Priority Health PCMH Grant Program

Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Saturday, November 1, 2008
Pilot/Demo Length: 
2-3 years

The Priority Health pilot seeks to demonstrate the value of specific attributes of the PCMH: access, care coordination and patient engagement. However, other PCMH attributes are impacted and are recognized. The emphasis is on improving population health, improving patient experience and reducing per capita costs. Priority Health provided grants to a limited number of PHO/PO or independent practices proposing to achieve the triple aim and allowing us to study their practice re-design around PCMH.

Grantee sites receive plan-provided case management resources and reporting specific to outcomes, along with member stratification reports to assist in care delivery. Grantees have access to an external evaluator to assist in building capacity to identify and measure the process and clinical changes. Priority Health is also aligning reimbursement by providing enhanced reimbursement to all Priority Health primary care providers and significant transformation support to a subset of practices.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Priority Health
Primary Contact: 
James F. Byrne, MD
E-mail: 
jim.byrne@priorityhealth.com
Phone: 
616/464-8362
Additional Contact
Name: 
Mindy Olivarez, MBA
Steve Williams
Phone: 
616/464-8614
616/464-8269
Participating Stakeholders: 

Priority Health; TransforMED; Michigan State University, College of Human Medicine.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
16
Number of Participating Physicians: 
108
Physicians per practice: 
1-19
Types of Practices: 
Internal Medicine, Family Medicine, Pediatrics
Health Plan Lines of Business Included: 
Commercial
Overall Number of Covered Lives: 
36300
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: 76-95%
Estimated % of practices with electronic medical record: 26-50%
Estimated % of practices with registry software: 5-25%
Other: E-prescribing, registries, patient portals

Consumer Involvement: 

Consumer organization input incorporated in evaluation process.
Coments: Evaluating patient and provider experience by using both the PACIC and Primary Care Assessment Tool

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Care Coordination
Increased Access
Information Technology (e.g., registries, patient portals)
New Pay for Performance Models
Team Approach to Care
Other: Using TransforMED in multiple pilot sites and an external evaluator to work with practices and plan.

Services participating practices have added as a result of their participation: 

Registry, care coordinators, additional staff.

Technology that participating practices have added as a result of their participation: 

Patient portals, Web sites, tracking mechanisms, updated practice management systems

Payment Model: 

Grantees received up-front funding in form of grants and the whole contracted Priority Health network received enhanced reimbursement in the form of increased capitation, ability to bill for new FFS codes that support access and patient engagement, and NCQA PPC-PCMH reimbursement for achieving any of the levels in 2009.

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction Provider Experience/Satisfaction

Which of the data types are being shared?: 

All grantee sites receive their own and each others’ clinical/ quality improvement performance, cost/efficiency, and patient and provider experience outcomes through the use of a plan-provided PCMH dashboard.

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Yes, Other demonstration practices Demonstration project convening organization Practice transformation consultant(s)

Results to Share: 

Available in 2010.

Relevant links: 

http://www.priorityhealth.com/provider/manual/performance/medical-home http://www.transformed.com