Transcript Webinar 1 Slides

PA SPREAD
Webinar #1
Webinar 1 of 3
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Introduction
Getting Started- Pre-work
Empanelment
Aim statement
Baseline Assessment
Webinar #2: Baseline Data Measurement
Webinar #3: Introduction to the Models
PA Spreading Primary Care
Enhanced Delivery Infrastructure
• Builds on success of PA Chronic Care Initiative
• Funded by AHRQ to develop infrastructure for
supporting/spreading primary care transformation
• Primary Care Extension Service
• Apply lessons learned from PA initiative to 2 new
collaboratives (SC and NW)
• Disseminate model, lessons learned in 3 other states
(NJ, NY, VT)
Model for Primary Care Extension
Service
• Based on the Agricultural Cooperative Extension
Model
 Most successful innovation spread program in U.S.
 1914 – Collaboration of federal, state, county
governments, land grant universities
 Helped famers adopt best practices
The Medical Home and More
LAYING THE FOUNDATION
The Medical Home
The Chronic Care Model
Community
Resources and
Policies
SelfManagement
Support
Informed and
Activated
Patient
Health System
Health Care Organization
Delivery
System
Design
Productive
Interactions
Decision
Support
Clinical
Info
Systems
Prepared and
Proactive
Practice Team
Improved Outcomes
Transformation/Paradigm Shift
• Population Management - shift from treating one
patient at a time to managing populations of
patients
• Continuum of care - shift from defining a single
medical encounter as a complete entity to viewing it
as one point on a continuum of care
• Team-based care - shift from the physician providing
care alone to coordinated, physician-led
interprofessional team care.
NCQA PCMH 2011 Recognition
Most commonly used standards for evaluating
practice-wide systems of care related to:
• Access and Continuity
• Population Management
• Planning and Managing Care
• Self Management Support
• Tracking and Coordinating Care
• Measuring and Improving Performance
How This Work Will Help
• We will guide you in building these systems of care
and discuss relevant NCQA standards and
documentation throughout the year.
• Our focus is on diabetes, but you can apply your
systems of care to other chronic and preventive care
services.
(Note: Both NCQA and Meaningful Use require documentation on at least 3
different preventive care services and 3 different chronic care services.)
• Lot of crossover between NCQA and Meaningful Use
requirements!
Meaningful Use Incentives
Must attest this year to be eligible for maximum incentive
of $44,000 per Eligible Provider under Medicare.
CY 2011
CY 2012
CY 2013
CY2014
CY 2015
and later
CY 2011
$18,000
CY 2012
$12,000
$18,000
CY 2013
$8,000
$12,000
$15,000
CY 2014
$4,000
$8,000
$12,000
$12,000
CY 2015
$2,000
$4,000
$8,000
$8,000
$0
$2,000
$4,000
$4,000
$0
$44,000
$39,000
$24,000
$0
CY 2016
TOTAL
$44,000
Medicare penalties for not achieving Meaningful Use
begin in 2015!
Pre-Work
GETTING STARTED
Pre-Work
Goals are to:
1. Prepare you for the first learning session
2. Give you time to form your improvement team
3. Collect baseline data and information on your
practice
4. Allot time for you to meet your practice
facilitator
Practice Facilitators
• Northwest
Patricia J. Stubber, MBA
Executive Director
Northwest PA AHEC
8425 Peach Street
Erie, PA 16509-4788
814-217-6029 (phone)
814-594-4740 (cell)
814-864-4077 (fax)
[email protected]
• South Central
Sharon M. Adams RN, BA
Executive Director
Southcentral PA AHEC
PO Box 509
Carrolltown, PA 15722
814-344-2222 (phone)
814-344-2221 (fax)
[email protected]
Please send any questions to
[email protected]
WEBSITE www.paspread.com
Role of Practice Facilitators
• Support practice with QI processes, techniques
• Serve as sounding board/provide feedback and
benchmarking
• Assist in finding tools and resources
• Help prioritize change activities
• Serve as “honey bee” networker
• Assess practice education, training needs
• Provide “motivational coaching” (cheerleader)
• Assist with problem-solving
Pre-Work Learning Objectives
1.Understand the concept of empanelment and its
importance in assuring continuity of care and
develop a plan to organize patients into provider
panels if your practice is not already organized
that way.
