1. Practice facilitation as a strategy to spread the adoption of PCMH
Background, Approach, Learnings
Jean D'Aversa RN, BSN, PCMH CCE
Nancy Gratz, MPA, PCMH CCE
Denise Woodworth, MBA, CHI, PCMH CCE

2. Objectives Practice Facilitation - PCMH
Understand the tools utilized to create an administrative and organizational infrastructure.
Describe approaches utilized by the coaches to implement change within the practices.
Explain the benefits of using practice facilitators.

4. Transformation Timeline
2008
Primary Care Practice Assessment (IM, FM, Peds, OB)
2009
PA Collaborative (7 practices)
Population registries created
8 practices NCQA 2008
2010
Additional 20 practices- LVHN Collaborative
Reimbursement by self- insurer
2011
PCMH Charter
2012
Primary Care Practice Assessment 2
NCQA Facilitators
Community Care Teams
2013
8 NCQA re-recognized, 4 new
Retreat and Strategize
BLT Series
2014
Facilitator’s Content Expert Certification
6 practices seeking NCQA
2015
Multisite

5. Practice Change Facilitation Approaches
Collaborative learning cohorts
Resource sharing – across practices
Technology and communication infrastructures
Practice assessments
Teambuilding
Quality Improvement and change intervention

6. Practice Change Support
Customized/Adaptive
Common Target: “PCMH Recognition”
Facilitate Teams, Tools, Techniques, Stages of Change
Outcome: Improve Practice Capacity

7. Quality Improvement in the PCMH
Systemic
Data / Metrics
Identify Opportunities
Team creates and communicates plan
Implement
Measure and Communicate Performance

8. Technology, Technology and Facilitation
Electronic Medical Record
≠ all practices need
Technological Skills
═ needed in PCMH
Registries; manipulating data
Using Excel software – who are the patients of focus
Demographics (LVPG Informatics)
Meaningful use reports (LVHN IT)
Print Screens
Go To Meeting – use current capability
Storing documentation in one place
SharePoint lending library

9. Collecting examples for all to use
Naming Conventions

10. What support can Facilitators provide
What support can Facilitators provide? Who in the practice – hidden capacity?
NCQA Account and Survey Tool Management
Complexity of NCQA technology
Uploading proof
Administrative support to all practices
Business Associate Agreements, discounts, payments
Primary Contact for communication with NCQA
Find practice tech resource
Coach practice –how to use technology in patient care

11. Clinical Readiness/Capacity
Six NCQA PCMH Standards 1. Enhance Access and Continuity 2. Identify and Manage Patient Populations 3. Plan and Manage Care 4. Provide self-care support and Community Resources 5. Track and Coordinate Care 6. Measure and Improve Performance

12. Clinical Concepts Working in teams on patient panels
Managing transitions throughout continuum
Patients as partners in their care
Proactive, not reactive
Monitoring against your own standards
Closing the loop
Prioritization/ Registries
Is it documented???

13. Summary Share of ideas “best practices” across practices
Brought out collaboration and healthy competition
Seek dedicated time and space
Highlighted need to commit to focus on PCMH transformation
NCQA – useful roadmap and dialogue starting tool
Team building a focus
Quality Improvement – teach processes
Growth of people in practice – technology and knowledge of proactive care with learned tools
Standardized template create and used

14. NCQA Outcomes 8 practices re-recognized in 2013
Internal Medicine, Family Medicine, Pediatrics
Some residency practices
All achieved Level 2 or Level 3
3 practices initial recognition in 2013
Achieved Level 2 or Level 3
6 practices in progress 2014
Goal to move to multisite approach 2015

15. Facilitators’ Recommendations
Discovering mix of skill sets needed to transform to a PCMH
Modeling best practices as Facilitator Team
Seeking out the hidden skills in a Practice
Finding Team Building opportunities
Coaching and positive reinforcement needed at practices
Meeting the practice “where they’re at”
Looking to future – challenges
Achieve sustainability!
Evolving to multi-site approach as one means of addressing resource constraints

16. Acknowledgements Lehigh Valley Physician Hospital Organization
Lehigh Valley Health Network (LVHN)
Care Continuum Leadership
Department of Family Medicine
MATRIX Center for Interprofessional Collaboration
Clinical Informatics
Nyann Biery, Manager of Program Evaluation, LVHN Department of Family Medicine

17. Contact Information:
Jean D’Aversa
Nancy Gratz
Denise Woodworth