THE PEDIATRIC ALPHABET SOUP OF HEALTH SYSTEM CHANGE ALBERT Z. HOLLOWAY, MD, FAAP PRESIDENT, ALABAMA CHAPTER AMERICAN ACADEMY OF PEDIATRICS On Predicting The Future The future is here. It is just not widely distributed yet. William Gibson The best way to predict the future is to invent it. Alan Kay Prediction is very difficult, especially about the future. Niels Bohr Vision of Pediatrics 2020 This project is about CHANGE Removing blinders so all can be seen Considering likely scenarios Preparing for likely scenarios Flexibility to move and manage change when strategically important
Art of Scenario Thinking/Planning Always in motion the future is Yoda, Star Wars Episode V Essence of Scenario Planning Future is defined by the mix and interaction of relative certainties and uncertainties How we prepare for various what if scenarios and prevent or respond to them determines our future reality to a great degree Thinking through scenarios creates cellular memory Art of Scenario Thinking/Planning Three Basic Steps Identifying forces of change in the world Combining various forces to create a diverse set of portraits Like Burt, Mary and the children in Mary Poppins, you then jump into the picture and describe the reality of life in that scenario. Art of Scenario Thinking/Planning The point is not to predict the future, but arrive at a deeper understanding of the world in which you may be operating. This generates insight as well as creates cellular memory, so if the scenario does come true, it will not be new or a surprise. Three Guiding Principles The Long View (at least 10 years out) Outside-In Thinking (Seek to understand forces you do not control first) Multiple Perspectives (insight lies at the intersections of perspective)
Profession of Pediatrics Profession of Pediatrics Focus: Vision of Pediatrics 2020 Where Are The Opportunities For Primary Care Pediatrics? Developmental Models Greater emphasis on developmental counseling and support for parents Building relationships and bonds with parents Acute vs. Chronic Care Models Redefining the core role of pediatrics Community-Based Models Building new competencies Some of the Forces at Work Changing demography of child population Minorities % on Medicaid % with chronic illness Top health needs of children and requests from parents Mental/Behavioral Health Chronic Illness Management Domain of Primary Care Pediatrics Hospital care has shifted to hospitalists Increased referral to subspecialists for even basic conditions Financial models favor volume over time or quality Well care market increasingly competitive i.e. nurse practitioners, retail clinics
AZ s 2020 I. Increase of chronic disease management, medical home certification and QI for general pediatricians II. National movement to electronic medical record -Medicare Three Major Initiatives I. NCQA National Committee for Quality Assurance is a non-profit organization dedicated to improving health care quality. NCQA assesses whether physician practices are functioning as Patient-Centered Medical Homes. There is a certification process and a practice may be certified as a Level 1, 2 or. Three Major Initiatives, cont d II. PCPCC -Patient-Centered Primary Care Collaborative -employers, consumers, patients, clinicians and payors are working to promote the PCMH in order to improve the health of patients and the viability of the healthcare delivery system and support a better model of compensating clinicians. Compensation would incorporate enhanced access, improved coordination of care, reward for higher value, expanded administrative and quality innovations, and active patient and family involvement, all the while helping to control rising costs of healthcare.
NCQA National Committee for Quality Assurance PPC-PCMH Recognition practice must pass at least 5 basic elements a. Written standards for patient access and patient communication. b. Uses data to show it meets its standards for patient access and communication. c. Uses paper-or electronic-based charting tools to organize clinical information. d. Uses data to identify important diagnoses and conditions in practice. e. Tracks referrals. PPC-PCMH Content and Scoring Standard 1: Access and Communication Pts Standard 5: Electronic Prescribing A. Has written standards for patient access and patient A. Uses electronic system to write prescriptions communication** 4 B. Has electronic prescription writer with safety checks B. Uses data to show it meets its standards for patient access and 5 C. Has electronic prescription writer with cost checks communication** 9 Standard 2: Patient Tracking and Registry Functions Pts A. Uses data system for basic patient information (mostly nonclinical data) 2 A. Tracks tests and identifies abnormal results Standard 6: Test Tracking B. Has clinical data system with clinical data in searchable data systematically** fields B. Uses electronic systems to order and retrieve tests and C. Uses the clinical data system flag duplicate tests D. Uses paper or electronic-based charting tools to organize clinical information** 6 Standard 7: Referral Tracking E. Uses data to identify important diagnoses and conditions in 4 A. Tracks referrals using paper-based or electronic system** practice** F. Generates lists of patients and reminds patients and clinicians of services needed (population management) 21 Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by Standard : Care Management Pts physician or across the practice** A. Adopts and implements evidence-based guidelines for three B. Survey of patients care experience conditions ** C. Reports performance across the practice or by physician B. Generates reminders about preventive services for clinicians 4 ** C. Uses non-physician staff to manage patient care D. Sets goals and takes action to improve performance D. Conducts care management, including care plans, assessing E. Produces reports using standardized measures progress, addressing barriers 5 F. Transmits reports with standardized measures E. Coordinates care//follow-up for patients who receive care in electronically to external entities inpatient and outpatient facilities 5 20 Standard 4: Patient Self-Management Support Pts Standard 9: Advanced Electronic Communications A. Assesses language preference and other communication 2 A. Availability of Interactive Website barriers 4 B. Electronic Patient Identification B. Actively supports patient self-management** C. Electronic Care Management Support 6 **Must Pass Elements Pts 2 8 Pts 7 6 1 PT 4 4 Pts 2 1 15 Pts 1 2 1 4 Level of Qualifying PPC-PCMH Scoring 9 standards = 100 points 10 Must Pass elements linked to Level 1, 2 or Points Must Pass Elements at 50% Performance Level Level 75-100 10 of 10 Level 2 50 74 10 of 10 Level 1 25 49 5 of 10 Not Recognized 0 24 < 5 Levels: If there is a difference in Level achieved between the number of points and Must Pass, the practice will be awarded the lesser level; for example, if a practice has 65 points but passes only 7 Must Pass Elements, the practice will achieve at Level 1. Practices with a numeric score of 0 to 24 points or less than 5 Must Pass Elements are not Recognized.
What Does PPC-PCMH Measure? 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 Why is PPC-PCMH Important? Private and public plans and employers are looking at projects to recognize and compensate practices as Patient-Centered Medical Homes a. Blue Cross Blue Shield of Alabama Pilot b. Alabama Medicaid recent grant awarded
Primary Care Collaborative Multiple stakeholders large corporations, consumers, primary care societies, national health plans, patient groups and others united to support the Patient-Centered Medical Home A. PCMP Pilots 1. Preventive Model 2. Chronic Care Model Pediatric Medical Home Some Insurer s Model
Three Major Initiatives, cont d II. CCHIT -Certification Commission for Health Information Technology - February 2009 - Congress passed a law which offers multi-year series of incentive payments to providers and hospitals for the meaningful use of certified EHR Technology. Total payments are projected at $4 billion. Incentives a. Medicare--Beginning 2011, physicians get $47-67,000 over five years. After 2014, Medicare reimbursement rate cut by % per year for not utilizing EMR. b.stimulus funds for HIT will be channeled through Medicaid. Primary care pediatricians must have at least 20% Medicaid population to be eligible for funds. Summary CHANGE in our healthcare system is coming. In what form, we are not entirely sure, but the medical home concept and the use of EMR will be included in the change. The Alabama Chapter-AAP will be at the table with other stakeholders to help shape the changes that are coming in Alabama. As individual providers, we need to be familiar with what s on the horizon and be prepared for change.
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