Multi-Stakeholder Demonstration Project Summary

Prior to 2009, the Wisconsin Academy of Family Physicians (WAFP) attempted to organize a Patient-Centered Medical Home (PCMH) Multi-Stakeholder Demonstration project by convening both payers and providers. Due to potential anti-trust issues, the WAFP could not function as the convener. Discussions were held with the Wisconsin Department of Health Services (DHS) asking them to take the lead in convening interested participants.

In late 2010, MetaStar, the Wisconsin Medicare Quality Improvement Organization, agreed to function as convener. They organized and invited a steering team to create a Multi-Stakeholder Demonstration project. MetaStar presided over several organizational meetings and extended an invitation to a broad array of payers, providers, employers and other interested parties to meet in March 2010. At this meeting they discussed the feasibility of moving forward with the Multi-Stakeholder concept.

The purpose of the PCMH Multi-Stakeholder Demonstration Project was to create a vehicle for moving forward with PCMH in Wisconsin. The purpose was to create a mutual understanding of the definition of a PCMH, how practices would demonstrate they are a PCMH, what type of payment reform would be necessary to sustain a PCMH, agree upon pilot guidelines and determine how to measure progress and success.

Due to a number of unforeseeable circumstances, (passage of national health care reform, election of a new Wisconsin governor, pending state and federal health care regulations, payer uncertainty, and the Wisconsin Payment Reform Initiative, now known as the Partnership for Healthcare Payment Reform) the PCMH Multi-Stakeholder Demonstration Project stalled.

Although the steering committee and the payer and provider community still believed in the project's merit, the concept was slightly modified in late 2010:

The Wisconsin Academy of Family Physicians' goal is to bring together multi-stakeholders from across the state to participate in a Patient-Centered Medical Home (PCMH) demonstration program with the following expected outcomes:

1. Consensus on the definition of PCMH being the Joint Principles (.pdf).
2. Consensus that practices can demonstrate that they are a PCMH through the NCQA Physician Practice Connections - Patient Centered Medical Home recognition process.
3. Consensus that an enhanced payment system such as a blended payment system compensate practices for the level of effort necessary to become a PCMH (i.e., fee for service, care management fee, pay for performance).
4. Consensus that actual dollar amounts for the components of any payment system will not be discussed.
5. Consensus that there will be collaboration to support/explore/foster a multi-stakeholder PCMH demonstration program/pilot.
6. Consensus on the use of the PCPCC Demonstration Guidelines.
7. Consensus on how to measure the success of the demonstration program, including what should be measured and who should undertake the evaluation.
8. Ensure practices have access to resources that can help them become a PCMH.