PCMH Congress - Amazon S3 · PCMH Congress TM An Official Conference by NCQA October 7-9, 2016....

PATIENT-CENTERED MEDICAL HOME CONGRESS

PCMHCongressTM

An Official Conference by NCQA

October 7-9, 2016Chicago, IL

www.PCMHcongress.com

Transform care delivery here.

Developed by

ANNOUNCING –2016 KEYNOTE SPEAKER

Peter Basch, MD, MACP

The conference dedicated to transforming care delivery.

PCMH Congress, an official conference of NCQA, is celebrating its second year as a forum designed for leaders dedicated to redesigning the care delivery system and achieving the Triple Aim through the patient-centered medical home model of care. The 2016 meeting will feature an expanded educational program focused on the medical home neighborhood with more opportunities to network with high-level executives throughout the care delivery system.

The medical home neighborhood, an expanded concept of patient-centered care, recognizes that the effectiveness of the PCMH care model is dependent on the coordination of specialists, subspecialists, and other health care entities involved in patient care.

Participate in PCMH Congress and learn how the medical home neighborhood can transform the delivery of patient care.

PCMHCongressTM


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Follow us on: facebook.com/NCQA.orgTwitter @NCQA#pcmhcongress

The patient-centered medical home (PCMH) is the model for primary care delivery, focused on providing the highest level of patient care. To date, the National Committee for Quality Assurance (NCQA) has recognized 56,626 clinicians at 11,458 sites as part of its PCMH Recognition program.*

*As of March 31, 2016

Register early for the lowest rates!Use code PCMHSAVE50 by June 30 to SAVE $50 on your registration.

REGISTER EARLY AND SAVE www.PCMHCongress.CoM 800.218.3185

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WHO SHOULD ATTEND?The conference is designed for professionals focused on the redesign of care delivery, including:

The conference is especially beneficial to those who are—or are considering becoming—an NCQA-recognized PCMH, PCMH CCE, Patient-Centered Connected Care provider or PCSP.

™Trademark of the National Committee for Quality Assurance

• Primary care physicians, including those from PCMH-recognized practices, and Accountable Care Organizations

• Specialists, including those from Patient-Centered Specialty Practices (PCSPs)

• Patient-Centered Connected Care™ providers

• NCQA PCMH-Certified Content Experts (CCEs)

• Administrators from hospitals, long-term care and home health care

• Allied and behavioral health professionals

• Practice administrators

• Quality managers

• Consultants to primary care or specialty practices

• Policymakers

• Health IT

• Pharmacists

• Complex case managers and patient navigators

• Non-clinical partners, including representatives from public health agencies, community centers, schools and workplaces

• Other allied health providers

• Gain an understanding of the stages of the PCMH transformation process and the medical neighborhood model

• Network with experts and peers across the care continuum to learn, share and identify best practices for improving the delivery of patient care

• Connect with other health care stakeholders to create and maintain critical medical neighborhood linkages

• Learn about the value of the PCMH, PCSP and Patient-Centered Connected Care Recognition programs and how to leverage them for your organization

• Earn up to 21 CME/CNE/CPE and up to 15 maintenance of certification credits for PCMH CCEs

• Discover relevant patient-care solutions in the Exhibit Hall

AT PCMH CONGRESS, YOU WILL:



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New for 2016 KEYNOTE SPEAKERPeter Basch, MD, MACPSenior Director, Health IT Quality and Safety, Research, and National Health IT PolicyMedStar HealthSenior Fellow Health IT Policy, Center for American Progress Visiting Scholar in Health IT Policy, Center for Healthcare Reform, Brookings Institution Chair, Medical Informatics Committee American College of PhysiciansWashington, DC

2016 STEERING COMMITTEEMichael S. Barr, MD, MBA, MACPExecutive Vice President, Quality Measurement & Research GroupNational Committee for Quality AssuranceWashington, DC

Patricia Barrett, MHSAVice President, Product Design and SupportNational Committee for Quality AssuranceWashington, DC

Joseph E. Fojtik, MD, FACP, PCMH CCEMercy Health SystemsMedical Deputy CoordinatorIllinois Department of Finance and Professional RegulationsChicago, IL

Mina Harkins, MBA, PCMH CCEAssistant Vice PresidentRecognition Programs Policy and ResourcesNational Committee for Quality AssuranceWashington, DC

Paul Klintworth, MSPM, HITMedical Home, Public Health AnalystOffice of the National Coordinator for Health Information Technology (ONC)U.S. Department of Health and Human Services (DHHS)Washington, DC

James Tan, MD, MPH, MBA, CPEPhysician Director, North Service AreaStaff Physician, Family Medicine DepartmentNorthwest Permanente, PC (Kaiser Permanente)Oregon State & Washington StateRidgefield, WA

NC Tenenbaum, PCMH CCEOwnerMedical FrontiersMount Kisco, NY

1) Expanded Program: Focused on the medical neighborhood

2) Educational Tracks: To better tailor your conference experience, the program has been organized into five tracks:

• Achieving PCMH Recognition• Medical Neighborhood• PCMH Optimization• Special Populations• Technology/Health IT

3) New Location: PCMH Congress takes place in Chicago. This was the most requested location by 2015 PCMH Congress conference participants.

