Blue Cross Blue Shield of Georgia Launching Medical Home Incentive Program
Blue Cross Blue Shield of Georgia (BCBS GA) may be the first health care plan in Georgia to offer primary care physicians increased payment for patient centered medical home (PCMH) model of care. The program, Patient Centered Primary Care (PC2), promotes primary care functions that provide coordinated, evidence-based care that has the greatest effect on achieving improved quality and patient experience. The program is scheduled to launch later this year.
GAFP leaders continue to meet with payers in Georgia to discuss the benefits of a PCMH to the patient, the physician, and the payer, along with data that supports the value of PCMH. The discussions also encourage the payers to increase payment to primary care physicians who have achieved recognition.
For additional information on the BCBS GA PC2 program, visit their webpage: http://www.bcbsga.com/wps/portal/chpproviderbcbsga?content_path=shared/noapplication/f0/s0/t0/pw_e192412.htm&label=Patient-Centered.
PCMH Education and Available Resources
Over the past few years, the GAFP leadership has encouraged members to embrace the Patient Centered Medical Home (PCMH). The GAFP has offered educational lectures, hands-on workshops, and created the PCMH University project, which has guided more than 200 clinicians through the process of being recognized as a National Committee for Quality Assurance (NCQA) medical home.
As we look to the future of the patient centered medical home and think about the continued efforts as an Academy, we want to continue to offer you and your practice tools to help you along the continuum.
Finding resources to help guide you through the journey of becoming a Patient Centered Medical Home can feel like a daunting task. It helps to know that there are organizations who offer key resources, many of them free, designed to help you learn more about the process through workshops, teleconferences, webinars, and downloadable forms.
The NCQA offers a Recognition Training Calendar that outlines their PCMH educational programs through Summer 2013. The calendar includes information on upcoming webinars, teleconferences, and focuses for all levels of education on becoming a patient centered medical home. You can access the NCQA courses online at http://www.ncqa.org/Programs/Recognition/RelevanttoAllRecognition/RecognitionTraining.aspx.
Patient Centered Primary Care Collaborative (PCPCC) also serves as a resource for those focused on transforming their practice into a Patient Centered Medical Home by offering free on-demand continuing medical education. These archived activities may serve as a valuable resource through the recognition process. To access the PCPCC activities, visit http://www.pcpcc.net/webinars and http://www.pcpcc.net/media.
The GAFP will also bring PCMH educational opportunities to the members in 2013 with live activities, online education, and other shared resources. Be sure to check the GAFP website at www.gafp.org/medical_home.asp for information on activities planned by the Academy or links that take you directly to additional resources. It is important for the Academy to continue to be a resource for our members who are on the forefront of the medical home movement, and serve as leaders in the charge. We encourage more family physicians to become familiar with the patient centered medical home model, and to become educated using resources available to them through organizations that are dedicated to the future of family medicine.
National Recognition Programs - Patient Centered Medical Home
Bridges to Excellence (BTE), National Committee on Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Joint Commission – it can be confusing. What does each program offer and which is better for family physicians? The Georgia Academy of Family Physicians encourages PCMH recognition.
The two programs with the most longevity are BTE and NCQA. URAC and Joint Commission’s PCMH programs are relatively new with both programs being launched in 2011. In Georgia there are currently no URAC PCMH accredited physicians, and Joint Commission has a total of 30 practices nationally, one in Georgia, that have achieved their PCMH certification.
In Georgia, NCQA has 255 clinicians and 37 sites that have achieved PCMH recognition (as of October 25, 2012). The first class of GAFP’s PCMH University had 15 practices apply to NCQA and all 15 received PCMH recognition. In 2011, NCQA released their new standards which align with physician-level quality measures and Meaningful Use. Practices that have attested to Meaningful Use for CMS-funded bonuses will find it an advantage when transforming to a PCMH and applying to NCQA for recognition.
