Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination

With the advent of the medical neighborhood, care coordination is no longer the sole domain of the primary care practice (PCP) but a responsibility shared among all providers that touch the patient. But how to formalize co-management of patients by PCPs and specialists in a way that both assures efficient delivery of high-quality healthcare and addresses the 'pain points' of each provider group? This report describes WellPoint's efforts to clearly define these roles and responsibilities: the testing of care compacts in its Patient-Centered Specialty Care (PCSC) program. In this 2014 venture, WellPoint has recruited 20 progressive specialist practices to work with its established patient-centered medical home practices to test the use of care compacts as a means of bridging primary care-specialist collaborations. In this 25-page resource, director of payment innovation at WellPoint, Inc., describes how the care compact, adapted from a Colorado System of Care/Patient-Centered Medical Home (SOC/PCMH) template, addresses such care coordination concerns as communications, referrals, patient handoffs, and more, and provides details on the following: *Selection criteria for participating specialties; *WellPoint's three-part scorecard to evaluate care coordination, quality and appropriateness of care in the PCSC program, as well as future scorecard goals; *The tiered savings incentive approach supporting PCSC and anticipated evolution of the reimbursement model; *Templates for care coordination agreements and strategies for addressing 'pain points' from provider group perspectives, including specifics around patient referrals, provider communications, and more; *Engaging specialists in the use of care compacts and the role of care coordination; *Best practices and suggested add-ons for care compacts and referral agreements; *Tools, education and learning collaboratives to support the use of care compacts; *Future plans for the Patient-Centered Specialty Care program; and much more. Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination underscores how care compacts, also known as care collaboration agreements or referral agreements, are helping to construct a framework for care coordination within a medical neighborhood. Table of Contents: *Care Compacts: Forming the Foundation of PCP-Specialist Care Teams *Introducing Patient-Centered Specialty Care *Limited PCSC Rollout *Tiered Savings Approach *The PCSC Scorecard *Components of Care Coordination *Defining Care Compacts *Template for Collaborative Care Agreements *Engaging Specialists in Care Compacts *Opportunity to Address Primary Care, Specialist Pain Points *Furthering Care Coordination in the Medical Neighborhood *Best Practices in Referral Agreements *Add-Ons to Care Compacts *Education and Engagement *Lessons Learned and Early Feedback *Q&A: Ask the Experts *Participant Selection Criteria *Estimated Savings from Care Compacts *Primary Care Practice Sign-On *Future Specialty Participation *Practice Care Coordination Capabilities *Care Compact Best Practices *Sharing Savings Between PCPs and Specialists *Non-Financial Rewards and Incentives *Conditions Conducive to Care Compacts *Care Compact Challenges for Practices *Including Champions in Care Compacts *Glossary *For More Information *About the Speakers