1. Lessons Learned: PCMH and Value Based Payment
-Why we are on the journey
Texas Medical Home Summit Julie Schilz BSN MBA
April 5, 2018

2. PCMH-The Early Years Let’s Dive In

3. Why We Started…..
Primary care is critical to achieving the triple aim of promoting health, improving care, and reducing overall system costs.
Current visit-based fee-for-service system may not provide resources for comprehensive primary care.
A major barrier to transformation in practice is transformation in payment.
The definition of insanity is doing the same thing and expecting different results.
~ Albert Einstein

4. Enhanced Access to Comprehensive, Coordinated, Evidence-Based, Multidisciplinary Care

5. Collaboratively Developed Principles

6. The Payment Model

7. The Next Phase

8. Shift from Volume to Value Based Care
Volume Based
Value Based
Payment
Fee for Service
Performance Based
Incentives
Volume
Value
Focus
Acute Episodes
Planned Care Strategy
Patients
That’s not my
patient
We are responsible for all patients
Role of the Provider
Single Episode
Team Based Care
Information
Retrospective
Prospective

10. Planned Care Strategy Prepared Care Team Develop Strategy
Prepared Practice
Risk stratification for high-risk patients
Patient outreach plan
Evaluate member access to care for all visit types
Measure next available appointment
Nurse/MA
Annual screenings/HRAs
Standing orders
Patient flow optimization
Provider (MD/PA/NP)
Care Team
Set shared agenda for visit
Review chronic, preventive, acute care opportunities
Document burden of illness to highest degree of specificity
Create care plan using shared decision-making
Prepared Care Team
Structured pre-visit planning
Review clinical results, care gaps, chronic conditions
Medical Neighborhood (Co-located or referred)
Specialists
Behavioral Health
Dental/vision services
Hospitals
Pharmacy
Community resources
Social work
Home health
Complex case managers
Skilled nursing facilities
Other ancillary services
Care Plan Management/Coordination
Coach and Site Mgt. support
Implement plan
Assess barriers/Solutions
Support change
Gather Patient Experiences
Progress/symptom monitoring
Satisfaction
Self-efficacy
Follow-up
Test and referral tracking
Review/revise plan
Problem solve
Population Management
Registry/reporting
Annual visits
Ongoing outreach
Front Office
Explore appointment needs & preferences
Collect administrative information
Before the Visit
During
the Visit
After the Visit
Develop Strategy
Develop action plan that identifies team roles and responsibilities
Establish project timelines and milestones

11. Lessons Learned

12. Collaboration is Key
Enablement Services

13. Teamwork Makes the Dream Work

14. Checking the Box Doesn’t Work

15. Collaborative Learning Accelerates Improvements

16. You Can’t Bypass the “Hard” Stuff
Patient Engagement, Self Management Support, Leadership

17. Leadership Matters
Enablement Services

18. Documentation is Critical

19. Current State

23. Stay Focused

25. Questions