Advanced Primary Care


One of the priorities for the Maryland Health Care Commission (MHCC) is to support advanced primary care and practice transformation to shift the focus from quantity of care delivered to improved health outcomes and coordinated care delivery. Advanced primary care activities and demonstrations are aimed at implementing a new fundamental strategy focused on patient needs, where primary care is the foundation for maximizing value in health care delivery through better health outcomes and lower costs.

Primary Care Council (PCC)

MHCC formed the Primary Care Council (Council) in February 2016 to discuss opportunities to align primary care with evolving payment methodologies, such as the Maryland hospital global payment model. The Council, which has met four times in 2016, is comprised of representatives from physician groups around the State and State agencies. The Council develops policy matters for consideration by MHCC on ways primary care may be organized, measured, and reimbursed under the global budget revenue model.

Transforming Clinical Practice Initiative

The Centers for Medicare & Medicaid Services (CMS) developed a Transforming Clinical Practice Initiative (TCPI) to assist providers in achieving practice transformation to align with the innovative strategies of the Affordable Care Act. CMS awarded 29 organizations a Practice Transformation Network (PTN) Cooperative Agreement to collaboratively lead practices through the transformation process. The MHCC, in partnership with MedChi, The State Medical Society, and the Department of Family and Community Medicine at the University of Maryland School of Medicine, is working with the New Jersey Innovation Institute a CMS PTN awardee, as a sub-contractor for implementing practice transformation activities in Maryland.  

The PTN supports clinical practices throughout the transformation process from fee-for-service to value-based reimbursement. The national goal for TCPI is to transform 140,000 clinicians and save $1.4 billion in health care costs. The goals are achieved through alternative payment methods, value-based incentives, patient-centered care, and improved health care outcomes. The PTN helps transform practices by offering the following assistance:

  • Customized coaching;
  • Leverage meaningful use;
  • Identify and incorporate patient centered medical home model concepts into practice workflows; 
  • Support for reporting measures for the physician quality reporting and interpreting the results;
  • Measure outcomes for value-based payments under MACRA;
  • Alternative payment preparedness;
  • Navigate reporting programs for CMS compliance under MACRA; and
  • Data analysis for quality  workflow and revenue improvement.

The PTN focuses on the following metrics;

 Number

 Metric

 1

 Adult Smoking Reduction

 2

 HbA1c Poor Control Cost Savings due to decrease cost of hospitalizations

 3

 Controling high BP for patients with hypertension aged 18-85

 4

Reduction of Cardiac stress imaging for low risk patients

 5

Inappropriate imaging for low back pain

 6

Potentially Preventable ER Visits (PPV) – Primary Care Related and Non-Emergent

 7

Advanced Care Plan

 8

Third next available appointment (TNAA) - Total # practices with measure fully implemented

 9

Increase Transitional Care Management (TCM)

 10

Reduction in unplanned 30 day readmissions per 1,000

PTN Resources

PTN Activities

Newsletter

PQRS Flyer

PQRS List of Eligible Professionals

TCPI FAQ

 

MACRA Awareness and Support (MAS)

In April 2015, Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (MACRA). This legislation aims to significantly move the needle on health care delivery payment reform starting, with Medicare, with the aim of expanding to Medicaid and commercial markets. Practices in Maryland—especially small practices located in rural or underserved areas and/or not affiliated with a hospital—need technical and administrative support to transform practice workflows and optimize the use of health IT. The MAS Program will assist stakeholders subject to MACRA, such as ambulatory practices and hospitals, in adjusting their current approach and practice management based upon MACRA's specifications.  

Maryland Multi-Payor Patient Centered Medical Home Program

The Maryland Multi-Payor Patient Centered Medical Home (PCMH) Program (MMPP) pilot was program testing the effectiveness of the PCMH model in 52 Maryland Primary Care practices. The program began in April of 2011 and ended in June of 2016. The MMPP was a catalyst for practice transformation in Maryland by providing financial support and individual practice coaching for participating practices. The MHCC and IMPAQ, International, LLC conducted an independent evaluation of the MMPP pilot to assess the impact of MMPP. Findings suggest the MMPP positively impacted practice transformation; provider satisfaction; patient satisfaction with provider communication; chronic disease management; and disparities in care by practice location. The Medicaid results, outlined in a separate brief, where particularly notable. MMPP reports are available at the links below 

MPP Reports:

Evaluation of the Maryland Multi-Payor Patient Centered Medical Home Program - Medicaid Program Impacts - Report

Evaluation of the Maryland Multi-Payor Patient Centered Medical Home Program - Medicaid Program Impacts - Commission Presentation

Evaluation of the Maryland Multi-Payer Patient Centered Medical Home Program - Final Report

Evaluation of the Maryland Multi-Payer Patient Centered Medical Home Program - First Annual Report.

19 Practices Achieved Net Savings for 2011-2014

 


Last Updated: 1/18/2017