PATIENT- CENTERED

MEDICAL HOME: A NEW (BUT FAMILIAR) PATH TO

VALUE-BASED CARE DELIVERY

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PATIENT-CENTERED MEDICAL HOME: A NEW (BUT FAMILIAR) PATH TO VALUE-BASED CARE DELIVERY According to the Patient-Centered Primary Care Collaborative (PCPCC), primary care—which typically delivers and coordinates care for patients and their families—is well-positioned to help repair and optimize the broken U.S. healthcare system.i And as providers position themselves for success in a new world of value-based reimbursement, the patient-centered medical home (PCMH) has re-emerged as an ideal operational model. PCMH defines a philosophy of care that is centered on the needs and preferences of each patient, delivered by a coordinated, physician-led team of care providers, across a healthcare system that uses new workflows and technologies to make care more accessible. The focus is on quality and safety, providing the information and support that patients need to participate in their care and make more informed decisions about their health.

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Until recently, reimbursement has hindered healthcare providers’ ability to deliver patient-centered care, since traditional volume-based, fee-for-service reimbursement models don’t pay for key PCMH features. Those features include sharing information and coordinating care with other providers; managing technology platforms such as patient portals, personal health records, and email and telephone visits; developing connections to community-based organizations, and integrating behavioral health. High-touch medicine is difficult to practice if it is not compensated. New reimbursement models are rapidly evolving, however, which support value-based medical care rather than traditional volume-based payment.

Today, PCMH exists in a growing segment of the provider population: those who are focused on quality improvement by tapping a model founded on team-based care and who are readying themselves for payment reform. Data shows that those providers who are effectively pursuing PCMH are thriving—and so are their patients. iv

“PCMH isn’t a check list for certification. There’s no finish line. It’s a journey that continues as we serve our communities in pursuit of the Triple Aim.”- Dr. Joe Siemienczuk, Chief Medical Officer

Enli Health Intelligence

ENHANCES EXPERIENCE OF CARE

REDUCES PER CAPITA COST OF CARE

IMPROVES HEALTH OF POPULATIONS

IHI TRIPLE AIMiii

PCMH is an innovation in care delivery designed to advance and achieve the Triple Aim of improved patient experience, improved population health, and reduced cost of care. ii

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REPORTEDFOUND

IMPROVEMENTS REPORTEDFOUND

IMPROVEMENTS REPORTEDFOUND

IMPROVEMENTS REPORTEDFOUND

IMPROVEMENTS REPORTEDFOUND

IMPROVEMENTS

The Roadmap for Advanced Primary CareThe philosophy behind PCMH already has tremendous momentum. PCMH is the fastest-growing service from the National Committee for Quality Assurance (NCQA), with more than 7,000 practices recognized by NCQAv, plus many more practices certified through statewide bodies. There has also been phenomenal growth in PCMH incentive programs—from 26 in 2009 to 160 in 2016—which represents more than 500 percent growth in just a few years.vi

Several factors are catalyzing this transition from volume- to value-based reimbursement. The U.S. Department of Health and Human Services (HHS) is pushing payment reform with an aggressive timetable to bring primary care into the value-based arena for federally paid healthcare, and has published clear objectives and goals to guide payment reform. HHS also created the Health Care Payment Learning and Action Network (HCP-LAN), bringing together public and private stakeholders to accelerate the transition to alternative payment models and to help guide the national transition to value-based reimbursement. At the same time, PCMH certification criteria from organizations such as NCQA is helping guide practices who are building medical homes, providing discrete measures and offering an on-ramp to other programs such as Accountable Care Organization (ACO) certification.

PCPCC produces an annual report to characterize evidence on medical homes, which supports the efficacy of PCMH. The most recent report reviewed 30 publications from peer-reviewed studies, state government evaluations, industry reports, and independent federal program evaluations. According to the report, “[t]his year’s 30 publications point to a clear trend showing that the medical home drives reductions in healthcare costs and/or unnecessary utilization, such as emergency department (ED) visits, inpatient hospitalizations, and hospital readmissions.vii” Looking at the 14 peer-reviewed studies alone, the majority found improvements in cost, utilization, quality, access, and satisfaction.

0% 20%10% 30% 40% 50% 60% 70%

ENLICUSTOMERS

US PCPs

LIVE PLANNING

50% 9%

33%

Enli customers, who explicitly state that they use CareManager as a fundamental component of their PCMH strategy, are pursuing PCMH much more aggressively than the industry at large.

