Date & Start Time 2/10/2009 8:00 Am End Time: 9:30 Am
DRAFT Meeting Agenda & Minutes
Date & Start Time 2/10/2009 8:00 am End Time: 9:30 am
Meeting Type: Medical Home Project Meeting Location: NHCHI Offices
Call in information is 1-309-946-5000, Access code 524881 Go to meeting: https://www1.gotomeeting.com/join/523752558
HANDOUTS : / INVITEES/ATTENDEES:Agenda
Project Plan / Facilitator / Heather Staples
Bill Kassler, MD / Scott Beaudette / Ned Helms
Jeannie McAllister / Kathy Fortin / Barbara Walters, MD
Carl Cooley, MD / Sean Brennan / Diane Andrews
Ned Helms / Eric Walker / Gidya Discola
Amy Schwartz / Doris Lotz, MD
Richard LaFleur, MD / Debbie Snow / Stewart Brock
Alan Freeman, MD / Julie Schilz
AGENDA NOTES ACTION ITEMS /
1 / Kick-Off Follow Up / Kathi Fortin relayed that the practices are a bit shell shocked and are very concerned about a 3/1 submission date to NCQA. They are evaluating the cost/benefit for participating given the licensing fees.
The group discussed that the fees are per site, unfortunately, but the practices applied as individual sites and would only need to pursue the site(s) included in the pilot. For the FQHC’s it is Medicaid’s intent to also use NCQA, however, the timeline is later and therefore they could defer applying for the other sites at this point.
2 / Attribution / The group discussed the challenges with attribution and the files to date. T he files have included providers that should not be considered (OBGYN, PA’s) and sites that weren’t included in the application. The group asked that the attribution documentation be revised to reflect, the following DRAFT changes:
Attribution may be run once every six months, in May and December. There will be no monthly updates or reconciliation processes. The count will be for adult members only,used for the purposes of payment, and may not change within the six month period. Since the attribution process relies on claims data, we understand that a portion of patients who never present to the practice may not be counted until such time as they present and are included in the next period's claims extract. Additionally, patients may be assigned to a particular provider, however it is known that patients may be seen at times by other providers including mid-levels and therefore any payments that are made after attribution may be paid to the practice or group as a whole and not to individual providers. Further:
§ OBGYNs and PA’s are not eligible,
§ PA’s bill under the MD, so their services will be captured through the claims process,
§ Certified Nurse Practitioners and MD's must be credentialed as PCPs by 5/1 to be paid,
§ Providers must practice at least 50% of their scheduled time at the pilot site to be considered part of the practice (this recognizes that the practice may have part-time providers, but 50% of their time must be at the site to be considered),
§ Medical, and if possible, pharmacy claims will be pulled for an 18 month period for the providers listed by the practices,
§ The members from those claims will be tied to the providers,
§ If there is more than one visit in that period for a particular member, the latest visit will be used to tie the member to a provider
§ If two visits for a member occur on the same day, the visit with the higher dollar amount will be used to tie the member to the provider,
§ The count of unique patients will be used for the per member per month calculation
The group further discussed that the carriers should maintain their files for use in evaluation.
3 / Payment / The group discussed the NCQA delays and developed the following proposal:
§ Practices must submit by 05/01/2009,
§ At submission, the practices will send off their score to the project facilitator, who will in turn submit to the carriers,
§ Payment will occur at NCQA-PCMH recognition, and can be paid up to 3 months retrospectively for those who receive recognition after 6/1/2009,
§ If there are practices who haven't heard by 09/01/2009, the project will reach out to NCQA and request provisional letters so that payment can be made.
4 / Technical Support & Learning Collaboration / Heather requested that individuals self-identify to participate on a sub-committee that will design the Year One learning collaboration plan.
5 / Evaluation Update / Submission is in to RWJ – awaiting decision.
6 / Other Items / Bill Kassler suggested that the P4P programs be documented across the carriers to better understand similarities and differences. Scott Beaudette asked whether other carriers are considering a gain sharing/shared savings opportunity. The next meeting will be focused on P4P.
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