Thanks to AAFP for recognizing Ohio AFP’s leadership in launching the PCMH Medical Home Education Pilot Program. Many AAFP constituent chapters have successfully advocated for passage of medical home legislation within their states – so what’s the big deal. Well anyone who has worked to shepherd a bill through the legislative process knows it’s a huge deal! You all deserve Leadership in State Governmental Advocacy Awards!!
In Ohio’s specific situation, the medical home legislation provided no money, no staff and no existing administrative or fiscal structure to launch implementation of the enacted legislation. We had a law. But it was just like it was when we didn’t have a law - nothing was happening. It seemed that all of the hard work and effort it took to pass the legislation was in danger of being lost. Things seemed to be going south quickly. It seemed that the pilot might be finished before it actually got started. So OAFP stepped up to the plate to build a foundation upon which the statutorily created program could survive and thrive. The AAFP recognition, I suspect, is more about stepping up to the plate to fill a leadership void, than it is about passing a medical home bill or a PCMH pilot.
Our experience with this project taught us that passage of legislation is sometimes just the beginning of the advocacy journey. This lesson holds true on many levels – Passage of legislation is not a guarantee that a problem is solved or that a project will move forward. Sometimes the rules making process after passage of legislation is as important as the legislation itself. Advocacy is definitely a journey – not a short stroll in the park!
Now let’s turn to the legislation itself. HB 198 was enacted in 2010. It created a PCMH Education Advisory Group or EAG to implement and administer the pilot.
Representative (now Senator) Peggy Lehner was sponsor of the legislation. She is pictured with family physician Ted Wymyslo who is now director of the Ohio Department of Health and commonly referred to as Ohio’s PCMH czar. The gentleman at the right is Jeff Harwood who was our Academy president when the legislation passed in 2010.
Most of the objectives of HB 198 are most likely similar to the objectives of medical home legislation in your state. The unique thing about Ohio’s legislation, and the thing that sets it apart from other state efforts, is the emphasis on education – creating PCMH practice sites in which medical students, residents, and nurses can be trained in and truly experience delivering care in the PCMH model. Including nurses in the legislation, the pilot and curriculum design has been challenging and at times rather combative but in the spirit of working in teams, the ability for all of us to “play nicely” in the sandbox has grown.
It is our objective to attract and retain primary care physicians in Ohio buy producing a more satisfying practice environment as studies show that by 2020, America will need at least 39,000 more family physicians nationwide. Improving patient care and patient experience are also vital
And no discussion of health care is complete without examination of cost – providing higher quality care in an more affordable and accessible fashion. Practice transformation, of course, costs money so legislative sponsors envisioned creating an entity that could accept funding – public or private donations to support PCMH transformation efforts.
These slides we can breeze through quickly as we are all on board with the value PCMH brings to health care. But the evidence is substantial and compelling.
Legislation specifically limited the focus of PCMH practices to the four regions of the state not having a sizable PCMH project already in place. The 3 Cs of Ohio – Cleveland, Columbus and Cincinnati – already had important PCMH work underway and were, therefore, not included in the legislation. The legislation’s intent was to spread PCMH into the other parts of Ohio beyond the 3 large metropolitan centers.
Again money remains a major issue – Ohio’s economic and state budget environment are typical of what is being experienced across the country. Finding funding, even for the most worthy of projects, is difficult.
Abbreviations: Ohio Chapter of American College of Physicians; Ohio Chapter American Academy of Pediatrics, Ohio Osteopathic Association; Ohio Nurses Association of Advanced Practice Nurses, Ohio Department of Insurance
Abbreviations: Ohio Department of Health
Dr. Wymyslo resigned as EAG chair when he became Director of the Ohio Department of Health but he is still one of two OAFP representatives on the Education Advisory Group. Dr. Ecklar is a general internist, Dr. Snow is an osteopathic physician and Dr. Milstead is an advanced practice nurse.
So in the absence of money, staff and administrative/fiscal structure and considering the fact that the university specifically named in the legislation to help with the launch backed out, OAFP stepped up to the plate. We coordinate the work of EAG and its task forces. We prepare and staff EAG’s monthly meetings. We work to keep the group focused, on track and moving in the same direction.
OAFP is the common thread, the glue holding EAG, its task forces, regional leadership and consultants together.
EAG utilized three task forces to organize and coordinate its work.
The funding/reimbursement reform group focused on finding funding for the project. OAFP helped EAG apply for and receive a $300,000 grant from the Health Care Coverage and Quality Council. This 7-month grant ended June 30. EAG hired a sustainability consultant who helped identify funding streams for the pilot. The search for funding continues.
The Practice Selection/Metrics Group determined the measurement metrics for selected pilot practices. The Practice Selection/Metrics Group also developed and completed, with the help of TransforMed, a rigorous practice selection process.
One of the consultants hired was TransforMED. Practices were evaluated using TransforMed’s established, evidence-based assessment tools. Input on practices was collected regionally. Required affiliated teaching agreements were verified as was board certification of practice participants. And as an aside, our experience working with TransforMED was excellent. They were knowledgeable, professional and extremely helpful – I don’t know how we would have managed without their assistance.
The Curriculum Group focused on developing a curriculum for teaching medical students and nursing students how to deliver the PCMH model of care to patients.
We are still looking for funding and have some excellent leads. We continue to communicate regularly with selected practices to let them know our progress and to keep them engaged. Administrative/fiscal management of EAG and the project are slated to transfer to the Ohio Department of Health on January 1, 2012.
Follow our progress on the OAFP web site – the EAG and pilot web site in accessible from a tab on the OAFP home page.
At the time the PCMH Education Advisory Group and its pilot needed structure and administrative/fiscal management, OAFP stepped in to provide that leadership for 13 months. We are now in the process of transitioning that leadership to the Ohio Department of Health. OAFP built a foundation for the pilot project. ODH is now positioned to take over project administration, is actively engaged in fundraising, and is equipped to use Medicaid match dollars to enhance privately raised dollars in a way that OAFP is unable to do. It is possible that ODH may be interested in contracting with OAFP to conduct pieces of the work effort that lies ahead. Nevertheless, OAFP will continue to be actively involved in the pilot regardless of whether contract work is a part of the deal. We believe in this cause!
Remember – successful passage of legislation is sometimes just the beginning of the advocacy journey.
Ohio’s PCMH Education Pilot Colette R. Willins, M.D. President Ohio Academy of Family Physicians