Affiliated with Children’s Medical ServicesAffiliated with Children’s Medical Services

Introduction to theIntroduction to theMedical HomeMedical Home

Part 2Part 2

How does a How does a Practice adopt thePractice adopt the

Medical Home Medical Home Model?Model?

Webinar Presentation Webinar Presentation

~ June 2010 ~~ June 2010 ~

Affiliated with Children’s Medical ServicesAffiliated with Children’s Medical Services

E-mail Questions to:E-mail Questions to:

admin@partnershipforchildhealth.org admin@partnershipforchildhealth.org

1 - What is the Medical Home Model?

2 - How does a Practice adopt the Medical Home Model?

3 - What Tools Can We use to Assess the Medical Home Qualities of our Practice?

4 - How Can Assessment Tools be Used to Quantify and Support a Practice’s Quality Improvement Process?

Introduction to theIntroduction to theMedical HomeMedical Home

~ 4 Part Webinar Presentation Series ~

Objectives for Today…Objectives for Today…

Review – the reasons, in the current health care environment, that adoption of the medical home model is important to the sustainability of your practice

Introduce – national tools and supports to help you organize your practice to implement the model and prepare to meet medical home standards for NCQA Recognition

A A Medical HomeMedical Home is… is… … provision of care through a primary care

physician’s partnership with the family, other health care professionals and community services.

Through this partnership, the physician helps the patient/family access and coordinate specialty care, educational services, out-of-home care, family support, and other public and private community services that are important to the overall health of the child.

(American Academy of Pediatrics)

“The Patient Centered Medical Home model is based on a large and growing body of evidence that shows that care delivered by primary care physicians, supported with information systems and with the appropriate reimbursement incentives, can improve the quality and efficiency of care provided to patients, especially for patients with multiple chronic illnesses.”

Patient Centered Medical Home CollaborativePatient Centered Medical Home Collaborative

….reduced use of the emergency room by 55% (http://www.jpeds.com/article/PIIS0022347609012402/fulltext)

….eliminate disparities in terms of access to quality care among vulnerable population (http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/Jun/Closing-the-Divide--How-Medical-Homes-Promote-Equity-in-Health-Care--Results-From-The-Commonwealth-F.aspx)

….save money and improve quality of care and patients’ experience while creating a better work environment for providers 

(http://content.healthaffairs.org/cgi/reprint/29/5/8355)

Where’s the evidence?Where’s the evidence?

In the news…In the news…

The medical home has emerged as a catalyst for health care reform efforts related to the delivery and reimbursement of primary care.

Demonstration projects have support from employers, insurers, state and federal agencies, and professional organizations.

Medicare medical home demonstration projects include payment components for care coordination and quality improvement – a feature essential to the success of the model

http://www.amchp.org/AboutAMCHP/Newsletters/member-briefs/Documents/http://www.amchp.org/AboutAMCHP/Newsletters/member-briefs/Documents/Medical%20Home%20Issue%20Brief.pdf Medical%20Home%20Issue%20Brief.pdf

How can a busy practice implement the medical home model?

““Building” aBuilding” aMedical Home Medical Home

requires…requires…

Vision and leadership by physician

Collaboration in all learning and improvement efforts

Commitment from:

- lead physician

- all office staff

- care coordinator

AAP National Center for Medical Home AAP National Center for Medical Home ImplementationImplementation

and Center for Medical Home Improvementand Center for Medical Home Improvement--

Building Your Medical HomeBuilding Your Medical Home~ Toolkit ~~ Toolkit ~

Supports your development and/or improvement of a pediatric Medical Home.

Prepares you to apply for and potentially meet the National Committee for Quality Assurance (NCQA) Physician Practice Connections® Patient Centered Medical Home (PPC-PCMHTM) Recognition program requirements.

Offers capacity to chart progress

Web site: http://www.pediatricmedhome.org

Start Building Your Medical Home

1. Care Partnership Support

2. Clinical Care Information

3. Care Delivery Management

4. Resources & Linkages

5. Practice Performance Measurement

6. Payment & Finance

Medical Home Standards - What is NCQA and How Does it Impact Your Practice?

Quality Improvement Basics - Your Medical Home: Well Designed Using a Quality Improvement Process

Progress Summary

Toolkit Building BlocksToolkit Building Blocks

Tracking Your ProgressTracking Your Progress

Reviewing your Notes and Reviewing your Notes and Action Steps Action Steps

• Review triage and scheduling processes for relevancy Review triage and scheduling processes for relevancy to needs of CSHCN.to needs of CSHCN.

