Transcript Slide 1

Understanding Louisiana Medical
Home System of Care
DECEMBER 4, 2009
10:00 AM TO 12:00 PM (EST)
PRESENTATION BY
GWEN LAURY RN, CCHC
LOUISIANA PRIMARY CARE ASSOCIATION
Medical Home System of Care
 Louisiana Revised Statues of 1950.
 R.S. 46:978-979, Reform Healthcare for Medicaid
Recipients and low-income uninsured.
 R.S. 39:100.51, Establish Health Care Redesign as a
special treasury fund.
 “Health Care Reform Act 2007.”
“Health Care Reform Act”
 Improve health care outcomes in Louisiana by
developing and implementing a health care
delivery system that provides a continuum of
evidence – based quality driven health care
services.
 Health care delivery system is known as,
Louisiana Home First and consist of Medical
Home System of Care.
Medical Home System of Care
 A health care delivery system is define as the primary care
that is accessible, continuous, comprehensive, and family
centered, coordinated, companionate and culturally
effective.
 A partnership between the primary care provider (PCP)
and the beneficiary (patient/family) to assure that all
medical and non medical needs of the patient are met.
 PCP will personally guide and coordinate and facilitate
Preventative and Primary Care that improves the patients
outcomes in the most cost-efficient manner.
Medical Home System of Care
 Coordinate and Provide Access to evidence base health
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care services; Convenient and Comprehensive to
Primary Care.
Access to appropriate Specialty Care and Inpatient
Services.
Quality Driven and Cost-Effective Health Care.
Strong and Effective Medical Management.
Patient and Provider Accountability.
Prioritize Local Access to the continuum of Health
Care Services.
Chronic Care Disease Model
The Center for Health Studies
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Organizes the care of a population of patients with chronic
diseases
Addresses a mix of effective interventions to improve
office performance
Care becomes proactive rather than reactive, where there
are missed opportunities to improve overall care and/or
meet care goals
Care Model
Community
Resources and Policies
SelfManagement
Support
Informed,
Activated
Patient
Health System
Health Care Organization
Delivery
System
Design
Decision
Support
Productive
Interactions
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Functional and Clinical Outcomes
Clinical Information System: Registry
A registry defines your total population of
patients – know who your patients are.
Provide reminders for care that is due at the time of
the visit and remind the provider who is due for a
visit.
 Provides feedback for providers and patients.
 Identify relevant patient subgroups and provide
proactive care. (Those that are in need of better
management)
 Facilitate individual patient care planning through
the registry.
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Decision Support
 Embed evidence-based guidelines which describe
stepped-care into daily clinical practice.
 Integrate specialist expertise into primary care.
 Defines what the standard of care is.
 Inform patients about guidelines pertinent to
their care.
Delivery System Design
 Define roles and delegate tasks amongst team
members.
 Use planned visits to support evidence-based
care.
 Integration of standing orders.
 Build “effective” case management
functionality into practice
 Assure continuity by the primary care team.
 Assure regular follow-up.
Self- Management: An Essential Shift in
Chronic Care Disease Management
Putting the patient back into the center of their
care
 Between 95-99% of chronic care illness care is
delivered by the patient who has the illness.
 Noncompliance can be defined as the doctor and
the patient working toward different goals.
 Acknowledges their place on the health care team.
 A team is a group of people that work together to
achieve a common purpose and are mutually
accountable to each other.
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Share responsibility for the ultimate outcome.
The work could not be accomplished independently.
Health Care Organization Concepts (from
BPHC)
 Accepted part of the work of the organization.
 Upper management visibly supports the work
through dedicated time and resources
 Part of the center’s annual goals
 The board understands and supports the work.
 Population based disease management is an
expectation for all who work at the center.
 Duties of staff are in job descriptions and
evaluations.
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act
Plan
Study
Do
How are the health centers
playing a role?
A l l F Q H C s w i l l p a r t i c i p a t e i n o n e o r m o r e o f t h e
health disparities collaborative. (HDC)
A l l F Q H C a r e m o v i n g t o w a r d s t h e
implementation of EHR
R e v i s e a l l h e a l t h c a r e f o r m s w i t h i n t h e F Q H C t o
make sure they are capturing the Demographic
and Clinical Data that is needed for the UDS
report to HRSA
How is the initiative working in Louisiana
– what is being done to ensure HRSA
grantees are participating ?
C l i n i c i a n b r a n c h m e e t i n g w i t h C H C
providers for input quarterly
O n s i t e v i s i t f o r t e c h n i c a l a s s i s t a n c e
with HDC activities
L P C A a s s i s t a n c e i n m a r k e t i n g t o
provide community partnerships that
will facilitate the medical home
concept
What assistance can HRSA provide?
M o r e F u n d i n g F o r A s s i s t a n c e W i t h H I T
M o r e T e c h n i c a l A s s i s t a n c e W i t h
Appropriate Reimbursements
A s s i s t a n c e W i t h R e c r u i t i n g A n d R e t e n t i o n
Of Providers And Support Staff.
A s s i s t a n c e W i t h F u n d i n g F o r N e w A c c e s s
Points
Strategies on getting the State to
recognize the health center as the model
for this initiatives;
The following comparative analysis is based
on the “medical home” recommendation
made jointly by
A m e r i c a n C o l l e g e O f P h y s i c i a n s
A m e r i c a n A c a d e m y O f F a m i l y P h y s i c i a n s
A m e r i c a n A c a d e m y O f P e d i a t r i c s
A m e r i c a n O s t e o p a t h i c A s s o c i a t i o n
Why Louisiana’s FQHCs are the Best Active Model
for a Medical Home System of Care
Medical Home Concept Recommendations
Personal physician provides first contact and continuous
care.
Physician directed practice in which a personal doctor
leads a team of providers.
Whole person orientation where the physician
arranges for care for all stages of life.
Coordinated care across the health system.
Quality, safety, with evidence-based medicine
guiding decision making.
Enhance access to care through systems such as open
scheduling and expanded hours.
N/A
Some providers are eligible based on their location
N/A
N/A
Louisiana’s Federally Qualified Health Centers
(FQHCs)
Louisiana’s FQHCs employ Primary Care
Physicians, Physician Assistants, Nurse Midwives
and/or Nurse Practitioners.
The majority of Louisiana’s FQHCs have
implemented practice care models such as the Chronic
Care Management Redesign Model that create
medical care teams to direct and manage the clinical
care of patients.
The majority of Louisiana’s FQHCs participates in the
state’s managed care program that operates the same
principles.
Most of Louisiana’s FQHCs have referral partnerships
with their local hospitals and specialty providers.
The majority of Louisiana’s FQHCs are JACHO
accredited.
Louisiana’s FQHCs see walk-ins and have
arrangements for care after normal business hours.
FTCA (Malpractice Immunity)
Medicaid Prospective Payment System
Reimbursement.
FQHCs provide Dental and Mental Healthcare.
Limited grant dollars to assist with the uninsured.
Challenges and Opportunities
 Stronger clinical
 Decrease health disparities
workforce
 Decrease in inappropriate
 Funding for health center
use of hospital ER
capital projects.
 Joint partnerships with
 Increased timely access
to medical specialist
LSU and other State
Healthcare Entities to
improve quality outcomes
THE END