Medical Home Monitor
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March 15, 2010
Vol. II, No. 21

Medical Home Monitor Archives

Medical Home Q&A's:
Risk Reduction,
Shared Medical Home Success

Medical Home Monitor

Reducing Risk in the Elderly

Q: What factors in the elderly are the most predictable and intervenable in future medical cost control with a positive ROI?

A: People with multiple conditions often have interacting factors, and there are often social factors. Even though you can’t resolve the fact that someone does have diabetes, heart disease and something else, you can help that person make sure they have follow-up care, that someone reconciles their medications, and that treatments for these conditions do not conflict with each other. If you’re trying to look at factors going forward to affect medical cost, look at things like managing blood pressure and lipids for someone with diabetes. Managing those things for everybody helps, but that’s farther over the horizon.

(Dr. Marcia Wade, F.C.C.P., M.M.M.,senior medical director for Aetna Medicare Medical Management.)

For more on assessing and predicting health risk in the elderly, please visit:

Marrying the Medical Home
to Health Plan Benefits

Q: How does Geisinger Health Plan integrate medical homes with medical plan benefits and share success between practice and plan?

A: We make the whole site part of the medical home. Every individual in that site has an important role, and that’s been a key to our success. The person that answers the phone is just as important as the provider. We have seen a chain of success by doing it that way. At our meetings, we share metrics — readmission rates, ER per member per month, generic versus brand use and ambulatory care services. We ask, “Are we not doing enough?” "What do we need to do to get patients in more?" We’ll look at our colonoscopy rates and ask, "Why are they low? Do we need to reach out?" Having the health plan claims makes this relationship so valid and allows us to make change.

(Joann Sciandra, R.N., regional manager of case management for health services for Geisinger Health Plan.)

For more on the medical home case manager, please visit:

Sponsored By: Health Integrated

In its third year, Health Integrated’s Executive Leadership Series is a gathering of health plan executives, national policy thought leaders and health management experts sharing ideas, perspectives and real-world solutions to challenging issues facing health plans today. Executives can network, learn and discuss topics of key importance. Join us.

Minnesota Introduces Care Coordination Rates
for Medical Homes

The Minnesota Department of Human Services (DHS) has introduced a system of per-person risk-stratified care coordination payments for the state's certified Health Care Homes (or medical homes). The payment methodology, including a system of categorizing patient complexity, was designed with extensive stakeholder input throughout 2009.

The payment rates are based on a complexity tiering structure in which providers will identify and count the number of “major” conditions (conditions that are chronic, severe and likely to require a care team). DHS proposes paying a per-member per-month (PMPM) care coordination rate for patients in Tiers 1 through 4, with a DHS adjusted average PMPM rate of $31.39.

There will also be a 15 percent increase in the rate for each tier for patients that have a primary language other than English or a serious and persistent mental illness.

To access the report, please visit:

HealthSounds Podcast: Achieving Medication and Care Plan Adherence Through an Integrated Care Team

While neither colocation of team members nor an electronic health record is a prerequisite for a successful integrated care team, explains Dr. Jan Berger, chief medical officer of Silverlink Communications Inc., there are four essential factors that contribute to the confidence and comfort levels of both patients and team members.

To listen to this HIN podcast, please visit:

CDPHP Pilot Phase 2: Seeking Practices with EMRs, E-Prescribing

Primary care practices utilizing EMRs and e-prescribing improve their chances of being selected for the second phase of CDPHP®'s patient-centered medical home (PCMH) pilot. For phase two of the pilot, originally launched in May 2008, the New York-based IPA model HMO will select 21 additional primary care practices (adult primary care, family practice, general practice, and internal medicine) by June 2, with official launch planned for September.

Due to the significance of technology in the PCMH model, practices utilizing EMR and e-prescribing are preferred.

Developed to improve the quality and efficiency of healthcare through transformation of primary care delivery and reimbursement, the second phase of the pilot is expected to encompass 100 area practitioners serving nearly 100,000 members in New York's Capital Region.

Current pilot participants have each undergone 18 months of practice transformation and have just concluded their first year of testing a new payment model. The second phase will increase practice participation from three practices to up to 24 practices.

Selected practices will display strong leadership and a stable practice culture, and serve a significant number of CDPHP patients. The practice will need to demonstrate commitment to achieving NCQA Level III Medical Home recognition, enhancing access and openly collaborating with CDPHP.

Phase 2 practices that receive PCMH level III recognition and have been active participants in the 12-month CDPHP-sponsored transformation process will be financially rewarded under a new payment model starting in fall 2011. The move to the new payment model will be contingent on outcomes of the pilot evaluation.

For more information, please visit:

HIN Survey of the Month: Fourth Annual Patient-Centered Medical Home

Patient-centered medical home (PCMH) pilots are in high gear around the country and high on the healthcare reform agenda. Complete HIN's fourth annual survey on your organization's PCMH experience by March 31 and get a FREE executive summary of the compiled results. Don't miss out on data from the more than 50 organizations that have already responded. Your responses will be kept confidential. .

Complete the survey by visiting:

Healthcare Benchmarks: Second Annual Health & Wellness Incentives Survey Results

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate, both as a response to escalating healthcare costs and to the shift of more health ownership to consumers. This executive summary consolidates the responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey administered in February 2010 and captures the expanding focus, utilization and impact of health and wellness incentives in the healthcare industry — from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

To download this complimentary white paper, please visit:

Save 10% on new medical home resource:
Health Coaching Benchmarks, 2010 Edition

An all-new follow-up to the best-selling 2009 Health Coaching Benchmarks, the 2010 edition is packed with actionable new data on health coaching activity, with the latest metrics on the prevalence of health coaching, favored delivery methods, targeted populations and lifestyle conditions, preferred behavior change models, coaching case loads and much, much more from more than 200 healthcare organizations.

Benefit from peers' experience and get recommendations, advice and year-over-year comparative data on targeted populations for coaching; targeted health conditions for coaching; preferred coaching modalities — telephonic, online and in-person; matching coaching modalities to participants' health conditions; enrollment trends — eligibility, participation and completion rates; recommended coach caseloads by coaching modality and the factors that can influence this; suggested formulas for measuring ROI and program effectiveness; and much more

Use ordering code MHMP to save 10 percent on this new resource by visiting:

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Editor: Patricia Donovan,;
Publisher: Melanie Matthews,;

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