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DISTINGUISHED FACULTY

David Asch, MD, MBAProfessorPerelman School of Medicine and Wharton SchoolExecutive Director, Center for Health Care InnovationUniversity of Pennsylvania Philadelphia, PA

Alexander Blount, EdDFounding Director, Center for Integrated Primary CareProfessor of Family Medicine, Community Health, and PsychiatryUniversity of Massachusetts Medical SchoolWorcester, MA

Andrew Chapman, DODirector, Division of Regional Cancer CareJefferson Medical Oncology AssociatesJefferson UniversityPhiladelphia, PA

Paul CottonDirector of Federal AffairsNational Committee for Quality AssuranceWashington, DC

Shari M. Erickson, MPHVice PresidentGovernmental and Medical PracticeAmerican College of PhysiciansWashington, DC

Jeffrey O. Greenberg, MD, MBAAssistant Professor of MedicineHarvard Medical SchoolMedical Director, Innovation HubMedical Director, Standardized Clinical Assessment and Management PlansBrigham and Women’s HospitalBoston, MA

Regina Neal, MPH, MS, PCMH CCEDirector, Practice Development and Client RelationsQualis HealthSeattle, WA

Margaret E. O’Kane, MHS PresidentNational Committee for Quality AssuranceWashington, DC

Nadine RobinHealth IT Program DirectorLouisiana Health Care Quality ForumBaton Rouge, LA

FACULTY

Adele Allison, BSDirector of Provider Innovation StrategiesDST Health SolutionsBirmingham, AL

Michael Attanasio, DOOwnerRitner Medical AssociatesPhiladelphia, PA

Nicole Bauer, MAAccount ManagerBehavioral Healthcare ProvidersGolden Valley, MN

Monaco Briggs, MBADirector of Informatics and OptimizationEast Tennessee State UniversityDepartment of Family MedicineJohnson City, TN

Shauna Brown, MSLProgram Manager, Clinician EducationNational Committee for Quality AssuranceWashington, DC

Emilie Buscaj, MPH, PCMH CCEProgram ManagerHealthTeamWorksGolden, CO

Susanne Campbell, RN, MS, PCMH CCESenior Project DirectorCare Transformation Collaborative of Rhode IslandProvidence, RI

Janet Duni, RN, BSN, CCM, MPADirector of Care CoordinationVanguard Medical GroupVerona, NJ

Chris Espersen, MSPHQuality DirectorPrimary Health CareDes Moines, IA

Caitlin Feller, MPP, PCMH CCEPrincipalCommunity Health SolutionsRichmond, VA

Dan Fishbein, PhDVice President for Corporate Business DevelopmentCorporate Compliance OfficerJefferson Center for Mental HealthWheat Ridge, CO

Lori Francis, BS, PCMH CCEBlue Cross Blue Shield of TennesseePCMH-Provider Performance Consultant, East RegionQuality Care PartnershipKnoxville, TN

Robert Gabbay, MD, PhDChief Medical OfficerJoslin Diabetes CenterBoston, MA

Jessica Grabowski, AM, LCSWDirector of Social ServicesAging Care ConnectionsLa Grange, IL

Sally Graham, RN-C, ANPExecutive DirectorGoochland Free Clinic and Family ServicesGoochland, VA

Nicole Harmon, MBA, PCMH CCESenior DirectorPCMH Advisory ServicesHANYS SolutionsBuffalo, NY

Saad H. Howard, MBA/MHA, PCMH CCEStrategic Projects ManagerNew York City Department of Health and Mental HygienePrimary Care Information ProjectLong Island City, NY

Scott Hultstrand, JD, PCMH CCEManager, Quality Improvement and Performance ManagementCare Coordination InstituteGreenville Health SystemGreenville, SC

Robert KrebbsDirector of Payment InnovationAnthem Inc.Chesapeake, VA

Allison LaValley, MBAExecutive DirectorQuality Performance & Value-Based Care, Clinical PerformanceathenahealthWatertown, MA

Lucy Loomis, MDDirector, Family MedicineDenver HealthDenver, CO

Janice Magno, MPA, PCMH CCEAssistant Director of StrategyNew York City Department of Health and Mental HygienePrimary Care Information ProjectLong Island City, NY

Aaron McHone, MBAExecutive DirectorUnityPoint Health – Berryhill CenterFort Dodge, IA

Randall Messier, MT, MSA, PCMH CCEOwner/PrincipalRandy Messier LLCFairfield, VT

Sari Miettinen, MD, FAAP, PCMH CCEPresidentOptimum Practice ManagementHeywood Medical CenterGardner, MA

Cari Miller, MSM, PCMH CCEStrategic Partnerships, Consultant Horizon Healthcare InnovationsNewark, NJ

Cynthia Newbille, PhDProgram Officer & Patient-Centered Medical Home CoordinatorRichmond Memorial Health FoundationRichmond, VA

Shannon Nielson, MHSA, PCMH CCEVice President of Consulting ServicesCenterprise, Inc.Milford, OH

Charles North, MD, MSExecutive Medical Director for Ambulatory CareUniversity of New Mexico Hospital AdministrationAlbuquerque, NM

Martha PaapPractice Transformation CoordinatorCare Coordination InstituteGreenville Health SystemGreenville, SC

Jill Patton, DOProgram Director and Vice ChairpersonDepartment of MedicineAdvocate Lutheran General HospitalPark Ridge, IL

Steven Peskin, MD, PCMH CCEExecutive Medical Director, Population ManagementHorizon Blue Cross Blue Shield of New JerseyNewark, NJ

Kia Poe, MS, PCMH CCEProgram DirectorPatient-Centered Specialty Care ProgramAnthem Inc.Chesapeake, VA

Peter Prizzio, MEdChief Executive OfficerThe Daily PlanetRichmond, VA

Peggy A. Reineking, MS, MBA, PCMH CCENCQA Consultant Reviewer for PCMH, PCSP, and ACO ProgramsLady Lake, FL

Michelle Rodriguez, MBA, PCMH CCEPatient-Centered Medical Home Program ManagerChildren’s Hospital of Wisconsin Milwaukee, WI

Megan Santanna, MADirector, Practice OptimizationRitner Medical AssociatesPhiladelphia, PA

Sue Schell, MAVice President and Clinical DirectorBehavioral HealthChildren’s HealthDallas, TX

Karla Silverman, RN, CNM, MSInterim Chief Program OfficerPrimary Care Development CorporationNew York, NY

Alan Stricoff, DO, FACPSenior Medical DirectorCMO Cigna Onsite Health Hartford, CT

Jennifer Ternay, MBA, CPA, PCMH CCEHealthcare StrategistJLS Advisory GroupOcean City, NJ

Audrey Whetsell, MA, PCMH CCEPrincipal and Co-FounderMedical Home Development GroupCharleston, SC

Amber Winkler, MHA, PCMH CCECEOClarify Company, LLCCharleston, SC

*Faculty subject to change.


