Post on 19-Sep-2020
MEDICAL HOME SUMMIT: WELCOME AND OVERVIEW
Marci Nielsen, PhD, MPH; President & CEO
Patient‐Centered Primary Care Collaborative
@Marci_PCPCC
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PATIENT‐CENTERED PRIMARY CARE COLLABORATIVE
Unifying
for a better health system ‐‐‐
by better investing in team‐based
patient‐centered primary care
PAYERS:Employers, Government,Health plans,Consumers
PUBLIC:Patients,Families,Caregivers,Communities
HEALTH CARE PROVIDERS: People who take care of patients/families
Collaborative:•Convene•Communicate•Advocate
PATIENT‐Centered “MEDICAL HOME”?
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ). Patient‐centered medical homeresource center, defining the PCMH. Retrieved from http://pcmh.ahrq.gov/page/defining‐pcmh 3
MARCI’S TOP TEN CHALLENGES
1.
Skepticism
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5
Medical Home
Term in Standards
of Child Health
Care
by Council on
. Ped. Practice
Alma Alta
Declaration
Surgeon
General Koop’sConf. Report:MH for CSHCN
PCPCC Founded
Medical Home
and Hawaii
Child Health
Plan
(Calvin Sia, MD)
Future of
Family
Medicine
ACP &
Advanced
Medical Home
1989198919671967
19671967‐‐20062006Milestones in PCMH Development
19781978 19791979 2004200420022002 20062006
AAFP &TransforMED
6
Joint
Principles
of PCMH
Recognition or
accreditation
of NCQA PCMH
begins
20082008
20062006‐‐PresentPresentMilestones in PCMH Development
20072007 2010 2015 2016 2010 2015 2016 . .
CommonwealthFund PCMH Programs
State & Local PCMH
Pilots
AffordableCare Act (ACA)
passed
Medicare Access & CHIP
Reauthorization Act (MACRA)
Passes
NationalBusinessGroup on Health (NBGH_Award
7
Various multi‐payer
initiatives tested
(CPC, MAPCP, IAH,
SIM)
Various multi‐payer
initiatives tested
(CPC, MAPCP, IAH,
SIM)
“CPC Plus”Announced
MARCI’S TOP TEN CHALLENGES
1.
Skepticism
2.
Nomenclature (PATIENT, MEDICAL, & HOME)
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TERMINOLOGY PREFERRED BY PATIENTS AND CONSUMERS
Amanda Holt (2014). Communicating health care concepts: Finding language to help consumers
understand the PCMH. Masters Thesis.
MARCI’S TOP TEN CHALLENGES
1.
Skepticism
2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)
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800 LB GORILLA IN THE ROOM
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MARCI’S TOP TEN CHALLENGES
1.
Skepticism
2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)
4.
Measurement fatigue (process vs outcome)
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MARCI’S TOP TEN CHALLENGES
1.
Skepticism
2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)
4.
Measurement fatigue (process vs outcome)
5.
Administrative burden (in PCMH recognition/certification programs)
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PCMH as a “certification”
• External validation
• “Short term”
view of model• Focused more on process
measures
• Role in practice
transformation & increased
reimbursement
• Role in assessing value by
payers
PCMH as ideal of practice
transformation
• “North star”
–
aspirational
guide
• “Long term”
view of model
• Focused more on outcomes
• What’s most important to
patients, families, caregivers
& consumers?
MARCI’S TOP TEN CHALLENGES
1.
Skepticism
2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)
4.
Measurement fatigue (process vs outcome)
5.
Administrative burden (in PCMH recognition/certification programs)
6.
Transformation costs ($ & opportunity costs)
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Primary Care Practice “Journey”
http://www.safetynetmedicalhome.org/resources‐tools/all‐resources
MARCI’S TOP TEN CHALLENGES
1.
Skepticism 2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)4.
Measurement fatigue (process vs outcome)
5.
Administrative burden (in PCMH recognition/certification programs)
6.
Transformation costs ($ & opportunity costs)7.
Workforce: roles, training & effectiveness of
teams
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COMMON ELEMENTS OF SUCCESSFUL TEAM‐BASED INITIATIVES
• Focus on patient‐ centered care
• Cultural sensitivity and community focus
• Continuous quality improvement
• Development of effective team practice
• Dispersed team leadership
• Integration of behavioral health
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MARCI’S TOP TEN CHALLENGES
1.
Skepticism 2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)4.
Measurement fatigue (process vs outcome)
5.
Administrative burden (in PCMH recognition/certification programs)
6.
Transformation costs ($ & opportunity costs)7.
Workforce: roles, training & effectiveness of
teams8.
Payment sufficiency & sustainability
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PRIMARY CARE UNDERVALUED
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MARCI’S TOP TEN CHALLENGES
1.
Skepticism 2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)4.
Measurement fatigue (process vs outcome)
5.
Administrative burden (in PCMH recognition/certification programs)
6.
Transformation costs ($ & opportunity costs)7.
Workforce: roles, training & effectiveness of teams
8.
Payment sufficiency & sustainability9.
Shifting from fee‐for‐service (FFS) to Alternative
Payment Models (APM)
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PAYMENT REFORM AND MEDICARE
Health & Human Services
• Shift 30% of Medicare FFS
payments to value through
APMs by 2016, 50% by
2018
• Created of Health Care
Payment Learning & Action
Network
• Investment in Multi‐payer
Efforts: MAPCP, CPC, CPC+
Congress
• Medicare Access and CHIP
Reauthorization Act
(MACRA)
• Merit‐based Incentive
Payment System (MIPS)
• Alternative Payment
Models (APMs)
23http://doctorwhostories.wikia.com/wiki/The_Macra_Terror_(TS)https://hcp‐lan.org/
MARCI’S TOP TEN CHALLENGES
1.
Skepticism 2.
Nomenclature (PATIENT, MEDICAL, & HOME)
3.
Buy‐in (leadership & culture change)4.
Measurement fatigue (process vs outcome)
5.
Administrative burden (in PCMH recognition/certification programs)
6.
Transformation costs ($ & opportunity costs)7.
Workforce: roles, training & effectiveness of teams
8.
Payment sufficiency & sustainability9.
Shifting from fee‐for‐service (FFS) to Alternative
Payment Models (APM)10.
Public awareness & support
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MORE HEALTH CARE
IS NOT THE GOAL
WELCOME!
WWW.PCPCC.ORG
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@Marci_PCPCC