Question

What Makes a Patient-Centered Medical Home? No unread replies.No replies. Case prepared by Cynthia Sieck, Jennifer Hefner, and Ann McAlearney (Health Services Management, 11th Ed.: 2018) Introduction Crescent Medical Practice is a midsized primary care practice in the Midwest with approximately 17,000 patients. It has 10 full-time and 5 part-time practicing physicians, and its staff includes a practice manager, 2 administrative assistants, 16 medical assistants, 5 physician assistants, 6 registered nurses, a care manager, a social worker, and a part-time nutritionist. Crescent has been in existence since 2001. The practice implemented an electronic health record in existence in 2010 and a tethered patient portal (i.e., a patient portal connected to the EHR) in 2013. Since the introduction of the EHR and patient portal, providers and staff have become more comfortable with electronic documentation and communication. In addition, patients have expressed their appreciation for the convenience of scheduling appointments and communicating with their providers through the patient portal. This case examines Crescent's decision about whether to adopt a patient-centered medical home (PCMH) model of care. Before the Case Electronic health records introduced at Crescent (2010) Tethered patient portal introduced (2013) During the Case Jill Smith, practice manager at Crescent, charged with exploring transition to patient-centered medical home (PCMH) Jill forms Transition Management Committee Committee elects to hire a practice facilitator to guide the PCMH transition Practice facilitator delivers a report to the committee Administration of a patient survey about access to appointments Implementation of an increase in the number of same-day appointments Plan to enhance information technology capabilities to track patients and coordinate their care Development of a dashboard of metrics to compare practice performance to regional and national targets for use in tracking success of quality improvement projects Additional training to staff in health information technology capabilities Crescent considers starting a patient and family advisory group After the Case Crescent decides to pursue PCMH certification Medicare starts the Comprehensive Primary Care Plus program to provide financial incentives for practices to incorporate elements similar to the PCMH standards The Evidence for Becoming a Patient-Centered Medical Home The PCMH model represents a comprehensive team-based approach to care that focuses on providing the patient with "the right care, in the right amount, at the right time" (NCQA 2014). This approach emphasizes the critical role of primary care practices in transforming the US healthcare system. Crescent is considering becoming a PCMH, and it has learned of several incentives available to PCMH practices in the area that could help offset the cost of transition to a PCMH. Evidence suggests that the PCMH model can help engage patients and their families in the healthcare process, while also potentially improving healthcare quality and leading to cost savings (Higgins et al. 2014; Markovitz et al. 2015; NCQA 2017). In addition, the team based structure of a PCMH may lead to a greater employee satisfaction by encouraging all employees to practice at the top of their licenses and distributing care responsibilities across the team (Nielsen et al. 2012). However, for a PCMH to be effective, organizational process must be enhanced beyond just focusing on care coordination (McWilliams 2016). Jill Smith, practice manager at Crescent, is charged with exploring the requirements of transitioning to the PCMH model, and she beings by searching for as much information as she can find related to PCMH recognition. Jill quickly finds the the National Committee for Quality Assurance (NCQA), which recognizes PCMH practices, defines six standards that must be achieved for a practice to become a certified PCMH: Patient-centered access - Structures that meet patient needs during and after hours. Team-based care - Care organized to include all members and meet the cultural and linguistic needs of patients. Population health management - Use of data to improve the health of the population. Care management and support - Support for patients in management of their conditions through the use of evidence-based guidelines. Care coordination and care transitions - Coordination of tests, referrals, and points of transition in care. Performance measurement and quality improvement - Use of ongoing performance and experience data to guide quality improvement. Through her search, Jill learns that practices can receive NCQA recognition as a PCMH if they attain certain metrics within each of the these standards. She also learns the three levels of certification exist and that the timeline for achieving each can vary depending on existing practice elements and how long it takes to implement new elements. Level 1 certification, representing the most basic PCMH, allows both paper and electronic-based systems and stresses the importance of processes for documenting the services provided by the practice. Level 2 certification requires the the practice have some electronic means to document, plan, and coordinate care, but it does not require full electronic capabilities. Finally, Level 3 certification requires the use of an EHR for care and practice management: this level identifies the most advanced practices. As a physician-led practice, Crescent is eligible for recognition as a PCMH, but Jill notes the the practice must first meet certain requirements in specific areas. These areas include providing patient-centered appointment access, organizing team-based care, using data for population management, providing care planning and self-care support, and implementing continuous quality improvement. Throughout the process, Crescent will be required to provide data to NCQA to document its progress. Transitioning to a PCMH Model Upon learning how comprehensive the process of becoming and maintaining status as a PCMH will be for Crescent, Jill decides to convene a PCMH Transition Management Committee. She invites a lead physician, Dr. Beth Myers; one of the staff nurses Rachel Piccolo; and a care coordinator, Brian Williams, to join her committee. Collectively, the committee's role will be to provided overall direction for the process, to help staff understand the reasons for the transition and what each staff member can do in support of the effort, and to address additional practice needs identified through the transition process. During the Committee's first meeting, Jill explains to the group: "There is evidence that a new type of staff member, a practice facilitator, can assist practices with the transition to a PCMH and make the transition process more manageable. Lead physician Dr. Myers asks, 'What does that really mean? And how would that be helpful for us here at Crescent?" Jill replies: "Apparently practice facilitators can help a practice like ours to examine current clinical, business, and organizational practices and see where there might be gaps or opportunities for improvement. Practice facilitators have been through this before, so they know what data are most helpful to guide a practice's transition to a PCMH. For us at Crescent, this means we could learn about quality improvement methods that we could apply to improve how our practice runs. Also, a skilled practice facilitator can provide feedback and coaching throughout the transition process, so we would have a resource person w could turn to when we had questions." "That's all very well and good," notes Dr. Myers, "but how is Crescent supposed to pay for a new staff member? You know that we run on a tight budget, so it's not clear to me that brining in a fancy consultant is going to work for us." 'Yes, that's an important point, Beth," Jill acknowledges. "But what I've learned through investigating this process is that we don't have the capability to do this on our own. If we agree that pursuing a PCMH model is the right direction for Crescent, I'm going to need help to get us there." After more discussion, the members of the committee decide that the potential benefits of becoming a PCMH will be worth the investment in the services of a practice facilitator. Benefits include expert guidance and input from an external evaluator who can assess the status of Crescent relative to the PCMH standards and provide an action report. The home is that these benefits will speed the process of PCMH certification and save time and resources, this offsetting the cost of the facilitator. After reaching out to her colleagues, Jill is referred to Mara Thomas, a practice facilitator based in Washington, DC. After several conversations, Jill decides that Mara's approach is a good fit for Crescent, so they finalize a contract. Mara's first step is to learn about Crescent, so she requests that Jill send has as much background information as possible. Mara receives summaries of discussions related to the Crescent organizational structure and current clinical processes. She notes whom she would like to meet in person to learn more. Mara's next step is to visit Crescent so she can meet with stakeholders and observe how the practice is run. In a busy first visit, Mara meets with the Transition Management Committee, speaks with several physician members of the practice, and observes practice operations. She returns for a follow-up visit two weeks later for additional meetings and further observation. Based on her findings, Mara develops a feedback report identifying areas in which Crescent would need to consider changes to become a PCMH. Mara recommends that Jill share the report with the committee, adding that she would be happy to answer any questions that come up. A Year Down the Road Crescent decides to pursue certification as a PCMH, and a year later, it learns about a new program being implemented for Medicare patients. Called the Comprehensive Primary Care Plus (CPC+) program, the initiative offers additional incentives to practices that engage in efforts to transform care delivery in five areas: (1) access and continuity of care, (2) care management, (3) comprehensiveness ad coordination of care, (4) patient and caregiver engagement, and (5) planned care and population health. CPC+ provides reimbursement for care management, a performance-based incentive payment, and payment according to the Medicare Physician Fee Schedule, with an additional payment for practices that provide even more comprehensive care. Practices must apply to the program in one of two tracks that cover the five areas, with Track 2 addressing the area more comprehensively than Track 1. If selected, practices participate for a period of the five years (Centers for Medicare & Medicaid Services 2017). Please discuss any, or all, of the following questions:

Questions

(1) What areas of organizational design does Crescent need to take into consideration or change if it transitions to a PCMH model? How will new staff change the design?

(2) Crescent is considering the use of a patient and family advisory group to help it incorporate patient feedback into its transformation efforts. What other means of feedback could the practice use?

(3) How does Donald Trump's election change the approaches you would recommend in this case? Please in total i need 500 words for the answer.

Answer 1

Question 2

a) Advisory Group - Patients and his/her family needs to be educated about the disease of the patient, what are the necessary steps needed for cure. Once the implications of the disease is communicated, it makes them understand the seriousness of the situation. There is huge misunderstanding that hospitals/clinics do unwanted lab tests so that more money is being charged. This perception happens because of the lack of understanding of the medical situation. By proper guidance and information, this situation is useful.

b) Current process (Outpatient interview) - This is a good way to collect valuable feedback from patients on how the hospital diagnosed and resolved their illness. This data can be used in process improvement. A process needs to be in place which collects feedback during the outpatient process.

c) Patient medical history (Data collection during consultation) - proper data collection at different stages of patient care, will require a proper data on patients’ medical history. This data aids in identifying allergies, identify re occurrences etc. This helps in fast disease identification and much faster resolution

d) Health check-up feedback (At first touch point)– Information on past yearly health checkups done by the patient. This can be used in identifying any hidden complications.