REGISTRATION AND COMPLIMENTARY BREAKFAST 7:00 a.m. – 8:00 a.m.

WELCOME AND OPENING REMARKS NCQA PRESIDENT MARGARET O’KANE, MHS8:00 a.m. – 8:10 a.m.

OPENING SESSION: MAKING GOOD NEIGHBORS: HOW PCMHs AND PCSPs CAN WORK TOGETHER TO IMPROVE CARE WITHIN THE MEDICAL NEIGHBORHOOD 8:10 a.m. – 9:10 a.m. Collaborative care requires cooperation between various providers in order to improve the patient experience and create an effective medical neighborhood. Join Dr. Chapman and Dr. Greenberg as they provide both the specialist and primary care perspectives on what it takes to optimize the medical neighborhood model of care. (UAN 0850-9999-16-036-L04-P)Andrew Chapman, DO and Jeffrey O. Greenberg, MD, MBA

WORKSHOPS (SELECT 1 OF 3) 9:20 a.m. – 10:20 a.m.

TECHNOLOGY/HEALTH ITPATIENT ENGAGEMENT AND DIGITAL HEALTH: OPPOR-TUNITIES FOR CARE COORDINATORS AND CHRONIC DISEASE MANAGEMENTThis presentation will describe the integration of digital health with care coordination and health coaching in a PCMH. The benefits and challenges of the introduction of a FDA-cleared, evidence-based type 2 diabetes app with patient coaching and provider clinical decision support will be discussed. Patient engagement, clinical outcomes, and the provider experience will be presented. (UAN 0850-9999-16-043-L04-P)Janet Duni, RN, BSN, CCM, MPA

MEDICAL NEIGHBORHOODSUPPORTING PATIENT CARE: FROM MEDICAL HOME TO MEDICAL NEIGHBORHOOD This session will provide participants an overview of Anthem’s Patient-Centered Specialty Care (PCSC) pilot program. The PCSC program combines the power of payment reform, a virtually guided practical cur-riculum designed to target day-to-day processes, and a highly engaging multimedia engagement model to provide specialty practices with an array of resources to support specialty care delivery transformation. (UAN 0850-9999-16-006-L04-P)Robert Krebbs and Kia Poe, MS, PCMH CCE

PCMH OPTIMIZATIONTHE ROLE OF THE PCMH UNDER MACRAIn April 2015, the Medicare Access and CHIP Reauthorization Act (MAC-RA) was signed into law, heralding the end of fee-for-service reimburse-ment for providers. Beginning in 2019, providers will be reimbursed for Medicare through an alternative payment model (APM) such as the Accountable Care Organization (ACO) or using the Merit-based Incen-tive Payment System (MIPS). This session will discuss how the NCQA PCMH aligns with and supports these new Medicare cost containment initiatives. (UAN 0850-9999-16-010-L04-P)Adele Allison, BS

WORKSHOPS (SELECT 1 OF 3) 10:30 a.m. – 11:30 a.m.

ACHIEVING PCMH RECOGNITIONBEST PRACTICES IN PCMH ACHIEVEMENT AND MAINTENANCEFor many, the NCQA PCMH recognition process is confusing and overwhelming. Clinicians struggle to translate elements and factors into the clinical setting. In addition, practices focus too much on obtaining recognition rather than achieving true practice transforma-tion. Both of these factors lead to frustration and uninspired change. This session is intended to provide participants with concrete tools and examples for organizing themselves for NCQA recognition, while simultaneously implementing meaningful and sustainable change. (UAN 0850-9999-16-019-L04-P)Sari Miettinen, MD, FAAP, PCMH CCE

PCMH OPTIMIZATIONALTERNATIVE PAYMENT MODELS: HOW THEY’RE CHANGING HEALTHCARE FINANCEUnderstanding changing healthcare finance and alternative payment models (APMs) is extremely important in being a successful organization, serving patients, being a good place to work, and being able to survive and thrive in the competitive healthcare marketplace. Having a healthy business is important – and understanding alternative payment models (APMs) and transitioning from volume to value is an important element of success. Attendees of this session will be able to better understand how to capitalize on the high-quality care they currently provide, along with learning about new opportunities to positively impact revenue. (UAN 0850-9999-16-011-L04-P)Amber Winkler, MHA, PCMH CCE

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2016 Program

Friday, October 7, 2016


Topic Tracks

Achieving PCMH Recognition

Medical Neighborhood

PCMH Optimization

Special Populations

Technology/Health IT

Learner Level

Beginner

Intermediate

Advanced


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MEDICAL NEIGHBORHOODCONNECTING THE DOTS OF NCQA’S PATIENT-CENTERED CONNECTED CARETM RECOGNITIONNCQA’s Patient-Centered Connected Care Recognition program supports clinical integration and communication by creating a roadmap for how sites delivering intermittent or outpatient treatment can effectively communicate and connect with primary care and fit into the medical home “neigh-borhood.” This program supports the use of evidence-based guidelines in treating patients. It provides a consensus-driven framework for how non-PCMH and non-specialty sites fit within the medical home neigh-borhood, and ultimately results in better outcomes and improved patient experience. Experts on this panel will discuss how their organizations were able to align with NCQA’s Patient-Centered Connected Care Recognition requirements to attain recognition including day-to-day business operations and the benefits gained since becoming a recognized PCCC site. (UAN 0850-9999-16-034-L04-P)Michelle Rodriguez, MBA, PCMH CCE and Alan Stricoff, DO, FACP


11:40 a.m. – 12:40 p.m. BEHAVIORAL ECONOMICS: IMPROVING HEALTH BEHAV-IORS THROUGH FINANCIAL AND SOCIAL INCENTIVESJoin Dr. Asch, a leader in behavioral economics, as he explores how health incentives can improve patient care in the PCMH setting. Dr. Asch will discuss how these strategies can not only improve patient health and behavior, but also affect provider performance. (UAN 0850-9999-16-037-L04-P)David Asch, MD, MBA

12:40 p.m. – 1:55 p.m. LUNCH IN THE EXHIBIT HALL

WORKSHOPS (SELECT 1 OF 3)2:10 p.m. – 3:10 p.m.

