THE EVER EVOLVING PATIENT CENTERED MEDICAL HOMEKathy Willis, MD

Jay Besse

WHAT IS THE PCMH?

Medical Home is not a place, but rather a theory and model for providing comprehensive primary care.

It creates and encourages partnerships between health care providers/teams and individual patients—and sometimes the patient’s significant others.

LSU HISTORY

HERE

NCQA PPC-PCMHJOINT PRINCIPLES

Personal physician Physician directed medical practice

Team of individuals who collectively take responsibility for ongoing care

Whole person orientation Personal physician takes responsibility for all

the patient’s health care needs

NCQA PPC-PCMHSTANDARDS

Standard

1. Access and Communication

2. Patient Tracking & Registry Functions

3. Care Management

4. Patient Self-Management Support

5. Electronic Prescribing

6. Test Tracking

7. Referral Tracking

8. Performance Reporting and Improvement

9. Advanced Electronic Communications

CONTINUING THE LSU MEDICAL HOME

Accountable Care Organization agreement Representatives from our partners will work

with us Important that a consistent concept is

maintained across the LSU Medical Home locations

CONTINUING THE LSU MEDICAL HOME

Same patients Same providers Same staff Same program Same dedication

WHAT DO WE NEED TO DO NOW?

Address the challenges to meeting the NCQA requirements

Formalizing the requirements of the LSU Medical Home

Identify and adapt to system changes

DEFINING THE LSU MEDICAL HOME STANDARDS

Two Perspectives Providers

What do we expect from the patients? What things should we are providers do to improve the

patients experience? What do we expect from our staff in the Medical

Home? Patients

What should a patient expect as a member of the LSU Medical Home?

Comprehensive Multi-Domain Flexible

LSU MEDICAL HOME MEASUREMENT DOMAINS

ACCESS PROCESS SCREENING & PREVENTION OUTCOMES PERCEPTION & SATISFACTION

DOMAIN 1: ACCESS

Appointment Show Rate Median Days to Appointment Referrals * Telephone Follow-up * Assessing Electronic Access to patient

records *

* In Development

DOMAIN 2: PROCESS

Documentation Blood Pressure Weight Height Smoking Status

Primary Care/Medical Home Verification Verify patient-provider relationship

Medication Reconciliation

47117734

3894

6931

6906

68164662 41654

.65

.7

.75

.8

.85

.9

.95

1

BMC

EKLLA

KLJ

CM

CLUM

CW

OM_T

OT

SITES over QUARTERSGraph uses data from quarters 200901 through 201301

documentation: PP, fraction with blood pressure documenteddenom: MHCD patients in qrt

DOMAIN 3: SCREENING & PREVENTION Cancer Screening

Breast – Mammogram in past 2 years, age 40-75 Cervical – PAP test in past 3 years, age 21-65 Prostate – PSA or PSA education in the past 2 years, age 50-75 Colorectal – Colonoscopy in past 10 yrs, Flex Sig in past 5 years, or

FOBT in past year Tobacco Cessation Depression Screening Lipid Assessment

Lipid Profile in the past 2 years Lipid Profile in the past 3 years

Routine Flu Immunization Current flu shot

Pneumococcal Vaccination Pneumovax administered ever

Abdominal Aortic Aneurysm (AAA) Screening *

* In Development

DOMAIN 4: OUTCOMES

Blood Pressure Control Last BP > 140/90 mmHg Sustained BP > 140/90 mmHg

Lipid Management Most recent LDL < 100 Composite Lipid management

LDL <130, HDL>50, Trig <200

Smoking Quit Rate

5654

9449

4939

9435

7088 8574

6626

51765

.2

.25

.3

.35

.4

.45

.5

BMC

EKLLA

KLJ

CM

CLUM

CW

OM_T

OT

SITES over QUARTERSGraph uses data from quarters 200901 through 201301AWARD criterion = 0.27, see line on graph

wellness: Last BP > 140/90, Total [R]denom: MedHmCD sustained 6/12

DOMAIN 5: PERCEPTIONS & SATISFACTION

Pre-Visit Medical Home Perceptions

Post-Visit Medical Home Satisfaction

PATIENT PERCEPTIONS

Focuses on capturing patient responses to domain related questions

Multiple Versions Constant

Refinement Will identify areas

for focus by the Medical Home

PERCEPTION RESULTS

3. Short wait to see doc

2. Easy to get appt

4. Helps me reach goals

1. Clinic communication

5. Follows up with test results

12. Easy to get care when needed

11. Friendly and helpful

7. Teaches me about health

10. Gets screenings done

8. Educates about meds

9. Assesses affordability

14. Overall satisfaction

6. Staff concerned with quality

15. Willing to recommend

13. Overall quality rating

3.3

3.4

3.5

3.6

3.7

3.8

3.9 4

4.1

4.2

4.3

4.4

4.5

4.6

4.7

4.8

4.9 5

Response Levels

Showing Highest and Lowest Clinic LevelsSurvey Results

Line connects overall system levels. Dots are LAK_NEW CLINIC valuesGraph includes data from quarter 201104 to 201202Samplesize in range (103;117) - average : 110

PATIENT SATISFACTION

Will align with Medical Home domains Focused on quick feedback to improve the

patient experience Will validate if improvements made through

improved patient perceptions have improved patient satisfaction

WHY MEASURE THE MEDICAL HOME?

The Medical Home is fluid and requires constant review and refinement. There is no one model that fits the patient population, therefore, measurement helps to identify areas for improvement and action.

GOALS FOR THE LSU MEDICAL HOME

Continued measure development through data dissemination

Identify areas for improvement Participation in Medical Home-related

improvement projects*

LSU ICON - MEDICAL HOME INTEREST GROUP

Identifying areas of improvement to assist with meeting or exceeding the defined NCQA standards

Assist with the refinement of the currently identified measure set

THANKS TO THE MH STANDARDS SUBCOMMITTEE

Kathy Willis, MD Karen Applewhite, RN Tena Turnage, RN Pam Wright, RN Jay Besse Kris Like, RN Julie Nevers, RN Mary K Blackburn, RN

THANKS