Affiliated with Children’s Medical Services Affiliated with Children’s Medical Services Introduction to the Medical Home Part 2 How does a Practice adopt the Medical Home Model? Webinar Presentation ~ June 2010 ~

Affiliated with Children’s Medical Services Affiliated with Children’s Medical Services Questions to:

1 - What is the Medical Home Model?  2 - How does a Practice adopt the Medical Home Model?  3 - What Tools Can We use to Assess the Medical Home Qualities of our Practice? 4 - How Can Assessment Tools be Used to Quantify and Support a Practice’s Quality Improvement Process? Introduction to the Medical Home ~ 4 Part Webinar Presentation Series ~

Objectives for Today… Review – the reasons, in the current health care environment, that adoption of the medical home model is important to the sustainability of your practice Introduce – national tools and supports to help you organize your practice to implement the model and prepare to meet medical home standards for NCQA Recognition

A Medical Home is… … provision of care through a primary care physician’s partnership with the family, other health care professionals and community services. Through this partnership, the physician helps the patient/family access and coordinate specialty care, educational services, out-of-home care, family support, and other public and private community services that are important to the overall health of the child. (American Academy of Pediatrics)

“The Patient Centered Medical Home model is based on a large and growing body of evidence that shows that care delivered by primary care physicians, supported with information systems and with the appropriate reimbursement incentives, can improve the quality and efficiency of care provided to patients, especially for patients with multiple chronic illnesses.” Patient Centered Medical Home Collaborative

….reduced use of the emergency room by 55% ( ….eliminate disparities in terms of access to quality care among vulnerable population ( Reports/2007/Jun/Closing-the-Divide--How-Medical-Homes- Promote-Equity-in-Health-Care--Results-From-The-Commonwealth- F.aspx) Reports/2007/Jun/Closing-the-Divide--How-Medical-Homes- Promote-Equity-in-Health-Care--Results-From-The-Commonwealth- F.aspx ….save money and improve quality of care and patients’ experience while creating a better work environment for providers ( Where’s the evidence?

In the news… The medical home has emerged as a catalyst for health care reform efforts related to the delivery and reimbursement of primary care. Demonstration projects have support from employers, insurers, state and federal agencies, and professional organizations. Medicare medical home demonstration projects include payment components for care coordination and quality improvement – a feature essential to the success of the model

briefs/Documents/Medical%20Home%20Issue%20Brief.pdf briefs/Documents/Medical%20Home%20Issue%20Brief.pdf

How can a busy practice implement the medical home model?

“Building” a Medical Home requires…  Vision and leadership by physician Collaboration in all learning and improvement efforts  Commitment from: - lead physician - all office staff - care coordinator

AAP National Center for Medical Home Implementation and Center for Medical Home Improvement - Building Your Medical Home ~ Toolkit ~ Supports your development and/or improvement of a pediatric Medical Home. Prepares you to apply for and potentially meet the National Committee for Quality Assurance (NCQA) Physician Practice Connections® Patient Centered Medical Home (PPC-PCMHTM) Recognition program requirements. Offers capacity to chart progress Web site:

Start Building Your Medical Home 1. Care Partnership Support 2. Clinical Care Information 3. Care Delivery Management 4. Resources & Linkages 5. Practice Performance Measurement 6. Payment & Finance Medical Home Standards - What is NCQA and How Does it Impact Your Practice? Quality Improvement Basics - Your Medical Home: Well Designed Using a Quality Improvement Process Progress Summary Toolkit Building Blocks

Tracking Your Progress

Reviewing your Notes and Action Steps Review triage and scheduling processes for relevancy to needs of CSHCN. Review triage and scheduling processes for relevancy to needs of CSHCN. Research development of a practice website Research development of a practice website Identify language support services and informational materials for Spanish-speaking families Identify language support services and informational materials for Spanish-speaking families

Building Your Medical Home ~ Toolkit ~

National Standards Improvement approaches can vary widely from practice to practice. So how does one know when it's being done correctly? So how does one know when it's being done correctly?

National Committee for Quality Assurance NCQA “Recognition” Practices seeking PPC ® - PCMH TM NCQA Recognition complete a Web-based data collection tool and provide documentation that validates responses. Results of the tool measure how well the practice functions as a medical home. The Patient Practice Connections® - Patient-Centered Medical Home The Patient Practice Connections® - Patient-Centered Medical Home TM

Recognition and Reimbursement NCQA Recognition standards are the basis for efforts toward transforming payment systems to increase fees to physicians who provide medical homes.

A number of private health insurance plans are already beginning to reward practices for achieving NCQA Medical Home Recognition. The Centers for Medicare and Medicaid Services (CMS) is using an adapted version of NCQA’s Recognition program to evaluate medical practices in its three-year Medicare Medical Home Demonstration Project. Practices that qualify as medical homes will receive additional payments from Medicare.

 Access and Communication  Patient Tracking and Registry Functions  Care Management  Patient Self-Management Support  Electronic Prescribing  Test Tracking  Referral Tracking Standard  Performance Reporting NCQA Standards

NCQA Key Requirements Data system to organize and analyze clinical and non-clinician information Written standards for patient access and communication protocols Identification of important diagnoses and conditions in the practice and implementation of evidence-based treatment guidelines Coordination of care by non-physician staff Support for patient/family self-management Systematic tracking and follow up on tests and referrals Measurement and report of physician performance Implementation of practice wide quality improvement system

NCQA Web-based Survey Tool

Recognition Levels

National Committee for Quality Assurance NCQA “Recognition”

Benefits of NCQA Recognition Achievement of proven and nationally accepted practice improvements. Included in NCQA published Recognized Physician Directory. Identified in Health Plan provider network lists. (Health Plans which identify Recognized Physicians include Aetna, CIGNA, United and Humana among others.) Accepted into high performance networks of some Health Plans. (Health Plans which use Physician Recognition as a requirement for entry into high performance networks include Aetna, CIGNA and United among others.) Reward from Health Plans for achieving recognition. Future opportunities for increased compensation

Other National Supports and Resources

Provides consultation for primary care medical home development and transformation. TAPPP (Team, Access, Population, Planned and Patient/family centered) measures practice capacity and offers individualized support (arranged and delivered via phone, web, on-site/face to face, ) to improve "medical homeness” Center for National Medical Home Improvement

Campaigning for increased compensation for quality, proactive care. Advancing the Patient Centered Medical Home (PCMH) concept in the public and private sectors Hosting web-based conferences, meetings, summits and congressional briefings Join at Patent Centered Primary Care Collaborative

American Academy of Family Physicians

Steps... revisited Step # 1. Educate and engage all physicians and practice staff Step # 2. Identify the children with special health care needs in the practice Step # 3. Unite the medical home team and assess the current medical home qualities of the practice Step # 4. Implement a quality improvement process

One Step at a Time…. Next Step… View Introduction to the Medical Home Webinar # 3 – “What Tools Can We Use to Assess the “What Tools Can We Use to Assess the Medical Home Qualities of our Practice?” Medical Home Qualities of our Practice?”

Please send us your questions and comments! And return to the project website: and click on the to take a brief survey Q & A