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."

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The Patient-Centered Medical Home

  1. 1. THE PCMH <ul><li>Lyndee Knox, PhD </li></ul><ul><li>LA Net A Project of Community Partners </li></ul>
  2. 2. Change is Hard . . .
  3. 3. Objectives <ul><li>Create a common departure point for discussion to follow </li></ul><ul><li>A 101 overview, not a deep dive into PCMH </li></ul><ul><li>Introduce PCMH efforts underway in L.A. </li></ul>
  4. 4. Presentation Outline
  5. 5. What is a Patient Centered Medical Home (PCMH) The patient-centered medical home is &quot;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.&quot; (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.
  6. 6. According to the ACP, it is:
  7. 7. Other descriptions <ul><li>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) </li></ul><ul><li>PCMH requires a compact between payers and primary care practices. Simultaneously, </li></ul><ul><ul><li>Practices improve their care </li></ul></ul><ul><ul><li>Payers pay the practices more to help them improve their care </li></ul></ul><ul><ul><li>Neither practices or payers can do it themselves. Both are needed (T. Bodenheimer) </li></ul></ul>
  8. 8. 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…
  9. 9. Principles were created by the
  10. 10. Referred to as the Patient Centered Primary Care Collaborative (PCPCC) PCPCC on the web:
  11. 11. Critique of the PCMH: Some feel it doesn’t go far enough
  12. 12. Presentation Outline
  13. 13. How do you Know a PCMH When you See One?
  14. 14. Recognition Programs for PCMH Developed or Under Development Quality Organizations PCMH Standards Activity 2010
  15. 15. NCQA PPC-PCMH Recognition Module; Major Domains/Standards <ul><li>Access & Communication </li></ul><ul><li>Patient Tracking & Registry Functions </li></ul><ul><li>Care Management </li></ul><ul><li>Patient Self-Management Support </li></ul><ul><li>Electronic Prescribing </li></ul><ul><li>Test Tracking </li></ul><ul><li>Referral Tracking </li></ul><ul><li>Performance Reporting & Improvement </li></ul><ul><li>Advanced Electronic Communication </li></ul><ul><li>Each standard contains sub-elements – 10 of which are considered “must pass” </li></ul>For more information: 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
  16. 16. Key Points for Level 1 PCMH
  17. 17. Level 2 -> Level 3
  18. 18. More Features of a PCMH Practice
  19. 19. NCQA Recognition Activity SOURCE: NCQA, July 2010
  20. 20. SOURCE: NCQA, December 2009
  21. 21. Critique of NCQA <ul><li>Beal et al created a patient centered definition of a medical home w/ 4 questions: </li></ul><ul><ul><li>Do you have a regular doctor or place of care? </li></ul></ul><ul><ul><li>Can you easily contact your provider by phone? </li></ul></ul><ul><ul><li>Can you easily get care or medical advice on weekends or evenings? </li></ul></ul><ul><ul><li>Are your physician visits well organized and running on time? </li></ul></ul><ul><li>Practices doing well on these could flunk NCQA </li></ul><ul><li>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 </li></ul><ul><li>T. Bodenheimer </li></ul>
  22. 22. Presentation Outline
  23. 23. Complex Delivery <ul><li>Health care delivery is complex – e.g., the typical primary care physician coordinates care with 229 other physicians working in 117 practices </li></ul><ul><li>H H Pham, et al Ann Intern Med. 2009;150:236-242 </li></ul>
  24. 24. Specialty Care Connections * FAQs available at: running_practice/pcmh/understanding/specialty_physicians.htm
  25. 25. 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.
  26. 26. Presentation Outline
  27. 27. 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)
  28. 28. Federal PCMH Efforts For more information on CMS/Medicare PCMH Efforts:
  29. 29. Federal PCMH Efforts (cont.)
