The Patient-Centered Medical Home
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The Patient-Centered Medical Home

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The patient-centered medical home is "a model for care provided by physician practices aimed at strengthening the physician-patient relationship."

The patient-centered medical home is "a model for care provided by physician practices aimed at strengthening the physician-patient relationship."

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    The Patient-Centered Medical Home The Patient-Centered Medical Home Presentation Transcript

    • THE PCMH
      • Lyndee Knox, PhD
      • LA Net A Project of Community Partners
    • Change is Hard . . .
    • Objectives
      • Create a common departure point for discussion to follow
      • A 101 overview, not a deep dive into PCMH
      • Introduce PCMH efforts underway in L.A.
    • Presentation Outline
    • What is a Patient Centered Medical Home (PCMH) The patient-centered medical home is "a model for care provided by physician practices aimed at strengthening the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship." (NCAQ) A recent Journal of General Internal Medicine provides a core definition of the PCMH as a team of people committed to improving the health and healing of individuals in a community.
    • According to the ACP, it is:
    • Other descriptions
      • The PCMH is a political construct that includes new ways of organizing and financing care , while attempting to remain true to the proven value of primary care (Stange et al, 2010)
      • PCMH requires a compact between payers and primary care practices. Simultaneously,
        • Practices improve their care
        • Payers pay the practices more to help them improve their care
        • Neither practices or payers can do it themselves. Both are needed (T. Bodenheimer)
    • Based on the Joint Principles Team-based care: NP/PA RN/LPN Medical Assistant Office Staff Care Coordinator Nutritionist/Educator Pharmacist Behavioral Health Case Manager Social Worker Community resources DM companies Others…
    • Principles were created by the
    • Referred to as the Patient Centered Primary Care Collaborative (PCPCC) PCPCC on the web: http://www.pcpcc.net
    • Critique of the PCMH: Some feel it doesn’t go far enough
    • Presentation Outline
    • How do you Know a PCMH When you See One?
    • Recognition Programs for PCMH Developed or Under Development Quality Organizations PCMH Standards Activity 2010
    • NCQA PPC-PCMH Recognition Module; Major Domains/Standards
      • Access & Communication
      • Patient Tracking & Registry Functions
      • Care Management
      • Patient Self-Management Support
      • Electronic Prescribing
      • Test Tracking
      • Referral Tracking
      • Performance Reporting & Improvement
      • Advanced Electronic Communication
      • Each standard contains sub-elements – 10 of which are considered “must pass”
      For more information: http://ncqa.org/tabid/631/Default.aspx Each standard contains sub-elements 10 of which are considered “must pass” Standards are currently under revision and will be available Jan 2011 – Integrate IT w/in core domains
    • Key Points for Level 1 PCMH
    • Level 2 -> Level 3
    • More Features of a PCMH Practice
    • NCQA Recognition Activity SOURCE: NCQA, July 2010
    • SOURCE: NCQA, December 2009
    • Critique of NCQA
      • Beal et al created a patient centered definition of a medical home w/ 4 questions:
        • Do you have a regular doctor or place of care?
        • Can you easily contact your provider by phone?
        • Can you easily get care or medical advice on weekends or evenings?
        • Are your physician visits well organized and running on time?
      • Practices doing well on these could flunk NCQA
      • Many standards require that a practice have a “plan” to improve , but do not require demonstration of improvement and no clear benchmarks in many cases
      • T. Bodenheimer
    • Presentation Outline
    • Complex Delivery
      • Health care delivery is complex – e.g., the typical primary care physician coordinates care with 229 other physicians working in 117 practices
      • H H Pham, et al Ann Intern Med. 2009;150:236-242
    • Specialty Care Connections * FAQs available at: http://www.acponline.org/ running_practice/pcmh/understanding/specialty_physicians.htm
    • Patient Centered Medical Home Neighbor (PCMH-N) Draft Definition A specialty practice recognized as a Patient Centered Medical Home Neighbor (PCMH-N) engages in processes that: These processes would take the form of service agreements (compacts) between/among the participating practices.
    • Presentation Outline
    • Combined Commercial and Medicaid/CHIP PCMH Activity = Identified to have at least one private payer medical home pilot under development or underway = Identified to have a Medicaid and/or CHIP medical home initiative = Identified to have both a private payer and a Medicaid and/or CHIP medical home initiative * As tracked by the American College of Physicians (updated March 2010)
    • Federal PCMH Efforts For more information on CMS/Medicare PCMH Efforts: http://www.acponline.org/running_practice/pcmh/demonstrations/index.html
    • Federal PCMH Efforts (cont.)
    • Safety-Net Medical Home Initiative Source: http://www.qhmedicalhome.org/safety-net/index.cfm
    • Common Practice Support Approaches in PCMH Demos
    • Presentation Outline
    • Evaluation Collaborative sponsored by Commonwealth
