Practice facilitation as a strategy to spread the adoption of PCMH Background, Approach, Learnings Jean D'Aversa RN, BSN, PCMH CCE Nancy Gratz, MPA, PCMH CCE Denise Woodworth, MBA, CHI, PCMH CCE

Objectives Practice Facilitation - PCMH Understand the tools utilized to create an administrative and organizational infrastructure. Describe approaches utilized by the coaches to implement change within the practices. Explain the benefits of using practice facilitators.

Transformation Timeline 2008 Primary Care Practice Assessment (IM, FM, Peds, OB) 2009 PA Collaborative (7 practices) Population registries created 8 practices NCQA 2008 2010 Additional 20 practices- LVHN Collaborative Reimbursement by self- insurer 2011 PCMH Charter 2012 Primary Care Practice Assessment 2 NCQA Facilitators Community Care Teams 2013 8 NCQA re-recognized, 4 new Retreat and Strategize BLT Series 2014 Facilitator’s Content Expert Certification 6 practices seeking NCQA 2015 Multisite

Practice Change Facilitation Approaches Collaborative learning cohorts Resource sharing – across practices Technology and communication infrastructures Practice assessments Teambuilding Quality Improvement and change intervention

Practice Change Support Customized/Adaptive Common Target: “PCMH Recognition” Facilitate Teams, Tools, Techniques, Stages of Change Outcome: Improve Practice Capacity

Quality Improvement in the PCMH Systemic Data / Metrics Identify Opportunities Team creates and communicates plan Implement Measure and Communicate Performance

Technology, Technology and Facilitation Electronic Medical Record ≠ all practices need Technological Skills ═ needed in PCMH Registries; manipulating data Using Excel software – who are the patients of focus Demographics (LVPG Informatics) Meaningful use reports (LVHN IT) Print Screens Go To Meeting – use current capability Storing documentation in one place SharePoint lending library

Collecting examples for all to use Naming Conventions

What support can Facilitators provide What support can Facilitators provide? Who in the practice – hidden capacity? NCQA Account and Survey Tool Management Complexity of NCQA technology Uploading proof Administrative support to all practices Business Associate Agreements, discounts, payments Primary Contact for communication with NCQA Find practice tech resource Coach practice –how to use technology in patient care

Clinical Readiness/Capacity Six NCQA PCMH Standards 1. Enhance Access and Continuity 2. Identify and Manage Patient Populations 3. Plan and Manage Care 4. Provide self-care support and Community Resources 5. Track and Coordinate Care 6. Measure and Improve Performance

Clinical Concepts Working in teams on patient panels Managing transitions throughout continuum Patients as partners in their care Proactive, not reactive Monitoring against your own standards Closing the loop Prioritization/ Registries Is it documented???

Summary Share of ideas “best practices” across practices Brought out collaboration and healthy competition Seek dedicated time and space Highlighted need to commit to focus on PCMH transformation NCQA – useful roadmap and dialogue starting tool Team building a focus Quality Improvement – teach processes Growth of people in practice – technology and knowledge of proactive care with learned tools Standardized template create and used

NCQA Outcomes 8 practices re-recognized in 2013 Internal Medicine, Family Medicine, Pediatrics Some residency practices All achieved Level 2 or Level 3 3 practices initial recognition in 2013 Achieved Level 2 or Level 3 6 practices in progress 2014 Goal to move to multisite approach 2015

Facilitators’ Recommendations Discovering mix of skill sets needed to transform to a PCMH Modeling best practices as Facilitator Team Seeking out the hidden skills in a Practice Finding Team Building opportunities Coaching and positive reinforcement needed at practices Meeting the practice “where they’re at” Looking to future – challenges Achieve sustainability! Evolving to multi-site approach as one means of addressing resource constraints

Acknowledgements Lehigh Valley Physician Hospital Organization Lehigh Valley Health Network (LVHN) Care Continuum Leadership Department of Family Medicine MATRIX Center for Interprofessional Collaboration Clinical Informatics Nyann Biery, Manager of Program Evaluation, LVHN Department of Family Medicine

Contact Information: Jean D’Aversa Jean.DAversa@lvhn.org Nancy Gratz Nancy_C.Gratz@lvhn.org Denise Woodworth Denise_R.Woodworth@lvhn.org