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Overview
PCMH Learning Community
Dec 6, 2011 Mazhar Shaik, Chief Clinical Officer
Lynda Meade, Program Manager
Agenda
• Why We are Doing it? How We are Doing it? What Does the PCMH Initiative Entail?
• Goals and Aspirations of This Collaborative • Features, Benefits and Value Proposition • Approach, Structure and Requirements • Tools and Resources • Q&A (MPCA/PCDC)
Why MPCA is Initiating the PCMH Learning Community?
Prioritization Grid of Health Center Areas of Need (Operations)
MPCA is responding to our stakeholders’ needs.
Preferred Methods of Learning
Again, MPCA is responding to stakeholders’ needs and preferences.
How Are We Doing It?
We are executing the PCMH initiative in partnership with a national expert agency. MPCA identified the national expert agency on PCMH through an evaluation process:
National Pool Finalists Winner
NCQA TransforMed PCDC
JACHO PCDC
AAAHC
TransforMed
PCDC
- Interview - Presentations - Proposal Evaluation - Reference Check
What Does the PCMH Program Entail? Goals and Aspirations:
This 12-month program, entitled the “PCMH Learning Community” will equip Health Centers with knowledge, tools, resources and one-on-one consultations to successfully: • Compile an NCQA PPC‐PCMH survey submission with the goal of obtaining PCMH recognition at a level appropriate for the organization • Collect and organize data for required Stage 1 MU objectives with the goal of attesting • Identify future areas for improvement that fully embody the principles behind PCMH and MU concepts
PCMH Learning Community Road Map
Understand
• The Regulations • The Objectives • The Measures • The Collaborative
Assess • PCMH Readiness • MU Readiness • The Gaps • The Organization
Decide
• Medicaid/Medicare • Level 1,2,3 • 2011, 2012 • The Collaborative
Map
• Join the Collaborative • Redesign • Collect and Organize • Attest and recognize
Features of This Collaborative
• Builds a learning community – brings together organizations committed to making improvements in care delivery
• Uses evidence-based best practices as framework for designing improvement at individual sites/practices
• Is an action-learning approach – you learn and do and learn…
• Change is specific, measureable and directly related to an improvement outcome
• Uses teams (in partnership with leaders) to learn, test and lead implementation of change improvement
• Builds in sustainability at all points • Coaching and technical assistance support (e.g., coaching
calls, webinars, on-site and virtual site visits) • Increases the degree of improvement achieved
Strengths of Learning Community
1. Cost-effective/scalability (leverage experts)
2. Activity (real world) focused
3. Leads to actionable work plan
4. Peer networking
5. High participant accountability
6. Action period reinforces learning
7. Supports self-paced learning
8. Allows for wider organizational participation
Benefits
Timeline flexibility/resource availability
One effort, two results (PCMH/MU)
Content value
Not a cookie cutter approach - we meet you where you are
CHC expertise
Build capability - preparing for future stages of PCMH and MU
Benefits …
MPCA has high knowledge of CHCs, has established working relationships with CHCs
MPCA is a trusted partner of Michigan CHCs
PCDC trusted consultant to the Primary Care Community
PCDC reputation with collaborative assistance for over 400 locations
MPCA/PCDC have the capacity and capability to do this work
Dollar savings $20,000 - $25, 000 per CHC
PCDC: A Learning Community
Partner
December 6, 2011 Peter Cucchiara, BSMIS ,MBA, Managing Director
Deborah Johnson Ingram, Sr. Program Manager
PCDC Background
Manual
Funded by New York Community Trust
Released 11/09 “Comprehensive “How To”
10,000 Downloads
Presentations
At more than 20 conferences, forums, webinars
Several 1-2 day training sessions
Focus on rationale, standards and process
PCMH/MU
Collab.
Partnered with CHCANYS (NY PCA)
12 CHC in Wave 1; Planning Wave 2
Focus on achieving two results in one effort
Technical
Assistance
Redesign Faciliation
Project Management Coaching
Consulting toward HH recognition and MU certification
A Sample of Significant PCDC Activities
PCMH/MU CHCANYS/PCDC Collaborative
• Access CHC
• Basics/Promesa Systems Inc
• Bronx Lebanon Hospital
• Brooklyn Plaza Medical Center
• Charles B. Wang CHC
• East Harlem Council for Human Servics Inc.
