating practices will be required to have sufficient volume of patients covered by Emblem Health.

Practice Recognition and Payment:

The project will use the NCQA PPC PCMH survey and supplementary questions for assessing medical homeness of participating practices. Participating practices are not responsible for the costs of the survey. The practice will be responsible for the cost of electronic medical record (EMR) licensing and implementation, as well as hardware/network costs. Use of an EMR by participating practices is not required for participation, but will be incentivized through the payment arrangements available to the experimental group, with special pricing arrangements available through specific EMR and hardware/infrastructure vendors.

The proposed payment model consists of:

Care management payment—equal to a maximum of 7 % of the average physician’s revenue from the covered patients adjusted for the severity of risk of the physician’s panel and the practice’s level of Medical Home recognition.
Fee-for-service
Performance-based payment—equal to a maximum of 7 % of the average physician’s revenue from covered patients based upon results on performance measures related to clinical quality, efficiency and patient experience.

It is estimated that a practice with 200 enrollees can earn up to an additional $10,000 each year for each participating physician. Thus, for a 4 physician practice with each physician having 800 covered patients, it is estimated that the practice can earn an additional $40,000 a year.

Practice Support:

The project will provide three support components:

Data—Participating practices will receive quarterly reports on their performance on clinical quality, efficiency and patient experience measures.
Redesign support—Participating practices will receive intensive, individualized, practice-redesign technical support.
Care management staff support—nurse care manager support projected at .2 FTEs for each 200 enrolled members in a participating practice

Project Measurement and Evaluation:

The project will be evaluated by the Ethel Donaghue Center for Translating Research into Practice and Policy of the University of Connecticut Health Center. The Commonwealth Fund has awarded $460,000 to the Center to pay for the evaluation of this project.

The project will collect:

Clinical quality process and outcome data at the practice level using data based on HEDIS measures.
Efficiency data using medical claims to produce a practice-level index of efficiency consisting of a risk-adjusted ratio of expected to actual episode costs.
Patient experience data to include measures of overall satisfaction, access, physician communication and perceived ability to self-manage.