Bridges to Excellence is unique in its Medical Home recognition. It is a national pay for performance program and provides financial rewards to NCQA recognized clinicians. BTE uses NCQA’s, CMS’, and other organizations’ established criteria and review processes to make their determination. There is no cost to achieve BTE Medical Home recognition. Requirements for BTE Medical Home Designation consist of two parts:
Part 1: Clinicians/practices can achieve recognition in the BTE Physician Office Systems Recognition program in two ways - Option 1 Achieve NCQA Patient Centered Medical Home recognition of level II or III, or Option 2 Have a meaningful use certified electronic medical record system.
Part 2: Positive patient outcomes are identified through the achievement of Level II or III in any two BTE Care Recognition programs, which demonstrate that clinicians are measuring and reporting clinical performance data resulting in improved delivery of care.
GAFP continues its support of family physicians in Georgia by on-going discussions with the business community.
PCMH Online Resources
For additional information on PCMH and GAFP’s PCMH University, contact Cathi Durham, GAFP Director of Outreach, at 800-392-3841 or at firstname.lastname@example.org.
Patient Centered Medical Home University - The Next Class
The GAFP Board of Directors is proud to announce its next class of the Patient Centered Medical Home University - class of 2013. At the August Board of Directors meeting, it was once again approved to remove over $100,000 from our long term reserves to launch the next class of PCMH U.
The Patient Centered Medical Home (PCMH) is a set of principles developed jointly and endorsed by all of medicine's primary care membership organizations including the American Academy of Family Physicians. The guiding principles describe improved primary care practices that focus on Quality and Safety, a personal Physician for each patient, enhanced access to care, care coordination for each patient, and appropriate payment structures for more efficient care.
The following practices were accepted and will begin the journey with the kick off meeting November 9:
Habersham Family Medicine of Demorest
Albany Internal Medicine of Albany
Urban Family Practice of Marietta
Mt. Yonah Family Practice of Cleveland
Terry A. Cone, MD of Columbus
Horizons Diagnostics of Columbus
Family Health Center - MCCG FM Residency Program of Macon
Essential Medical Care of College Park
Medical Center of Dublin
DeKalb Family Medicine on Candler of Decatur
Delta Exchange - A Resource for All Practices on Medical Homes
All GAFP/AAFP members have the benefit of access to Delta Exchange (www.aafp.org/online/en/home/practicemgt/deltaexchange.html). This website created by TransforMED, a subsidiary of AAFP, is a wonderful resource for all things related to the Patient Centered Medical Home (PCMH). However, there are many useful tools available for all practices, not just those interested in PCMH.
For instance, it is a known frustration for a family physician to refer a patient to a specialist and never receive an update, or any kind of feedback, from that specialist. Delta Exchange has a template that can be customized to your practice and used to establish an understanding between you, the primary care physician, and the specialist. This template can also be found online, on the Delta Exchange website under "Shared Files - Practice Forms and Templates."
Ending Medical Homelessness – GAFP and IBM Join Forces
By Harry S. Strothers III, MD, MMM, FAAFP
Board Chair, Georgia Academy of Family Physician
"So you walk into a room and see an IBM Executive, a Family Physician and a Medical Insurance CEO"… .no, this is not the beginning of a bad joke, but a realistic scenario when, on a recent mild spring morning, a group of disparate Georgia leaders came together to discuss the need to end medical homelessness in Georgia.
Dr. Paul Grundy, IBM's Global Medical Director came at the invitation of Georgia's family physicians to speak to the business and insurance community about his passion and IBM's vision as it relates to the medical home.
The medical home is an ideal that all national primary care physician groups, representing nearly 333,000 physicians, have developed to describe the characteristics of the Patient Centered Medical Home (PCMH). The PCMH is a health care setting that facilitates partnerships between individual patients, their personal physicians and, when appropriate, the patient's family. This allows a more holistic, more coordinated, and more effective health care experience, as proven again and again across the country.