• Joseph P. Addabbo FHC
• Morris Heights Health Center
• Pediatrics 2000
• Settlement Health
• Soundview Healthcare Network
PCMH Assessment/Facilitation Services
• Bassett Healthcare Network
• Lutheran Family Health Center
• Maimonides Medical Center – ICL
• Montefiore Community Pediatrics Program
• Montefiore Medical Group
• St. Barnabas Ambulatory Care Clinics
• Stepping Stone Pediatrics
• Bedford Stuyvesant FHC (Emblem)
• Primary Medical Care – PC (Emblem)
• SL Quality Care DTC (Emblem)
• Fort Drum Region Health Planning Org.
PCMH/MU Training/Educational Sessions for PCAs • Alabama Primary Health Care Association • Alaska Primary Care Association, Inc. • Bi-State Primary Care Association (Vermont & New Hampshire) • California Primary Care Association (120 Centers) • Community Health Care Association of the Dakotas • Michigan PCA • Wisconsin Primary Health Care Association (April 2011) • CTPCA • OKPCA • SCPCA
PCDC Partners with PCA’s
10%
94%
% of NYS Practices PCDC Assisted with PCMH Recognition as of 12/2011
PCDC
NYS
75
739
3.0%
97.0%
% of U.S. Practices PCDC Assisted with PCMH Recognition as of 10/2011
PCDC
USA
Value Proposition Considerations
Average Cost of Two Day Conference $3,000
Average Cost EMR 2 day education $1,500
Average Cost for HIT 2 day education $1,500
NCQA PCMH Training 1 ½ day $1,000
Plus Travel Expenses $3,000
Total Range $4500 - $6000
PCMH MU Collaborative
4 Learning Sessions (4 days)
12 Webinars
Weekly T/A Coaching for PCC
Weekly T/A Coaching for PCA
Other:
Webinars
Webinettes
Sharepoint
Tools
Resources
Total Price for 12 month package $5,000
Value Proposition Considerations
What Comes With your HRSA 35K
Going it alone yields:
• A link to tools and resources from NCQA
• The challenge to stretch your 35K to gain NCQA submission/recognition – Hire a private consultant (>
$30,000.00) not including in kind cost
– Send staff to NCQA training (1.5 day training w/ travel and hotel >$1700.00) not including in kind cost
Joining the MPCA collaborative yields:
• 12 months of direct/ indirect consultant services from industry experts
• Guided process to getting a submission completed in projected time frame
• Projections of ROI (inclusive of in-kind costs*)
Value Proposition Considerations
Medicaid FFS 10,000 Medicaid FFS visits/year Level 1: 10,000 * $ 5.50 = $ 55,000/year Level 2: 10,000 * $11.25 = $112,500/year Level 3: 10,000 * $16.75 = $167,500/year Medicaid Managed Care (PMPM) 3,000 Medicaid Managed Care patients Level 1: 3,000 * $2 * 12 months = $ 72,000/year Level 2: 3,000 * $4 * 12 months = $144,000/year Level 3: 3,000 * $6 * 12 months = $216,000/year
• Practice with 10 providers that sees 10,000 Medicaid managed care patients per year and achieves level 3 PCMH and MU Stage 1 by 2011 could generate by 2015 a total of:
– MU
• $63,750/EP/five years X 10 MDs = $ 630,750
– PCMH
• L3: 10k pts X $6/Pt/yr = $720,000/year X 5yrs = $3,600,000
Projected 5 Year Total = $4,230,750
PCDC Approach
Guiding Principles
1 2
Map – see the path before we walk it
Balance – test/principles
Measure twice cut once
Three work strands as one
Decision Catalogue
Teams & Collaboration
Focuses on system design as source of results Redesign of specific system elements for desired results and outcomes
Client needs through use of a targeted, results- and outcomes-focused assessment (combination of data, interviews, observations and organizational strategic goals)
data and observations key opportunities for change
Develop an implementation plan focused on redesign for high impact results and sustainable changes
Integrated
Approach
Understanding
Synthesize
Identify
Implementation
supports implementation to enable effective, sustainable changes in operations and results.
