2012 Health Care By the Numbers Part Two
 

2012 Health Care By the Numbers Part Two

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Reform of the U.S. health care system is at hand. On June 28, 2012, the Supreme Court of the United States (SCOTUS) upheld one of the most historic health care laws in the U.S. since the establishment ...

Reform of the U.S. health care system is at hand. On June 28, 2012, the Supreme Court of the United States (SCOTUS) upheld one of the most historic health care laws in the U.S. since the establishment of the Medicare and Medicaid programs in 1965 under President Lyndon Johnson—the Affordable Care Act (ACA). Last year, 21.4 cents of every Federal income tax dollar received went to Medicare and health care spending, second only to the military in U.S. expenditures. According to the last report by the Congressional Budget Office (CBO) issued in March 2012, ACA will cost $1.76 trillion (net cost of $1.1 trillion) to fully implement between now and 2022. That amount represents significant provisions to fuel reform.

Prior to ACA, use of electronic health records (EHR) was triggered under the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH component of this law is specifically designed to reward and accelerate interoperable EHR adoption by hospitals and providers through an incentive program known as Meaningful Use.

Between ARRA and ACA, delivery of health care in America will look very different in the next five years. The following numbers and metrics are brought to you by SuccessEHS and tell the tale of health care transformation. Enjoy!

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2012 Health Care By the Numbers Part Two 2012 Health Care By the Numbers Part Two Presentation Transcript

  • Part tWO eLECTRONIC HEALTH rECORD aDOPTION & hEALTH iNFORMATION eXCHANGEhipaa pRIVACY, sECURITY & bREACH nOTIFICATION pRIORITY pRIMARY cARE pROVIDERS cOMMUNITY hEALTH cENTERS b.R.I.E.F. SURVEY RESULTS CITATIONS
  • ehr adoption & health information exchangeSince the Meaningful Use program launched in January 2011, the U.S. has seen asignificant up-tick in adoption of certified EHR technology (CEHRT). Additionally,HITECH provisioned cooperative agreements with every state and territory to “getwired” for health information exchange (HIE). Although the adoption and use ofCEHRT and HIE is not pervasive in the marketplace, the growth is recognizable.
  • ehr adoption & hIE$30,000,000,000 Amount that has been spent by the federalgovernment since 2009 under the HITECH Act 57 57 Percent of U.S. Physicians to advance EHR & HIE adoption who report using “any” 17 EHR technology in 2011, as compared to only 17 40.2 2002 2011 percent in 2002 40.2 Percent of primary care physicians in the U.S. who report using basic EHR at the end 34 Percent of U.S. physicians 17.1 34 who report using “basic” of 2011, up from 12 EHR functionality in 2011, 17.1 percent in 2002 a significant increase from 2002 2011 2007 2011 just 12 percent in 2007 85 Number of ambulatory Number of operational HIEs6,879 practices (3 percent total) participating in HIEs that are operational that were identified in the U.S. in 2011; another 98 were in the planning phase
  • ehr adoption & hIE 30.9 Percent of specialists who 88 2011 2010 18 30.9 report using basic EHR in12.4 2011, compared to 12.4 percent in 20022002 2011 Percent of operational HIEs that are exchanging Percent of U.S. hospitals that were shown to test results, the most have adopted basic EHR functionality in common exchange; 2011, compared to just 11.5 percent in 2010 demographic information follows at 76 percent for ambulatory settings 40 2011 2010 8.7Percent growth rate that was Percent of hospitals that adoptedseen in the HIE market from comprehensive EHRs in 2011, 2010 to 2011 compared to only 2.6 percent in 2010
  • hipaa privacy, security & breach notificationContained in ARRA, HIPAA privacy and security was supplemented with newregulations requiring all physicians covered under HIPAA to notify patients ofsecurity breaches of their protected health information. This is known as theHIPAA Breach Notification Rule. In addition to notifying affected individuals, HIPAAcovered entities must also report PHI breaches to the Secretary of HHS and, insome cases, to the media. HIPAA breaches can carry stiff penalties regardless ofthe size of the covered entity. The idea is to strengthen the fabric of public trustthat having PHI “out there” in digital form is safe, private and secure.
