Overview

PCMH Learning Community

Dec 6, 2011 Mazhar Shaik, Chief Clinical Officer

Lynda Meade, Program Manager

Agenda

• Why We are Doing it? How We are Doing it? What Does the PCMH Initiative Entail?

• Goals and Aspirations of This Collaborative • Features, Benefits and Value Proposition • Approach, Structure and Requirements • Tools and Resources • Q&A (MPCA/PCDC)

Why MPCA is Initiating the PCMH Learning Community?

Prioritization Grid of Health Center Areas of Need (Operations)

MPCA is responding to our stakeholders’ needs.

Preferred Methods of Learning

Again, MPCA is responding to stakeholders’ needs and preferences.

How Are We Doing It?

We are executing the PCMH initiative in partnership with a national expert agency. MPCA identified the national expert agency on PCMH through an evaluation process:

National Pool Finalists Winner

NCQA TransforMed PCDC

JACHO PCDC

AAAHC

TransforMed

PCDC

- Interview - Presentations - Proposal Evaluation - Reference Check

What Does the PCMH Program Entail? Goals and Aspirations:

This 12-month program, entitled the “PCMH Learning Community” will equip Health Centers with knowledge, tools, resources and one-on-one consultations to successfully: • Compile an NCQA PPC‐PCMH survey submission with the goal of obtaining PCMH recognition at a level appropriate for the organization • Collect and organize data for required Stage 1 MU objectives with the goal of attesting • Identify future areas for improvement that fully embody the principles behind PCMH and MU concepts

PCMH Learning Community Road Map

Understand

• The Regulations • The Objectives • The Measures • The Collaborative

Assess • PCMH Readiness • MU Readiness • The Gaps • The Organization

Decide

• Medicaid/Medicare • Level 1,2,3 • 2011, 2012 • The Collaborative

Map

• Join the Collaborative • Redesign • Collect and Organize • Attest and recognize

Features of This Collaborative

• Builds a learning community – brings together organizations committed to making improvements in care delivery

• Uses evidence-based best practices as framework for designing improvement at individual sites/practices

• Is an action-learning approach – you learn and do and learn…

• Change is specific, measureable and directly related to an improvement outcome

• Uses teams (in partnership with leaders) to learn, test and lead implementation of change improvement

• Builds in sustainability at all points • Coaching and technical assistance support (e.g., coaching

calls, webinars, on-site and virtual site visits) • Increases the degree of improvement achieved

Strengths of Learning Community

1. Cost-effective/scalability (leverage experts)

2. Activity (real world) focused

3. Leads to actionable work plan

4. Peer networking

5. High participant accountability

6. Action period reinforces learning

7. Supports self-paced learning

8. Allows for wider organizational participation

Benefits

Timeline flexibility/resource availability

One effort, two results (PCMH/MU)

Content value

Not a cookie cutter approach - we meet you where you are

CHC expertise

Build capability - preparing for future stages of PCMH and MU

Benefits …

MPCA has high knowledge of CHCs, has established working relationships with CHCs

MPCA is a trusted partner of Michigan CHCs

PCDC trusted consultant to the Primary Care Community

PCDC reputation with collaborative assistance for over 400 locations

MPCA/PCDC have the capacity and capability to do this work

Dollar savings $20,000 - $25, 000 per CHC

PCDC: A Learning Community

Partner

December 6, 2011 Peter Cucchiara, BSMIS ,MBA, Managing Director

Deborah Johnson Ingram, Sr. Program Manager

PCDC Background

Manual

Funded by New York Community Trust

Released 11/09 “Comprehensive “How To”

10,000 Downloads

Presentations

At more than 20 conferences, forums, webinars

Several 1-2 day training sessions

Focus on rationale, standards and process

PCMH/MU

Collab.

Partnered with CHCANYS (NY PCA)

12 CHC in Wave 1; Planning Wave 2

Focus on achieving two results in one effort

Technical

Assistance

Redesign Faciliation

Project Management Coaching

Consulting toward HH recognition and MU certification

A Sample of Significant PCDC Activities

PCMH/MU CHCANYS/PCDC Collaborative

• Access CHC

• Basics/Promesa Systems Inc

• Bronx Lebanon Hospital

• Brooklyn Plaza Medical Center

• Charles B. Wang CHC

• East Harlem Council for Human Servics Inc.