Training Coaching
Our Traditional Approach
Knowledge & Skills Trusted Colleague Protected Time
The Messages The Audience
The Team
Decisions
Communications
Detailed
Assessments
Outlining Plan, Resources, Timeline Managing the Plan and by the Plan Making the Adjustments
Workplan
Assessing Scope & Capacity Getting Organizational Backing
Assessments – evaluating readiness/capability
Defining gaps
Optimization
Work Area Considerations
100% of MU is incorporated into PCMH but
Only 44% of PCMH is met by MU and You only get 1 must pass element out of 6
When choosing 6 MU clinical measures
…align them with the 3 diagnostic
conditions you selected for PCMH and
your UDS clinical measures
PCMH/MU Overlap Summary
MU objectives fall in All 6 standards 12 of the 27 elements 34 of the 149 factors In several cases, multiple PCMH factors relate to 1 MU objective E.g., MU C8 incorporates 5 PCMH factors
1
2
3
Structure
Le
arn
in
g E
ve
nts
Theme
Objectives
Core Concepts/Topics
Activities
Tools
Resources
Delivery Methods
Ac
tivity P
erio
ds
Objectives
Activities (Based on Topics)
Progress Monitoring
Work Tools
Work Aids/Resources
Phase 1: Pre- Work (October December 2011-January 2011) The first phase of the project called “pre-work” will place strong emphasis on completing assessments of each of the 18 practices. Using several of PCDC’s tools from its 2009 publication Obtaining Patient-Centered Medical Home: A How-To Manual, and other tools. Practices will conduct comprehensive practice profiles and self-assessments to provide understanding of their operational and technological capacity as it relates to the four clinical interventions. PCDC will analyze the data from these assessments and earlier data, as well as conduct an on-site visit to each practice, to produce gap analyses and generalized project work plans. This phase will include a number of webinars and virtual meetings to orient practices to the goals of the collaborative and to use assessment and profile tools effectively. This pre-work phase takes a blended approach of using site visits and virtual coaching to establish and reinforce the coach/practice relationship.
Objectives Topics/Activities Tools/Resources Recommended Delivery Methods
Introduction and overview of the Learning Collaborative model and curriculum.
Identify and evaluate each practice’s operational and technological strengths and gaps related to the four clinical interventions
Identify change/process management steps that need to be taken in order to ensure successful adoption of performance improvement practices
Leadership Orientation (PCDC/ Practice Team Leaders)
Completing “practice profile”
Selecting a team Kickoff (PCDC/ Practice Teams)
Introduction to CCBC four clinical interventions
Preliminary exploration of goals and measures
Organizational Impact Review Pre-Training
Introduction to PCDC’s PCMH 2011 Self-Assessment Tool
On-Site Visits (PCDC Coach)
Review results and deliver feedback of practice profile and self-assessment
Identify practice goals and units of measure for CCBC clinical quality measures
Design general project workplan (to be expanded and customized in Learning Session 1)
Additional activities (for each site):
Collect baseline data and assess practice capabilities
Assess ability to collect data, run reports, use registries and current care management capabilities
Identify current staff/clinical team member composition
Collect and review any prior assessment data
Evaluate level of technical assistance required
1. PCDC Practice Profile:
a. PCDC PCMH 2011 Self-Assessment: focus on standards directly related to the four interventions (e.g. Standard 2 Element D “using data for Population Management)
b. Depth of PCMH review c. Post-recognition dashboard
2. Team Selection Grid 3. Team Selection Toolkit 4. EMR Assessment Tool to identify
Clinical Decision Support, Health Information Exchange, e-prescribing and reporting capabilities
Webinars – pre training
Site Visits
Recorded Webinars and Webinettes
Conference calls
Virtual weekly meetings with PCDC coaches via Webex, conference call, video conference, etc.
Case Studies
Simulations
Estimated T/A time allocation: 5 hours per practice, per week
Tools and Resources
1 – Pre Work Tools
2 – Webinars & Webinettes
3 - Reference
Team Chart and Team Development Template PCMH Assessment, Gap Analysis Template Workplan Development Template Communications Campaign Outline
Beginning your Team Journey Webinettes for Every Standard Meaningful Use/PCMH FAQ
Manuals – PCMH, CDSS MU/PCMH Vendor Guide Vendor Inquiry
Sample Resource Inventory
Peter Cucchiara BSMIS, MBA Managing Director Performance Improvement
22 Cortlandt St. New York, NY 10007 212-437-3921 [email protected]
Deborah Johnson Ingram Senior Program Manager
22 Cortlandt St. New York, NY 10007 212-437-3935 [email protected]
Questions? More information and to access
information, resources and tools:
www.mpca.net/PCMH Mazhar Shaik, Chief Clinical Officer [email protected] 517.827.0487 Lynda Meade, Program Manager [email protected] 517.827.0470