ORIGIN AND MISSION
Pennsylvania’s partnership began with an HRSA state planning grant that established the HRSA State Plan Advisory Council. A consensus that emerged from that process led to the Prescription for Pennsylvania (Rx for PA), an initiative that is administered through the Governor’s Office of Health Care Reform. Rx for PA is Gov. Edward G. Rendell’s comprehensive health care reform initiative to address the access, affordability, and quality of health care in the commonwealth. Rx for PA is a set of integrated strategies to eliminate inefficiencies in the health care system, better manage chronic conditions, eliminate health facility acquired infections, enact common sense insurance reforms, and offer access to affordable health care insurance for the uninsured. Rx for PA aims to ensure that every Pennsylvanian has access to quality health care.
State officials are working through Rx for PA to align quality initiatives of various state agencies, including the Pennsylvania Health Care Cost Containment Council (PHC4); the of Health, Public Welfare, and Insurance; and an independent state agency, the Patient Safety Authority (PSA).
Although the Governor’s Office of Health Care Reform has no formal governance structure, it coordinates the efforts of several state agencies that have public-private governance structures, including PHC4, PSA, and the Chronic Care Management, Reimbursement and Cost Containment Commission (CCC). Regular cabinet meetings are held to coordinate internally.
Funding is provided through the state budget process.
ACTIVITIES AND ACCOMPLISHMENTS
The CCC was created under Rx for PA through executive order by Gov. Rendell in May 2007 to improve how Pennsylvanians with chronic disease receive health care. The commission is responsible for developing a strategic plan to effectively manage chronic disease across the state. The strategic plan includes recommendations for the informational, technological, and reimbursement infrastructure needed to support the implementation of a combination of the chronic care model and the patient-centered medical home (PCMH) model throughout Pennsylvania, which will improve quality outcomes and cost effective treatments for patients with chronic diseases.
The Chronic Care Commission has established a multi-payer partnership, with support and funding by all large payers, convened and supervised by OHCR. Practices sign up for and make a three-year commitment to participate in regional learning collaboratives that are implementing patient-centered medical home and chronic care models. Practices are making infrastructure and care delivery changes, including:
• Attending quarterly learning collaborative meetings for training on how to transform their delivery of care to conform to the patient-centered medical home and chronic care models;
• Hiring staff (certified registered nurse practitioners, case managers, health educators) to create care teams that will coordinate and facilitate care and provide education and self-management skills training;
• Using a practice coach to facilitate transformation of the practice and assist with preparation for National Committee for Quality Assurance (NCQA) Physician Practice Connections-Patient Centered Medical Home (PCC®-PCMH™) recognition;
• Implementing a patient registry with embedded, secure, encrypted e-mail capability for enhanced patient-practice communication, as well as the ability to generate both care gap reminders to patients and monthly reports of performance metrics for monitoring;
• Implementing open access scheduling to improve access to care; and
• Agreeing to apply for and achieve NCQA PCC®-PCMH™ recognition in the first year.
Payers support the program financially by making payments to support infrastructure development and staffing. The model has participating payers make payments proportionate to the 1099 revenue received from the payer in relation to total revenue received by the practice. This model allows for fair participation by various coverage models (HMO, PPO, POS) and for commercial, managed Medicaid, and Medicare Advantage products. The Governor’s Office annually collects and validates revenue and periodically generates statements to payers to initiate the reimbursement process as milestones are achieved. Health plans are also paying for health coaches in proportion to revenue.
Other related accomplishments of Rx for Pa include:
• New laws to provide transparency in health quality and to protect patients from health facility-acquired infections, which in the first six months helped result in a 7.8 percent decrease in hospital-acquired infections and 300 fewer hospital acquired infection-related deaths than the year before;
• Changes in scope of practice laws to allow physicians’ assistants, certified nurse practitioners, clinical nurse specialists, and dental hygienists to practice to the full extent of their education and training;
• Developing a statewide health information exchange; and
• Payment reform, including the Medicaid program no longer paying for “never events.”