  • hipaa privacy, security & breach notification70,982 16,259 Number of cases investigated since Number of HIPAA complaints that April 2003 resulting in changes in have been registered with the HHS privacy practice & other corrective Office of Civil Rights since April 2003 actions by the covered entities 91 500+ Number of individuals affected $1,000 19 Amount per violation that Millions of Americans by unsecured protected health is applied for violations that have experienced a information (PHI) breaches that deemed secondary to a major HIPAA breach will result in public posting on since effective date of the HHS website of the breach “reasonable cause” with the HIPAA breach Percent of the in accordance with the Interim an annual maximum of notification IFR in lateabove-noted complaints Final Rule for Breach Notification $100,000 under the IFR 2009 (or 64,449) that were resolved through $50,000 investigation & Amount per violation (up to $1.5 millionenforcement, a finding of for repeat occurrences) in fines that isno violation or ineligibility applied for breaches deemed the result for enforcement of willful neglect
  • hipaa privacy, security & breach notification40,396 Number of patients on average who were affected per each of the 385 PHI Percent of all breaches breaches that occured in 2011 59 in 2011 that involved a business associate 3.25Millions of dollars that were paid by CVS 97 39 Percent of all breaches in 2011 that occurred on a laptop or otherPharmacy, Inc. & Rite Aid Corporation in portable deviceJanuary 2009 & July 2010, respectively, to resolve violations of the Privacy Rule Percent increase in total records breached that was Percent of all breaches $100,000 25 realized from 2010 to 2011 in 2011 that occurred on a desktop PC or server 1.7 Millions of dollarsAmount that was reached as a settlement that were applied for HIPAA federal by Phoenix Cardiac in federal penalties Surgery in June 2012 Percent of all breaches to the Alaska Department of Health & Social Services (Medicaid) for HIPAA 60 in 2011 that resulted from malicious intent such as theft or hacking violations in July 2012
  • priority primary care providersAccording to the National Association of Community Health Centers, the U.S. isfaced with nearly 60 million disenfranchised patients who do not have adequateaccess to primary care services. Approximately 75 percent of the 2,050 ruralU.S. counties include a primary care health professional shortage area. HITECHgives priority for needing health IT—or a Priority Primary Care Provider (PPCP).The formal definition of a PPCP is a licensed MD, DO, nurse practitioner orphysician assistant with prescriptive privileges who provides primary careservices in the area of Family Practice, Internal Medicine, OB/Gynecology and/orPediatrics practicing in an individual or small practice (10 or less) serving theuninsured, underinsured and medically underserved populations.
  • priority primary care providers Primary Care Providers (PCPs) 60 Millions of are defined as physicians working in family practice, geriatrics, general practice, general internal medicine and general pediatrics. Americans who lack adequate 624,434 access to primary Number of physicians who care providers due work in direct patient care in each individual = 1 million to a shortage the United States 52 33.5 43.4 25 48.1 Percent of nurse Percent of physicians in Percent of physician Percent increase in the Percent of visits topractitioners practicing in the U.S. that are assistants practicing in yearly number of primary care physiciansprimary care in the U.S. - classified as primary care primary care in the U.S. - ambulatory visits from in office-based practices approximately 55,625 - approximately 209,000 approximately 30,400 1997 to 2007
  • priority primary care providers 16.4 81 9.3 5.2 4.3Percent of visits to Average percent of PCPs Average percent of PCPs Average percent of PCPs Average percent of PCPssurgical specialists that practice in an urban that practice in a large, that practice in a small, that practice in a remote, setting (including nurse rural setting defined as rural setting defined as rural or frontier market practitioners & physician having a population of having a population of defined as having a assistants) 10,000 to 50,000 2,500 to 9,999 population less than 2,500 250 18.4 1.2 Billions of visits to physician offices, hospital emergency departments & outpatientPercent of visits tomedical specialists centers Millions of dollars that are earmarked under the Affordable Care Act & the Public Health Fund to train professionals in primary care
  • Community health centersCommunity Health Centers (CHCs) are non-profit ambulatory care clinicsdesigned to enhance the health and well-being of all people, with particularemphasis on those patients who are medically underserved. CHCs offeraffordable health care services through well-trained professional staff ataccessible locations throughout the country. Delivering a dedicated staff topopulations and areas that have too few options, CHCs will play a key role incaring for newly covered Americans under the Affordable Care Act.