Turning to the business leaders, Dr. Grundy stated, "It is immoral for you to purchase insurance based solely on episodes of care." And to the insurance industry, he cajoled, "And it is unethical for you to sell insurance products that are based on episodes of care like heart bypass and back surgery without basing your health insurance products on the broader base of primary care that includes the medical home, prevention, and care coordination."
The Georgia Academy of Family Physicians took the lead in Georgia and in 2010 established a PCMH University to help Georgia's primary care physicians to transform into nationally recognized medical homes – graduating its first class in March. It's time that others joined the cause in Georgia to end medical homelessness so all of us have access to a primary care physician who is focused on coordinated and integrated care.
The tide is turning nationally as Wellpoint/Anthem, Aetna, and UnitedHealthcare have all announced plans to change payments for primary care physicians who are performing along the medical home elements and proving that they are taking better care of their patients.
So – what are the next steps? Georgia businesses need to purchase insurance for their employees that focus on primary care and prevention focusing on practices that are medical homes. IBM has done so with significant financial savings and improved outcomes for its employees.
- Georgia health insurance companies need to assist physicians with this transformation within their practices and reward them for learning how to better care of Georgia's citizens.
- And Georgians need to demand more from their physicians and seek out those practices that are medical homes and in turn become more accountable for their own health care.
Dr. Grundy ended the meeting with a charge to the entire group but focusing on the primary care doctors, he encouraged, "You have to work with the payers to have the copper wire (the infrastructure) to manage your patients."
"It is just as unethical for you to accept a fee-for-service payment only for an episode of care for your diabetic as it for them to try and only to pay you that way. In central NY the primary care docs have all agreed with all of the health plans to only deliver PCMH level care –and it is working!!"
It is time to declare victory and boldly move the patient centered medical home model into Georgia.
To watch Dr. Paul Grundy talking about the medical home and the need for change, watch one of his recent lectures on You Tube: http://youtu.be/dV57_FGcOzc
PCMH University a Success!
The Georgia Academy of Family Physicians, in partnership with TransforMED and Discern Consulting, launched the Patient Centered Medical Home University on November 13, 2010. It has been an 18 month long process that assisted small practices, of five or fewer physicians, in achieving the NCQA recognition as a Patient Centered Medical Home (PCMH).
In December 2011 fifteen of these practices submitted their application to NCQA (National Committee for Quality Assurance) for recognition as a Patient Centered Medical Home. All fifteen received recognition! Congratulations to the following practices for their accomplishment:
And the following Residency Programs:
Floyd Family Medicine Residency Program
Morehouse School of Medicine, Department of Family Medicine
The remaining practices plan to submit their application in 2012. For information on the next class of PCMH University contact Cathi Durham, GAFP Director of Outreach, at 800-392-3841 or email@example.com
Delta Exchange is Free for All GAFP members
As of February 1, all AAFP members have free access to Delta Exchange. This online network is dedicated to physicians, clinical staff, office staff, and primary care-focused residency programs committed to the Patient Centered Medical Home (PCMH).
Benefits of Delta Exchange include networking with other family physicians and experts from Georgia and around the nation, as well as access to valuable resources on best practices as related to PCMH. Some of these resources include online seminars, access to the TransforMED team and practice leaders, tools that assist in the transformation, and up-to-date NCQA requirements, URAC accreditation, and Joint Commission Standards. Delta Exchange also offers support for family medicine residency programs.
To access Delta Exchange for the first time, visit: https://secure.aafp.org/login/. Delta-Exchange is a service of TransforMED, which is a non-profit subsidiary of the American Academy of Family Physicians.
PCMH University - The Journey
Everywhere you turn you likely hear the term "Patient Centered Medical Home" and over the past few years your understanding of the term has probably become clearer. As an Academy we continuously brought education about the patient centered medical home to our members in the form of lectures, workshops, and articles. In 2010, the GAFP embarked on a monumental task of helping our members achieve NCQA Recognition as a Patient Centered Medical Home. The project, PCMH University brought together 27 practices and residency programs to begin the arduous task of transforming their practices. In 2012 the GAFP's PCMH University project will reach the conclusion of this exciting, hard fought, challenging, and eye-opening journey.