Team-based care is an underlying tenet of this model, but it requires providers to make fundamental structural and technology changes in their practices so they can scale their efforts for both cost and clinical effectiveness. Adopting the philosophies and workflows of PCMH—whether for full certification or as the first steps toward this new approach—requires fundamental changes in a practice’s culture, staff, and overall structure. A key element for success is the use of technology that provides both the foundation for this change and the ability to implement it. New technology must provide population health data and up-to-date clinical guidelines to help providers identify and reach out to at-risk populations. And it must address gaps in patient care through care plans that can be implemented by the entire team, including patients and their support networks within the community. It must also integrate with existing electronic health record (EHR) systems, which are a data source for PCMH but which can’t support advanced primary care on their own.

The time has come to look seriously at how your practice will adopt and thrive as a PCMH. We can help, by showing you what the transition looks like and how to get there, and by outlining specific use cases and a detailed case study for the underlying technology that will support your efforts.

PCMH RESULTS FROM 14 PEER-REVIEWED STUDIESviii

COST

10 13 3 4 46 12 2 4 4

UTILIZATION QUALITY ACCESS SATISFACTION

PCMH Program Participation

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The PCMH model is relevant even for providers who are not ready to pursue full certification. Providers can still effectively use this approach to shift patient care back to the front line and treat at-risk populations before they arrive in the emergency room. Early efforts position them to succeed in a world where contracts are no longer driven by volume. Sustainable models have been created through a range of commercial and government reimbursement programs that complement team-based delivery.

Even without certification, ‘leaning into’ the PCMH methodology indicates to the community and to payers that providers are transitioning to the quality model of the Triple Aim.- Dr. Amy Mechley, Medical Director

Wellness | Division The Christ Hospital Health Network

The framework for alternative payment models (APMs) shows the progress from traditional volume-based payments (Category 1) through the continuum that ultimately results in a single payment for comprehensive and condition-specific populations (Category 4). Today’s medical homes primarily reside in Categories 2 and 3.

Category 2 introduces support for infrastructure investment and reimbursement for clinical quality measurement, with payments for reporting and performance. Category 3 introduces financial risk with sub-categories for upside risk only, as well as both upside and downside risk, in which practices can lose money if they perform poorly. Payments in Category 3 are structured to encourage providers to deliver effective and efficient care, and medical homes are well-positioned to pursue these more aggressive payment models. Primary care medical homes are recognized within Category 3 of HCP-LAN’s framework, and PCMH practices that accept downside risk are building competencies for population-based payment programs.

PCMH practices have the flexibility to participate in fee-for-service (FFS) reimbursement programs that are linked to quality and value. PCMH also figures prominently in new federal payment systems that will soon go into effect. In fact, Andy Slavitt, acting administrator of the Centers of Medicare and Medicaid Services (CMS), was recently quoted at a JP Morgan conference saying: “The implementation of the bipartisan MACRA legislation is a major item squarely on our punch list that has everyone’s attention. At its most basic level, it is a program that brings pay-for-value into the mainstream through something called the Merit-Based Incentive Program, which compels us to measure physicians on four categories: quality, cost, the use of technology, and practice improvement. xi” With the changing economics of value-based reimbursement, MIPS aims to accelerate the nation’s shift to pay-for-performance reimbursement and financial bonuses based on quality achievements using the PCMH as one of the most promising foundations for systemic improvements.

1. Source: Health Care Payment Learning & Action Network, https://hcp-lan.org/workproducts/apm-whitepaper-onepager.pdf

ENLICUSTOMERS

US PCP’s

PCMH

Non-PCMH

AVERAGE OPERATING COSTS

$144per patient

$127per patient

NET MEDICALREVENUE

AVERAGE OPERATING COSTS

$84per patient

$78per patient

PCMH practices earned nearly 85% more per patient than non-PCMH practices.

