Upload
job-stanley
View
218
Download
1
Tags:
Embed Size (px)
Citation preview
Project Summary:
Washington Patient-Centered Medical Home Collaborative
Pat Justis, MA Department of Health
Objectives
• Briefly summarize the project goals, structure ,activities, and participants
• Provide an initial look at results• Provide information related to
accreditation and the national work on medical home
• Discuss key lessons
3
DOH
• Seven collaboratives since 1999• Diabetes• Later hypertension, asthma, youth obesity,
medical home• Partners
– Qualis Health– Improving Chronic Illness Care (ICIC) funded by Robert Wood
Johnson Foundation.– Acumentra Health, University of WA– Washington Academy of Family Physicians
Washington Patient-Centered Medical Home Collaborative
• 33 teams began, 31 finished.• 24 months, 2009-2011• Five learning sessions/ 8 full days• Five plus site visits by Quality
Improvement Coach • Monthly webinars/e- news bulletins• Reporting of data and narrative reports• Ongoing support by e-mail/phone/website
What are we trying to accomplish?
The Mission
To implement medical homes in a variety of primary care clinics and improve the care of patients/families using the collaborative methodology.
Goals
• Develop an implementation model for primary care medical home which:– Improves health outcomes for patients – Improves the patient and family’s experience
of care – Improves primary care team satisfaction
• Examine overall health care utilization and costs impacted by medical home implementation.
The “other” medical home legislation-2009Health Care Authority/Puget Sound Health Alliance
• Separate but “connected” payer demonstration with anti-trust safe harbor.
• 12 practice sites/8 organizations• 9 of 31 Collaborative teams participating• Official start-May 2, 2011• 26,000 attributed patients• Now collecting data on first two months.
Total number of providers, all Collaborative sites=755 providers
11
12
9
Number of sites that have providers in the des-ignated number range
Collaborative participants
5 or fewer providers 6 to 20 providers 21+ providers
Population density surrounding participating clinics
13
11
3
6
Participating clinics by population density
Urban 50,000 +
Sub-Urban 30-49% commuter flow to Urban
Large Rural to 10,001 to 49,000
Small town/isolated rural up to 10,000
Patients at participating sites by age group
Total estimated patients, all ages= 738,111
under 18 adults (includes over age 65) estimated over age 650
100,000
200,000
300,000
400,000
500,000
600,000
700,000
129,316
608,795
64,916
Estimated patients in WPCMHC by age
age categories
estimated number of pa-tients
Early evidence suggests…
• Patient satisfaction improves.• Provider satisfaction improves.• Burn-out decreases.• Avoidable emergency room visits
decrease.• Clinical outcomes improve.• Cost savings or neutralizes cost increase.
12
Measure synopsis
• Patient experience-flat in aggregate, individual clinics made significant gains
• Provider/team satisfaction• Clinical measures-many clinics have
significant progress– Prevention– Diabetes
• Medical Home Index-improved steadily
MHI Overall Score Domain 1: Organiza-tional Capacity
Domain 2: Chronic Condition Man-
agement
Domain 3: Care Co-ordination
Domain 4: Com-munity Outreach
Domain 5: Data Management
Domain 6: Quality Improvement/Change
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
4.17 4.10 3.93 3.983.63
5.81
4.59
5.25 5.234.95 4.98
4.50
6.74
6.22
5.69 5.58 5.60 5.54
5.04
6.83
6.33
Change in Medical Homeness Over Time
September 2009 September 2010 September 2011
Ave
rage
sco
re fo
r all
clin
ics
com
bine
d
Medical Home Index
Relationships between measures/ clinic characteristics
• To be explored in final analysis– Do clinic traits correlate with any particular
findings?– Are there any connections between the
various measures, for example do high medical home index scores associate with improved clinical outcomes?
Medical Home Indexheadlines
• Some clinics may overestimate their own scores, others may be too self-critical.– The scores between clinics are not a useful
comparison.• Use as a tool to stimulate understanding,
continual self-assessment and instigate quality improvement.
The tools
• Medical Home Index-adult and peds (MHI) (Center for Medical Home Improvement)
• Patient-Centered Medical Home Assessment (PCMH-A) ( Safety Net Medical Home Initiative)
• Medical Home Implementation Quotient (MHIQ) ( Transform Med-AAFP profit arm)
• http://www.urban.org/uploadedpdf/412338-patient-centered-medical-home-rec-tools.pdf
The accreditation quandary
• Newly revised NCQA PCMH standards• Joint Commission has new voluntary
standards for “primary care homes.”• States with state legislated accreditation:
Oregon, Minnesota• Tools : Medical Home Index, Transform
Med, The Patient-Centered Medical Home Assessment , and more.
States with the most activity; rapidly spreading
• Colorado• Vermont• New Hampshire• Michigan• Maine• New York• North Carolina• North Dakota• Minnesota
• Ohio• Texas• Arizona• Louisiana• Pennsylvania• Rhode Island• Georgia• Tennessee• Illinois
19
Health Home Bill 5394 (2011)
“To promote the adoption of primary care health homes for children and adults and, within them advance the practice
of chronic care management to improve health
outcomes and reduce unnecessary costs. “
Health Home Bill 5394 (2011)
• Payers must offer incentives for quality and adoption of health home, care of chronic disease to providers.
• Affects all plans under HCA, including PEBB plans
• Payment to support providers to participate in training and technical assistance.
DOH role with 5394
• Training and technical assistance for providers of primary care;
• Related to evidence based high quality preventive and chronic disease care
• In collaboration with Health Care Authority
Section 2703 Affordable care act
• 5% of Medicaid clients responsible for 50% of costs.
• Scale up and spread existing demonstrations.
• Team based care coordination with behavioral health integration.
• Remove funding silo barriers.
Ongoing challenges
• Accreditation vs. quality measures• Payment reform: risk, patient choice, gains
sharing, transition between FFS and bundles and or PMPM
• Solo providers and networks• Payers ability to test models• Transitions :cross-setting improvements
Workforce puzzles
• Scope of practice for medical assistant wildly variable.
• What helps physicians transform leadership to a team facilitation style?
• Better integration of pharmacists.• More intentional change to role of RN• Shortage of primary care providers/nurses
The Transform Med Demonstration lessons
• Clinic autonomy• Adaptive reserve• Transformative level of change• Changes are linked and interdependent
Lessons learned
• Every funder wants a pet measure; this places an undesirable burden; must find root drivers, proxies, alignment etc.
• Data must be in the hands of the team; and organizations vary in this ability.
• EMR’s vary widely in registry like functions for population management
Health literacy
A large, fundamental
paradigm shift related to who
has the responsibility to
create understanding.
Relationships are the center
• Providers and teams• Teams and other teams• Provider/Team and patients/families• Across care settings and transitions in
care.• Continuity of relationship is patient-
centered and must trump convenience and provider schedule preferences.
Lessons
• Teamwork is a learned skill, not an innate ability.
• Facilitative leadership comes easier to some than others but begins with willingness to develop trust.
What is ahead?
• Age specific/• Peds involvement• Community based
and across settings• Rural• Behavioral health• Prevention of chronic
conditions
• Scalable; more teams, more open enrollment.
• Testing face-face “dosage”
• More linkage between education and coaching.
• Cross-setting improvements