MEDICAL NEIGHBORHOODWELCOME TO THE NEIGHBORHOOD: SPECIALISTS AS GOOD NEIGHBORS—DEFINING THE MEDICAL NEIGHBORHOODThe patient-centered medical neighborhood is a coordinated system involving all providers that deliver care efficiently and effectively. A stronger partnership between primary care practices and specialty care is essential to this model. Just as many medical home pilots focused on diabetes as an initial target disease, diabetes lends itself well to defining the optimal medical neighborhood given its high cost, prevalence, complexity, and need for coordination of multiple specialty services. Using diabetes as an example, this session will highlight specific mechanisms to better link the medical neighborhood to achieve the Triple Aim with recommendations that are translatable to other chronic diseases. (UAN 0850-9999-16-002-L04-P)Robert Gabbay, MD, PhD

PCMH OPTIMIZATIONAFTER PCMH RECOGNITION: HITTING THE STARTING LINE RUNNINGThis session will help physician practices and those who assist with PCMH recognition to position themselves for continued improvement. Helpful tips for creating patient-centered activities after achieving NCQA Recognition will also be offered. Participants will be encouraged to think beyond the moment of recognition and proactively take steps to motivate physician practices to continue what they started. (UAN 0850-9999-16-015-L04-P)Scott Hultstrand, JD, PCMH CCE and Martha Paap

ACHIEVING PCMH RECOGNITIONWHO’S THE PATIENT? A PANEL ON EMPANELMENTEmpanelment is a process for the assignment of patients to a primary care provider (PCP) or care team while incorporating patients and family preferences. As the foundation for population management, it enables practices to stratify and identify patients for preventive care services, chronic care and high-risk care management. Once empanel-ment and risk stratification have occurred, practices can build teams to help mitigate poor health outcomes. This session includes represen-tatives from practices who will discuss their process for empanelment to stratify and identify patients. (UAN 0850-9999-16-035-L04-P)Mina Harkins, MBA, PCMH CCE


PCMH OPTIMIZATIONBUILDING A CHANGE MANAGEMENT STRATEGYAcknowledging the people side of change is imperative as practices seek to operationalize the NCQA PCMH Standards. With increasing value-based pay-ment arrangements, practices must ensure sustainability of changes as well as improvement in clinical outcomes. By focusing on the people side of change rather than an EMR or process-only approach, sustainability is more likely. This session will identify approaches to ensure sustainable transformation by focusing on people, process and technology. (UAN 0850-9999-16-014-L04-P)Nicole Harmon, MBA, PCMH CCE

BEHAVIORAL HEALTHADDRESSING THE WHOLE PERSON: INTEGRATING BEHAVIORAL HEALTH INTO THE PEDIATRIC PATIENT CENTERED MEDICAL HOMEThis session will discuss integrating the physical, mental and social well-being components of health in accessible and sustainable ways within the patient-centered medical home and the medical neighborhood. The session will examine the model and approaches for integrating behavioral health services within primary care practices to transform them into patient-cen-tered medical homes, the place where all health and wellness needs are addressed. The discussion will include scope of behavioral health services, evidence-based decision support, and utilization of health information technology. (UAN 0850-9999-16-024-L04-P)Sue Schell, MA

“ The first Congress was full of evidence-based practice examples that help support the ongoing process improvement activities within the PCMH framework.”


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MEDICAL NEIGHBORHOODBRINGING THE MEDICAL NEIGHBORHOOD TO LIFE FOR PATIENT CENTERED MEDICAL HOMES WITH ANALYTICSOver the past six years, Horizon-BCBSNJ has collaborated with a broad range of clinical partners, including solo primary care Family Physicians, Internists and Pediatricians, multiple location primary care groups, large multi-specialty group practices, and clinically integrated organizations. As we evolved with our clinical partners to advance comprehensive, per-son-centered, team-based high-value care with emphasis on chronic con-dition management, we recognized that high-value primary care needs to be harmonized with subspecialists that are also committed to cost-aware, patient-centered care. This session will provide detailed sample reports and describe how those reports are presented to/reviewed with clinicians and relevant administrative staff. (UAN 0850-9999-16-003-L04-P)Steven Peskin, MD, PCMH CCE

4:30 p.m. – 5:30 p.m. KEYNOTE ADDRESS THE ELECTRONIC HEALTH RECORD NOW AND THEN: MOVING FROM REGULATORY BURDEN TO ENABLING A PATIENT-CENTERED MEDICAL HOMEPeter Basch, MD, MACP

5:45 p.m. – 7:15 p.m. EXHIBIT HALL GRAND OPENING

7:00 a.m. – 8:00 a.m. COMPLIMENTARY BREAKFAST IN EXHIBIT HALL

BREAKFAST WITH NCQA PRESIDENT MARGARET O’KANE FOR PCMH CCEs

WORKSHOPS (SELECT 1 OF 3)8:10 a.m. – 9:10 a.m.

PCMH OPTIMIZATIONDATA AND INFORMATION-DRIVEN TRANSFORMATIONThe use of data in your PCMH transformation should go beyond meet-ing the application requirements. Learn how data should be used to drive your project plan, implement and measure changes and create a sustainable PCMH environment that will drive success in your overall population health strategy. (UAN 0850-9999-16-026-L04-P)Shannon Nielson, MHSA, PCMH CCE

MEDICAL NEIGHBORHOODAN INTERDISCIPLINARY COLLABORATIVE: PEDIATRICIANS, INTERNISTS, AND FAMILY MEDICINE IMPROVING PATIENT-CENTERED CARESince 2013, the Advocate Primary Care Transformation Collaborative has been meeting with the shared goal to redesign primary care with patients in mind to build relationships, service, and reliability designing a patient-cen-tered medical home model. Our interdisciplinary approach lead to shared best practices and accelerated transformation that can be easily replicated. We will demonstrate how shared data among our practices will advance our patient-centered population health journey. (UAN 0850-9999-16-007-L04-P)Jill Patton, DO

