Gonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group

Transcription

1 Gonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group

2 Describe the main characteristics of a PCMH Analyze potential benefits of becoming a PCMH Examine the criteria and requirements for NCQA recognition as a PCMH Describe the application process for a small/medium sized practice and a large multispecialty group Analyze important steps and resources for a successful NCQA PCMH application process

3 The Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults. The Patient-Centered Medical Home is a health care setting that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient s family.

4 Accessible Family centered Continuous Comprehensive Coordinated Compassionate Culturally effective

5 Personal Physician Physician directed medical practice Whole person orientation Care is coordinated and/or integrated Quality and safety are hallmarks of a medical home Enhanced access to care Payment appropriately recognizes the added value

6 1967 Medical home first used by the American Academy of Pediatrics (AAP) 2004 American Academy of Family Physicians (AAFP) 2006 American College of Physicians (ACP) primary care medical home report 2007 AAP, ACP, AAFP, and the American Osteopathic Association (AOA) publish Guidelines for PCMH Recognition and Accreditation Programs 2011 Updated Guidelines for PCMH Recognition and Accreditation Programs

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8 AAP CSHCN definition: Children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally

9 Greater provider satisfaction Better patient outcomes Additional payment from commercial insurers? Infrastructure to perform chronic care management services Prepare for value based payment Improve financial performance (MGMA cost survey) Source: MGMA

10 Aggregated outcomes from the 28 peer-reviewed studies, state government program evaluations, and industry reports: 17 found improvements in cost 24 found improvements in utilization 11 found improvements in quality 10 found improvements in access 8 found improvements in satisfaction Source: MGMA

11 Accreditation Association for Ambulatory Health Care (AAAHC) National Committee for Quality Assurance (NCQA) The Joint Commission URAC (formerly the Utilization Review Accreditation Commission) All are national in scope, have formal PCMH standards and recognize large numbers of medical organizations Source: MGMA

12 A team approach to care delivery Using the EHR as a quality tool and to schedule preventive services Using patient registries to evaluate and improve the health status of patient populations Enhanced patient access Increased patient engagement Compliance with Stage 2 Meaningful Use

13 Established in 2008 Currently 6,762 practices and 34,492 clinicians recognized Recertification every 3 years Standards updated in 2014

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15 Standard Element Must Pass Element Factor Critical factor

16 Standard 1: Patient Centered Access Element 1A: Patient Centered Appointment Access (Must Pass) The practice has written process and written standards for providing access to appointments, and regularly assesses its performance on: (Element 1A has 6 factors) o Factor 1 (critical factor): Providing same day appointments for routine and urgent care

17 Access High risk condition: CSHCN Pediatric chronic conditions: WCC, asthma, ADHD, obesity. Registries Care coordination/ transitions of care Care plans/ self management Patient surveys Quality improvement

18 Community based pediatric medical home in Arlington, Virginia Eligibility criteria: County residents Families with incomes up to 200% of FPL No private insurance Serves as a safety net provider for children 0-19y in Arlington County Located in low income area of the county, easily accessible by public transportation

19 Pediatricians/ PNP MAs Nurses (LPN, RN) Care Coordinators LCSW Eligibility Coordinator Intake coordinator

20 Main Tasks: Referral to specialists and other services Pre-authorizations Transportation Coordination with specialists and community and school based programs Patient education and advocacy Entirely funded by local foundation

21 Kathy and Julia Premature twins Kathy: CP, severe developmental delay Julia: selective mutism Multiple barriers to care: language, socioeconomic, literacy Initial challenges-kathy: undernourished, missed medical appointments, poor compliance, not thriving in special ed program at school

22 Paper charts to EHR transition: first step Hired a consultant for NCQA process Required significant time commitment from Executive Director, Medical Director and Clinic Director Broad participation from staff Accomplished in about 7 months Conditions used: WCC, asthma, ADHD and CSHCN (high risk) Became the first Level III PCMH under 2011 standards in Virginia

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24 Multispecialty physician group in central MA Founded in1929 as Fallon Clinic 467 providers 2,147 employees IM/FP, Pediatrics and all major adult medical and surgical specialties 18 primary care sites

25 IM/FP had been recognized in 2011 under the 2008 standards Recertification in 2014: 11 primary care sites, including pediatrics Used consultant and designated project manager Multi-site application Timeline: 12 months

26 8 sites 30 providers Conditions used: CSHCN, asthma, ADHD and WCC

27 This is a project that requires significant time and commitment Don t plan to do this at a time your practice is undergoing other major changes (move, EHR conversion, merger, etc.) Start early; do gap analysis

28 Have a dedicated project manager; consider hiring a consultant Regular meetings with broad representation PDCA cycles; trial and error for new flows and processes Assume variability in processes and flows (provider/sites)

29 Physician champions are key Use this process as an opportunity to improve office flows, develop team based care and enhance support for providers Have fun and celebrate successes along the way Constant focus: improving patient care in ways that are meaningful to your practice

30 Linking PCMHs with community based organizations Alternative payment models/ accountable care Workforce development

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