Copyright 2011. Medical Group Management Association. All rights reserved. 1 Meaningful Use and the Capabilities of HIE to Support the Needs of a PCMH.

Copyright 2011. Medical Group Management Association. All rights reserved. 1

Meaningful Use and the Capabilities of HIE to Support the Needs of a PCMH

Hawaii Health Information ExchangeBeacon Grantees Meeting

Honolulu, Hawaii

David N. Gans, MSHA, FACMPEVice President Innovation and ResearchMedical Group Management Association

July 29, 2011


About MGMA

Our mission…To continually improve the performance of medical group practice professionals and the organizations they represent

MGMA has• 23,500 members…• Who manage and lead 13,700 organizations• With 280,000 physicians• Providing about 40% of U.S. physician services


What is a Patient Centered Medical Home (PCMH)?


What Is a Patient Centered Medical Home (PCMH)?• A medical home is not a building, house, or hospital, but rather an

approach to providing comprehensive primary care. • The PCMH is an approach to providing comprehensive primary care

for children, youth and adults. • The PCMH is a health care setting that facilitates partnerships

between individual patients, and their personal physicians, and when appropriate, the patient’s family.

• “A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” -- American Academy of Pediatrics


1. Personal physician providing first contact, continuous and comprehensive care

2. Physician directed medical team3. Whole person orientation with the personal physician responsible for

providing for all the patient’s health care needs4. Care is coordinated across all elements of the health care system

including subspecialty care, hospitals, home health, nursing homes and the patient’s community

5. Care is facilitated by registries, information technology, and exchange of health information

Joint Principals of the PCMH


6. Quality and safety are hallmarks of the medical home– Evidence-based medicine and clinical decision-support tools guide

decision making– Physicians in the practice accept accountability for continuous

quality improvement through voluntary engagement in performance measurement and improvement

– Patients actively participate in decision-making7. Enhanced access to care is available through open scheduling,

expanded hours and new options for communication between patients, their personal physician, and practice staff

8. Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home

Joint Principals of the PCMH (Continued)


What Changes When a Primary Care Practice becomes a PCMH• An EHR is used not only for its medical record capabilities but also as

a quality tool and to schedule preventive services for individual patients

• Patient registries are used to evaluate and improve the health status of patient populations

• Advanced scheduling and asynchronous care become normal• Group visits and self management support are common• Care delivery evolves from “practice-work “ to “teamwork”


Voluntary Recognition as a PCMH

To demonstrate that a practice is a PCMH, it undergoes voluntary recognition by an appropriate non-governmental entity to demonstrate that it has the capability to provide patient centered services consistent with the medical home model

Recognizing Bodies• National Committee for Quality Assurance (NCQA)• Accreditation Association for Ambulatory Health Care (AAAHC)• The Joint Commission• URAC


Today’s Care Medical Home Care

Our patients are those who are registered in our medical home

Care is determined by today’s problem and time available today

Care is determined by a proactive plan to meet health needs, with or without visits

Care varies by scheduled time and memory or skill of the doctor

Care is standardized according to evidence-based guidelines

Patients are responsible for coordinating their own care

A prepared team of professionals coordinates all patients’ care

I know I deliver high quality care because I’m well trained

We measure our quality and make rapid changes to improve it

It’s up to the patient to tell us what happened to them

We track tests and consultations, and follow-up after ED and hospital

Clinic operations center on meeting the doctor’s needs

An interdisciplinary team works at the top of our licenses to serve patients

My patients are those who make appointments to see me

PCMH Approach to Delivering Health Care

Source: Adapted with permission from F. Daniel Duffy, MD, MACP, Senior Associate Dean for Academics, University of Oklahoma School of Community Medicine


Qualifying as a PCMH

Under the NCQA standards, a practice must demonstrate proficiency in six standards:1. Enhance access and continuity2. Identify and manage patient populations3. Plan and manage care4. Provide self-care and community resources5. Track and coordinate care6. Measure and improve performance

The AAAHC and proposed Joint Commission and URAC requirements are similar

Source: National Committee for Quality Assurance, Standards for PCMH 2011


MGMA 2011 Patient-Centered Medical Home (PCMH) Study Results


Study Methodology

• Study Goals:– To identify the challenges and barriers that medical groups encounter

or anticipate will encounter in becoming a PCMH– To provide information to MGMA members and others on the

experiences of practices that have attained PCMH recognition.– To identify how primary care practices deliver care

• Online electronic questionnaire distributed by direct e-mail to MGMA members and customers

• Data collected 25 March – 29 April 2011• 341 medical organization responded prior to data cut-off• Responses represented information for practices with 5,790 primary care

physicians and 1,996 nonphysician providers


Responses by Organization Type

Physician-owned medical practice

Hospital-owned or integrated delivery system (IDS)-owned medical practice

Federally qualified health center, community health center or similar practice

Other

0% 20% 40% 60% 80% 100%

54%

22%

15%

9%

45%

39%

4%

12%

63%

21%

6%

9%

Interested in becoming a PCMH

Transforming to become a PCMH

Accredited or rec-ognized PCMHs


Motivation to Become a PCMH

The opportunity to improve the health of our patients

To provide patient-focused care

PCMH is the future of primary care

The opportunity to increase practice revenue

To be on board with the priorities of the National Strategy for Quality Improvement in Healthcare

