Lessons Learned: PCMH and Value Based Payment -Why we are on the journey Texas Medical Home Summit Julie Schilz BSN MBA April 5, 2018

PCMH-The Early Years Let’s Dive In

Why We Started….. Primary care is critical to achieving the triple aim of promoting health, improving care, and reducing overall system costs. Current visit-based fee-for-service system may not provide resources for comprehensive primary care. A major barrier to transformation in practice is transformation in payment. The definition of insanity is doing the same thing and expecting different results. ~ Albert Einstein

Enhanced Access to Comprehensive, Coordinated, Evidence-Based, Multidisciplinary Care

Collaboratively Developed Principles

The Payment Model

The Next Phase

Shift from Volume to Value Based Care Volume Based Value Based Payment Fee for Service Performance Based Incentives Volume Value Focus Acute Episodes Planned Care Strategy Patients That’s not my patient We are responsible for all patients Role of the Provider Single Episode Team Based Care Information Retrospective Prospective

Planned Care Strategy Prepared Care Team Develop Strategy Prepared Practice Risk stratification for high-risk patients Patient outreach plan Evaluate member access to care for all visit types Measure next available appointment Nurse/MA Annual screenings/HRAs Standing orders Patient flow optimization Provider (MD/PA/NP) Care Team Set shared agenda for visit Review chronic, preventive, acute care opportunities Document burden of illness to highest degree of specificity Create care plan using shared decision-making Prepared Care Team Structured pre-visit planning Review clinical results, care gaps, chronic conditions Medical Neighborhood (Co-located or referred) Specialists Behavioral Health Dental/vision services Hospitals Pharmacy Community resources Social work Home health Complex case managers Skilled nursing facilities Other ancillary services Care Plan Management/Coordination Coach and Site Mgt. support Implement plan Assess barriers/Solutions Support change Gather Patient Experiences Progress/symptom monitoring Satisfaction Self-efficacy Follow-up Test and referral tracking Review/revise plan Problem solve Population Management Registry/reporting Annual visits Ongoing outreach Front Office Explore appointment needs & preferences Collect administrative information Before the Visit During the Visit After the Visit Develop Strategy Develop action plan that identifies team roles and responsibilities Establish project timelines and milestones

Lessons Learned

Collaboration is Key Enablement Services

Teamwork Makes the Dream Work

Checking the Box Doesn’t Work

Collaborative Learning Accelerates Improvements

You Can’t Bypass the “Hard” Stuff Patient Engagement, Self Management Support, Leadership

Leadership Matters Enablement Services

Documentation is Critical

Current State

Stay Focused

Questions