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Karen DeSalvo, MD, MPH, MSc Tulane University Chair, Medical Home Committee

Karen DeSalvo, MD, MPH, MSc Tulane University Chair, Medical Home Committee. Four Critical Questions. Why does the Patient-Centered Medical Home matter for Louisiana? What demonstrations are underway? What is on the horizon?. Critical Questions.

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Karen DeSalvo, MD, MPH, MSc Tulane University Chair, Medical Home Committee

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  1. Karen DeSalvo, MD, MPH, MSc Tulane University Chair, Medical Home Committee

  2. Four Critical Questions • Why does the Patient-Centered Medical Home matter for Louisiana? • What demonstrations are underway? • What is on the horizon?

  3. Critical Questions • Why does the Patient-Centered Medical Home matter for Louisiana? • What demonstrations are underway? • What is on the horizon?

  4. Baicker and Chandra, Health Affairs, 2004.

  5. Quality & Spending in Louisiana Source: Health Dialog, 2007; Data from 2005; www.lhcqf.org Higher costs do not appear to correlate with low gap scores (high quality) “Gap” scores represent aggregation of quality metrics, lower gap score=higher quality Diamonds represent Louisiana Hospital Services Areas (HSAs) with ≥ 10,000 people *Chronics: CHF, COPD Diabetes, Asthma, CAD

  6. Lack of Primary Care Providers 7 Baicker and Chandra, Health Affairs, 2004

  7. Our Opportunity from Tragedy Source: nola.com

  8. Redesign Collaborative Redesign Priority Louisiana Recovery Authority Public Health and Healthcare Task Force Bring New Orleans Back Commission Patients First “Framework” Group Louisiana Hospital Association Governor’s Health Reform Panel (Pre-Katrina) Louisiana Healthcare Redesign 05 10/05 11/05 1/06 7/06 DeSalvo, ASIM, July/August 2006

  9. Major Reform Recommendations • LA Health Care Redesign Collaborative • Expanding choice and access Connector/Medicaid • Supporting care health information technology • Ensuring quality Louisiana Quality Forum • Improving delivery  Focus on Primary Care October 2006, http://www.dhh.louisiana.gov/offices/?ID=288

  10. Major Reform Progress • LA Health Care Redesign Collaborative • Expanding choice and access Connector/Medicaid • Supporting care health information technology • Ensuring quality Louisiana Quality Forum • Improving delivery  Focus on Medical Home October 2006, http://www.dhh.louisiana.gov/offices/?ID=288

  11. Redesign Collaborative Redesign Priority Louisiana Recovery Authority Public Health and Healthcare Task Force Bring New Orleans Back Commission Patients First “Framework” Group Louisiana Hospital Association Louisiana Healthcare Redesign Health Care Quality Forum 10/05 11/05 1/06 7/06 7/07 DeSalvo, ASIM, July/August 2006

  12. Medical Home Committee Convene the state’s major healthcare stakeholders…for the purpose of developing and accelerating the adoption of standard components and criteria for the delivery of health care services via the patient-centered medical home

  13. LA Medical Home Committee • 15 committee members • Broad-based and balanced representation • Across the state, rural and urban providers • Skills or experience in one or more of the following categories: • Operational and Clinical Requirements • Practice Management • Consumer/Patient Advocacy • Quality Measurement and Evaluation • Quality Improvement • Policy and Legal Affairs • Payers (Medicaid, Medicare, Private)

  14. MHC Strategic Goals • Implement Patient-Centered Medical Home • Learning collaborative • Shape the Medical Home Systems of Care • Implement Medical Home Systems of Care demonstrations • Begin an environmental scan of potential barriers to implementation of the patient centered medical home and medical home system of care in Louisiana

  15. Medical Home in Louisiana Louisiana has embraced the national definition of a medical home Joint Principles NCQA criteria

  16. Critical Questions • Why does the Patient-Centered Medical Home matter for Louisiana? • What demonstrations are underway? • What is on the horizon?