  • Community health centers 1,137 Number of Community Health Centers (CHCs) that are established in the U.S. 8,649 Number of CHC clinic sites that are available to deliver safety net services 20.2 1.7 Millions of patients who Billions of dollars in 109 Millions of dollars that 650 Number of CHCs, roughly, were awarded to 278 that offer safety net dental were served by CHCs in Affordable Care Act (ACA) school-based health services (of the 1,137 2011 (including grants that were awarded center programs in available), supplying 7-8 members of ethnic & to the Health Center FY2011 & to 45 programs million of the underserved minority groups) Program in FY2011 in FY2012 under ACA with dental care 80 Millions of Americans 9,900 Number of physicians serving patients in CHCs 7.4 71who are disenfranchised for general dental care 6,900 Number of mid-level providers serving in CHCs Percent of babies with a low birthrate in CHCs, as compared to the national Percent of diabetics treated at CHCs that had control over diabetes with average at 8.16 percent a hemoglobin A1C < 9
  • About the b.r.i.e.f. readersIn June, SuccessEHS surveyed around 500 readers of it publication known as TheB.R.I.E.F. (Bringing Relevant Information & EHR Facts) to get their thoughts on keyissues and topics. Around 22 percent of readers responded. Approximately 71percent were affiliated with primary care providers, 28 percent with specialtyproviders, and 2 percent hospital administration. Here are the results.
  • About the b.r.i.e.f. readers 50.5 34.2 25.2 36.9 61.3 Percent of readers who use Percent of readers that advanced Certified EHR Percent of readers that Percent of readers that have performed the first year technology to provide Percent of readers that have or will perform 90 performed Year One adopt, of 90 continuous days of point-of-care alerts when continuous days ofevidence-based clinical events have registered for implement or upgrade as Meaningful Use in required under the Medicaid Meaningful Use in for wellness, prevention or CMS EHR Incentive CY2011 Meaningful Use program CY2012chronic disease management Programs are outstanding on a patient 59 56 75 20.7 30.6 Percent of readers that identified the Percent of readers that listed Percent of readers that list Percent of readers that Patient-Centered Medical Accountable Care ICD-10, Meaningful Use Percent of readers that have received Year One Home, Health Information Organizations, Value-Based Stage 1 or Meaningful Use Exchange or Physician Modifiers, ePrescribing or have been paid for Year AIU Incentives under Stage 2 as the number one Quality Reporting System as HIPAA security as the least One of the Medicare Medicaid stressful matter to health care the second most stressful stressful matter to health Meaningful Use program stakeholders today matter to stakeholders care stakeholders
  • CITATIONSThe American Patient- United Nations, Population and Vital Statistics Report, Series A, Vol. LXIV, January 1, 2012, http://unstats.un.org/unsd/demographic/products/vitstats/sets/Series_A_2012.pdf- Ibid.- L. Murphy, J. Xu, K. Kochanek, National Vital Statistics Reports, Deaths: Preliminary Data for 2010, Volume 60, Number 4, January 11, 2012,http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf- Central Intelligence Agency, The World Factbook, Country Comparison: Life Expectancy at Birth, 2011, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html- U.S. Census Bureau, Profile America, Facts for Features, Older Americans Month: May 2012, March 1, 2012,http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff07.html- Department of Defense, Military Personnel Statistics, December 31, 2011, http://www.usa.gov/Federal-Employees/Active-Military-Records.shtml#Data_and_Statistics- CDC/NCHS, Data