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HPC dives into medical home standards, behavioral health integration and more

HPC dives into medical home standards, behavioral health integration and more

March 10, 2014

HPC Categories for Patient Centered Medical Home Certification standards

Just a few weeks since its previous meeting, the Health Policy Commission (HPC) reconvened on Wednesday, March 5 with a packed agenda including patient-centered medical home standards, the health care cost growth benchmark for 2015, and Phase 2 for the Community Hospital Acceleration, Revitalization, & Transformation (CHART) Investment Program. Slides from the meeting can be found here. Full details after the break:

Following a presentation by the State Ethics Commission, David Seltz gave the Executive Director’s report covering recent visits to two recipients of the phase 1 CHART grants (Charlton Memorial Hospital and St. Luke's Hospital), upcoming committee meetings, and the expected activities at the HPC for 2014 (slides 7-8). 

Next up was an update from Commissioner Dr. Carole Allen, Chair of the Care Delivery and Payment System Transformation (CDPST) Committee. Commissioner Allen provided an overview of the CDPST Committee’s mission and role in developing the Patient Centered Medical Home (PCMH) Certification Program, which will provide a building block for developing ACO standards. Commissioner Allen described the certification program as building on what practices are already doing, with a focus on outcomes, evaluation and measurement. In developing the standards, the committee and HPC staff engaged in a process of meeting with multiple stakeholders and seeking external advice from national experts. The standards aim to incorporate the highest value elements for medical homes which will improve health while lowering the financial and administrative burden on practices. Commissioner Allen then walked through her construct of a PCMH model, emphasizing that developing trust between with the patient and provider is key to improved outcomes and cost reduction (slide 11).

She then turned the presentation over to Patti Boyce, Policy Director for Care Delivery and Quality Improvement, who described the HPC’s approach to the PCMH certification. The three-pronged approach will standardize criteria for accountable care; align payment with PCMH capabilities; and evaluate the impact on cost and quality with the overall goal of transforming primary care (slides 12-13).  The HPC is planning a phased approach to implementation through a 12 to 18 month demonstration beginning this summer, with select organizations/entities committed to PCMH implementation and select health plans (slides 14-17). 

The HPC proposes the following 6 certification standards: care coordination; enhanced access and communication; integration clinical care management; population health management; data systems/performance measurement and resource stewardship. Within these 6 standards are 45 criteria, organized via a tiered approach of basic, advanced and optimal (slide 18). The public comment period for the proposed PCMH criteria runs from March 5 – April 4, 2015, with a public listening session scheduled for March 18, 2104 from 12 noon – 1:30 pm at 2 Boylston Street, 5th floor, Boston. Written comments may be submitted to the HPC at HPC-PCMH@state.ma.us (slides 21-22).

Following the presentation, discussion among the commissioners focused on the need to harmonize the program with existing models, as opposed to adding another completely separate model. The commissioners acknowledged the challenges of engaging payers and providers in a voluntary program. Commissioners also recognized the holistic approach of the medical home model. For example, focusing on the hours one spends outside of the medical care setting further demonstrates where the value is.

Next on the agenda was an update from the Quality Improvement and Patient Protection (QIPP) Committee. Chair Commissioner Marylou Sudders reported that the revised Office of Patient Protection regulations on internal and external grievances would go into effect on March 14, 2014. She then turned to the HPC’s 2014 behavioral health agenda, which will aim to address many of the barriers to behavioral health integration identified by the Behavioral Health Task Force, such as reimbursement issues, difficulty accessing behavioral health treatment, and lack of interoperability and connection of the behavioral health system to electronic health records (slides 25-26). 

The 2014 behavioral health agenda includes development of behavioral health criteria and standards to be included in the PCMH and ACO certification programs; providing CHART awardees a number of behavioral health capacity-building opportunities; and coordinating with the behavioral health work of the Health Planning Council and Public Payer Commission, to name just a few (slide 27). As some immediate next steps, the QIPP and CDPST will next meet jointly to discuss behavioral health standards to be included in the PCMH certification program and receive an update from MassHeath on the integration of behavioral health in the Primary Care Payment Reform program. The QIPP Committee will also invite updates from the Health Planning Council to discuss opportunities for aligned work and the Division of Insurance to provide an update on the mental health parity regulations mandated by Ch. 224 and the first report on parity certification (slide 28).

Commissioner David Cutler, Chair of the Cost Trends and Market Performance (CTMP) Committee, then provided a detailed update on numerous Committee activities, including the health care cost growth benchmark for 2015; the cost trends and research agenda for 2014; and the status of material change notices and regulatory development. Commissioner Cutler walked through the calculation for the health care cost growth benchmark for calendar year 2015 (slides 31-32). The Commission voted unanimously to approve the benchmark as 3.6%, which is unchanged from 2014 (slide 33). Nikhil Sahni, Policy Director for Cost Trends and Special Projects, next discussed the research agenda, first reviewing some of the major findings from the 2013 cost trends report (slides 35-37). Areas of opportunity identified in the 2013 report include HPC and other state agency activities focused on fostering a value-based market, promoting an efficient, high-quality delivery system; advancing alternative payment methods; and enhancing transparency and data availability (slide 38). From those opportunities, the HPC’s preliminary research agenda for 2014 includes hospital operating expenses, wasteful spending, high-cost patients and provider mix (slide 39). Commissioners suggested that within this research agenda, the HPC should play an active role in promoting or opposing certain items.

The Committee update then moved to the cost and market impact review (CMIR) process. Karen Tseng, Director of Policy for Market Performance, provided a breakdown of the material change notices received (slide 43) and an update on the material change notice regulations, including how to define “primary and dispersed service areas” (slides 45-48). As next steps, the HPC will model definitions of statutory terms and continue working closely with experts and stakeholders, as well as Commissioners and the CTMP Committee. Proposed regulations are expected to be released in the spring – summer of 2014.

Last up on the agenda was an update from the Community Health Care Investment and Consumer Involvement Committee, chaired by Commissioner Paul Hattis. The CHART investment program is fully executed and operational for the 28 hospital awardees for Phase 1. Iyah Romm, Director for System Performance and Strategic Investment, and Marian Wrobel, Director of Research, provided a detailed overview of the evaluation framework for Phase 1 of the CHART Investment Program, with baseline finding due for summer 2014 and the Phase 1 evaluation report expected for winter 2015 (slides 52 – 54). The staff is now looking towards transitioning from Phase 1 to Phase 2, which will focus on driving system transformation through a deeper investment in a limited set of hospitals (slide 55). Guided in part by the barriers to reform outlined in the 2013 cost trends report, Phase 2 will focus on addressing applicable remedies for hospital operating expenses, wasteful spending and high-cost patient, with the broader goals of increasing quality of care delivery, improving the health of populations and improving resource stewardship (slides 56-60). The staff propose total funding of approximately $50 million with two tiers: large scale transformation awards and focused intervention awards, with a central theme of community-focused, collaborative approaches to care delivery transformation (slide 61). Romm concluded with a timeline for CHART Phase 1 and 2, and the ongoing staff activities and Committee engagement, such as conducting site visits with awardees early in Phase 1 and evaluating approaches to achieving economies of scale relative to CHART projects. 

The next full HPC meeting is scheduled for April 16, 2016.  In the meantime, stay tuned on the HPC’s website for other Committee meetings and activities.