1. David Colman MD Assistant Professor Albany Medical Center Family Medicine Residency Program dcolman@communitycare.com May 3, 2013

2. Disclosures CDPHP – Enrolled our office in Phase 2 of an Enhanced Primary Care Initiative

3. PCMH Principles Personal Physician Physician-Directed Medical Practice Whole Person Orientation Care is Coordinated/Integrated Quality/Safety Open Access Payment Reform

4. The Patient Centered Medical Home – Triple Aim Improve Health of Population Reduce Cost Improve Patient Experience Experience Cost Health of Population Early Evaluations of the Medical Home: Building on a Promising Start. Peikes, et al. AHRQ Publication. February, 2012.

5. Education – the Fourth Aim

6. Triple Aim and Adolescents Population Health Low Incidence of Injury, Systemic Illness Cost Timing and Place of Care Adolescent Patient Experience Quality Measures Access to Care Satisfaction with Care

7. Patient Experience - Quality Means of Measuring Quality of Adolescent Care: CHIPRA HEDIS Outcomes? Are Pediatric Quality Care Measures Too Stringent? Casciato, et al. JABFM, Sep-Oct 2012. Vol. 25 No. 5

8. Patient Experience - Satisfaction How do you measure patient satisfaction? Surveys? No-Shows? A Brief Instrument to Measure Patients’ Overall Satisfaction With Primary Care Physicians. Hojat, et al. Family Medicine. June, 2011. Vol. 43 No. 6.

9. Patient Experience - Access How can we improve access for pediatric patients? What are the impediments for Adolescent patients to visit their physician? Time? Money? Motivation?

10. Our Practice Center Albany Family Practice is an urban residency based practice in Albany, New York We are a private office, with an academic affiliation with Albany Medical College The site is home to a 6-6-6 Family Medicine Residency program

11. The Albany Family Medicine PCMH Transformation Initial Meetings, Team Development (September, 2010) Data Gathering, Meaningful Use Implementation (Ongoing, 2010-2011) Quality Improvement Project: Adolescent Well Visit (August, 2011)

12. Why Adolescent Well Visit? As a practice, we were doing worse than expected “Low Hanging Fruit” Achievable goal – required a two month intervention to significantly improve care

13. Adolescent Well Visit All patients identified who were 12-21 years old who had not been billed for a comprehensive well-care visit in the past year Note that all patients enrolled were members of either CDPHP or CDPHP/Select (managed Medicaid)

14. Adolescent Patient Recruitment Recruitment was performed by a Quality Enhancement Community Coordinator, employed by CDPHP The Quality Enhancement Community Coordinator greeted patients and provided a $25 gift card upon arrival for all eligible patients Eligible patients for reimbursement were those with CDPHP/Medicaid (CDPHP Select)

15. Staffing Four evening clinics were run during the month of August, 2011 The clinics were run from 5 to 8 pm on consecutive Wednesdays, following normal clinic closing hours Four residents staffed these clinics, with one attending physician to precept, and two MA’s to room patients, take vitals, give immunizations, etc.

16. Outreach (July, 2011): Patients were recruited by our embedded QECC Of the 83 patients identified on the gap list in July 2011, 62 patients were scheduled for visits during the August Evening sessions Of these 62 patients, 41 eventually completed their visits (66%). 31 gift cards were offered, and 20 were given during this period

17. Results for 2011 Total patients requiring visits: 210 Completed physicals: 127 (60%) 41 visits accomplished in August (32% of total for year) Patients still requiring visits: 83 Gift cards issued: 32 ($800)

18. Failure to Complete Visit Both cancellations and no-shows were issues during this project Of the 21 patients who did not complete visits, 5 called ahead to cancel 16 patients no-showed 11 patients who had been offered gift cards and scheduled appointments still no-showed

19. Residents and the AWV Project Residents were integral to this project, both as staff for the clinics, as well as learning about the Adolescent Well Visit

20. Lecture One hour lecture given by a Program Director at Noon Conference This didactic session was attended by all residents not on night float or Pediatrics service

21. One Year On: In 2012, we revisited this project and found the following: Our practice had 264 patients eligible for an AWC visit By the end of the year, 124 patients (47%) had completed such a visit 38 gift cards were given out ($950) for eligible patients

22. How did we do? Health of our Population – Outcomes not measured Cost Practice Expenditures Health Plan Expenditures Incentives & Labor Patient Experience: Satisfaction/Access Evening hours in the summer were good for adolescent patients Satisfaction was not directly measured during this project

23. Observations Percentage of AWVs increased through this month- long intervention, then decreased the next year. This intervention provided a valuable learning opportunity for residents, both didactically and practically. Quality improvement projects such as this have the potential to serve as the basis for a significant portion of the residency education of the future.

24. Sources Early Evaluations of the Medical Home: Building on a Promising Start. Peikes, et al. AHRQ Publication. February, 2012. The Children’s Health Insurance Program Reauthorization Act Quality Measures Initiatives: Moving Forward to Improve Measurement, Care, and Child and Adolescent Outcomes. Dougherty et al. Academic Pediatrics, 2011;11:S1-S10. Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data. Gold, et al. Pediatrics Vol 130, Number 1, July 2012 Are Pediatric Quality Care Measures Too Stringent? Casciato, et al. JABFM, September-October 2012 Vol. 25 No. 5

25. Sources, continued A Brief Instrument to Measure Patients’ Overall Satisfaction With Primary Care Physicians. Hojat, et al. Family Medicine. June, 2011. Vol. 43 No. 6.