Over the past 18 months, the 27 practices and residency programs that make up the PCMH University project have come to the realization that becoming a Patient Centered Medical Home is a team effort and the responsibility of reaching journey's end does not lie with any one physician. Through it all; the workshops, conference calls, consultations, and internal team meetings, the teams worked tirelessly to transform their practice processes in an effort to make their clinics more accessible for patients.
We noted in a past article that at the end of 2011, 15 of the 27 project participants completed and submitted their applications to NCQA for review. As of March 15, 2012, 11 of the 15 applicants have been awarded NCQA Recognition as a Patient Centered Medical Home. Congratulations to these practices!
As newly minted PCMH practices are announced each day, we salute other Georgia practices who worked diligently to transform their practices into model clinics and have also achieved NCQA Recognition as a Patient Centered Medical Home. These practices include:
- Center for Primary Care, PC --- Augusta, GA
- Eisenhower AMC-Ft. Gordon - Fort Gordon, GA
- Georgia Health Sciences University - Augusta, GA
- Harbin Clinic Internal Medicine - Rome, GA
- Martin Army Medical Home - Primary Care - Fort Benning, GA
- Memorial Health University Medical Center - Savannah, GA
- Northeast Georgia Physicians Group Braselton Clinic - Hoschton, GA
- TMC-5-Ft. Benning, Primary Care Clinics - Fort Benning, GA
To date, Georgia now boasts more than 20 practices or residency programs, and more than 125 physicians and their teams who have achieved NCQA Recognition as a Patient Centered Medical Home. Note how far our State has come with this healthcare milestone; just a short time ago Georgia only had 5 practices and 45 clinicians with NCQA recognition.
As an Academy, we continue to support all the participants of the PCMH University project throughout their journey towards becoming a PCMH, and their continued transition beyond achieving PCMH status. We also recognize and congratulate all physicians and clinicians in our great state for their continued commitment to the communities in which they serve, as we all strive for excellence in providing patient care.
Doctors to Get Paid More for 'Medical Home'
By: Andy Miller Published: Jan 31, 2012 in Georgia Health News (reprinted with permission)
Paying primary care doctors more for delivering better care is not a new idea. It has been championed for years as a way to improve patients' health and reduce medical costs.
Now, two health insurers with a major presence in Georgia have announced big steps to make the idea a reality. And the prospect has primary care physicians excited.
WellPoint, the parent company of Blue Cross and Blue Shield of Georgia, announced a plan last week for raising primary care pay.
Blue Cross, Georgia's largest health insurer with more than 2 million members in the state, said it will launch this ''patient-centered medical home'' payment plan in the state next year. Doctors in the Blue Cross network could eventually earn up to 50 percent more than their current pay.
A central goal is to control health costs. In an announcement last week, WellPoint said some of its pilot medical-home programs have seen an 18 percent decrease in hospital admissions and a 15 percent drop in emergency room visits.
Meanwhile, Aetna, a Hartford, Conn.-based insurer with 600,000 members in Georgia, announced a plan Monday to pay some primary care physicians an extra $2 to $3 per member per month.
In both cases, the insurers are focusing on the medical home concept, which designates a specific primary care doctor's practice as the patient's "home."
Under this concept, a primary care doctor (such as an internist, pediatrician or family medicine physician) coordinates care for all the patient's needs. This would include managing chronic diseases such as asthma and diabetes and delivering other services that aren't now reimbursed.
It may mean having 24-hour access for patients as an alternative to the emergency room, or bringing in a social worker or psychologist to work with a patient, Dr. Kathryn Cheek, a Columbus pediatrician, said Tuesday. "We already do it a lot in pediatrics,'' said Cheek, who is president of the Georgia chapter of the American Academy of Pediatrics. "It's exciting that somebody is finally realizing the value of what we do and potentially what we can do. I hope it comes to fruition."
