Willins oh afp lsga

Ohio’s PCMH Education Pilot

Colette R. Willins, M.D.President

Ohio Academy of Family Physicians

Successfully advocated for passage of medical home bill

Lots of chapters have done

So what’s the big deal?

Thanks for AAFP recognition

Stepping up to the plateNo $$No staffNo structureNo home

Filling the Void of Leadership

Lesson Learned from the OAFP experience:

“Successful passage of legislation is sometimes just the beginning of the

advocacy journey.”

Take Home Message

H.B. 198 – Ohio’s Medical Home Bill

Created PCMH Education Advisory Group – to implement and administer pilot

Bill sponsor Rep. Peggy Lehner receiving OAFP Friend of Family

Medicine Award

H.B. 198 Objectives

Facilitate more rapid adoption of PCMH model by primary care physicians

Create practice sites where medical students, residents and nurses can experience PCMH model

Revise medical student, resident and nursing curricula to incorporate PCMH principles.

H.B. 198 Objectives

Attract and retain PCPs in Ohio by producing a more satisfying practice environment

Enhance quality of care delivered to citizens of Ohio

Enhance patient’s health care experience in PC office and community

H.B. 198 Objectives

Bend the health care cost curveMake health care more affordable and

accessibleCreate an organization that would

facilitate bringing available funding to Ohio for PCMH implementation

Evidence Supporting PCMH Value

NC Medicaid:40% decrease in asthma hospitalizations15% improvement in diabetes measures16% decrease in ED visits

Boeing Seattle Pilot – 20% cost reduction

Evidence Supporting PCMH Value

TransforMED analysis of 36 PCMH practices:58% increase in physician satisfaction66% increase in staff satisfaction

Evidence Supporting PCMH Value

Group Health of Puget Sound PCMH Model:36.3% drop in hospital stays32.2% drop in ED utilization9.6% reduction in total cost10.5% drop in inpatient specialty care18.9% drop in ancillary costs15% drop in outpatient specialty costs

Charges of PCMH Education Advisory Group

Select 44 primary care practices with at least 4 being APN-led for participation

Practices must have affiliated teaching agreements with area’s medical and nursing schools

Focus on 4 regions of state (Dayton, Toledo, Akron/Canton and Athens)

Charges of PCMH Education Advisory Group

Seek funding for project (no funding in bill)

Provide PCMH model training to participating practices

Work with medical and nursing schools to develop curricula in PCMH model of care

Advisory Group Membership

Voting Members: Medical school reps (4) OAFP (2) Ohio Chapter ACP (1) Ohio Chapter AAP (1) OOA (1) Ohio Council of Deans – Nursing (1) ONA (1) OAAPN (1) ODI (1)

Advisory Group Membership

Non-voting membersState Medical Board (1)Board of Nursing (1)Chancellor, Board of Regents (1)Medicaid (1)ODH (1)

Leadership

Ted Wymyslo, M.D., OAFP – Past ChairPat Ecklar, M.D., ACP, Ohio – Current

ChairRichard Snow, D.O., OOA – Co-Vice

Chair Jeri Milstead, R.N., PhD, ONA – Co-Vice

Chair

OAFP’s Role

Launch/coordinate work of EAG and its task forces

Coordinate monthly meetings Keep the group on track, moving

forward in the same direction

OAFP’s Role

Fiscal/administrative management agentWorked with leaders in each of 4 regions to

promote understanding of projectCoordinated work of consultants to recruit

practices to apply for pilot participationWe are the glue holding everything

together

Advisory Group Organizational Structure

Three Task Forces and Chairs:Funding/Reimbursement Reform – Dr. SnowPractice Selection/Metrics – Dr. BertkaCurriculum – Dr. Costa

Funding/Reimbursement Reform Group Initially pulled together application materials

for state grant funding - $300,000 Worked with sustainability consultant to:

Develop case for support Write sustainability plan Identify potential funding opportunities Prepare boilerplate application materials for grant

funding Submit 2 applications for grants

Practice Selection/Metrics Group

Determined pilot measurement metrics Developed a process for selecting

practices for pilot participation64 practices applied; 44 were selected - 37 physician-led

practices; 7 APN-led practices

Practice Selection/Metrics Group

Worked with TransforMED to evaluate practice applicants:Utilized established, evidence-based

assessment toolsCollected regional input on applicantsVerified required affiliated teaching

agreementsVerified board certification of participants

Curriculum Group

Developed integrated PCMH medical and nursing curriculum – with emphasis on: Importance of personal clinician Patient-centeredness Team approach Integrated, coordinated care Continuous quality improvement Importance of information systems Timely access

Still looking for fundingContinued communication with

practices to keep them engagedOAFP remains administrative/fiscal

agent through December 31, 2011ODH assumes responsibility January 1,

2012

Next steps

Everyone is talking about primary careODH Director selected for job because

of his advocacy for PCMHAdministration supports PCMHEAG is positioned to led the effortCollaboration on this project with nurses

has eased some historic tensions

Opportunities

Challenges

Talk about value of primary care and PCMH is cheap

Practice transformation is expensive for PCP practices operating on a shoestring

For politicians, PCMH is akin to motherhood and apple pie – they like the sound of

Show me the $$$

Project Web site:

http://ohioafp.org/OhioPCMHProject/

Organizational Structure

Project Contacts

Expectations & Responsibilities

Resources & Tools

Meeting Minutes, etc.

Final Thoughts

In a void of leadership, OAFP stepped in to fill the void

OAFP moved the effort forward when no one else stepped up to lead

ODH is now positioned to take over project administration and is actively engaged in fundraising

Final Thought

“Successful passage of legislation is sometimes just the beginning of the

advocacy journey.”