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Colorado Multi-Payer Patient-Centered Medical Home Statewide Pilot

Rationale / Objectives

This project wanted to demonstrate that the PCMH model would work in Colorado. By transforming the delivery model, they would improve quality of care and health outcomes for patients requiring complex care or suffering from multiple conditions. Multiple payers would reduce the cost burden on practices of providing quality care to complex patients.5 6

Project/Program Description & Major Achievements

Practices that successfully delivered certain aspects of care received a financial reward. All of the participating plans provided a per member per month care management fee to participating practices for up to 20,000 plan members in addition to traditional fee-for-service and a pay-for-performance bonus. A monthly fee paid by participating health plans helped implement comprehensive care management and care coordination activities centered around the patient. Emergency department (ED) costs decreased by 11.8%, and ED use by about 9.3%. 3 5 7

Lessons Learned

Impacts on quality measures were mixed. The reduction in primary care visits could favourably be attributed to visits being more effective, but could also have been the cause for the reduction in some preventative screenings, as physicians had fewer opportunities to interact with patients. By demonstrating positive results for the payers, providers and practices involved, the project laid the foundation for a significant expansion of support to PCMH in Colorado including the Colorado Comprehensive Primary Care Initiative, Colorado Medicaid Accountable Care Collaborative, and the Colorado Medical Home Initiative. Because of this pilot project, the PCMH model is widely supported in Colorado. 1 3 5 7

People / Organizations Involved

Further Description

The Colorado Multi-Payer Patient-Centered Medical Home statewide pilot project was one of the first multi-payer medical home pilot projects. It ran from 2009 to 2012 and involved 5 private health plans and the State's high-risk pool carrier, Cover Colorado, who provided additional compensation to 16 primary care practices. All participating practices were required to achieve at least level 1 PCMH recognition by the National Committee for Quality Assurance. Typical fee-for-service payment methods do not compensate physicians for performing certain value-added but possibly time-consuming functions such as coordinating specialist care. In embracing the patient-centered medical home model of primary care delivery, healthcare providers would incur financial loss under the existing payment method. The project’s effectiveness was evaluated by the Harvard School of Public Health. With involvement from the local and national levels, the Patient-Centered Medical Home (PCMH) pilot was successful in improving aspects of quality of care while cutting costs in some areas. HealthTeamWorks provided support to practices on quality improvement and transformation to PCMH through individual coaching and learning collaboratives. Overall cost savings were not realized by practices or their patients due to increased use of other services. While cervical cancer screening rates saw an improvement, colon cancer screenings and hemoglobin testing for patients with diabetes did not. Patient satisfaction (perception of efficiency, availability of physicians and so on) increased. Health indicators for diabetes patients and those at risk for cardiovascular disease were above national benchmarks. 1 3 5 7

Major Achievements

Metric Result Detail
Emergency department use Decreased About 9.3% (p=0.01)
Emergency department costs Decreased 11.8% (p=0.001)
Primary care visits Decreased 1.5% (p=0.02)
Cervical cancer screening Increased 9% (p<0.001)

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