March 15, 2010
Vol. II, No. 21
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.
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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.
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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. .
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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.
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Editor: Patricia Donovan, email@example.com;
Publisher: Melanie Matthews, firstname.lastname@example.org;
HIN's Medical Home Monitor Archives put at your fingertips complimentary video, podcasts, white papers and blog posts on the advancement of the PCMH — plus back issues of this e-newsletter and links to additional medical home resources. Please bookmark this site and check back often for new content:
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