NET MEDICAL REVENUE

$

Fee for Service–No Link to Quality &

Value

CATEGORY 2CATEGORY 1

AFoundational payments

for Infrastructure & Operations

BPay for Reporting

CRewards for Performance

DRewards and Penalties

for Performance

AAPMs with Upside

Gainsharing

BAPMs with Upside

Gainsharing/Downside Risk

ACondition–SpecificPopulation–Based

Payment

BComprehensive

Population–BasedPayment

Fee for Service–No Link to Quality &

Value

CATEGORY 3APMs Built on

Fee-for-ServiceArchitecture

CATEGORY 4Population–Based

Payment

PCMH and Non-PCMH Revenue vs. Operating Costsx Framework for Alternative Payment Models (APM)1

Costs, Reimbursement Models & Outcomes Certainly, the move to patient-centered care requires an investment to build and operate a medical home, but evidence indicates that the economics scale. The cost to construct a medical home runs about $10,000 per clinician, while operating costs average $64,768 per clinician (based primarily on additional staffing costs for full-time employees). But quantified returns justify the investment. The medical home delivers on the Triple Aimix with proven reductions in the both the cost of care and the quality of outcomes.

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Core Competencies in Teams, Processes & TechnologyNCQA has established six standards for PCMH certification, with 27 elements that are grounded in these standards. But these six standards are essentially universal, and apply not only for organizations that are pursuing NCQA certification, but also those who are responding to a state-based or payer-based initiative. Efforts to meet these standards provide advantages even to those practices that are not yet prepared for certification, but whose philosophies match the model of patient-centered medical home, and who are determined to take strides in that direction.

In a medical home, the patient is recognized as a member of the care team, not a customer. A continuous, meaningful relationship with a clinical team is founded upon key fundamentals. These include effective patient engagement, a proactive identification of each patient’s needs, and a comprehensive, whole-person approach to health that is based on established standards of care and includes the medical, behavioral, and social economic status of the patient.

The team-based approach to clinical care delivery is a central theme of patient-centered care, which requires a fundamental change in practice culture to become consistent with the medical home. Extended team members, such as care coordinators, educators, and behaviorists, begin to migrate into the care team to provide case management support for high-risk patients. Training within the practice is critical to help the team learn new skills and work together more effectively, and to support top-of-licensure workflows for each member of the care team.

In order for the practice to proactively engage patients and operate cost-efficiently, new processes must be established. This includes how team members work together to make sure high-risk patients are identified and get the attention they need, and how communication flows across the care team and out into the community. The outcome is improved care, lower costs, increased joy in the work by physicians and staff, and an improved patient experience so that they’re more able to take an active role in caring for themselves.

Technology Enables New Delivery ModelTechnology is a significant enabler to the new team and its workflow, as well as for the reporting that is required for organizations pursuing PCMH. Driven primarily by the Meaningful Use legislation (HITECH Act) and its associated incentive payments, EHRs now enjoy widespread provider adoption. However, EHRs are designed for data capture, not visualization or knowledge transfer, making them a transactional—rather than actionable—tool. Overall, EHRs are ill-equipped to address rigorous requirements for PCMH certification or serve as the technology foundation for providers pursuing value-based programs such as Chronic Care Management (CCM) or the Comprehensive Primary Care Initiative (CPCI). But while new technology platforms must support the workflow, communication, and data requirements of PCMH, they must also integrate seamlessly into current workflows and technologies such as the EHR, which is—at least today—a cornerstone of practices’ technology foundation.

STANDARD SUMMARY OF REQUIREMENTS

PCMH 1:Patient-Centered Access

The practice provides 24/7 access to team-based care for both routine and urgent needs of patients/families/caregivers.

PCMH 2:Team-Based Care

The practice provides continuity of care using culturally and linguistically appropriate, team-based approaches.

PCMH 3:Population Health Management

The practice provides evidence-based decision support and proactive care reminders based on complete patient information, health assessment and clinical data.

PCMH 4:Care Management and Support

The practice systematically identifies individual patients and plans, manages and coordinates care, based on need.

PCMH 5:Care Coordination and Care Transitions

The practice systematically tracks tests and coordinates care across specialty care, facility-based care and community organizations.

PCMH 6:Performance Measurement and Quality Improvement

The practice uses performance data to identify opportunities for improvement and acts to improve clinical quality, efficiency and patient experience.

6 Standards for PCMH Certification

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There are three critical processes required from technology that supports the PCMH:

• Risk Stratification. Technology taps clinical, claims, socioeconomic, and healthbehavior data to build a population risk profile, and allows providers to definepopulation goals consistent with contract requirements.