PCMH OPTIMIZATIONTHE NUTS AND BOLTS OF PATIENT-CENTERED MEDICAL HOME CONTENT EXPERT CERTIFICATION EXAM PREPARATIONAchieving the title “NCQA Patient-Centered Medical Home Certified Content Expert™ (PCMH CCE)” demonstrates a comprehensive knowl-edge of medical home concepts and NCQA’s PCMH 2014 Recognition

Program requirements. The PCMH Content Expert Certification program was launched in January 2013 and currently there are more than 935 PCMH CCEs in 47 states. Candidates interested in becoming a PCMH CCE must demonstrate their expertise by completing prerequisite coursework and passing a standardized examination. This session will help prepare candidates for the required exam. It will be facilitated by current content experts (PCMH CCEs) and leaders in the medical home field who will dis-cuss best methods to prepare for the exam. Our experts will share helpful hints and frequently asked questions to help ease anxiety regarding the test. As a participant in this session, you are encouraged to bring your questions. (PCMH CCE Maintenance of Certification credit only.)Shauna Brown, MSL, Nicole Harmon, MBA, PCMH CCE, Cari Miller, MSM, PCMH

CCE, and Peggy A. Reineking, MS, MBA, PCMH CCE



TECHNOLOGY/HEALTH ITEXAMINING THE IMPACT OF HEALTH IT ON CARE INTE-GRATION: ACHIEVING WHOLE-PERSON CAREAchieving whole-person care requires that the PCMH optimize all aspects of care integration. Integral to this optimization is the use of data and technology within an optimized care integration work flow. This session will explore the importance of health IT for documenting data needed for integration approaches, as well as how to use data to make care integra-tion an organizational strategic priority. (UAN 0850-9999-16-044-L04-P)Regina Neal, MPH, MS, PCMH CCE

PCMH OPTIMIZATIONUSING PANEL STRATIFICATION IN THE MEDICAL HOMEOver the past decade, Denver Health’s approach to practice transforma-tion has evolved from disease-focused collaboratives and simple open access to using a detailed panel analysis to develop teams and services that are in line with the population needs. We will review that evolution with specific attention to the effects of application of a panel risk strat-ification model on development of the care team and enhanced services in the individual medical home. (UAN 0850-9999-16-018-L04-P)Lucy Loomis, MD

ACHIEVING PCMH RECOGNITIONEVALUATING YOUR TRANSFORMATIVE TEAM’S APTITUDE TO ADVANCEPrimary care’s continuing transformation hinges on its ability to expand its role beyond reactive, added work. Teams must constantly be looking for opportunities for learning and action to replace and sustain val-ue-added work. High-performing practices will transition from a tradition-al practice structure to transforming the culture of the practice through team redesign. Change-weary practices must look for ways to evaluate their infrastructure for change management and embed a change into the daily experience of the entire practice – the patients, their medical neighborhood and their community to affect sustainable change in the local health delivery system. (UAN 0850-9999-16-020-L04-P)Emilie Buscaj, MPH, PCMH CCE

WORKSHOPS (SELECT 1 OF 3)10:30 a.m. – 11:30 a.m. Industry-Supported Symposium

11:40 a.m. – 12:40 p.m. ORAL ABSTRACT PRESENTATIONSModerated by Mr. Klintworth, this session puts you front and center as attendees put select poster presenters in the hot seat! This session will feature six 5-minute poster presentations, followed by 5 minutes of questions from the audience. Be prepared to challenge and debate during this interactive session! (UAN 0850-9999-16-038-L04-P)These posters and additional presentations will also be displayed during the Congress.Paul Klintworth, MSPM, HIT

Saturday, October 8, 2016



PCMH OPTIMIZATIONCO-MANAGEMENT AGREEMENTS: WHAT ARE THESE AND WHERE DO I BEGIN?The goal for this session is to provide attendees with important infor-mation and actionable next steps to assist in understanding the need for developing and implementing an active and effective co-man-agement process in practice. This session will provide an overview of co-management agreements, the importance of putting these into place within the practice, and initiate basic steps for getting started. (UAN 0850-9999-16-016-L04-P)Cari Miller, MSM, PCMH CCE

TECHNOLOGY/HEALTH ITUTILIZING THE ELECTRONIC HEALTH RECORD TO ACHIEVE AND MAINTAIN PCMH RECOGNITION AND ALIGN WITH OTHER CONTINUOUS QUALITY IMPROVEMENT PROGRAMSOrganizations today have numerous programs such as MU, PQRS, PCMH, Managed Care, and ACO requirements to meet – all while trying to make the patient the priority. Many providers and staff feel overwhelmed and worry that they are not providing the care their patients deserve. Streamlining the many program requirements can ensure that the patient – and not the program requirements – is the primary focus. By utilizing the tools and resources that are available in electronic health records, practices can streamline many measures and requirements to minimize the burden placed on everyone. Developing efficient and organized workflows, processes, templates and other tools to support the care team can significantly impact the outcome for the patient, staff, and providers while increasing revenue. (UAN 0850-9999-16-012-L04-P)Monaco Briggs, MBA and Lori Francis, BS, PCMH CCE

ACHIEVING PCMH RECOGNITION HOW TO BUILD AN INTERDISCIPLINARY TRANSFORMATION TEAM AND THE IMPORTANCE OF INCLUDING PATIENTS AND COMMUNITY PARTNERSThe goal of this presentation is to highlight the importance of creating an inter-professional transformation and/or quality improvement team within the PCMH. The session will emphasize the importance of expanding the medical home neighborhood to include patients and community partners. Expanding the Medical Home Neighborhood will offer greater success in transforming your primary care clinic into a Medical Home and become a valued resource to your patients, community and ACO. (UAN 0850-9999-16-021-L04-P)Randall Messier, MT, MSA, PCMH CCE