    • Community Implications - Published Results of PCMH Projects to Date Source: PCPCC Pilot Guide, 2009
    • Community Implications – Published Results of PCMH Projects (cont.) Source: PCPCC Pilot Guide, 2009
    • Community Implications Source: Metcare Press Release, February 23, 2010
      • Practices made changes, process measures improved, docs happier,
      • but patients were dissatisfied and felt disconnected from physician
    • Community Implications Source: Metcare Press Release, February 23, 2010
    • Estimates on Co$t? Future of Family Medicine Report ( http://www.annfammed.org/cgi/reprint/2/suppl_3/s1 ), 2004 Deloitte: The Medical Home, Disruptive Innovation for a New Primary Care Model ( http://www.deloitte.com/dtt/cda/doc/content/us_chs_MedicalHome_w.pdf ), 2008
    • What Does it Co$t? AMA ( http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/ruc-medicare-medical-home-demonstration-project.shtml ), 2008 Urban Institute Report - Co-Funded by The Commonwealth Fund and ACP – Available at: http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Oct/Incremental-Cost-Estimates-For-The-Patient-Centered-Medical-Home.aspx , 2009
    • Presentation Outline
    • Some resources for Practices
      • PCPP --- http://www.pcpcc.net/
        • Tools for practices, patients
        • Meaningful Connections: IT and the PCMH
      • National Academy for State Health Policy http://www.nashp.org/node/1681
      • AAP Toolkit http://www.pediatricmedhome.org/start_building/
      • ACP Medical Home builder http://www.acponline.org/running_practice/pcmh/
      • TransforMed resources http://www.transformed.com/TransforMED_is_How.cfm
      • NCQA webex training on accreditation www.ncqa.org/rptraining.aspx
      • MacColl Institute’s Tool PCMH-A http://qhmedicalhome.org/safety‐net/change‐concepts.cfm
      • Planned: AHRQ National Learning Collaborative for Facilitating PCMH advancement
      • Recent Journal supplements on the PCMH
      • AFM Supplement http://www.annfammed.org/content/vol8/Suppl_1/index.shtml
      • Health Affairs, 29, no. 5 (2010) supplement on the PCMH
      • Annals of Internal Medicine http://www.acponline.org/running_practice/pcmh/resources_tools/abstracts.htm
      • Links are available to much of this material on LA Net’s website: www.lanetpbrn.net
    • Presentation Outline
    • Local Activities to Support PCMH
      • L.A. Care PCMH Initiative
      • LA Net CCM and PCMH funded by AHRQ
      • L.A. County initiative
    • LA Net
      • Is a Practice-Based Research and Resource Network (PBRN) for the region
      • Focused on improving quality and reducing disparities and through:
        • provider-led research on issues that matter
        • supporting local learning and innovation
        • implementing best practices
    • Network for generating & disseminating good ideas
    • LA Net (cont)
      • Consists of 16 FQHC/CHC “partners” representing 116 practice sites
      • Governed by a board of 80% clinicians, 20% researchers, others.
        • John Kotick – Current Chair
        • Felix Nunez – Past Chair
    • LA NET
      • Part of a national network of more than 100 PBRNs in the U.S.
    • Some recent projects
      • Management of Obstructive Sleep Apnea in Primary Care (AHRQ/CMS)
      • National Children’s Study pilot (NICHD)
      • Study of AHRQ’s web-based medication errors and adverse drug event reporting system for primary care (MEADERS)
    • Examples of projects
      • Replication of a diabetes self-management program in 23 PC practices in Texas (AAFP, Lilly, WHO)
      • Development of low-cost “talking” survey software to use with low-literacy patients available in 7+ languages
    • AHRQ funded CCM and PCMH project
      • Evaluating use of practice facilitation to support 20 FQHC/CHCs in CCM and PCMH changes
      • Based on input from steering cmt: Tom Bodenheimer, Jim Mold, Grace Floutsis, Rich Seidman
      • And experts from US and Canada during Consensus Panel hosted by LA Net in January 2010
          • Blueprint Vermont, CareOregon, Oklahoma, IPIP, Impact BC, Quality Counts, QIIP, and others
      • Continuation of project by MacColl, RAND, Safety Net Institute
      • Demonstration of Primary Care Extension Program
      • Created by recent reform legislation –modeled after agricultural extension program
      • Jim Mold was author - working with us to design demonstration
      • PCMH projects and REC in LA might provide foundation
      Long-term goal: Provide sustained workforce to practices
    • Acknowledgements Shari M. Erickson, MPH Senior Associate, Center for Practice Improvement & Innovation Tom Bodenheimer, MD UCSF Katie Coleman, MPH MacColl Institute Jim Mold, MD U of Oklahoma
    • References
      • American College of Physicians. 2006. The Advanced Medical Home: A Patient-Centered Physician Guided Model of Healthcare. http://www.acponline.org/advocacy/where_we_stand/policy/adv_med.pdf
      • American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). 2007. Joint Principles of the Patient-Centered Medical Home. March 2007. http://www.acponline.org/running_practice/pcmh/demonstrations/jointprinc_05_17.pdf
      • American Academy of Family Physicians (AAFP). 2004. The Future of Family Medicine: A Collaborative Project of the Family Medicine Community. Annals of Family Medicine 2 (1): S3-S32.
      • American Academy of Pediatrics, Council on Pediatric Practice. Pediatric Records and a "medical home." In: Standards of Child Care. Evanston, IL: American Academy of Pediatrics; 1967: 77–79
    • Thank you