• Joseph P. Addabbo FHC

• Morris Heights Health Center

• Pediatrics 2000

• Settlement Health

• Soundview Healthcare Network

PCMH Assessment/Facilitation Services

• Bassett Healthcare Network

• Lutheran Family Health Center

• Maimonides Medical Center – ICL

• Montefiore Community Pediatrics Program

• Montefiore Medical Group

• St. Barnabas Ambulatory Care Clinics

• Stepping Stone Pediatrics

• Bedford Stuyvesant FHC (Emblem)

• Primary Medical Care – PC (Emblem)

• SL Quality Care DTC (Emblem)

• Fort Drum Region Health Planning Org.

PCMH/MU Training/Educational Sessions for PCAs • Alabama Primary Health Care Association • Alaska Primary Care Association, Inc. • Bi-State Primary Care Association (Vermont & New Hampshire) • California Primary Care Association (120 Centers) • Community Health Care Association of the Dakotas • Michigan PCA • Wisconsin Primary Health Care Association (April 2011) • CTPCA • OKPCA • SCPCA

PCDC Partners with PCA’s

10%

94%

% of NYS Practices PCDC Assisted with PCMH Recognition as of 12/2011

PCDC

NYS

75

739

3.0%

97.0%

% of U.S. Practices PCDC Assisted with PCMH Recognition as of 10/2011

PCDC

USA

Value Proposition Considerations

Average Cost of Two Day Conference $3,000

Average Cost EMR 2 day education $1,500

Average Cost for HIT 2 day education $1,500

NCQA PCMH Training 1 ½ day $1,000

Plus Travel Expenses $3,000

Total Range $4500 - $6000

PCMH MU Collaborative

4 Learning Sessions (4 days)

12 Webinars

Weekly T/A Coaching for PCC

Weekly T/A Coaching for PCA

Other:

Webinars

Webinettes

Sharepoint

Tools

Resources

Total Price for 12 month package $5,000

Value Proposition Considerations

What Comes With your HRSA 35K

Going it alone yields:

• A link to tools and resources from NCQA

• The challenge to stretch your 35K to gain NCQA submission/recognition – Hire a private consultant (>

$30,000.00) not including in kind cost

– Send staff to NCQA training (1.5 day training w/ travel and hotel >$1700.00) not including in kind cost

Joining the MPCA collaborative yields:

• 12 months of direct/ indirect consultant services from industry experts

• Guided process to getting a submission completed in projected time frame

• Projections of ROI (inclusive of in-kind costs*)

Value Proposition Considerations

Medicaid FFS 10,000 Medicaid FFS visits/year Level 1: 10,000 * $ 5.50 = $ 55,000/year Level 2: 10,000 * $11.25 = $112,500/year Level 3: 10,000 * $16.75 = $167,500/year Medicaid Managed Care (PMPM) 3,000 Medicaid Managed Care patients Level 1: 3,000 * $2 * 12 months = $ 72,000/year Level 2: 3,000 * $4 * 12 months = $144,000/year Level 3: 3,000 * $6 * 12 months = $216,000/year

• Practice with 10 providers that sees 10,000 Medicaid managed care patients per year and achieves level 3 PCMH and MU Stage 1 by 2011 could generate by 2015 a total of:

– MU

• $63,750/EP/five years X 10 MDs = $ 630,750

– PCMH

• L3: 10k pts X $6/Pt/yr = $720,000/year X 5yrs = $3,600,000

Projected 5 Year Total = $4,230,750

PCDC Approach

Guiding Principles

1 2

Map – see the path before we walk it

Balance – test/principles

Measure twice cut once

Three work strands as one

Decision Catalogue

Teams & Collaboration

Focuses on system design as source of results Redesign of specific system elements for desired results and outcomes

Client needs through use of a targeted, results- and outcomes-focused assessment (combination of data, interviews, observations and organizational strategic goals)

data and observations key opportunities for change

Develop an implementation plan focused on redesign for high impact results and sustainable changes

Integrated

Approach

Understanding

Synthesize

Identify

Implementation

supports implementation to enable effective, sustainable changes in operations and results.

