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Colorado Patient Centered Medical Home Pilot

Colorado is the site of a Multi-Payer, Multi-State Patient Centered Medical Home Pilot that includes multiple participants at both the local and national level.  The Patient Centered Medical Home (PCMH) is not a place but an approach to providing continuous, comprehensive, coordinated care, with a partnership between patients and their personal healthcare team, as part of an integrated medical neighborhood.

The Medical Home emphasizes whole person orientation with coordinated and/or integrated care across all elements of the complex health care system; enhanced access to make it easier for patients to contact their personal healthcare team; and improved quality and safety by promoting prevention, proactively managing chronic illness, engaging patients in their care to attain optimum health, and using electronic systems to support this work.  To enable practices to make this transformation and build important infrastructure, the PCMH model realigns payment to include standard fee for service, a monthly care management fee and a bonus for meeting or exceeding quality outcomes.  This ‘blended’ payment model shifts the focus of care delivery away from episodic care toward more comprehensive, holistic care and incorporates the characteristics associated with both lower costs and better outcomes. 

Thank you!

We are very grateful to the following organizations for funding the Patient Centered Medical Home Pilot.

The PCMH model will be tested in sixteen Family Medicine and Internal Medicine practices (17 sites) selected from across the Colorado Front Range as well as several practices in Ohio, our partner state.  Following an initial preparation period, payment for the two-year PCMH Pilot will begin in Spring 2009, once practices have met specific requirements to achieve at least a Level 1 NCQA Medical Home designation.  Practices will receive modified payments for up to 30,000 patients covered by the participating health plans, including Anthem-Wellpoint, United Healthcare, Humana, Aetna, CIGNA, Colorado Medicaid and Colorado Access. 

The Colorado Clinical Guidelines Collaborative (CCGC) will serve as the Convening Organization and provide technical assistance for the PCMH Pilot practices in Colorado, including in-office coaching and innovative technology.  The pilot will be evaluated by Meredith Rosenthal, PhD from Harvard School of Public Health to determine the effect on quality, cost trends and satisfaction for patients and their healthcare team. Funding for the pilot has been generously provided by The Colorado Trust and The Commonwealth Fund.

The Patient Centered Medical Home is based on years of research that supports the need to bolster and reorganize how primary care is delivered and paid for.  By following a patient-centric approach, every segment of the health care system stands to benefit: patients, providers, employers, and payors.  This will be a period of discovery to learn what works and what doesn’t – but the most important aspect is taking this important step towards healing our broken healthcare system. 

Stakeholders

Health Plans

  • Aetna
  • Anthem-Wellpoint
  • CIGNA
  • Cover Colorado
  • Colorado Medicaid
  • Humana
  • UnitedHealthcare

Employers

  • Centura
  • IBM
  • Colorado Business Group on Health
  • Patient Centered Primary Care Collaborative
  • McKesson Corporation
  • State of Colorado

Hospitals

  • Colorado Hospital Association
  • Centura Health
  • Exempla Healthcare
  • HealthONE Hospitals
  • Memorial Health System

Physician Societies

  • American Academy of Family Physicians
  • American College of Physicians
  • Colorado Academy of Family Physicians
  • Colorado Medical Society

Pilot Partner Region

  • Health Improvement Collaborative of Greater Cincinnati

Pilot Evaluator

  • Harvard School of Public Health

Others

  • Colorado Department of Public Health & Environment
  • University of Denver Health Science Center

Convening Organization and Technical Assistance

  • Colorado Clinical Guidelines Collaborative

Funders

  • The Colorado Trust
  • The Commonwealth Fund

Selected Pilot Practices

The following 16 practices were selected to participate in the Patient-Centered Medical Home pilot. They have been recognized as PPC-PCMH practices by NCQA for demonstrating high standards of access to care, communication, care management quality and safety. Congratulations! 

We appreciate the leadership, dedication and pioneering spirit they have shown by stepping to the plate and taking the challenge of implementing true practice transformation.

Practice
NCQA Level
Belmar Family Medicine 3
Broomfield Family Practice 3
Clinix Health Services of Colorado 3
DeYoung Family Medicine 2
Family Care Southwest 3
Family Practice Associates 3
Ideal Family Healthcare 3
Internal Medicine Clinic of Fort Collins 3
Lakewood Family Medicine 2
Lone Tree Family Practice 2
Michael Douglas Mignoli, MD 3
Miramont Family Medicine 3
Mountaintop Family Medicine 3
Provident Adult and Senior Health 3
SouthPark Internal Medicine 3
Westminster Medical Clinic 3

 

Associated IPAs

  • Integrated Physician Network
  • Northern Colorado IPA
  • Physician Health Partners (Primary Physician Partners and South Metro Physicians)
  • MedSouth

 

pcmh

Additional Information

For questions and additional information, please contact Kari Loken at (720) 297-1681.