1. Deizel Sarte, Chief Operations OfficerJune 24, 2015 ACA-PCMH-TBC and The Medical Assistant-Health Coach Initiative

2. Today’s Agenda NCHS-The Organization ACA: Affordable Care Act Where NCHS Fits in This Journey PCMH: Patient Centered Medical Home The Medical Assistant Health Coach Initiative

3. NCHS-The Organization Established in 1971 11 Sites Medical Dental WHS 59,262 Patients 16,194 New Patients in 2014 242,233 Visits All Primary Care Clinics NCQA PCMH Recognized at Level 3 since 2012

4. Historical Perspective

6. ACA PPACA: Patient Protection and Affordable Care Act Signed into law: March 23, 2010 EXPANDED COVERAGE Medi-Cal Expansion (Also known as Medicaid) Medi-Cal was expanded beginning January 2014. Medi-Cal became available to adults under 138% of the federal poverty level who are citizens or legal California residents for 5 or more years. For example, under 2011 FPL levels, a single individual making less than $1252 per month, or a couple making less than $1,691 per month, would be eligible.

7. NCHS At The Forefront Strategic Planning Process SWOT Analysis Internal and External Scan Board of Directors and the Executive Team Communicating the Plan Implementing the Plan

8. Patient Centered Medical Home What is PCMH? A PCMH facility is a health care setting that facilitates partnerships between individual patients, and their personal clinicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. There is a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams and coordinating and tracking care over time.

9. Patient Centered Medical Home PCMH Why PCMH? Health care quality and access are suboptimal, especially for minority and low-income groups Health care in the community is fragmented Poor health outcomes Increased costs Poor morale amongst primary care healthcare professionals Supports IHI’s Triple Aim

10. Medical Assistant Health Partners Initiative Received a grant from The California Endowment to establish a MA Health Coach Program Curriculum A collaborative between UCSD, FHCSD, NCHS and San Diego Mesa College Grant provided: Funding to create a Health Career Ladder Project Funding to create a community health workforce development partnership

11. Medical Assistant Health Partners Initiative Started in 2013 First year: 2 cohorts So far: 7 cohort 16 sessions Train the “Mentors” General Class 81 Medical Assistants graduated

12. Medical Assistant Health Partners Initiative The Curriculum: 8 week program with two 4 hour sessions per week taught by core instructor group Core instructor group comprised of RNs and health educators with expertise in area of focus Comprised of theoretical and clinical skills modules with focus on family medicine Available for review http://ca-hwi.org/http://ca-hwi.org/

13. Medical Assistant Graduates Considered a promotion Able to trigger “orders” from the “Pre-Visit Protocols” 40 year old female: Screening mammograms 50 year old: Colon cancer screening Establish a care plan with patients through motivational interviewing, teach back method, etc Provide health education from a structured program Reach out to patients from a disease based registry for coordination and follow ups

14. Loma Alta Implemented TBC Q4 2013 >> Q2 2014

15. Chronic Disease Management - Diabetes 2013 to 2015

16. Prevention Improvement Team Based Care Implemented in 2013 to Current

17. Questions and Discussion For details, please contact: Lisa McGerald, NCHS Director of Nursing Email: Lisa.McGerald@nchs-health.org