Pennsylvania

In response to Pennsylvania’s growing chronic disease burden and its impact on healthcare spending, the Governor issued Executive Order 2007-05 on May 21, 2007. This order created the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission, also known as the Chronic Care Commission. The Commission proposed and then implemented the Pennsylvania Chronic Care Initiative (CCI) designed to achieve four strategic goals:

  • Widespread use of a new primary care reimbursement model that rewards PCMH care based on the Chronic Care Model.
  • Broad dissemination of the Chronic Care Model to primary care practices across Pennsylvania, through regional chronic care learning collaboratives. 
  • Achievement of tangible and measurable improvement in patiient satisfaction, access to care, health outcomes and quality of life.
  • Reduction in the cost of providing chronic care with the reduction of avoidable hospitalizations and emergency room visits and mechanisms to ensure that some of the savings are realized by all entities paying for health care. 

The first rollout (Southeast PA) started in May 2008 and six more learning collaboratives were launched through December 2009, involving a total of 152 mostly small and medium-size primary care practices and 640 providers (75% of the practices have 5 or fewer FTE providers). In four of PA’s seven regions, 17 payers, including Medicaid, provided $30 million in infrastructure payments to practices to support transformation. Since 2009, the state’s contracts with Medicaid managed care organizations (MCOs) have required MCOs to participate in the CCI. Phase II of the CCI began in January 2012 with funding from the Multi-payer Advanced Primary Care Practice demonstration.

CHIPRA: 
Yes
MAPCP: 
No
Dual Eligible: 
No
2703 Health Home: 
No
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
12,759,200
Uninsured Population:
10%
Total Medicaid Spending FY 2013: 
$21.0 Billion 
Overweight/Obese Adults:
64.5%
Poor Mental Health among Adults: 
35.5%
Medicaid Expansion: 
Yes

Aetna-Wellspan ACO

Aetna and WellSpan Health (WellSpan) have established an accountable care organization (ACO) agreement that is designed to improve the quality of care and lower overall health care costs for Aetna commercial plan members and for communities WellSpan serves. The contract is Aetna’s first ACO agreement in Pennsylvania. Using WellSpan’s comprehensive, integrated system of physicians, hospitals and ambulatory services, the collaboration will give area employers better health care options for their employees by:

Quality Blue Patient-Centered Medical Home Program

In October 2012, Highmark launched both the Quality Blue Patient-Centered Medical Home and the Quality Blue Accountable Care Alliance (ACA). The ACA builds on the Patient-Centered Medical Home concept of patient-centered care coordinated by a primary care physician but adds a dimension of closer care coordination with specialists, hospitals and other health care facilities. Providers who participate in the ACA are able to lay the groundwork for becoming a full-fledged accountable care organization as our program becomes available.

Pennsylvania Chronic Care Initiative (CCI)

The Chronic Care Initiative, a multi-payer, collaborative initiative involving public and commercial payers designed to train primary care practices in the PCMH model, has provided support to 171 practices treating over one million patients. Practices have been supported in their transformation through: 

Independence Blue Cross Patient-Centered Medical Home Program

Independence Blue Cross (IBC) is an independent licensee of the Blue Cross and Blue Shield Association of Philadelphia and southeastern Pennsylvania.  IBC revised its progressive incentive program, the Quality Incentive Payment System or QIPS, in early 2010 to attract and retain high-performing primary care physicians in southeastern Pennsylvania, as well as to motivate and encourage doctors to improve quality and provide care in a more efficient way, which helps control rising health care costs.

UPMC Patient-Centered Medical Home Model

The UPMC Health Plan is part of a large, integrated delivery and financing system headquartered in Pittsburgh, Pennsylvania. From 2008 through 2010, sites participating in the plan’s PCMH pilot achieved lower medical and pharmacy costs; and lower utilization of services such as ED visits, hospital admissions and readmissions. The plan also experienced a 160 percent return on the plan’s investment when compared with nonparticipating sites.

Pittsburgh Regional Health Initiative

Pittsburgh Regional Health Initiative is receiving an award for a plan to create specialized support centers, staffed by nurse care managers and pharmacists, to help small primary care practices offer more integrated care within the service areas of seven regional hospitals in Western Pennsylvania. The project will focus not only on approximately 25,000 Medicare beneficiaries with COPD, CHF, and CAD, but also the general primary care population of this area.

CMS State Innovation Model Design Award - Pennsylvania

The Pennsylvania plan builds upon current private and public sector payer and provider initiatives to advance new care delivery models and payment methodologies. The plan places strong emphasis on the need for innovative models on transitions of care, telemedicine and care management.

CMS CHIPRA Quality Demonstration Program - Pennsylvania

Pennsylvania's Department of Public Welfare has been awarded this grant to work with seven health systems and their pediatric provider practices to focus on improving the quality of care through the adoption of health information technology by electronically extracting and reporting from their electronic health records (EHRs) the CMS core pediatric quality set which identifies twenty-four pediatric specific quality measures.

Patient-Centered Oncology Care

The National Committee for Quality Assurance has worked with the National Coalition for Cancer Survivorship, the American Society of Clinical Oncology, Oncology Management Services, Independence Blue Cross, and RAND, as well as a broader multi-stakeholder advisory group, to define the Patient-Centered Oncology Care model. The demonstration will take place in 10 oncology practices in southeastern Pennsylvania. Practices will receive implementation support during the 24-month demonstration period.

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