BEHAVIORAL HEALTHDEC CO-MANAGEMENT MODEL PROVIDES PATIENT-CENTERED BEHAVIORAL CRISIS CAREBehavioral Healthcare Providers has developed an innovative process that integrates a web-based behavioral health application (Diagnostic Evaluation Center) with telehealth technology, allowing licensed mental health profes-sionals to assess and coordinate care for patients experiencing a behavioral crisis. Goals of the session will be to review some successes and pitfalls of providing an on-demand telehealth service using a co-management model and to discuss ways in which this type of service can enhance care provided in Patient-Centered Medical Homes. (UAN 0850-9999-16-032-L04-P)Nicole Bauer, MA

ACHIEVING PCMH RECOGNITION QUALITY FIRST: A VIRGINIA SAFETY NET CLINIC COLLABORATIVE’S JOURNEY TO PATIENT-CENTERED TRANSFORMATIONThis session will provide examples of best practices for achieving NCQA PCMH Recognition from among six Virginia safety net providers (i.e., both rural and urban, FQHCs, free clinics, and community health clinics), highlighting the practical processes, relationship building, resources, investment, challenges and commitment necessary by clinical and philanthropic leadership to create and sustain a long-term strategic initiative to implement care model transformation and maintain a Pa-tient-Centered Medical Home model of care. (UAN 0850-9999-16-022-L04-P)Caitlin Feller, MPP, PCMH CCE, Sally Graham, RN-C, ANP, Cynthia Newbille, PhD, and

Peter Prizzio, MEd

PCMH OPTIMIZATION THE FUNDAMENTALS OF STRUCTURING AND ADVANCING A TEAM-BASED ENVIRONMENTThis session is primarily focused on assisting practices to understand their current state of the office from a team-based approach and evaluate ways of improvement. This session will provide templates, tools, and real-life examples of successful implementation using the team-based approach to achieve goals on quality initiatives and illustrate best practices in transformation, in addition to our lessons learned. Our goal is to provide the practical how-to for offices to take our examples and tools and apply it in their offices, while extending those guidelines to help build the medical neighborhood by part-nering with specialty groups. (UAN 0850-9999-16-027-L04-P)Michael Attanasio, DO and Megan Santanna, MA

4:30 p.m. – 5:30 p.m. FEATURED SESSION REDESIGNING THE PCMH RECOGNITION PROGRAMNCQA is not just updating its PCMH program, but planning an ambitious full redesign in response to feedback from clinicians, practices, employers, payers, health services researchers and other key stakeholders. The project has been underway for approximately 12 months. NCQA recently completed pilots of the revised program involving over 120 practices across 15+ states and a variety of primary care practices (e.g., size, geography, ownership). Join Dr. Barr as he pres-ents the proposed model that strengthens NCQA’s commitment to patient-cen-tered care principles while simplifying, streamlining — and even eliminating — some administrative inconveniences. Panel guests include representatives from practices that participated in the pilot tests to share their experience and perspective on the redesigned program. (UAN 0850-9999-16-039-L04-P)Michael S. Barr, MD, MBA, FACP

5:45 p.m. – 7:15 p.m. EXHIBIT HALL RECEPTION

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90% of attendees would recommend PCMH Congress to a colleague.

SOURCE: 2015 PCMH ATTENDEE EVALUATION


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7:00 a.m. – 7:15 a.m. BREAKFAST

7:25 a.m. – 8:25 a.m. STRATEGIES FOR SUCCESSFUL INTEGRATION OF BEHAVIORAL HEALTH INTO THE PRIMARY CARE PRACTICE: FOCUS ON MAJOR DEPRESSIVE DISORDERJoin Dr. Blount as he reviews the importance of integrated behavioral health, strategies for successful integration into the PCMH practice, and the impact of successful integration on the patient experience. (UAN 0850-9999-16-040-L04-P)Alexander Blount, EdD


PCMH OPTIMIZATION TRI-NAVIGATIONAL COMMUNITY CARE COORDINATION: THE INTERSECTION OF BEHAVIORAL HEALTH, PUBLIC HEALTH AND CLINICS IN THE PCMHThe goal of the session is to describe the successful Tri-Navigational Community Care Coordination model to improve health outcomes for complex patients and the impact on the PCMH. This model emphasizes holistic care and relies on risk assessment and stratification, team-based care, common care planning, patient engagement, community involvement, and continual performance improvement. The model recognizes that individuals may have different health/social determi-nant needs, which require different entry points with distinct supports – public health, primary care, behavioral health. The effort is further described as part of the regional ACO, value-based contracts and Inte-grated Health Homes toward addressing population health needs. (UAN 0850-9999-16-009-L02-P)Aaron McHone, MBA

BEHAVIORAL HEALTHDEVELOPING SUSTAINABLE BEHAVIORAL HEALTH INTEGRATION INTO THE PCMHThere are major disconnects between models of behavioral health integration that were developed in public health agencies and gov-ernment clinics, and the private medical practices that make up the majority of the medical system. Many of the models being advanced are not financially sustainable and rely upon projected changes in the reimbursement system. This presentation builds upon a fast-growing program of integration into 24 different medical practices, many of whom are NCQA-certified PCMHs. (UAN 0850-9999-16-025-L04-P)Dan Fishbein, PhD

TECHNOLOGY/HEALTH IT HEALTH INFORMATION EXCHANGES: INCREASING QUALITY REPORTING IN THE MEDICAL NEIGHBORHOODPresent-day practices rely on quality data in order to improve patient care, reduce costs, and optimize their businesses. Join Nadine Robin, Health IT Program Director of the Louisiana Health Care Quality Forum as she explores how the state system, which includes hundreds of hospitals and healthcare providers, improved care at the practice level. (UAN 0850-9999-16-046-L04-P)Nadine Robin


ACHIEVING PCMH RECOGNITION PATIENT-CENTERED MEDICAL HOME: NAVIGATING THROUGH RECOGNITION AND REWARDSWhile the evidence supports the rationale to become a PCMH, and many pro-viders are on board, it is impossible to meet the requirements without proper technology support. This session will discuss the requirements for achieving certification, capabilities providers should consider working with their vendors to achieve, and best practices for introducing the program to the practice and getting buy-in from all staff. (UAN 0850-9999-16-045-L04-P)Allison LaValley, MBA