Brief No. 82, Prevalence of Obesity in the U.S. 2009-2010, January, 2012, http://www.cdc.gov/nchs/data/databriefs/db82.pdf- R. Hammond, Brookings, Obesity, Prevention, and Health Care Costs, May 4, 2012, http://www.brookings.edu/research/papers/2012/05/04-health-care-hammond- American Cancer Society, Cancer Facts and Figures 2012, http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012 - L. Murphy, J. Xu, K. Kochanek, National Vital Statistics Reports, Deaths: Preliminary Data for 2010, Volume 60, Number 4, January 11, 2012,http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf- American Heart Association and American Stroke Association, Statistical Fact Sheet, 2012 Update, http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319585.pdf- Ibid.- Alzheimer’s Association, 2012 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, Volume 8, Issue 2, 2012, http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319585.pdf- J. Loyd, USA Today, Many with mental illness go without treatment, Survey Says, January 19, 2012,http://www.usatoday.com/news/health/medical/health/medical/mentalhealth/story/2012-01-19/Many-with-mental-illness-go-without-treatment-survey-says/52653166/1- Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and over: United States, 2005–2008. NCHS data brief, no 76. Hyattsville, MD: National Center for HealthStatistics. 2011- Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Expenditure Projections 2010-2020, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2011PDF.pdf- Henry J. Kaiser Foundation, Health Care Costs: A Primer, Key Information on Health Care Costs and Their Impact, May, 2012, http://www.kff.org/insurance/upload/7670-03.pdf- Martin A.B. et al., “Growth In US Health Spending Remained Slow in 2010; Health Share of Gross Domestic Product Was Unchanged from 2009,” Health Affairs, 2012,http://content.healthaffairs.org/content/31/1/208.short- Ibid.- CDC/NCHS, Health, United States, 2011, Tables 138, 140, and 141. Data from the National Health Interview Survey (NHIS).- CDC/NCHS, Health, United States, 2011, Table 99. Data from the National Health and Nutrition Examination Survey (NHANES).- Henry J. Kaiser Foundation, Health Care Costs: A Primer, Key Information on Health Care Costs and Their Impact, May, 2012, http://www.kff.org/insurance/upload/7670-03.pdf- Ibid.- Ibid.
  • CITATIONSMeaningful Use- Harvard School of Public Health, Mathematica Policy Research, Robert Wood Johnson Foundation, Health Information Technology in the United States: Driving Toward DeliverySystem Change, 2012, http://www.rwjf.org/files/research/74262.5822.hit.full.rpt.final.041612.pdf- Ibid.- Centers for Medicare & Medicaid Services, Data and Reports, June, 2012, http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.Electronic Health Record Adoption & Health Information Exchange- H. Anderson, Information Security Media Group, $30 Billion: Money Well Spent?, February 3, 2012, http://www.govinfosecurity.com/blogs.php?postID=1185- Harvard School of Public Health, Mathematica Policy Research, Robert Wood Johnson Foundation, Health Information Technology in the United States: Driving Toward DeliverySystem Change, 2012, http://www.rwjf.org/files/research/74262.5822.hit.full.rpt.final.041612.pdf- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Chilmark Research, 2012 HIE Market Report, June 25, 2012, http://healthinformationexchanges.org/perspectives-on-the-trends-in-the-hie-market/- Harvard School of Public Health, Mathematica Policy Research, Robert Wood Johnson Foundation, Health Information Technology in the United States: Driving Toward DeliverySystem Change, 2012, http://www.rwjf.org/files/research/74262.5822.hit.full.rpt.final.041612.pdf- Ibid.- Ibid.