2.Understand the clinical guidelines and related
measures for diabetes.
3.Collect baseline data on the number of diabetes
patients in your practice and the # meeting
evidence-based diabetes measures.
4.Develop an aim statement for what and how
much you want to improve over the next year.
Pre-Work To-Do’s
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Identify a provider champion
Form a multi-disciplinary improvement team
Write an aim statement
Develop a plan to address any issues with provider
panels
Complete and submit the PCMH-A assessment
Collect and report baseline diabetes data on the
monthly practice status report
Participate in the 3 pre-work webinars
RSVP attendees for Learning Session #1
Selecting a Provider Champion
• Change and improvement are not possible without
committed leadership.
• Each practice should have a provider champion (not
just one for a system of practices).
• Champion must want to do this work.
• Champion must have standing in the practice to lead
practice-wide changes.
• Champion (and entire improvement team) should be
allotted time to meet, plan, and test changes.
Forming an Improvement Team
• Multi-disciplinary: provider, clinical, and
administrative champions.
• Team members should be able to embrace change.
• Team members should be leaders among their
peers.
• Team members should be comfortable soliciting and
providing feedback to peers and providers.
Model for Improvement
• Three fundamental questions
• Aim statement
• Measurement plan
• Selecting changes to test
• Plan-Do-Study-Act (PDSA) cycle
• Scientific method used for action-oriented
learning
• Cycles of testing continue until desired
outcomes, implementation, and spread
Writing an Aim Statement
• Agree on what you’re trying to accomplish.
• Be specific.
• Set timeframes and numerical goals to clarify the
aim, create tension for change, and focus initial
changes.
• Aim high: set stretch goals that cannot be met by
just tweaking the system.
Aim Statement Example #1
By May 2013, we will adopt components of the
Patient Centered Medical Home and Chronic Care
Models to improve diabetes care as follows:
• Less than 15% of our patients will have an A1C
greater than 9.0.
• More than 75% of our patients will have an A1C less
than 8.0.
• More than 75% of our patients will have their most
recent blood pressure less than 140/90.
• More than 60% of our patients will have an LDL less
than 100.
Aim Statement Example #2
Within the next 12 months, we will implement
components of the PCMH and Chronic Care Models to
ensure that at least 90% of patients with diabetes in
our practice at least annually receive:
• blood tests for A1c and LDL;
• a urine test for microalbuminin;
• a diabetic eye exam;
• a monofilament foot exam;
• smoking cessation counseling if they smoke.
Empanelment
ASSURING CARE CONTINUITY
PCMH practices:
• Assign all patients to a provider panel, confirm
assignments with providers and patients, and 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, etc.
Source: Safety Net Medical Home Initiative
http://www.safetynetmedicalhome.org/changeconcepts/empanelment
Key to PCMH: Continuity
NCQA PCMH 2011
PCMH 1: Enhance Access and Continuity
Element D: Continuity
The practice provides continuity of care for patients/families by:
1. Expecting patients/families to select a personal clinician.
2. Documenting the patient’s/family’s choice of clinician.
3. Monitoring the percentage of patient visits with a selected
clinician or team.
Value of Empanelment
Empanelment promotes:
Continuity of care with personal PCP
• Improves quality, patient safety
Organized approach to care delivery
• Continuity increases efficiency by at least 15%.
Management of provider demand to panel size
• Improves patient access to care
Provider accountability for population
management
• Facilitates team-based care
Patients in Provider Panels
PROVIDER 1
PROVIDER 2
PROVIDER 3
PROVIDER 4
PROVIDER 5
PROVIDER 6
Each Provider Responsible For
• The care of each patient in his/her panel.
• Population management for his/her entire panel.
• Clinical outcomes improvement for his/her panel of
patients.
• The overall effectiveness and efficiency of his/her
practice.
Creating Provider Panels
NCQA Requirements:
• Document and follow a process to encourage and
ask patients to choose a personal provider.
• During check-in?
• When patients call for an appointment?
• Materials/handouts letting patients know value of choosing
a personal provider and process to do so?
• What about patients who are seen infrequently?
• Send a mailing?
• Document and track each patient’s choice of a
personal provider.
• Put in EMR and scheduling system, if not integrated.
• Must be available when booking appointments,
checking in patients.
