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OUR ROAD TO PCMH RECOGNITION

Learn how Baldwin Family Health Care achieved Patient-Centered Medical Home accreditation through strategic projects and dedicated leadership. Follow their transformation from 2011 to becoming a recognized PCMH facility. Discover their challenges, successes, and the road to NCQA submission. Explore their new structure and planning tools for quality improvement.

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OUR ROAD TO PCMH RECOGNITION

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  1. OUR ROAD TO PCMH RECOGNITION Baldwin Family Health Care

  2. Russ Kolski RN • Strategic Projects Director • Background in • Quality Management • Safety and Compliance • Accreditation (Joint Commission / AAAHC) • Given Medical Home Responsibility in July 2011 • PCMH Accreditation • Meaningful Use • Pay for Performance (Not my only role)

  3. Baldwin Family Health Care • Health Center since 1967 • Rural Area • Serve West Central Michigan • 5 Medical Locations • 3 Locations with Retail Pharmacies • 3 School Based Health Centers • 25,000 Annual Medical Visits • PCMH Status as of 2011 • AAAHC Recognized for PCMH • BCBS Recognized for PCMH at 2 of 5 locations

  4. Baldwin Family Health Care Dedicated Lead Selected June 2011 HRSA PCMH Demonstration September 2011 MiPCT / CMSDemonstration October 2011 Transition toOpen Access October 2011 Staff Training(Familiarization) November 2011 Trial Staff Huddles/Pre-plan November 2011 LEAN EventStaff Work Flow November 2011 First Site LiveNextGen EHR December 2011 Submitted MU Year 1 January 2012 MiPCT CaseManagers Hired January 2012 ImplementedQuality Dept. January 2012 PCMHSteering Comm. October 2011 PCMH Weekly Workgroup August 2012 EducationMU Stage 2 April 2012 Hired AddedQuality Staff May 2012 Last Site LiveNextGen EHR June 2012 Referral TrackingMoved to Registry July 2012 HRSA QualityFunding September 2012 Report DevelopmentRegistry Enhancement Oct. 2012 – Feb. 2013 Annual TrainingPCMH Module November 2012 Participationin ACO February 2013 NCQA PCMHSubmission Pt.1 June 2013 NCQA PCMHSubmission Pt. 2 December 2013 Implemented i2i Tracks Registry January 2012 Pre-Visit Planning for All Patients March 2012 Road to NCQA PCMHStarted 2011

  5. “If we keep doing what we are doing, we will keep getting what we got.” Yogi Berra

  6. Personal PCMH Learning • Limited Understanding at Start • Attended PCMH Seminars • Local PHO • Michigan State Medical Society • Obtained Chronic Care Professional Certification • Reading • LEAN – Toyota Production System • TransforMed • IHI • PATH

  7. Internal Planning • EHR Transition (1st site live 12/2011 – last 6/2012) • Provider Coordinating Committee • Transition Committee • Established PCMH Steering Committee • Education at all levels • Visit Workflow Re-design • Transition from Acute Care to Preventative / Wellness Based Care • Match pre-EHR Provider Productivity • Integrate PCMH Elements into Standard Work

  8. Steering Committee Membership • CEO (Ex-Officio) • PCMH Lead • Quality Manager • Chief Medical Officer • Physician Lead for EHR • Mid-level Provider • COO / Privacy Officer • Site Facility Manager • Finance Representative • Dental Representative* • Behavioral Health*

  9. “Every system is perfectly designed to get the results it gets.” Paul B. Batalden MD Co-founder Institute for Healthcare Improvement Founding Director Center for Healthcare Improvement and Leadership – The Dartmouth Institute

  10. New Structure • Eliminate Medical Support Specialist Role at 5 sites • Former Diabetes Registry Coordination (Old PECS System) • Centralize Registry Function within Quality Department • Added Quality Department Staff • PCMH Registry Specialist – May 2012 • PCMH Report Generator – May 2012 • Care Managers for 2 locations (MiPCT) – January 2012 • CMS Muliti-payer Demonstration Project • Create PCMH Lead at each site – May 2012 • Additional responsibility for selected staff member

  11. Planning Tools • Annual Performance Improvement Plan • Schedule of Activities • Comparison of Clinical Quality Measures for UDS/MU/PCMH/Pay for Performance Measures • Crosswalk between NCQA and BCBS PCMH Standards • Working examples will be shown at end of presentation

  12. Annual PI Plan Activity

  13. Activity Schedule

  14. Periodic Assessment - BCBS

  15. What Needs Measured?

  16. Goal Comparisons

  17. Periodic Assessment - NCQA

  18. NCQA Report Priorities

  19. Data Location and Reporting

  20. NCQA Reporting

  21. Evidenced Based Care - MQIC

  22. Protocol Creation / Modification

  23. Staff / Patient Tools • PCMH Brochure • Care Management / Self Management Documentation • Standardized Work Documentation • Staff Education Tools

  24. PCMH Brochure

  25. Care Planning

  26. Create Staff Documentation

  27. Success’ • NextGen EHR Implementation • i2i Tracks Registry Implementation • Centralized PCMH Functions • Mailings for all sites using fold and seal mailers • Report processing and distribution • One Time download of all immunization in State Immunization Registry (MCIR) to our EHR • PCMH Module in Annual Competency Training • Planning • Worked Smarter, not Harder • Made sure Measures met multiple goals

  28. Weak Areas (Failures) • Open Access Scheduling • Competing Priorities • Internal CAHPS Surveying • Costly • Time Consuming • Interfaces • MCIR Upload • Identification of Managed Care Population • 4 different attempts • Too Large – Wrong Measures – Too Small – Just Right • Provider Engagement • Competing Priorities (Productivity / EHR / PCMH)

  29. Pearls • Education • Leadership (Administration and Board) • Provider • Staff (Clinical and Support) • Change is Difficult • Changing to the Chronic Care Model is More Difficult than meeting the NCQA PCMH Standards • Staff and Providers do not want to give up the old way • Competing Priorities • Care Management Population Selection • What is your time frame to meet goal? – Work Backwards • What percent of your proposed patients are seen during that time? • Who will do Care Magement?

  30. Pearls • Registry • Data Validation • How will you measure various aspects of care? • Will your registry report on those items? • Success is tied to staff proficiency with EHR. • Standardize • What will be documented where? • Who will perform specific ongoing reporting tasks? • Adopt the “Everyone works to their highest level of licensure or training” philosophy. • Live the “Triple Aim” and immerse yourself in PCMH

  31. Pearls • Communication • Newsletters • Reference Materials for Staff • Investment • Financial (Registry / Licenses / Education / Staffing) • Staff Time (Education / New Tasks / Learning Curve) • Flexibility • Modify timeline as needed • Ask for help

  32. Success? • NCQA PCMH Designation at all 5 sites • Meaningful Use Payments for Stage 2 (2014) • Reporting • Valid Results • Available for all known measures • Trending data available • Improved Quality Scores • UDS • Pay for Performance Indicators – All Payers • Gain Sharing with our new ACO Initiative

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