It is mandated by our parent organization

0% 20% 40% 60% 80% 100%

88%

87%

80%

63%

35%

8%


PCMH Status



Accredited or recognized PCMHs

Don't know PCMH status

Not interested in becoming a PCMH

0% 20% 40% 60% 80% 100%

41%

27%

21%

6%

5%


Change in Patient Satisfaction As a Result of Achieving PCMH Status

Considerable increase

Mild increase

No change

Mild decrease

Considerable decrease

Do not conduct patient satisfaction surveys

0% 20% 40% 60% 80% 100%

17%

40%

37%

0%

0%

6%


Practice Processes for Accredited or Recognized PCMHs

Assigns each patient to a primary care clinician

Exchanges clinical information electronically with pharmacies

Involves patients and family members in shared decision making about their care

Maintains chronic disease registries

Addresses patients' mental health issues and refers them to appropriate agencies

Uses chronic disease registries to conduct population management

Develops and documents self-management care plans prepared in collaboration with patients

Exchanges clinical information electronically with hospitals

Develops care plans for high-risk patients

Exchanges clinical information electronically with referral physicians

Has multidisciplinary care teams collaborating with a primary care clinician

Has a care coordinator managing high-risk patients

0% 20% 40% 60% 80% 100%

95%

88%

83%

81%

75%

71%

67%

59%

59%

58%

51%

44%

0%

10%

17%

14%

24%

17%

31%

31%

37%

39%

36%

37%

5%

2%

0%

5%

2%

12%

2%

10%

3%

3%

14%

19%

Does not provide cur-rently or does not in-tend to provide

Intends to provide within the next 12 months

Currently provide


Practice Processes for Those Transforming to Become a PCMH













0% 20% 40% 60% 80% 100%

85%

78%

63%

43%

69%

27%

23%

41%

36%

36%

30%

21%

12%

18%

33%

52%

24%

56%

68%

50%

57%

54%

56%

62%

4%

4%

4%

5%

6%

17%

9%

9%

7%

10%

14%

18%



Currently provide


Practice Processes for Those Interested in Becoming a PCMH













0% 20% 40% 60% 80% 100%

78%

67%

68%

32%

73%

18%

26%

33%

28%

35%

17%

8%

13%

28%

20%

46%

21%

53%

51%

48%

53%

48%

44%

50%

9%

6%

13%

23%

7%

29%

23%

18%

19%

18%

40%

42%



Currently provide


Top 5 Challenges of Accredited and Recognized PCMHs

Establishing care coordination agreements with refer-ral physicians

Financing the transformation to PCMH

Coordinating care for high-risk patients

Modifying or adopting an EHR system to support PCMH related functions

Projecting financial effects (practice revenue, costs, etc.) of the transformation to PCMH

0% 20% 40% 60% 80% 100%

51%

43%

38%

38%

36%

Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.


Top 5 Challenges of Practices Transforming to Become a PCMH

Revising clinical workflow

Contracting with health plans


Establishing care coordination agreements with referral physicians


0% 20% 40% 60% 80% 100%

51%

48%

48%

45%

41%



Top 5 Challenges of Practices Interested in Becoming a PCMH



Establishing care coordination agreements with referral physicians

Contracting with health plans

Obtaining physician buy-in

0% 20% 40% 60% 80% 100%

64%

60%

59%

57%

52%



Metrics in Place to Monitor Patients’ Use of Health Services

Process and outcome measures for chronic disease management

Process and outcome measures for prevention measures

Referral to specialists rates

Emergency room visit rates

Hospital admission rates

Hospital readmission rates

Home care use rates

0% 20% 40% 60% 80% 100%

73%

66%

63%

61%

58%

52%

32%

51%

42%

44%

47%

55%

47%

21%

28%

30%

31%

20%

28%

23%

11%



Accredited or recognized PCMHs


Comparing PCMH Requirements to the Meaningful Use Standards


Defining "Meaningful Use”

"Meaningful Use" is described in the American Recovery and Reinvestment Act (ARRA) as:1.Use of a "certified" EHR with e-prescribing capability as determined appropriate by the Secretary of HHS 2.The ability to report on clinical quality measures as specified by the secretary 3.The use of EHR technology that allows electronic exchange of patient health information 4.CMS and the Office of the National Coordinator for Health Information Technology (ONC) have developed comprehensive regulations outlining the complete definition of "meaningful use" and "certification."


Percent of EHR Systems with the Features Required to Meet Core Meaningful Use Criteria

Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data


Percent of EHR Systems with the Features Required to Meet Core Meaningful Use

Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data


Discussion on How the Meaningful Use Criteria Will Facilitate the PCMH Transformation


Name, credentialsOrganizationDate

David N. Gans, MSHA, FACMPEVice President, Innovation and ResearchMedical Group Management Association104 Inverness Terrace East, Englewood, CO 80112 Phone: (303) 799-1111, ext. 1270E-mail: [email protected]

Are There Any Questions?

mailto:[email protected]

Copyright 2011. Medical Group Management Association. All rights reserved. 1 Meaningful Use and the Capabilities of HIE to Support the Needs of a PCMH.

Documents

medical home care

patients health care

comprehensive care

medical home pcmh

visits care

asynchronous care

subspecialty care

doctor care