  • CITATIONSHIPAA Privacy, Security & Breach Notifications- U.S. Department of Health & Human Services, Office for Civil Rights, Enforcement Highlights, May 31, 2012,http://www.hhs.gov/ocr/privacy/hipaa/enforcement/highlights/index.html- Ibid.- Ibid.- U.S. Department of Health & Human Services, Office for Civil Rights, Breaches Affecting 500 or More Individuals,http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html- U.S. Department of Health & Human Services, Office for Civil Rights, Breach Notification Rule,http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/index.html- Ibid.- H. Anderson, Information Security Media Group, $30 Billion: Money Well Spent?, February 3, 2012, http://www.govinfosecurity.com/blogs.php?postID=1185- Redspin, Breach Report 2011, Protected Health Information, http://www.redspin.com/docs/Redspin_PHI_2011_Breach_Report.pdf- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- U.S. Department of Health & Human Services, Office for Civil Rights, Annual Report to Congress on HIPAA Privacy Rule and Security Rule Compliance for Calendar Years 2009and 2010, http://www.hhs.gov/ocr/privacy/hipaa/enforcement/compliancerept.pdf- M. Tremoglie, Legal Newsline, Alaska Fined for HIPAA Violation, July 3, 2012, http://www.legalnewsline.com/news/236619-alaska-fined-for-hipaa-violation- C. Scott, Becker’s Spine Review, Physicians Beware, HIPAA Violations can Affect Your Bottom Line Regardless of the Size of Your Practice, June 13, 2012,http://beckersorthopedicandspine.com/hitmeaningful-useemr/item/12239-physician-beware-hipaa-violations-can-affect-your-bottom-line-regardless-of-the-size-of-your-practicePriority Primary Care Providers- National Association of Community Health Centers, Access Endangered: Profiles of the Medically Disenfranchised, August 8, 2011,http://www.nachc.org/client//NACHC__Access_Endangered_2011.pdf- Primary Care Workforce Facts and Stats No. 1: The Number of Practicing Primary Care Physicians in the United States. AHRQ Publication No. 12-P001-2-EF, October 2011.Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/research/pcwork1.htm- Ibid.- Primary Care Workforce Facts and Stats No. 2: The Number of Nurse Practitioners and Physician Assistants Practicing Primary Care in the United States. AHRQ Publication No.12-P001-3-EF, October 2011. Agency for Health Care Policy and Research, Rockville, MD. http://www.ahrq.gov/research/pcwork2.htm- Ibid.- Schappert S, Rechtsteiner E: Ambulatory Medical Care Utilization Estimates for 2007, from National Center for Health Statistics Vital and Health Statistics, April, 2011,http://www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf
  • CITATIONSPriority Primary Care Providers continued- Ibid.- Ibid.- Ibid.- Ibid.- Primary Care Workforce Facts and Stats No. 3: Distribution of the U.S. Primary Care Workforce. AHRQ Publication No. 12-P001-4-EF, January 2012. Agency for Health CarePolicy and Research, Rockville, MD. http://www.ahrq.gov/research/pcwork3.htm- Ibid.- Ibid.- Ibid.- Patient Protection and Affordable Care Act of 2010, http://www.healthcare.gov/law/resources/authorities/patient-protection.pdfThe Affordable Care Act- Patient Protection and Affordable Care Act of 2010, http://www.healthcare.gov/law/resources/authorities/patient-protection.pdf- Health Care and Education Reconciliation Act of 2010, http://www.healthcare.gov/law/resources/authorities/reconciliation-law.pdf- Constitution of the United States of America, http://www.constitution.org/cs_found.htm- Patient Protection and Affordable Care Act of 2010, http://www.healthcare.gov/law/resources/authorities/patient-protection.pdf and Health Care and Education ReconciliationAct of 2010, http://www.healthcare.gov/law/resources/authorities/reconciliation-law.pdf- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- C-Span, Oral Argument on Anti-Injunction Act and Health Care Law, March 26, 2012, http://www.c-span.org/Events/Oral-Argument-on-Anti-Injunction-Act-and-Health-Care-Law/10737429097/- SCOTUS Slip Opinion, National Federation of Independent Business, et al v. Sebelius, Secretary of Health and Human Services, et al., June 28, 2012,http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf- Ibid.- Ibid.Accountable Care Organizations- Muhlestein, D., Croshaw, A., Merrill, T., & Peña, C. (2012). Growth and dispersion of Accountable Care Organizations: June 2012 update. Retrieved July 5, 2012, fromhttp://leavittpartners.com/wp-content/uploads/2012/06/Growth-and-Dispersion-of-ACOs-June-2012-Update2.pdf- Ibid.- Ibid.
