Rural Health Webinar: S trengthening H ealth S ystems in Resource-limited S ettings

1. Rural Health Webinar:Strengthening Health Systems in Resource-limited Settings R.W. Watkins, MD, MPH, FAAFP Institute for Emerging Issues (IEI) at NC State University and Duke University 9 April 2014

4. What is the Multi-Payer Demo? • The purpose of the Multi-Payer Advanced Primary Care Practice “demonstration project” (MAPCP) is: • To evaluate the effectiveness of the Patient Centered Medical Home (PCMH) model, when supported by both public (Medicaid and Medicare) and private payers (Blue Cross Blue Shield, and State Health Plan) • To utilize care management for these other payer sources

5. What is the Multi-Payer Demo? • NC is one of 8 states that was awarded an MAPCP demo • 7 rural counties across NC were chosen to participate in the demo: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga

6. Patient-Centered Medical Home The PCMH is a model of primary care re-designintended to improve the quality and efficiency of primary care delivery

7. What we have… What we need!! AtulGawande, MD

8. Benefits of the PCMH Model Quality – Outcomes for seven medical home demonstrations • Fewer ER visits (15%-50%) • Fewer hospital admissions (6-24%) • Lower mortality rates • Better preventive service delivery • Better chronic disease care • Higher patient satisfaction Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013, January 2014

9. Benefits of the PCMH Model Efficiency – Cost • Lower total costs of care - (6.5-22%) • Shorter patient wait times • Less staff burnout/turnover (10% Vs. 30%) • Higher staff satisfaction/productivity Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013, January 2014

10. This is a No-Brainer! Right? • So Why Aren’t Practices RUNNING to implement PCMHfor themselves?!? • Time • Resources • Consultants are expensive • Fear • Gov’t interference • Loss of control/independence • Change

11. How Do You Get All This Done?

12. ASU Practicum in Primary Care ASU College of Health Science, School of Healthcare Management

13. Watkins. Journal of MedicalPractice Management, Sept/Oct 2012, Vol 28:2, pp. 134-6.

14. Creation of Partnership with Appalachian State University PARTNERSHIP: • RecruitASU students from School of Health Care Management • Developcurriculum, syllabus, website, core documents • Createnew practicum course with internship opportunity • Teach students about PCMH, Provider Portal, Care management process • Send students out to practices to assist in attaining PCMH certification, BQPP cert and QI initiatives

15. ASU Practicum in Primary Care • Fall of 2011 – 5 students • Spring 2012 – 9 students – BSBSNC Foundation Grant Obtained • Summer 2012 internship – 8 students • Fall 2012 – 14 students • Spring 2013 – 15 students • Fall 2013 – 16 students • Spring 2014 – 15 students

16. ASU Practicum in Primary Care • Developed curriculum, core documents, website https://sites.google.com/site/pcmhprac/

17. Program Growth • ASU School of Health Care Management has made the “Practicum in Primary Care” a COREcurriculum class • Students willing to spend 2 semesters with us get full credit for their internship (300 hours) • “Keeping the Medical Home Fires Burning” is a new initiative where practices that have been recognized work with students on QI projects

19. Program Growth • Remote Learning Initiative • Students work with practices within 3 hours of Boone • MOVI (secure) web-hosting • Face-to-face visits every 3 weeks or so

21. CCNC’s PCMH Efforts Beginning of MP Project Beginning of MP Project

22. Rural Health Webinar:Strengthening Health Systems in Resource-limited Settings R.W. Watkins, MD, MPH, FAAFP Institute for Emerging Issues (IEI) at NC State University and Duke University 9 April 2014