CHC: A Health Care Home Paul Kaye, MD Chief Medical Officer Hudson River HealthCare May 6, 2008
Medical Home Development Standardized definition and qualification NCQA Physician Practice Connection- Patient Centered Medical Home Reimbursement reform: payment per patient in addition to FFS payment and P4P bonuses Aims to increase primary care compensation
Proposed Hybrid Blended Reimbursement Model Performance-based Payment Care Coordination Payment Visit-based Reimbursement
NCQA PPC-PCMH PCMH Access and Communication Patient Tracking and Registry Functions Care Management Patient Self-Management Support Electronic Prescribing Test Tracking Referral Tracking Performance Reporting and Improvement Advanced Electronic Communications
NCQA PPC-PCMH PCMH Written standards for patient access and patient communication Use of data to show standards for patient access and communication are met Use of paper or electronic charting tools to organize clinical information Use of data to identify important diagnoses and conditions in practice
NCQA PPC-PCMH PCMH Adoption and implementation of evidence-based guidelines for three chronic conditions Active patient self-management support Systematic tracking of test results and identification of abnormal results Referral tracking Clinical and/or service performance measurement, by physician or across the practice Performance reporting, by physician or across the practice
Hudson River HealthCare NCQA Physician Practice Connections Experience
HRHCare Sites New Paltz Walden Monticello Goshen SULLIVAN Pine Plains Amenia Poughkeepsie (2) Dover Plains Beacon Health Center Haverstraw Migrant Health Migrant Voucher program Public Housing Peekskill (2) Greenport Riverhead
Hudson River Healthcare Quality Journey 2006 2006 2005 2005 2004 2002 2000 2000 1998 1996 1993 Together for Tots Reengineering IHI Access and Efficiency BPHC Diabetes Introduction of EMR HRSA HIV Collaborative Prevention Pilot PCDC Redesign IHI Planned Care Harvesting Meetings Strategic Aims and Measures
Hudson River Healthcare NCQA Physician Practice Connections Awarded Recognition in 2007 Commercial HMO subsidized costs and assisted with application Closely aligned with Care Model elements Visit www.ncqa.org for details
NCQA Standards: Access and Communication Patients should have a regular source of care Patients should have easy access to appointments Patients should find it easy to contact their provider After Hours Access to Care and Advice Visits organized and on time
Access to Appointments (Number of Days Until 3rd Appointment Available) Days to third appointment 16.0 12.0 8.0 4.0 0.0 13.2 11.5 9.1 2.8 Nov-04 Nov-05 Nov-06 Nov-07
NCQA Standards: Care Management Care of Chronic Conditions Use of practice guidelines Resources for case management, care coordination, and medication management Preventable Admissions Community Care Partners in ER: NYS Patient Safety Award 2006 Care of a High Risk Condition: HIV Counseling and adherence support
Control of Diabetes % of Diabetics with HbA1C > 9 40 30 20 10 0 2002 2003 2004 2005 2006 2007 % of Diabetics with HbA1C > 9
NCQA Standards: Patient Education and Quality Improvement Educational Resources Assessment of language and learning needs JCAHO requirement Availability of multilingual resources Performance Improvement Data for performance improvement, goals, implementation of changes National Health Disparities Collaboratives
NCQA Standards :Use of Information Systems Registry Use Identified 3 conditions: Diabetes, HIV, Hypertension Advanced Medical Record (2 sites) EMR use 100% EMR functions and interfaces Prescribing and decision support
Community CCHIT interoperable EMR Community of Practice datasharing Participation in RHIO or other local network Financial Support through Health Plans., Hospitals, Foundations, State Health System Organization of Health Care EMR adoption part of Strategic Plan Adequate Training and Support Aims and Measures of Usage Exportability of EMR data to warehouse Self-Management Support List Patient Goals Track progress toward goals Document Steps of Change or other behavioral interventions Assess and document health literacy Delivery System Design Flexible clinical roles possible Workflow redesign using EMR communication tools Robust tracking and followup capabilities Medication Management tools- E-prescribing, reconciliation Decision Support Organization controlled alerts and reminders Actionable alerts and reminders Point of Care summary screens with comparisons to goal Ability to update guidelines easily Clinical Information Systems Reporting and registry functions accessible during patient visit User defined fields available Patient input of historical and self management data Integrated PMS/EHR to manage entire population
Hudson River NCQA Experience Awarded 6 of 9 modules All sites and providers listed on NCQA website Certificate for each practice 3 year recognition Migration to PPC-PCMH PCMH available
NCQA Criteria
NCQA PPC-PCMH PCMH Projection We estimated a score of 60-65 65 for our practices using a registry, and 80-85 85 with full EMR Health Centers should achieve Level 1 if they are in compliance with HRSA Program Expectations Health Centers participating in Health Disparities Collaboratives using registries should achieve Level 2
Health Care Home:CHC Challenges Appointment access: supply and demand Patient perception of off hours availability Community coverage challenges Mobile and undocumented populations Access to capital for IT and facility needs Integration of mental and physical health into a single patient-centered system
CHC: A Health Care Home Integration of medical, oral, and behavioral health Pharmacy and lab services Facilitated enrollment into public benefit programs On site WIC services Outreach and transportation Community involvement and linkages
Beyond the Medical Home Addressing the deeper roots of disparities Economic Security Educational and Career Opportunities Addressing Racism and Building Trust Linkages to educational and economic community institutions Assistance in accessing economic benefits Building a diverse healthcare workforce and delivering care in a team-based setting Whole person care
Expanding the Medical Home Definition: Future Directions Community Resources/Organization -diverse staff, identifying community needs, patient support from community organizations, community advisory boards, community involvement, outreach Access: financial access Family Involvement & Group Visits Medication Management, including access to medications Comprehensiveness of services-onsite