• Care Coordination. Care teams can assign cohorts to programs and standardizeworkflows to minimize variation in care. Tasks can be assigned to team membersaccording to their licensure, and workloads can be forecasted to align clinicdemand and capacity.

• Care Delivery. The care team is able to monitor, curate, and codify medicalguidelines within the software and create individualized care plans for patients.These can be viewed across the enterprise to monitor and enhance patienthealth and engagement.

Enli CareManagerCareManager is a population health management IT platform that enables PCMH through a comprehensive set of integrated capabilities:

• Evidence-based guidelines. Enli curates and codifies peer-reviewed clinicalguidelines and delivers them to the point of care—within existing providerworkflows—in 90 days or less.

• Data aggregation. CareManager taps a vast array of data sources—including EHR,claims, utilization, compliance, socioeconomic, and well-being—which are aggregatedto inform and accurately predict health interventions.

• Custom patient registry. A flexible filter builder identifies, stratifies, and prioritizesgaps in care and gaps in outcomes across specific at-risk populations.

• Clinical decision support. CareManager interprets evidence-based guidelines andrenders meaningful, cognitive images of patients on a single screen in a dashboardformat. This occurs inside of the EHR and at the point of care to optimize workflowsand aid clinical decision support.

• Patient care plan. CareManager surfaces the care plan directly in the EHR, which allowsproviders to engage patients at the point of care. By combining evidence-basedprompts with a shared view of the patient, the entire care team is working with thesame information and toward the same goal.

• Business process management. Enli’s cloud-based care team tasking engineconsistently applies care-management protocols to defined populations tocontinuously inform the team of progress toward plan objectives and optimizeprogram resources.

• Reporting. Enli’s population health management IT platform comes equippedwith a series of pre-configured reports and can also support custom report generation.

Enli’s ability to create a comprehensive patient record, and to improve the efficiency and effectiveness of care coordinators, is exceptional.- KLAS Research

Enli is unique with evidence-based guidelines curated, codified, and delivered in the software.- Chilmark Research

CareManager is the only population health management solution capable of bi-directional integration with multiple EHRs. - Cynthia Burghard, Research Director

Accountable Care Organizations I DC Health Insights

Enli CareManager is a population health management platform that was conceived by providers for providers, and was co-developed by more than 20 leading health systems. CareManager seamlessly integrates into current EHR systems, using population health data and evidence-based guidelines to support the core processes of the PCMH.

Top-Performing Population IT Vendor

Top-Ranked Care Management Vendor

EHR Established in Clinical Workflows, But Not Sufficientxii

Majority of clinicians (51%-53%) believe EHRs are

not su�cient for coordinating care

51-53% 53%

Majority of nurses and care managers (53%) believe EHRs are inadequate for e�ectively

communicating with physicians

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STANDARD FACTORSDEGREE OF COVERAGE

PRODUCT360

PROGRAMEHR

PCMH 1:Patient-Centered Access

Patient-Centered Appointment Access X

24/7 Access to Clinical Advice X

Electronic Access X

PCMH 2:Team-Based Care

Continuity X

Medical Home Responsibilities X X

Culturally & Linguistically Appropriate Services X

The Practice Team X X

PCMH 3:Population Health Management

Patient Information X

Clinical Data X

Comprehensive Health Assessment X X

Use Data for Population Management X X

Implement Evidence-Based Decision Support X X

PCMH 4:Care Management and Support

Identify Patients for Care Management X X

Care Planning & Self-Care Support X X

Medication Management X X X

Use Electronic Prescribing X

PCMH 5:Care Coordination and Care Transitions

Test Tracking & Follow-Up X X X

Referral Tracking & Follow-Up

Coordinate Care Transitions X X X

CareManager Addresses Key PCMH Certification Standards

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Scenarios for CareManager Within PCMH Top-of-License TeamworkA common desire for organizations pursuing PCMH is to optimize the contribution of each member of the care team. By allowing each member to work at the top of his or her licensure, practices can drive satisfaction, quality, performance, and efficiency into the workflow, with corresponding improvements in cost-efficiency.

A common scenario to achieve this goal starts with pre-visit preparation, in which staff members review the list of patients who are coming into the clinic within the next several days. Instead of scouring charts for information, teams use CareManager to filter charts automatically and identify gaps in reporting, lab or test information, and referral data. This information supports the team huddle—a new workflow addition in which the team rapidly reviews who’s coming in that day to smooth the clinic schedule and patient flow—and assures that each patient’s needs are considered in advance. Memo functionality within CareManager lets team members insert communication and task notes as needed.

