An Overview of Patient-Centered Health Care Home Napualani Spock, MA, MBA Pacific Islands PCA.
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Transcript of An Overview of Patient-Centered Health Care Home Napualani Spock, MA, MBA Pacific Islands PCA.
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An Overview of Patient-Centered
Health Care Home
Napualani Spock, MA, MBAPacific Islands PCA
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Goals for today’s session
Provide overview and historical context for the Patient Centered Medical Home (PCMH) movement
Review and discuss PCMH change concepts
Group discussion on PCMH in the Pacific context
Determine next steps for PIPCA
CHCs
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The U.S. Healthcare System is broken
2001 Institute of Medicine Report—health system error is leading cause of death in the U.S.
Fragmented care—poor communication between doctors, hospitals, pharmacies
Bureaucratic—emphasis on needs of the providers, not the patient: i.e. scheduling, processes
Patients are labeled “non-compliant” when they don’t conform (‘obey’)
Patients need to manage their own appointments, follow-up, etc.
Physicians work alone to provide all aspects of healthcare; in short visits
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Institute of Medicine’s “Crossing the Quality Chasm”
New Vision for Health Care
Patient Safety is a priority Evidence-based decision making Cooperation among providers Customize to patient needs and values Shared knowledge (patients/providers) allows
patients to make informed decisions about their own health care
Care based on continuous healing relationships Anticipation of needs/not reacting Goal is to eliminate waste (time and resources)
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Fixing the Broken U.S. Healthcare System
Video: http://www.youtube.com/watch?v=DE9rG3ACJ9Q&feature=player_detailpage
(12min)
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History of Patient Centered Medical Homes
1967: “Medical Home” developed as an approach to provide comprehensive services to special needs children
1978-79: Dr. Calvin Sia (pediatrician) and others campaigned to adopt the medical home concept into Hawaii’s State Child Health Plan
2001: Institute of Medicine Report—new vision—mentions patient-centeredness
2002: ACP and AAFP expand Medical Home concept to include adults
2007: Joint Principles of the PCMH developed by American College of Physicians, American Academy of Family Physicians, American Osteopathic Association, American Academy of Pediatrics
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2007
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PCMH is very similar to the National Health Disparities Collaborative—
Chronic Care Model
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PCMH--CHCs
PCMH is also based on many of the same principles as community health centers: Promote access to underserved All care in one place Treat the whole person Provide enabling services to
address socio-economic needs
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Video: PCMH in Clinical Settings
American Academy of Family Physiciansadopting PCMH across the U.S. http://
www.youtube.com/watch?v=2j5ImY8yvtA&list=PLC00ECBFBB45D4A72&feature=player_detailpage (9min)
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Recent PCMH Milestones
Health Care Reform – Affordable Care Act (ACA) of 2010 Patient Protection and Affordable
Care Act and Health Care and Education Reconciliation Act
Supports Advanced Primary Care and Innovation across the U.S., across providers
Provides new payment opportunities (through Medicaid matching and Insurance regulations)
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HRSA Promotes PCMH in CHCs
HRSA/NCQA partnership (Program Assistance Letter 2011-01)
• Encourages and supports health centers to gain NCQA recognition as medical homes• Provides structure and resources for
centers’ expansion and quality improvement efforts• Alignment with pilot/demonstration
projects with CMS, State Medicaid Agency, Health Plans
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HRSA’s Safety Net Medical Home Initiative
PCA/CHC Milestones by 2014 (coordinated by NACHC)
• PCMH Certification•HIT Infrastructure• Integrated Health Delivery Model• Payment Reform•Engaged Patients•Aligned Measurement and Reporting Systems
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Change Concepts for PCMH (2)
Handout: http://www.safetynetmedicalhome.org/sites/default/files/Change-Concepts-for-Practice-Transformation.pdf
EmpanelmentContinuous / Team-Based Healing RelationshipsPatient-Centered Interactions
Engaged LeadershipQI StrategyEnhanced AccessCare CoordinationOrganized, Evidence-Based Care
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PCMH concepts
Ed Wagner presenting Change Concepts:http://www.safetynetmedicalhome.org/sites/default/files/Change-Concepts-7-25-09.wmv
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PCMH I. Engaged Leadership
Provide visible and sustained leadership to lead overall cultural change as well as specific strategies to improve quality and spread and sustain change.
Ensure that the PCMH transformation effort has the time and resources needed to be successful.
Ensure that providers and other care team members have protected time to conduct activities beyond direct patient care that are consistent with the medical home model.
Build the practice’s values on creating a medical home for patients into staff hiring and training processes.
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II. Quality Improvement Strategy
Choose and use a formal model for quality improvement.
Establish and monitor metrics to evaluate routinely improvement efforts and outcomes;
Ensure all staff members understand the metrics for success.
Ensure that patients, families, providers, and care team members are involved in quality improvement activities.
Optimize use of health information technology to meet Meaningful Use criteria.