PCMH OPTIMIZATION COMPLEX CARE MEDICAL HOME: CAPTURING THE PATIENT VOICEThis session will discuss the use of a care plan in our EPIC platform that captures the patient’s story, the convergence of patient and medical goals, and the process that addresses the socioeconomic/behavioral as-pects of care. The presentation will also explore the challenges of spread-ing these concepts throughout a large Health System across 2 states (2 hospitals, 35 medical office buildings, dental and other care settings, with 9,000 staff, 700 physicians and allied clinicians, and 535,000 patients) while training over 170 staff members within a Complex Care Medical Home (CCMH) to use care plans. (UAN 0850-9999-16-017-L04-P)James Tan, MD, MHP, MBA, CPE

PCMH OPTIMIZATION REACHING YOUR HIGH-NEED PATIENTS THROUGH TEAM-BASED CARE: CHALLENGES AND SOLUTIONSHealthcare organizations are preparing for a value-based payment world where payment will be issued for high-quality care that produces positive outcomes, and not for volume of patients seen. Team-based, integrated care is a way to help and better support high-need, complex patients to reduce cost and improve outcomes. There is a lack of information on how to move towards this new care delivery model. This session will provide information on the changes and organizations needs to make to operationalize and imple-ment a team-based care delivery model for the high-need, high-risk patients. (UAN 0850-9999-16-047-L04-P)Karla Silverman, RN, CNM, MS


PCMH OPTIMIZATION ADDRESSING THE NEEDS OF PATIENTS WITHIN THE PCMH: OPTIMIZING CARE OF PATIENTS WITH DIABETESIndustry-Supported Symposium (0850-9999-16-030-L04-P, 0850-9999-16-032-L04-P, 0850-9999-16-033-L04-P)

MEDICAL NEIGHBORHOODTHE ROLE OF SOCIAL WORK IN THE NEW HEALTHCARE ENVIRONMENT OF PCMH INFUSED WITH TECHNOLOGYWhile experts have agreed that better communication with com-munity organizations and social services is critical, especially for PCMHs that focus on treating low-income patients or frail elders, many describe connections with the broader community as the most challenging for the medical neighborhood. At its core, the PCMH model suggests that Primary Care Clinicians should know about resources for patients’ needs and be able to track, coordinate, and assess the usefulness of identified community resources. However, many do not have the time to do the referral and follow up on those basic needs. In its current form, the medical neighborhood is fragmented, with little coordination among the myriad clinicians and institutions. Without a medical home, patients and caregivers are left to navigate the system on their own. Social workers are positioned to play a key role in decreasing the fragmentation, the inequities of care, and in the support of patient-centered care. (UAN 0850-9999-16-008-L04-P)Audrey Whetsell, MA, PCMH CCE

Sunday, October 9, 2016


11

ACHIEVING PCMH RECOGNITION ARE YOU MANAGING YOUR PCMH DATA, OR ARE THEY MANAGING YOU?This interactive session will help attendees make the most of their PCMH transfor-mation by harnessing the power of the NCQA data requirements. Attendees will receive tips and tools to make their PCMH data engaging to staff and patients. The session will be structured to be flexible enough to answer the highest de-mand questions of the audience, but systematic enough to have attendees at any level walk away with a game plan. (UAN 0850-9999-16-048-L04-P)Chris Espersen, MSPH

12:00 p.m. – 12:25 p.m. BOX LUNCH


ACHIEVING PCMH RECOGNITION STREAMLINING FOR SUSTAINABILITY: LEVERAGING EXIST-ING WORKFLOWS FOR POST-RECOGNITION SUCCESSPursuing PCMH recognition is a daunting undertaking for many primary care practices. Providers are often overwhelmed and intimidated by the volume of standards that need to be met, and are unaware that they may already have workflows in place that align closely with the PCMH model. Using case studies based on a cohort of 20 small practices in New York City, this session will offer practical approaches that can be used to streamline existing workflows and reduce redundancies while embedding sustain-able change in practice transformation. (UAN 0850-9999-16-049-L04-P)Saad H. Howard, MBA/MHA, PCMH CCE and

Janice Magno, MPA, PCMH CCE

MEDICAL NEIGHBORHOODTRANSFORMING OLDER ADULT HEALTH AND HEALTHCARE THROUGH A “MEDICAL NEIGHBORHOOD” BASED ON COMMUNITY ASSETSThis session will demonstrate the application of a multidisciplinary collec-tive to the “medical neighborhood” in the patient-centered medical home (PCMH). A unique composition of social service and medical providers are implementing evidence-based models of care and health programming to impact outcomes in older adult patients, caregivers, and older adult health at large. Evidence of program efforts, stakeholder buy-in, funding, and sustainability will be addressed by leaders of the medical neighborhood, including the key funder of the initiative. (UAN 0850-9999-16-004-L04-P)Jessica Grabowski, AM, LCSW

PCMH OPTIMIZATIONINSIDE TIPS TO TACKLING THE FINANCE BARRIERGain insight from a former CFO on how to present your best-case scenario for pursuing PCMH recognition when financial constraints are being cited as the reason for not obtaining recognition. Break down the barriers with finance by learning how to talk their language and relate the underlying importance of patient-centered recognition. (UAN 0850-9999-16-029-L04-P)Jennifer Ternay, MBA, CPA, PCMH CCE


MEDICAL NEIGHBORHOODGETTING STARTED IN YOUR NEIGHBORHOOD: PILOTING COMMUNITY HEALTH TEAMS THROUGH A MULTI-PAYER APPROACHDuring this session, primary care practices will learn how they can get started with forming a medical neighborhood – extending clinical services beyond their office settings – by forming a community health team that can deliver behavior-al health and social support services to assist patients with high-cost, complex care needs. The Care Transformation Collaborative of Rhode Island (CTC-RI) used a multi-payer approach to pilot and evaluate community heath teams in two diverse geographic neighborhoods and will offer practical guidance, tools and “lessons learned”. Participants will learn an initial approach to building an extended team that functions as an extension of the neighborhood’s primary care practices, and realize directional improvement in reducing costs of care and improving the provision of holistic care. (UAN 0850-9999-16-005-L04-P)Susanne Campbell, RN, MS, PCMH CCE

