MEDICAL HOME SUMMIT: WELCOME AND OVERVIEWJoint Principles of PCMH. Recognition or accreditation. of...

MEDICAL HOME SUMMIT: WELCOME AND OVERVIEW

Marci Nielsen, PhD, MPH; President & CEO

Patient‐Centered Primary Care Collaborative

@Marci_PCPCC

1

PATIENT‐CENTERED PRIMARY CARE COLLABORATIVE

Unifying

for a better health system ‐‐‐

by better investing in team‐based

patient‐centered primary care

PAYERS:Employers, Government,Health plans,Consumers

PUBLIC:Patients,Families,Caregivers,Communities

HEALTH CARE PROVIDERS: People who take care of patients/families

Collaborative:•Convene•Communicate•Advocate

PATIENT‐Centered “MEDICAL HOME”?

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ). Patient‐centered medical homeresource center, defining the PCMH. Retrieved from http://pcmh.ahrq.gov/page/defining‐pcmh 3

MARCI’S TOP TEN CHALLENGES

1.

Skepticism

4

Medical Home

Term in Standards

of Child Health

Care

by Council on

. Ped. Practice

Alma Alta

Declaration

Surgeon

General Koop’sConf. Report:MH for CSHCN

PCPCC Founded

Medical Home

and Hawaii

Child Health

Plan

(Calvin Sia, MD)

Future of

Family

Medicine

ACP &

Advanced

Medical Home

1989198919671967

19671967‐‐20062006Milestones in PCMH Development

19781978 19791979 2004200420022002 20062006

AAFP &TransforMED

6

Joint

Principles

of PCMH

Recognition or

accreditation

of NCQA PCMH

begins

20082008

20062006‐‐PresentPresentMilestones in PCMH Development

20072007 2010 2015 2016 2010 2015 2016 . .

CommonwealthFund PCMH Programs

State & Local PCMH

Pilots

AffordableCare Act (ACA)

passed

Medicare Access & CHIP

Reauthorization Act (MACRA)

Passes

NationalBusinessGroup on Health (NBGH_Award

7

Various multi‐payer

initiatives tested

(CPC, MAPCP, IAH,

SIM)

Various multi‐payer

initiatives tested

(CPC, MAPCP, IAH,

SIM)

“CPC Plus”Announced


1.

Skepticism

2.

Nomenclature (PATIENT, MEDICAL, & HOME)

8

TERMINOLOGY PREFERRED BY PATIENTS AND CONSUMERS

Amanda Holt (2014). Communicating health care concepts: Finding language to help consumers

understand the PCMH. Masters Thesis.


1.

Skepticism

2.


3.

Buy‐in (leadership & culture change)

10

800 LB GORILLA IN THE ROOM

11


1.

Skepticism

2.


3.


4.

Measurement fatigue (process vs outcome)

12


1.

Skepticism

2.


3.


4.


5.

Administrative burden (in PCMH recognition/certification programs)

14

PCMH as a “certification”

• External validation

• “Short term”

view of model• Focused more on process

measures

• Role in practice

transformation & increased

reimbursement

• Role in assessing value by

payers

PCMH as ideal of practice

transformation

• “North star”

–

aspirational

guide

• “Long term”

view of model

• Focused more on outcomes

• What’s most important to

patients, families, caregivers

& consumers?


1.

Skepticism

2.


3.


4.


5.


6.

Transformation costs ($ & opportunity costs)

16

Primary Care Practice “Journey”

http://www.safetynetmedicalhome.org/resources‐tools/all‐resources


1.

Skepticism 2.


3.

Buy‐in (leadership & culture change)4.


5.


6.

Transformation costs ($ & opportunity costs)7.

Workforce: roles, training & effectiveness of

teams

18

COMMON ELEMENTS OF SUCCESSFUL TEAM‐BASED INITIATIVES

• Focus on patient‐ centered care

• Cultural sensitivity and community focus

• Continuous quality improvement

• Development of effective team practice

• Dispersed team leadership

• Integration of behavioral health

19


1.

Skepticism 2.


3.



5.


6.


Workforce: roles, training & effectiveness of

teams8.

Payment sufficiency & sustainability

20

PRIMARY CARE UNDERVALUED

21


1.

Skepticism 2.


3.



5.


6.


Workforce: roles, training & effectiveness of teams

8.

Payment sufficiency & sustainability9.

Shifting from fee‐for‐service (FFS) to Alternative

Payment Models (APM)

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PAYMENT REFORM AND MEDICARE

Health & Human Services

• Shift 30% of Medicare FFS

payments to value through

APMs by 2016, 50% by

2018

• Created of Health Care

Payment Learning & Action

Network

• Investment in Multi‐payer

Efforts: MAPCP, CPC, CPC+

Congress

• Medicare Access and CHIP

Reauthorization Act

(MACRA)

• Merit‐based Incentive

Payment System (MIPS)

• Alternative Payment

Models (APMs)

23http://doctorwhostories.wikia.com/wiki/The_Macra_Terror_(TS)https://hcp‐lan.org/


1.

Skepticism 2.


3.



5.


6.


Workforce: roles, training & effectiveness of teams

8.

Payment sufficiency & sustainability9.

Shifting from fee‐for‐service (FFS) to Alternative

Payment Models (APM)10.

Public awareness & support

24

MORE HEALTH CARE

IS NOT THE GOAL

WELCOME!

WWW.PCPCC.ORG

26

@Marci_PCPCC

MEDICAL HOME SUMMIT: WELCOME AND OVERVIEWJoint Principles of PCMH. Recognition or accreditation. of...

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