PA 574: Health Systems Organization Session 5 – May 1, 2013

 At the nexus of levels of prevention Does secondary Overlaps with primary and tertiary  Natural point for entering individual level care system Most “upstream” entry point for individual Classic public/population health interventions have no individual “entry” point  Potential to leverage and connect the levels of prevention and care within and across a system

 About Primary Care Functions: Not specific treatments Not specialty of providers Leading to orientation of systems  PC Functions (similar to PCPCH core attributes) Usual Source of Care First contact for new health conditions Comprehensive care for the majority of health problems Long-term person focused care Care coordination across providers

 Really about coordination(?) Across individual conditions/states/needs Across time Across services Across providers Across systems  Really about basic organization/system functions and characteristics (as opposed to “health care”)?

 Many programs with similar core function/coordination focus: Program of All-Inclusive Care for the Elderly (PACE) – coordinated care program/home for elderly Assertive Community Treatment (ACT) - coordinated care program/home for persons with severe and persistent mental illness Chronic Care (CC) model - coordinated care program/home for persons with single/multiple chronic physical health conditions

 What is the limit of the scope of the PCPCH?  How does scope affect “fit” for average or specific person?  Relevance to individual  Ability to perform on cost and population health  Where should “home” be?  Case of behavioral/physical health care integration  How do we get PCPCHs to work with others and vice versa?  What do we need to do to make transformation successful?

 Implementation of the PCPCH model – including PCPCH Program elements; the number and distribution of PCPCH clinics and clients served; and, barriers and benefits of the Program.  Fidelity to the PCPCH Model – including the number and tiered distribution of recognized PCPCH clinics, and consistency of PCPCH-designated clinic characteristics with the normative model.  Clinical Quality - including the selection of specific indicators from among those established by OHPR, and PCPCH clinics’ assessment and reporting of performance and clinical quality improvement.  Cost & Efficiency of Care - including baseline rates and trends in utilization patterns and costs which can be derived from administrative claims data.  Patient Experience of Care - including assessment of care satisfaction and experiences corresponding to PCPCH model core attributes.  Provider & Staff Experience - including perceptions of coordination, integration, and identification of key factors which influence PCPCH implementation.