Training Coaching

Our Traditional Approach

Knowledge & Skills Trusted Colleague Protected Time

The Messages The Audience

The Team

Decisions

Communications

Detailed

Assessments

Outlining Plan, Resources, Timeline Managing the Plan and by the Plan Making the Adjustments

Workplan

Assessing Scope & Capacity Getting Organizational Backing

Assessments – evaluating readiness/capability

Defining gaps

Optimization

Work Area Considerations

100% of MU is incorporated into PCMH but

Only 44% of PCMH is met by MU and You only get 1 must pass element out of 6

When choosing 6 MU clinical measures

…align them with the 3 diagnostic

conditions you selected for PCMH and

your UDS clinical measures

PCMH/MU Overlap Summary

MU objectives fall in All 6 standards 12 of the 27 elements 34 of the 149 factors In several cases, multiple PCMH factors relate to 1 MU objective E.g., MU C8 incorporates 5 PCMH factors

1

2

3

Structure

Le

arn

in

g E

ve

nts

Theme

Objectives

Core Concepts/Topics

Activities

Tools

Resources

Delivery Methods

Ac

tivity P

erio

ds

Objectives

Activities (Based on Topics)

Progress Monitoring

Work Tools

Work Aids/Resources

Phase 1: Pre- Work (October December 2011-January 2011) The first phase of the project called “pre-work” will place strong emphasis on completing assessments of each of the 18 practices. Using several of PCDC’s tools from its 2009 publication Obtaining Patient-Centered Medical Home: A How-To Manual, and other tools. Practices will conduct comprehensive practice profiles and self-assessments to provide understanding of their operational and technological capacity as it relates to the four clinical interventions. PCDC will analyze the data from these assessments and earlier data, as well as conduct an on-site visit to each practice, to produce gap analyses and generalized project work plans. This phase will include a number of webinars and virtual meetings to orient practices to the goals of the collaborative and to use assessment and profile tools effectively. This pre-work phase takes a blended approach of using site visits and virtual coaching to establish and reinforce the coach/practice relationship.

Objectives Topics/Activities Tools/Resources Recommended Delivery Methods

Introduction and overview of the Learning Collaborative model and curriculum.

Identify and evaluate each practice’s operational and technological strengths and gaps related to the four clinical interventions

Identify change/process management steps that need to be taken in order to ensure successful adoption of performance improvement practices

Leadership Orientation (PCDC/ Practice Team Leaders)

Completing “practice profile”

Selecting a team Kickoff (PCDC/ Practice Teams)

Introduction to CCBC four clinical interventions

Preliminary exploration of goals and measures

Organizational Impact Review Pre-Training

Introduction to PCDC’s PCMH 2011 Self-Assessment Tool

On-Site Visits (PCDC Coach)

Review results and deliver feedback of practice profile and self-assessment

Identify practice goals and units of measure for CCBC clinical quality measures

Design general project workplan (to be expanded and customized in Learning Session 1)

Additional activities (for each site):

Collect baseline data and assess practice capabilities

Assess ability to collect data, run reports, use registries and current care management capabilities

Identify current staff/clinical team member composition

Collect and review any prior assessment data

Evaluate level of technical assistance required

1. PCDC Practice Profile:

a. PCDC PCMH 2011 Self-Assessment: focus on standards directly related to the four interventions (e.g. Standard 2 Element D “using data for Population Management)

b. Depth of PCMH review c. Post-recognition dashboard

2. Team Selection Grid 3. Team Selection Toolkit 4. EMR Assessment Tool to identify

Clinical Decision Support, Health Information Exchange, e-prescribing and reporting capabilities

Webinars – pre training

Site Visits

Recorded Webinars and Webinettes

Conference calls

Virtual weekly meetings with PCDC coaches via Webex, conference call, video conference, etc.

Case Studies

Simulations

Estimated T/A time allocation: 5 hours per practice, per week

Tools and Resources

1 – Pre Work Tools

2 – Webinars & Webinettes

3 - Reference

Team Chart and Team Development Template PCMH Assessment, Gap Analysis Template Workplan Development Template Communications Campaign Outline

Beginning your Team Journey Webinettes for Every Standard Meaningful Use/PCMH FAQ

Manuals – PCMH, CDSS MU/PCMH Vendor Guide Vendor Inquiry

Sample Resource Inventory

Peter Cucchiara BSMIS, MBA Managing Director Performance Improvement

22 Cortlandt St. New York, NY 10007 212-437-3921 pcucchiara@pcdc.org

Deborah Johnson Ingram Senior Program Manager

22 Cortlandt St. New York, NY 10007 212-437-3935 Djingram@pcdc.org

Questions? More information and to access

information, resources and tools:

www.mpca.net/PCMH Mazhar Shaik, Chief Clinical Officer mshaik@mpca.net 517.827.0487 Lynda Meade, Program Manager lmeade@mpca.net 517.827.0470