Keeping in touch with the patient
A medical home â€“ by tracking a patient's referrals, procedures, medications and appointments â€“ helps ''make sure your patients don't fall through the cracks,'' said Dr. Harry Strothers, an East Point family medicine physician.
If diabetic patients miss any of their regular appointments, for example, the doctor's office would call them to make sure they get the needed checkups, said Strothers.
Such follow-up care can prevent medical complications â€“ and higher health costs. "Philosophically, it's what family physicians want to do, but the way that we're paid now does not encourage it,'' said Strothers, who is chairman of the Department of Family Medicine at Atlanta's Morehouse School of Medicine.
Blue Cross said the payment plan would be available to all 5,225 primary care physicians in its network. Aetna said it was targeting doctors or their practices that receive recognition as medical homes by the National Committee for Quality Assurance.
Aetna is rolling out the program in Connecticut and New Jersey before taking it national. The company has about 5,000 primary care doctors in its Georgia network.
Dr. Jack Spicer, an Aetna medical director based in Alpharetta, said the company currently has a medical home pilot with Emory. "We believe it's the right direction to go,'' he said.
The new Aetna pay plan will come to Georgia over the next 12 months, the company said. "It's an important piece in controlling costs and improving quality, and improving care of chronically ill patients,'' Spicer said. "You really have to have an electronic medical record to make this work.''
Could Medicaid program be next?
Alexandra Leopold, a Blue Cross executive, said the medical home model "is transforming the way we're collaborating with providers and aligning our focus on patient health and quality outcomes.'' WellPoint's medical home plan will start this year in Ohio and Colorado, states that the company says have more experience in medical homes.
The WellPoint plan could have a major national impact, Paul Ginsburg, president of the Center for Studying Health System Change, a Washington nonprofit group, told the Wall Street Journal last week. The "scale is so much bolder than things we've seen," Ginsburg said. "This isn't an experiment."
Fay Brown, executive vice president of the Georgia Academy of Family Physicians, said her organization ''will heavily promote any insurer that will pay more for physicians who are patient-centered medical homes.'' "I think other insurance companies who are smart and cutting-edge will follow suit,'' Brown said.
Strothers said he hopes the medical home arrangement is adopted by Georgia Medicaid. State officials are currently studying new options for Medicaid to improve quality while controlling costs.
Amerigroup's Medical Home Initiative Benefits Family Physicians in Georgia
Amerigroup Community Care of Georgia launched the second phase of its Patient Centered Medical Home (PCMH) initiative. Amerigroup will be working with TransforMED to assist the practices in its transformation; as TransforMED has done in Florida, Maryland, Nevada, Tennessee, Texas and the GAFP PCMH University.
The first phase of the Amerigroup PCMH initiative launched in May of 2011 and included six practices. Three of the practices are part of GAFP's PCMH University. The second phase launched in November 2011 and consists of an additional six practices in Georgia â€“ one is a family medicine and pediatric office, three others are pediatric offices, the fifth is a multi-specialty office, and the sixth is a Federally Qualified Health Center (FQHC).
The goal of the initiative is two-fold: first to assist the practices in modeling PCMH, and second to support them beyond their transformation. One benefit Amerigroup has been able to offer providers is a medical home reporting package. The package includes the following reports of the provider's patients that are Amerigroup clients: a daily census report, a weekly emergency room report, a monthly HEDIS based quality report, and a monthly report with an index of clients who have the likelihood of being hospitalized soon. The clients typically also have disease management/case management needs.
The provider incentive program that supports PCMH work is a major benefit. The program is a quality weighted, gain share incentive program. By achieving a certain level of quality, the result is a decreased cost of care and the provider shares in the cost savings.
Amerigroup is planning a third phase to their PCMH initiative which will launch near the end of 2012. Dr. William Alexander, medical director for Amerigroup Community Care, said he is excited to be working alongside family physicians in Georgia and looks forward to supporting GAFP's PCMH University's activities.