On the day of the patient visit, integrated technology lets the patient enter new health information through the provider portal or a tablet in the waiting room without overburdening staff. Finally, during the encounter, visual prompts from CareManager within the EHR framework provide evidence-based and patient-specific standing orders for medical assistants to support the process and avoid alert fatigue.

Test Tracking & Follow-upTest and screening follow-up is a common challenge for practices adopting PCMH. For example, mammography screening recommendations continue to evolve, and patient-specific situations and needs must be taken into account when determining an appropriate interval for testing.

CareManager lets the provider see the default recommendation based on current evidence-based research, but the provider can also easily adjust cancer-screening intervals for high-risk individuals or for those who need a variation to meet personal needs. That data is fed into a registry that allows the care team to easily monitor the status of patients across the practice.

Communication technology built into CareManager lets the team generate automated, personalized notifications for a single patient—or thousands of patients at once—via mail or the practice’s patient portal, depending on each patient’s preference. Patients receive individual-ized information and clear instructions. CareManager also provides a critical closed-loop tracking process to make sure that no patient with abnormal results falls through the cracks.

Filter by patients overdue for cancer screening

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Emergency Room Follow-upIf a patient visits the emergency room, that information can easily be lost in traditional charts. CareManager uses risk stratification to capture information from many data sources to let the provider know which patients were seen in the emergency room and then populates a care-coordination tool for those patients.

CareManager can help the care team standardize a workflow for patients such as those at high risk for asthma. A critical element is to be able to set patient goals that can be shared across the care team, including the patient’s confidence in setting the goal and barriers to his or her success. Finally, a customized action plan can be recorded into the EHR and a patient-facing action plan can be sent to the patient via mail or patient portal, based on the patient’s preference.

Patient goal-setting includes assessment of confidence and barriers

Case Study: Practice Transformation at The Christ Hospital Health NetworkThe Organization:

The Christ Hospital Health Network (TCHHN) is a 555-bed acute-care hospital based in Cincinnati, OH that has 41 primary care locations and over 100 ambulatory sites. It is a recognized national leader in clinical excellence and patient experience. The organization is focused on improving the health of the community and creating patient value by providing exceptional outcomes, affordable care, and the finest experiences.

The Transition:

Like many organizations, TCHHN is making the transition from a traditional model that focuses on acute care with a one-to-one patient- physician approach, to a team-based approach that is focused on population health within the community. TCHHN recognizes that the patient-doctor visit is no longer the primary commodity in healthcare. Providers are now responsible for the population within the community they serve, and they need appropriate tools to accomplish that. PCMH helps standardize best practices across TCHHN and aligns delivery with emerging reimbursement models. PCMH pillars appear in all commercial payer contracts within the Christ Hospital community.

© copyright enli health intelligence – 2019 aLl rights reserved.

The Challenge:

The EHR is designed for data capture, not visualization or knowedge- transfer. TCHHN needed a more rigorous reporting structure and a more user-friendly format to help improve processes and quality, and to address rigorous NCQA requirements for PCMH or value-based programs such as CPCI and CCM.

The Solution:

Working with Enli, TCHHN initially addressed its diabetic population, using CareManager for risk stratification and outreach. Because labor costs are a major driver of overall practice costs, TCHHN used CareManager to help ensure that practices were using care managers and care coordinators wisely and to the top of their licensure, and so that they could be more efficient and effective in their outreach.

The Results:

As part of its CPCI initiative, 16 of TCHHN’s 34 practices were chosen to participate in the Medicare Advantage program. This provided a natural “control group” of 18 non-CPCI practices for the purposes of comparing results, and illustrates the dramatic difference in outreach and gaps closed for those practices utilizing CareManager.

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Work effort > Commercial Medicare Advantage

366

118

53

93

33

417

17 12 4 7 12 12 0

50

100

150

200

250

300

350

400

450

Call Made Left Message to Call Back

Referral Placed Refused Called for Report Gap Closed

CPCi O ces Non-CPCi O ces

CPCi and Non-CPCi Offices

Closed care gaps in this population also significantly increased revenue in Medicare Advantage contracts over just one quarter.

