New York – Mid-Hudson Valley PCMH Pilot

Project Location, Timeframe, and Scope:

The Taconic Health Information Network and Communities Regional Health Information Organization (THINC RHIO) will oversee this pay-for-performance/Medical Home (p4p/MH) project in New York’s Hudson Valley. The project will be multi-payer and is anticipated to run from 2008 (using retrospective data) through 2012. Eligible physicians for the initial phase of the project, which adheres to the two year THINC RHIO/NYSDOH p4p grant, will include Family Practice, Internal Medicine and Pediatric physicians practicing in the Hudson Valley. During the initial phase, up to 500 physicians will be enrolled in the project.

After the initial phase of the project, which will end in 2009 at the conclusion of the THINC/NYSDOH grant, all payers will be able to continue developing incentives methods based on the evolution of the project. Additional medical home thresholds and maintenance levels will need to be developed. Also, a combination of aggregated claims data and standardized structural, process and outcome measures reported directly from ambulatory EHRs will be added throughout the duration of the project.

Practice Recognition and Payment:

Incentive payments will include two components:

  1. an outcomes component based on process and outcomes measures derived from aggregated administrative data received from all health plans participating in the project and
  2. a structural component determined by achieving Level II Medical Home recognition using the NCQA PPC-MH assessment tool. In addition:

  • The cost of the NCQA PPC-PCMH recognition process will be covered by MedAllies/THINC RHIO

  • The cost of EHR acquisition will be significantly subsidized through the HEAL1 Project, which supports the adoption and use of EHRs by providers in the Hudson Valley (thincrhio.org/HEAL1.html)

  • The cost of practice transformation will be covered by MedAllies/THINC RHIO

Additional costs associated with the practices participation are expected to be covered through the incentive payments discussed above. Of note is that, under the NYSDOH P4P grant, THINC RHIO can match health plans dollar for dollar to a total of $1.5million dollars. Therefore, the maximum bonus amount for the total pool of participating physicians will be $3 million dollars. The participating health plans are still being finalized and each plan will determine the performance thresholds, timing and incentive distribution method the participating physicians.

Practice Support:

The bulk of practice support will come from MedAllies. MedAllies has developed a practice transformation approach in conjunction with Masspro, a performance improvement organization. MedAllies will provide comprehensive implementation support over the anticipated 6-12 month ramp up/ transformation period—their support will be in the areas of: operations and management, basic EHR infrastructure, data consistency and use, and care management/ whole practice workflow redesign. Also, as noted above, the HEAL1 Project will be leveraged to facilitate EHR acquisition and provide related technical support services

Project Measurement and Evaluation:

Project evaluation will be conducted by Weill Cornell Medical College

ACP Involvement:

ACP has been asked to consider endorsement of this project once all of the details are finalized.

Contact Information:

A. John Blair, III, MD
President, Taconic IPA, Inc.
CEO, MedAllies
Email: JBlair@taconicipa.com

 

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