Rural Health Webinar: Strengthening Health Systems in Resource-limited Settings R.W. Watkins, MD, MPH, FAAFP Institute for Emerging Issues (IEI) at NC State University and Duke University 9 April 2014

What is the Multi-Payer Demo?  The purpose of the Multi-Payer Advanced Primary Care Practice “demonstration project” (MAPCP) is:  To evaluate the effectiveness of the Patient Centered Medical Home (PCMH) model, when supported by both public (Medicaid and Medicare) and private payers (Blue Cross Blue Shield, and State Health Plan)  To utilize care management for these other payer sources

What is the Multi-Payer Demo?  NC is one of 8 states that was awarded an MAPCP demo  7 rural counties across NC were chosen to participate in the demo: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga

Patient-Centered Medical Home The PCMH is a model of primary care re-design intended to improve the quality and efficiency of primary care delivery

What we have… What we need!! Atul Gawande, MD

Benefits of the PCMH Model Quality – Outcomes for seven medical home demonstrations  Fewer ER visits (15%-50%)  Fewer hospital admissions (6-24%)  Lower mortality rates  Better preventive service delivery  Better chronic disease care  Higher patient satisfaction Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, , January 2014

Benefits of the PCMH Model Efficiency – Cost  Lower total costs of care - (6.5-22%)  Shorter patient wait times  Less staff burnout/turnover (10% Vs. 30%)  Higher staff satisfaction/productivity Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, , January 2014

This is a No-Brainer! Right?  So Why Aren’t Practices RUNNING to implement PCMH for themselves?!? 1.Time 2.Resources 3.Consultants are expensive 4.Fear a)Gov’t interference b)Loss of control/independence c)Change

How Do You Get All This Done?

ASU Practicum in Primary Care ASU College of Health Science, School of Healthcare Management

Watkins. Journal of Medical Practice Management, Sept/Oct 2012, Vol 28:2, pp

Creation of Partnership with Appalachian State University PARTNERSHIP:  Recruit ASU students from School of Health Care Management  Develop curriculum, syllabus, website, core documents  Create new practicum course with internship opportunity  Teach students about PCMH, Provider Portal, Care management process  Send students out to practices to assist in attaining PCMH certification, BQPP cert and QI initiatives

ASU Practicum in Primary Care  Fall of 2011 – 5 students  Spring 2012 – 9 students – BSBSNC Foundation Grant Obtained  Summer 2012 internship – 8 students  Fall 2012 – 14 students  Spring 2013 – 15 students  Fall 2013 – 16 students  Spring 2014 – 15 students

ASU Practicum in Primary Care  Developed curriculum, core documents, website

Program Growth  ASU School of Health Care Management has made the “Practicum in Primary Care” a CORE curriculum class  Students willing to spend 2 semesters with us get full credit for their internship (300 hours)  “Keeping the Medical Home Fires Burning” is a new initiative where practices that have been recognized work with students on QI projects

Program Growth  Remote Learning Initiative  Students work with practices within 3 hours of Boone  MOVI (secure) web-hosting  Face-to-face visits every 3 weeks or so

CCNC’s PCMH Efforts Beginning of MP Project

Rural Health Webinar: Strengthening Health Systems in Resource-limited Settings R.W. Watkins, MD, MPH, FAAFP Institute for Emerging Issues (IEI) at NC State University and Duke University 9 April 2014