Transcript Title of Presentation

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
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
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Washington Patient-Centered Medical Home
Collaborative
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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-2009
Health 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
Number of sites that have providers in the
designated number range
Collaborative participants
5 or fewer providers
6 to 20 providers
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11
12
21+ providers
Population density surrounding
participating clinics
Participating clinics by population density
6
3
11
Urban 50,000 +
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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
Estimated patients in WPCMHC by age
608,795
700,000
600,000
500,000
400,000
estimated number of
patients
300,000
129,316
200,000
64,916
100,000
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under 18
adults (includes over age
65)
age categories
estimated over age 65
Early evidence suggests…
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Patient satisfaction improves.
Provider satisfaction improves.
Burn-out decreases.
Avoidable emergency room visits
decrease.
• Clinical outcomes improve.
• Cost savings or neutralizes cost increase.
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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
Medical Home Index
Change in Medical Homeness Over Time
Average score for all clinics combined
8.00
September 2009
7.00
September 2010
September 2011
6.74
6.83
6.22 6.33
6.00
5.69
5.25
5.58
5.23
4.95
5.00
5.81
5.60
5.54
5.04
4.98
4.59
4.50
4.17
4.00
4.10
3.93
3.98
3.63
3.00
2.00
1.00
0.00
MHI Overall Score
Domain 1:
Domain 2: Chronic
Organizational Capacity Condition Management
Domain 3: Care
Coordination
Domain 4: Community
Outreach
Domain 5: Data
Management
Domain 6: Quality
Improvement/Change
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 Index
headlines
• 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-patientcentered-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
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Colorado
Vermont
New Hampshire
Michigan
Maine
New York
North Carolina
North Dakota
Minnesota
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Ohio
Texas
Arizona
Louisiana
Pennsylvania
Rhode Island
Georgia
Tennessee
Illinois
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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
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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
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Providers and teams
Teams and other teams
Provider/Team and patients/families
Across care settings and transitions in
care.
• Continuity of relationship is patientcentered 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