Surveying the Health Care Home Landscape

Surveying the Health Care Home Landscape

Questions to Ask Your Health Plans

  • What is your strategy, approach and plan for supporting primary care and HCH in Minnesota?
    • How long have these initiatives been in place and what have been their results?
    • What are your plans for future expansion and sustainability?
  • How many HCH’s are available to my members today?
    • How many of my members are seeing HCH providers?
    • When will HCH be available to everyone?
    • Where can I, and my members, get a list of these providers?
  • What is the payment model for these providers?
    • What percentage of their total reimbursement is fee for service vs. shared savings, per member per month payments, quality bonuses or other payments?
    • How HCH and Total Cost of Care payment reform work together?
  • How do you support physicians’ in enhancing primary care?
    • Do you provide data and information to providers on patient utilization and cost?
      • If so, do they receive the right information at the right time to identify patients in need before its too late?
      • Does it give them enough information to help them coordinate all their patients’ care?
    • Do you provide other services or technology and if so what are they?
    • What has been their reaction to your model?
  • How do self-funded employers pay for HCH?
    • What is the cost/benefit of this payment for self-funded employers?
    • When and how will I realize this benefit?
  • What is required of practices to be a PCMH?
    • How are they chosen and evaluated?
    • Do you measure their performance in reducing emergency room care, unnecessary hospitalizations, referrals, and unnecessary testing?
      • What is the variation across different practices?
      • What are the consequences of poor performance?
  • What is your approach for potentially duplicative programs like disease and case management with HCH providers?
    • How does effectiveness of phone-based care vs. HCH compare in cost and outcomes?
  • What benefits have patients realized?

Health Plan Questions for National Employers

  • How many of my markets have PCMH initiatives?
  • What is percentage of participating practices in each location and what percentage of total primary care providers does that represent?
  • What is your national expansion strategy; how many markets, how fast?
  • When will most of my members receive the benefit of enhanced primary care?

What to Communicate to Health Plans

  • How can provider payment models be revised to remove financial barriers for patients receiving HCH services (if applicable)?
  • How can provider payment models be revised to include or increase financial incentives to reduce overall costs and improve quality, so that fee for service doesn’t drive their decisions?
  • How can benefit plans be revised to remove financial barriers or add incentives to seek primary care from HCHs?
  • Provide enough information and tools so members can easily select primary care providers and HCHs.
  • Measure return on investment for my population including reduced avoidable hospitalizations ad emergency room visits, specialty referrals, and unnecessary testing.

Questions for Disease and Care Management vendors

  • Do your services duplicate those that are now provided through a HCH?
  • Do you communicate with patients physicians today and, if so, how?
  • Could you become part of the HCH team? What would it take?
  • How can I offer DM and CM to patients without HCHs and drop it for those with HCHs?