  • CITATIONSAccountable Care Organizations continued- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Ibid.- Center for Medicare and Mediciad Innovation. (2012). Pioneer Accountable Care Organization model: General fact sheet. Retrieved July 6, 2012, fromhttp://innovations.cms.gov/Files/fact-sheet/Pioneer-ACO-General-Fact-Sheet.pdf- Centers for Medicare and Medicaid Services. (2012). Medicare shared savings program Accountable Care Organizations. Start date: April 1, 2012. Retrieved July 6, 2012,from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-ACOs-List.pdf- Centers for Medicare and Medicaid Services. (2012). Advance payment ACO model. Retrieved June 6, 2012, from http://www.innovations.cms.gov/initiatives/aco/advance-payment/- McGinnis, T., Small, D. M., & Center for Health Care Strategies, Inc. (2012). Accountable Care Organizations in Medicaid: Emerging practices to guide program design.Retrieved July 6, 2012, from http://www.chcs.org/usr_doc/Creating_ACOs_in_Medicaid.pdfPatient-Centered Medical Home- Centers for Disease Control and Prevention, Obesity, Halting the Epidemic by Making Health Easier, At a Glance 2011, May 26, 2011,http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm#aag- Ibid. -American Diabetes Association, Health Care Reform and People with and at-risk for Diabetes, February, 2011, http://www.diabetes.org/assets/pdfs/advocacy/hcr-and-people-with-diabetes.pdf- Ibid.- Centers for Disease Control and Prevention, Diabetes, Successes and Opportunities for Population-Based Prevention and Control, At a Glance 2011, August 1, 2011,http://www.cdc.gov/chronicdisease/resources/publications/aag/ddt.htm- Norris SL, Kansagara D, Bougatsos C, et al. Screening Adults for Type 2 Diabetes: A Review of the Evidence for the U.S. Preventive Services Task Force. AHRQ Publication No.08-05116-EF-4, June 2008. http://www.uspreventiveservicestaskforce.org/uspstf08/type2/type2art.htm- Centers for Disease Control and Prevention, Tobacco Use, Targeting the Nation’s Leading Killer, At a Glance, February 22, 2011,http://www.cdc.gov/chronicdisease/resources/publications/aag/osh.htm- Free & Clear, Cancer & Lifestyle: How Employers Can Help Fight Cancer through the Promotion of Healthy Behaviors, 2010,http://www.alerewellbeing.com/_assets/cms_uploads/WP_Cancer_Lifestyle_ACS.pdf- American Cancer Society, Cancer Prevention & Early Detection, Facts & Figures 2012, Atlanta: American Cancer Society; 2012.- NCQA, Standards and Guidelines for NCQA’s Patient-Centered Medical Home (PCMH) 2011, January, 2011.- Patient Centered Medical Home Resource Center, Catalogue of Federal PCMH Activities, Agency for Healthcare Research and Quality, March 2011,http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/pcmh_federal_pcmh_activities_v2
  • CITATIONSPatient-Centered Medical Home continued- NCQA Clinician Directory and Search, July, 2012, http://recognition.ncqa.org/- The Joint Commission, Primary Care Medical Home Certified Organizations, June 19, 2012, http://www.jointcommission.org/pcmh_certified_providers/- National Academy for State Health Policy, Building Medical Homes: Lessons from Eight States with Emerging Programs, December, 2011,http://nashp.org/sites/default/files/building.medical.homes_.emerging.states.pdf- National Academy for State Health Policy, Medical Home & Patient-Centered Care, January, 2012, http://nashp.org/med-home-map- BlueCross BlueShield Association, Patient-Centered Medical Home (PCMH), 2012, http://www.bcbs.com/why-bcbs/patient-centered-medical-home/#navtab-2- A. Bitton, C. Martin, and B.E. Landon, “A Nationwide Survey of Patient-Centered Medical Home Demonstration Projects,” Journal of General Internal Medicine, June 201025(6):584-92.- Ibid.Community Health Centers- Health Resources and Services Administration, Data Warehouse, National Summary, July 12, 2012, http://datawarehouse.hrsa.gov/hitnFactSheet.aspx- Ibid.- Health Resources and Services Administration, The Affordable Care Act and Health Centers, Health Center Fact Sheet, 2012,http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf- Ibid.- Ibid.- Ibid.- Ibid.- J. Breslow, Frontline, Dollars and Dentists, How to Fix a Broken Dental Safety Net, June 27, 2012, http://www.pbs.org/wgbh/pages/frontline/health-science-technology/dollars-and-dentists/how-to-fix-a-broken-dental-safety-net/- Ibid.- Health Resources and Services Administration, The Affordable Care Act and Health Centers, Health Center Fact Sheet, 2012,http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf- Ibid.