Financial impact > Commercial Medicare Results

“We understand that PCMH is a new way of doing business and a new method of delivery, and to lean into that is critically important for the success not only for our systems and medical offices, but also for our patients.”- Dr. Amy Mechley

Medical Director

Wellness Division I The Christ Hospital Health Network

Q4 2014, MA Products

Intentional investment on focused resources leads to significant improvements

Q4 2015, MA Products

51-53%

53%

Actual Earned Potential Available Actual Earned Potential Available

3% of $153,16055% of $236,877

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TCHHN has also shown significantly higher clinical quality in almost all measures when compared to CPC performance within its region.

* TCHHN was not using Enli CareManager to identify and target patients for influenza immunization during the performanceperiod, the only clinical quality measure that did not demonstrate improvement.

Financial impact > Commercial Medicare Results

Clinical Quality Measure TCHHN Performance

All CPC Region Performance

Tobacco Use Assessment and Cessation Intervention 94% 70%

Colorectal Screening 60% 42%

Breast Cancer Screening 64% 41%

Diabetes Hemoglobin A1c Poor Control (low % desirable) 11% 12%

Diabetes LDL Control (Patients screened for LDL test) 80% 62%

Diabetes LDL Control (Patients LDL < 100) 46% 42%

Blood Pressure Control 73% 68%

Ischemic Vascular Disease (Patients Screened for LDL test) 75% 58%

Ischemic Vascular Disease (LDL controlled) 50% 42%

Influenza Immunization *24% 37%

© copyright enli health intelligence – 2016 all rights reserved.

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i Patient-Centered Primary Care Collaborative (PCPCC), “The Patient-Centered Medical Home’s Impact on Cost and Quality: Annual Review of Evidence 2014-2015.” https://www.pcpcc.org/resource/patient-centered-medical-homes-impact-cost-and-quality-2014-2015

ii PCPCC, “Patient-Centered Medical Home’s Impact on Cost and Quality…”

iii The Institute for Healthcare Improvement (IHI), "The IHI Triple Aim." http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.

iv PCPCC, “Patient-Centered Medical Home’s Impact on Cost and Quality…”

v Journal of the American Board of Family Medicine. Jan – Feb, 2016. Rosenthal. Are We Learning More About Patient-Centered Medical Homes (PCMHs), or Learning About Primary Care?

vi Health Leaders Media. January 2016. Letourneau. PCMH Model Soaring, Despite Funding Challenges

vii PCPCC, “Patient-Centered Medical Home’s Impact on Cost and Quality…”

viii PCPCC, “Patient-Centered Medical Home’s Impact on Cost and Quality…”

ix Institute for Healthcare Improvement (IHI), Triple Aim Initiative. http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx

x Based on a 2014 Medical Group Management Association survey of data collected from 2,518 medical groups. https://www.pcpcc.org/2014/10/01/patient-centered-medical-homes-spend-more-earn-more

xi CMS Blog, “Comments of CMS Acting Administrator Andy Slavitt at the J.P. Morgan Annual Health Care Conference, Jan. 11, 2016.” https://blog.cms.gov/2016/01/12/ comments-of-cms-acting-administrator-andy-slavitt-at-the-j-p-morgan-annual-health-care-conference-jan-11-2016/

xii Data from a survey by PerfectServe, conducted by Nielsen from nearly 1,000 clinicians, case managers and practice administrators. http://hitconsultant.net/2015/04/07/ehrs-not-sufficient-care-coordination/

WHAT’S NEXT:Looking forward, TCHHN has committed to invest further in CareManager, upgrading to incorporate additional clinical evidence to address at-risk populations. TCHHN is installing CareManager Central Worklist to support care teams engaged in PCMH outreach. And TCHHN is continuing to augment its technology platform and delivery model with creative strategies focused on patient engagement.

WHERE DO YOU GO FROM HERE?

Find more information on PCMH and how to get there.• The National Committee for Quality Assurance (NCQA) provides the standard approach to PCMH recognition

and certification (other certifications and accreditations are also available that follow similar guidelines).http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh

• The Institute for Healthcare Improvement provides reports and educational videos on PCMH.http://www.ihi.org/

• The Health Care Payment Learning & Action Network provides extensive resources to support the adoptionof value-based and alternative payment models.https://hcp-lan.org/

>>> Contact Enli Health Intelligence for more information about CareManager and how it can help you transform your practice.

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