  17. LA Medical Home Projects • Rural initiative in North Louisiana • Franciscan Missionaries of Our Lady • New Orleans • Medicaid Provider Service Networks

  18. Board of the Medical Home Task Force in Region VII • Implement NCQA guidelines at local clinics • David Raines Community Health Center • North Caddo Medical Center • Christus Schumpert • Coushatta • Plain Dealing • Martin Luther King Health Center • Pool of Siloam Medical Ministry and Free Clinic • Funded through HHS • Evaluation • Implementation of EHR, NCQA certification • School performance

  19. Franciscan Missionaries of Our Lady Health System • Non-profit statewide organization • Focus on St. Bernard Parish • Model • Franciscan Quality Trustee • the Medical Home • a Defined Population • Internal funding with discussions to expand www.fmolhs.org

  20. Primary Care Access Stabilization Grant • Build upon chassis of temporary care sites still active since recovery • Philanthropy has allowed flexible structure of care • Team care, Information technology, mental health • Post-Katrina assistance • Congressional hearing • $100 million from HHS in 5/07 • Build provider network of neighborhood based care • Pay for performance for medical home certification

  21. PCASG Grantee Meeting January 17, 2008

  22. Tulane Community Health Center at Covenant House – from ice chest to medical home

  23. Results to date *Kaiser Family Foundation, 2008; www.pcasg.org; • 17 funded primary care entities working together • Build fabric of the new system in New Orleans • Wide range in scope and size • Some advancing in to medical homes • 80,000 people served – increase in 10% of those served • $43 million distributed • 12 of 17 organizations working towards MH certification • 21% increase in citizens with “usual source of care” other than emergency rooms in past 2 years*

  24. Medicaid Medical Home • Louisiana Health Care Reform Act 2007 • Called for Louisiana Health First • “The medical home system of care shall incorporate the use of health information technology and quality measures to facilitate a safe, patient-centered, quality driven, evidence-based, accessible, and sustainable health care system to Medicaid recipients and low-income uninsured citizens.”

  25. Provider Service Network • = Medical Home System of Care • At least 25% ownership by a hospital and/or provider group • Pilot in 4 regions of the state • Mandatory enrollment • Potential coverage expansion • Medicaid and connector • All providers must move towards NCQA certification as a medical home

  26. Medical Home System of Care SPECIALIST SERVICES EHR PATIENT- CENTERED MEDICAL HOME ALL CITIZENS EHR ACUTE HOSPITAL EHR Referral as Medically Necessary Care Coordination Other Health care Providers & Extension Services SPECIALIZED MEDICAL HOME Services for Individuals with Complex Chronic Illnesses or at the End of Life EHR Adapted from the LHCRC, October 2006

  27. Medical Home Implementation in New Orleans • Build upon chassis of temporary care sites still active since recovery • Integrate mental services • Philanthropy has allowed flexible structure of care • Team care, Information technology, mental health • Advocacy win • Congressional hearing • $100 million from HHS (5/07) • Build provider network of neighborhood based care

  28. Results to date *Kaiser Family Foundation, 2008; www.pcasg.org; • 17 funded primary care entities working together • Build fabric of the new system in New Orleans • Wide range in scope and size • Some advancing in to medical homes • Highest density of certified medical homes in US • Winter 2009 • 21% increase in citizens with “usual source of care” other than emergency rooms in past 2 years*

  29. Critical Questions • Why does the Patient-Centered Medical Home matter for Louisiana? • What demonstrations are underway? • What is on the horizon?

  30. Health is More than Getting People to a Doctor 200,000 Households flooded. And the surrounding social infrastructure of churches…schools…friends…family... libraries…

  31. Social/Mental Determinants of Health The Hurricane Katrina Writing Group, JGIM, 2007; Grumbach, JAMA, 2002; DeSalvo, et al, J Urban Health, 2007; Kaiser Family Foundation, 2008. • Heavy burden of stress and mental health issues • 31% report mental health problems • 39% worse mental health since Katrina • 53% with higher general stress level • Increased PTSD associated with lack of adequate housing • Adjusted OR 2.0 (1.2-3.5) • Lack of social support associated with for cutting back on chronic care treatment • Adjusted OR 15.0 (3.8–59.4)

  32. Community Oriented Primary Care • Systematic approach to health care based upon: • Epidemiology • Primary care • Preventive medicine • Health promotion • Includes interventions for individuals and population at large • Providers play multiple roles • Community involvedin decisions Tollman, Soc Sci Med, 1991; Longlett, J Am Bd Fam Pract, 2001

  33. Neighborhood Centers

  34. Thank you.

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