• Research development of a practice websiteResearch development of a practice website

• Identify language support services and informational Identify language support services and informational materials for Spanish-speaking families materials for Spanish-speaking families

http://www.pediatricmedhome.org

Building Your Medical HomeBuilding Your Medical Home~ Toolkit ~~ Toolkit ~

National StandardsNational Standards

Improvement approaches can vary Improvement approaches can vary widely from practice to practice.widely from practice to practice.

So how does one know when it's So how does one know when it's

being done correctly?being done correctly?

National Committee for Quality National Committee for Quality AssuranceAssurance

NCQA “Recognition”NCQA “Recognition”

Practices seeking PPC®- PCMHTM NCQA Recognition complete a Web-based data collection tool and provide documentation that validates responses. Results of the tool measure how well the practice functions as a medical home.

The Patient Practice Connections® -The Patient Practice Connections® -Patient-Centered Medical HomePatient-Centered Medical HomeTM

Recognition and Recognition and ReimbursementReimbursement

NCQA Recognition standards are the basis for efforts toward transforming payment

systems to increase fees to physicians who provide medical homes.

A number of private health insurance plans are already beginning to reward practices for achieving NCQA Medical Home Recognition.

The Centers for Medicare and Medicaid Services (CMS) is using an adapted version of NCQA’s Recognition program to evaluate medical practices in its three-year Medicare Medical Home Demonstration Project.

Practices that qualify as medical homes will receive additional payments from Medicare.

Access and CommunicationAccess and Communication Patient Tracking and Registry FunctionsPatient Tracking and Registry Functions Care ManagementCare Management Patient Self-Management SupportPatient Self-Management Support Electronic PrescribingElectronic Prescribing Test TrackingTest Tracking Referral Tracking StandardReferral Tracking Standard Performance ReportingPerformance Reporting

NCQA StandardsNCQA Standards

NCQA Key RequirementsNCQA Key Requirements

Data system to organize and analyze clinical and non-clinician information

Written standards for patient access and communication protocols

Identification of important diagnoses and conditions in the practice and implementation of evidence-based treatment guidelines

Coordination of care by non-physician staff

Support for patient/family self-management

Systematic tracking and follow up on tests and referrals

Measurement and report of physician performance

Implementation of practice wide quality improvement system

NCQA Web-based NCQA Web-based Survey ToolSurvey Tool

Recognition Levels Recognition Levels

National Committee for Quality National Committee for Quality AssuranceAssurance

NCQA “Recognition”NCQA “Recognition”

www.NCQA.orgwww.NCQA.org

Benefits ofBenefits ofNCQA RecognitionNCQA Recognition

Achievement of proven and nationally accepted practice improvements.

Included in NCQA published Recognized Physician Directory.

Identified in Health Plan provider network lists. (Health Plans which identify Recognized Physicians include Aetna, CIGNA, United and Humana among others.)

Accepted into high performance networks of some Health Plans. (Health Plans which use Physician Recognition as a requirement for entry into high performance networks include Aetna, CIGNA and United among others.)

Reward from Health Plans for achieving recognition.

Future opportunities for increased compensation

Other National Supports Other National Supports and Resourcesand Resources

Provides consultation for primary care medical home development and transformation.

TAPPP (Team, Access, Population, Planned and Patient/family centered) measures practice capacity and offers individualized support (arranged and delivered via phone, web, on-site/face to face, e-mail) to improve "medical homeness”

http://www.medicalhomeimprovement.org

Center for National Medical Home Center for National Medical Home ImprovementImprovement

Campaigning for increased compensation for quality, proactive care.

Advancing the Patient Centered Medical Home (PCMH) concept in the public and private sectors

Hosting web-based conferences, meetings, summits and congressional briefings

Join at www.pcpcc.net

Patent Centered Primary Care Patent Centered Primary Care CollaborativeCollaborative

American Academy of Family PhysiciansAmerican Academy of Family Physicians

Steps... revisitedSteps... revisited

Step # 1. Educate and engage all physicians and practice staff

Step # 2. Identify the children with special health care needs in the practice

Step # 3. Unite the medical home team and assess the current medical home qualities of the practice

Step # 4. Implement a quality improvement process

One Step at a Time….One Step at a Time….

Next Step… ViewNext Step… View

Introduction to the Medical HomeIntroduction to the Medical HomeWebinar # 3 –Webinar # 3 –

“ “What Tools Can We Use to Assess What Tools Can We Use to Assess the the Medical Home Qualities of our Medical Home Qualities of our Practice?”Practice?”

Please send us your questions and comments!

admin@partnershipforchildhealth.org

And return to the project website:http://www.partnershipforchildhealth.org/mhip_tools_and_resources.htm

and click on the to take a brief survey

Q Q & & AA