• Needed for population management reports.
Other Things to Consider
• Historical information on patient visits:
• Which provider seen most often
• Which provider did last physical exam
• Which provider seen last
• Maximum panel size for each provider based on:
• # of hours/provider/year
• # of provider appointments available/hour
• Type of patient population and related visits/year
(risk stratification)
• Goal is to balance supply and demand and
balance provider panels.
Maximum Panel Size Formula
(# of hours worked/year) x (# of appointments/hour)
(average # visits/year for panel of patients)
= maximum provider panel size
Example
• A part-time provider working 1,000 hours per year
(20 hr/wk x 50 wks) and having 4
appointments/hour has 4,000 appointment slots per
year.
• If the patient population requires 10 visits/year, the
panel size for the provider could not exceed 400
patients.
• If the population requires 4 visits/year, the
panel size could be 1,000 patients.
Ongoing Support, Monitoring
• Need scheduling policies to support patient
visit continuity with selected provider.
• Likely need some form of open access scheduling to
facilitate sick visit continuity.
• Same-day appointments (NCQA PCMH Standard 1,
Element A: Access During Office Hours—MUST PASS
and CRITICAL FACTOR).
• Evaluate weekly schedules to see which days more
open appointment slots are needed to accommodate
patient demand.
• NCQA: Practice should monitor the percentage
of visits that occur with the selected clinician
and team.
NCQA Documentation
Documentation Needed for NCQA:
Documented process for patient/family selection of
a personal clinician.
Screen shot from electronic system showing
documentation of patient/family choice of clinician.
One week of data showing proportion of patient
visits that occurred with chosen clinician.
Empanelment Resources
• Safety Net Medical Home Initiative
Offers Implementation Guides and Webinars on Empanelment
http://www.safetynetmedicalhome.org/changeconcepts/empanelment
PCMH-A and Clinical Measures
BASELINE ASSESSMENTS
Assessing Where You Are Now
• Two types of baselines
• PCMH Assessment (PCMH-A)
• Clinical measures baselines: Topic of Webinar #2
• Practice Facilitators also will be collecting some
baseline assessment information when they visit
with you.
The PCMH-A
• Self-assessment tool developed by Qualis and the
MacColl Institute for the Safety Net Medical Home
Initiative.
• Assesses current level of “medical homeness.”
• Identifies areas for improvement.
• Should be completed at the practice level by the
team leader or provider champion in consultation
with improvement team.
Completing the PCMH-A
• Available online at:
http://www.safetynetmedicalhome.org/sites/default
/files/PCMH-A.pdf.
• Will also be emailed to key contacts (person who
completed your application).
• When you’re done, save a copy for your files and
print a copy to share with us.
• Please email a copy of your completed PCMH-A by
May 11 to [email protected] or fax it to
717-531-0182.
Webinar #2, #3; Learning Session #1
UPCOMING DATES
Dates for Upcoming Sessions
• Webinar #2: Baseline Data Measurement
• May 2: 7-8am
• May 8: 5-6pm
• Webinar #3: Introduction to the Models
• May 16: 7:30-8:30am
• May 21: 4-5pm
• NW Learning Session #1: May 23, 5-9pm
• SC Learning Session #1: June 7, 5-9pm
Please RSVP the team members who will
be attending Learning Session #1 to
[email protected] by May 11.
Pre-Work To-Do’s








Identify a provider champion
Form a multi-disciplinary improvement team
Write an aim statement
Develop a plan to address any issues with
provider panels
Complete and submit the PCMH-A assessment
Collect and report baseline diabetes data on the
monthly practice status report
Participate in the 3 pre-work webinars
RSVP attendees for Learning Session #1
Practice Facilitators
• Northwest
• South Central
Patricia J. Stubber, MBA
Executive Director
Northwest PA AHEC
8425 Peach Street
Erie, PA 16509-4788
814-217-6029 (phone)
814-594-4740 (cell)
814-864-4077 (fax)
[email protected]
Sharon M. Adams RN, BA
Executive Director
Southcentral PA AHEC
PO Box 509
Carrolltown, PA 15722
814-344-2222 (phone)
814-344-2221 (fax)
[email protected]
Any Questions CENTRAL EMAIL
[email protected]
WEBSITE www.paspread.com