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?
- Do you provide data and information to providers on patient utilization and cost?
- 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?