  30. 30. Safety-Net Medical Home Initiative Source:
  31. 31. Common Practice Support Approaches in PCMH Demos
  32. 32. Presentation Outline
  33. 33. Evaluation Collaborative sponsored by Commonwealth
  34. 34. Community Implications - Published Results of PCMH Projects to Date Source: PCPCC Pilot Guide, 2009
  35. 35. Community Implications – Published Results of PCMH Projects (cont.) Source: PCPCC Pilot Guide, 2009
  36. 36. Community Implications Source: Metcare Press Release, February 23, 2010 <ul><li>Practices made changes, process measures improved, docs happier, </li></ul><ul><li>but patients were dissatisfied and felt disconnected from physician </li></ul>
  37. 37. Community Implications Source: Metcare Press Release, February 23, 2010
  38. 38. Estimates on Co$t? Future of Family Medicine Report ( ), 2004 Deloitte: The Medical Home, Disruptive Innovation for a New Primary Care Model ( ), 2008
  39. 39. What Does it Co$t? AMA ( ), 2008 Urban Institute Report - Co-Funded by The Commonwealth Fund and ACP – Available at: , 2009
  40. 40. Presentation Outline
  41. 41. Some resources for Practices <ul><li>PCPP --- </li></ul><ul><ul><li>Tools for practices, patients </li></ul></ul><ul><ul><li>Meaningful Connections: IT and the PCMH </li></ul></ul><ul><li>National Academy for State Health Policy </li></ul><ul><li>AAP Toolkit </li></ul><ul><li>ACP Medical Home builder </li></ul><ul><li>TransforMed resources </li></ul><ul><li>NCQA webex training on accreditation </li></ul><ul><li>MacColl Institute’s Tool PCMH-A‐net/change‐concepts.cfm </li></ul><ul><li>Planned: AHRQ National Learning Collaborative for Facilitating PCMH advancement </li></ul><ul><li>Recent Journal supplements on the PCMH </li></ul><ul><li>AFM Supplement </li></ul><ul><li>Health Affairs, 29, no. 5 (2010) supplement on the PCMH </li></ul><ul><li>Annals of Internal Medicine </li></ul><ul><li>Links are available to much of this material on LA Net’s website: </li></ul>
  42. 42. Presentation Outline
  43. 43. Local Activities to Support PCMH <ul><li>L.A. Care PCMH Initiative </li></ul><ul><li>LA Net CCM and PCMH funded by AHRQ </li></ul><ul><li>L.A. County initiative </li></ul>
  44. 44. LA Net <ul><li>Is a Practice-Based Research and Resource Network (PBRN) for the region </li></ul><ul><li>Focused on improving quality and reducing disparities and through: </li></ul><ul><ul><li>provider-led research on issues that matter </li></ul></ul><ul><ul><li>supporting local learning and innovation </li></ul></ul><ul><ul><li>implementing best practices </li></ul></ul>
  45. 45. Network for generating & disseminating good ideas
  46. 46. LA Net (cont) <ul><li>Consists of 16 FQHC/CHC “partners” representing 116 practice sites </li></ul><ul><li>Governed by a board of 80% clinicians, 20% researchers, others. </li></ul><ul><ul><li>John Kotick – Current Chair </li></ul></ul><ul><ul><li>Felix Nunez – Past Chair </li></ul></ul>
  47. 47. LA NET <ul><li>Part of a national network of more than 100 PBRNs in the U.S. </li></ul>
  48. 48. Some recent projects <ul><li>Management of Obstructive Sleep Apnea in Primary Care (AHRQ/CMS) </li></ul><ul><li>National Children’s Study pilot (NICHD) </li></ul><ul><li>Study of AHRQ’s web-based medication errors and adverse drug event reporting system for primary care (MEADERS) </li></ul>
  49. 49. Examples of projects <ul><li>Replication of a diabetes self-management program in 23 PC practices in Texas (AAFP, Lilly, WHO) </li></ul><ul><li>Development of low-cost “talking” survey software to use with low-literacy patients available in 7+ languages </li></ul>
  50. 50. AHRQ funded CCM and PCMH project <ul><li>Evaluating use of practice facilitation to support 20 FQHC/CHCs in CCM and PCMH changes </li></ul><ul><li>Based on input from steering cmt: Tom Bodenheimer, Jim Mold, Grace Floutsis, Rich Seidman </li></ul><ul><li>And experts from US and Canada during Consensus Panel hosted by LA Net in January 2010 </li></ul><ul><ul><ul><li>Blueprint Vermont, CareOregon, Oklahoma, IPIP, Impact BC, Quality Counts, QIIP, and others </li></ul></ul></ul><ul><li>Continuation of project by MacColl, RAND, Safety Net Institute </li></ul>
  51. 51. <ul><li>Demonstration of Primary Care Extension Program </li></ul><ul><li>Created by recent reform legislation –modeled after agricultural extension program </li></ul><ul><li>Jim Mold was author - working with us to design demonstration </li></ul><ul><li>PCMH projects and REC in LA might provide foundation </li></ul>Long-term goal: Provide sustained workforce to practices
  52. 52. 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
  53. 53. References <ul><li>American College of Physicians. 2006. The Advanced Medical Home: A Patient-Centered Physician Guided Model of Healthcare. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>American Academy of Pediatrics, Council on Pediatric Practice. Pediatric Records and a &quot;medical home.&quot; In: Standards of Child Care. Evanston, IL: American Academy of Pediatrics; 1967: 77–79 </li></ul>
  54. 54. Thank you