Office of Medical Assistance Program’s Patient-Centered Medical Home (PCMH) Overview PCMH Advisory Council Meeting April 16, 2019 5/14/2019 1
PCMH Reporting and Data • Operations Report 19 is an annual report with mandated quarterly updates • As of March 31, 2019. . . – The MCOs have identified 1,223 unique PCMH practices; – 650,489 Medicaid members are being served by those PCMH providers; – 32,022 of those members are in the top 5% of medical costs; – 64,716 of those members have been diagnosed with a Serious Persistent Mental Illness; and – $13,534,142 have been paid to the PCMH practices. 5/14/2019 2
Centers of Excellence (OUD) • The 45 COEs across the state provide treatment that is team- based and whole-person focused, with goals of increasing access to MAT, integrating physical and behavioral healthcare services, and providing community-based care management services to keep patients engaged along the continuum of care. • Prior to these centers, as few as 48 percent of Medicaid patients diagnosed with opioid use disorder were receiving treatment. Of those, only 33 percent remained engaged in treatment for more than 30 days. Today, more than 70 percent receive treatment after being diagnosed with an opioid use disorder and 62 percent remain in treatment for more than 30 days. 5/14/2019 3
Centers of Excellence (OUD) As of October 31, 2018: ― 19,887 unique individuals with OUD have been in contact with a COE; ― 17,587 unique individuals had a level of care assessment completed; ― 16,975 unique individuals initiated treatment 5/14/2019 4
Centers of Excellence (OUD) • On January 1, 2019, Physical Health COEs began billing Physical HealthChoices MCOs for their care management services. On July 1, 2019, Behavioral Health COEs will beginning billing the Behavioral HealthChoices COEs for those services. • This represents a movement from grant funding to a more sustainable model of funding COE activities. DHS has developed a per-member-per-month (PMPM) rate for each COE patient, which, as a directed payment, is the same for all COEs and all MCOs. The PMPM amount is $277.22. 5/14/2019 5
Certified Community Behavioral Health Clinics • Key Points – Two-year demonstration • First year concluded • Second year 7-1-18 to 6-30-19 – Performance Metrics (1 st year) • Clinics are submitting their first year results to SAMHSA by 3-31-19 • The state is submitting their first year measurement results to SAMHSA by 6-30-19 5/14/2019 6
Medication Therapy Management (MTM) • DHS focus remains on medication adherence for diabetes, HTN, asthma, HIV, Hepatitis C, and antipsychotic medications • MTM programs are on track to exceed the number of members impacted in 2017 operations • Some MCOs have pharmacists internally conducting outreach, but many have embedded them in practices and some have initiated retail pharmacy partnerships • Pharmacists are responsible for: performing comprehensive medication therapy reviews, identifying medication-related issues, addressing gaps in care with both the member and provider, and counseling members on medication use 5/14/2019 7
Telemedicine (2011-2018) • Since 2011, an increase in visit counts occurred: 5,737 in 2011 to over 61,000 visits in 2018 • PH visits increased from 1,718 in 2011 to 17,669 in 2018 • BH visits increased from 3,624 in 2011 to 43,467 in 2018 • In 2011, 70% of visits were BH, and accounted for 71% of telemedicine visits in 2018 • In 2011, 58% of telemedicine visits occurred in rural counties, which decreased to 43% of telemedicine visits in 2018 5/14/2019 8
(1,000) Telemedicine Utilization (2011-2018) 1,000 2,000 3,000 4,000 5,000 6,000 7,000 - 201007 201009 201011 201101 201103 201105 201107 201109 201111 201201 201203 201205 201207 201209 201211 201301 Total Non-Psych Visits 201303 201305 201307 201309 201311 201401 201403 9 201405 201407 201409 201411 Total Psych Visits 201501 201503 201505 201507 201509 201511 201601 201603 201605 Total Visits 201607 201609 201611 201701 201703 201705 201707 201709 201711 201801 201803 201805
Questions? 5/14/2019 10
Contact Information • Dr. David Kelley, OMAP Chief Medical Officer c-dakelley@pa.gov 717.787.1870 • Michele Robison, Director OMAP Division of Quality and Special Needs Coordination, OMAP mirobison@pa.gov 717.772.6169 • Nancy Stadler, Quality Management Director, OMHSAS nstadler@pa.gov 717.346.1261 5/14/2019 11
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