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III. Empanelment
Assign all patients to a provider panel and confirm assignments with providers and patients; review and update panel assignments on a regular basis.
Assess practice supply and demand, and balance patient load accordingly.
Use panel data and registries to proactively contact and track patients by disease status, risk status, self-management status, community and family need.
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IV. Continuous and Team-Based Healing Relationships
Establish and provide organizational support for care delivery teams that are accountable for the patient population/panel.
Link patients to a provider and care team so both patients and provider/care teams recognize each other as partners in care.
Assure that patients are able to see their provider or care team whenever possible.
Define roles and distribute tasks among care team members to reflect the skills, abilities, and credentials of team members.
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V. Patient-Centered Interactions
Respect patient and family values and expressed needs.
Encourage patients to expand their role in decision-making, health-related behaviors, and self-management.
Communicate with patients in a culturally appropriate manner, in a language and at a level that the patient understands.
Provide self-management support at every visit through goal setting and action planning.
Obtain feedback from patients/families about their healthcare experience and use this information for quality improvement.
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VI. Organized, Evidence-Based Care
Use planned care according to patient need. Identify high risk patients and ensure they
are receiving appropriate care and case management services.
Use point-of-care reminders based on clinical guidelines.
Enable planned interactions with patients by making up-to-date information available to providers and the care team prior to the visit.
Example: TEAM HUDDLE AT UC Davis (9 min) http://www.youtube.com/watch?v=VxdG2_nZ2fc
&feature=player_detailpage
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VII. Enhanced Access
Promote and expand access by ensuring that established patients have 24/7 continuous access to their care teams via phone, e-mail, or in-person visits.
Provide scheduling options that are patient and family-centered and accessible to all patients.
Help patients attain and understand health insurance coverage.
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VIII. Care Coordination
Link patients with community resources to facilitate referrals and respond to social service needs.
Integrate behavioral health and specialty care into care delivery through co-location or referral agreements.
Track and support patients when they obtain services outside the practice.
Follow up with patients within a few days of an emergency room visit or hospital discharge.
Communicate test results and care plans to patients.
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Patient Experience of PCMH
Video, from a Patient’s Perspective:http://www.youtube.com/watch?v=LIPk9o0NUaY&feature=player_detailpage
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PCMH Certification
Multiple PCMH Accrediting Entities in the U.S.
National Committees for Quality Assurance (NCQA)
The Joint Commission (JACHO) Accreditation Association for Ambulatory
Health Care (AAAHC) URAC
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NCQA Recognition
NCQA is part of the HRSA Safety Net Demonstration Project 9 Elements examined 3 levels of recognition with different
levels of compensation for each level Video on NCQA process (22min)
http://www.youtube.com/watch?feature=player_detailpage&v=ZC4YCLG4h5k
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NCQA Recognition Process
OVERVIEW OF STEPS:1. Take self-assessment2. Submit data to NCQA3. NCQA evaluates and scores4. 5%+ of sites are audited onsite5. NCQA provides final evaluation to site6. If site passes, recognition is reported on
website and to users, including health plans
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How does your CHC fare?
Assessment: “PCMH-A” Created by the Safety Net Medical Home
Initiative (SNMHI) Organized in order of NCQA PCMH Certification
Standards • PCMH Crosswalk• PCMH-A Document
12 point rating scale Helps you to determine your organization’s
readiness; and to identify areas of need for training and technical support
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How do we adapt PCMH to
fit diverse community
health centers?
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How did Hawai’i CHCs approach it?
PCHCH Pilot 2008-2012 Project participants:
AlohaCare Hawaii Primary Care Association
Kalihi-Palama Health Center
Waianae Coast Comprehensive Health Center
Waimanalo Health Center
West Hawaii Community Health
Center
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Core Values of Hawai’i CHCs Pilot Project
“Patient Centered Healthcare Home” Patient-Driven and Family Centered
Care Barrier Free Access Team-Based Care Delivery Integrated and Holistic Care
Hawai’iPCHCH Pilot
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Hawai’i Activities
Monthly Steering Committee Meetings ICSI PCMH Consultants April 2011: Go Live
All processes/ workflows in place Care coordination tools and care plans
implemented Baseline data collected
3 min. video on PCMH coordination at W. Hawai’i CHC http://www.youtube.com/watch?v=tnrFcDSy-N8&feature=player_detailpage#t=73s
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Other CHCs across America
Oregon “Storyboard” PCMH Handouts\sample of 'storyboard' from Oregon CHC.pdfCHC In Connecticut (4 min video) http://www.youtube.com/watch?v=DroZOEt5q0s&feature=player_detailpage
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Where do we go from here?
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Next Steps?
Some Ideas: NACHC Model
Learning Communities•Email group (listserve)• Face-to-face training
Online webinars Site visits; coaching
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Pacific Islands PCMH Plan
Discussion: Next steps for PIPCA CHCs
What do You think?
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Mahalo.