PCMH OPTIMIZATIONBUILDING A TRANSFORMATIVE TEAM: CREATE YOUR MEDICAL HOME OR NEIGHBORHOODThe goal of this presentation is to provide participants with the necessary tools needed to build a team that can achieve successful and meaningful practice transformation into a medical home and/or neighborhood. Partici-pants will leave with concrete tools that enable them to harness leadership and staff engagement, approach change, create a team, and realize the full potential of their team members. (UAN 0850-9999-16-028-L04-P)Sari Miettinen, MD, FAAP, PCMH CCE

ACHIEVING PCMH RECOGNITIONA PUBLIC HOSPITAL ACADEMIC MEDICAL CENTER PCMH JOURNEYAcademic medical centers and public hospitals have more barriers to overcome in establishing the PCMH than private practices. The University of New Mexico Health Sciences Center is an academic medical center based in a safety net public hospital system with 12 Level 3 PCMH clinics in the community. This session will tell the story of the PCMH recognition journey for the clinics within the University of New Mexico Hospital System in the achievement of Level 3. We will discuss the integration of services including behavioral health, pharmacy clinicians, case management, social services including community health workers, therapy services and others into com-munity clinics. We will demonstrate the value of screening for and address-ing the social determinants of health. (UAN 0850-9999-16-013-L04-P)Charles North, MD, MS

2:55 p.m. – 3:55 p.m. PRACTICAL POLICY: WHAT THE LATEST UPDATES REALLY MEAN FOR THE PCMHMACRA. APMs. MIPS. Policy can sometimes be a confusing mix of acro-nyms and complicated policy documents. But what do the latest policy reforms mean from a practical standpoint for the practicing PCMH? Join our expert panel as they explore the latest hot topics in the policy arena and help shed some light on how these changes truly impact the PCMH. (UAN 0850-9999-16-041-L04-P)Michael S. Barr, MD, MBA, MACP, Paul Cotton, and Shari Erickson, MPH

3:55 p.m. – 4:10 p.m. CONFERENCE SUMMARY AND CONCLUDING REMARKS

Exhibit & Sponsorship OpportunitiesPCMH Congress is the venue to reach an audience of health care and policy leaders dedicated to improving the delivery of care. More than 800 professionals participated in the 2015 inaugural event. To learn more about ways to reach this audience of influential professionals from across the medical neighborhood, please contact:

David GordonDirector, National AccountsNACCME, [email protected]

SCHEDULE AT A GLANCEFRIDAY, OCTOBER 7, 2016

7:00 a.m. – 8:00 a.m. Registration and Complimentary Breakfast

8:00 a.m. – 8:10 a.m. Welcome and Opening Remarks Margaret O’Kane, MHS

8:10 a.m. – 9:10 a.m.OPENING SESSION: MAKING GOOD NEIGHBORS: HOW PCMHs AND PCSPs CAN WORK TOGETHER TO IMPROVE CARE WITHIN THE MEDICAL NEIGHBORHOOD Andrew Chapman, DO and Jeffrey O. Greenberg, MD, MBA

WORKSHOPS (Select 1 of 3)

9:20 a.m. – 10:20 a.m. PATIENT ENGAGEMENT AND DIGITAL HEALTH: OPPORTUNITIES FOR CARE COORDINATORS AND CHRONIC DISEASE MANAGEMENT Janet Duni, RN, BSN, CCM, MPA

SUPPORTING PATIENT CARE: FROM MEDICAL HOME TO MEDICAL NEIGHBORHOOD Robert Krebbs and Kia Poe, MS, PCMH CCE

THE ROLE OF THE PCMH UNDER MACRA Adele Allison, BS


10:30 a.m. – 11:30 a.m. BEST PRACTICES IN PCMH ACHIEVEMENT AND MAINTENANCE Sari Miettinen, MD, FAAP, NCQA PCMH CCE

ALTERNATIVE PAYMENT MODELS: HOW THEY’RE CHANGING HEALTHCARE FINANCE Amber Winkler, MHA, PCMH CCE

CONNECTING THE DOTS OF NCQA’S PATIENT-CENTERED CONNECTED CARE™ RECOGNITION

Michelle Rodriguez, MBA, PCMH CCE and Alan Stricoff, DO, FACPE

11:40 a.m. – 12:40 p.m.BEHAVIORAL ECONOMICS: IMPROVING HEALTH BEHAVIORS THROUGH FINANCIAL AND SOCIAL INCENTIVES David Asch, MD, MBA



2:10 p.m. – 3:10 p.m. WELCOME TO THE NEIGHBORHOOD: SPECIALISTS AS GOOD NEIGHBORS—DEFINING THE MEDICAL NEIGHBORHOOD Robert Gabbay, MD, PhD

AFTER PCMH RECOGNITION: HITTING THE STARTING LINE RUNNING Scott Hultstrand, JD, PCMH CCE and Martha Paap

WHO’S THE PATIENT? A PANEL ON EMPANELMENT Mina Harkins, MBA, PCMH CCE


3:20 p.m. – 4:20 p.m. BUILDING A CHANGE MANAGEMENT STRATEGY Nicole Harmon, MBA, PCMH CCE

ADDRESSING THE WHOLE PERSON: INTEGRATING BEHAVIORAL HEALTH INTO THE PEDIATRIC PATIENT-CENTERED MEDICAL HOME Sue Schell, MA

BRINGING THE MEDICAL NEIGHBORHOOD TO LIFE FOR PATIENT-CENTERED MEDICAL HOMES WITH ANALYTICS Steven Peskin, MD, PCMH CCE

4:30 p.m. – 5:30 p.m. KEYNOTE ADDRESS

THE ELECTRONIC HEALTH RECORD NOW AND THEN: MOVING FROM REGULATORY BURDEN TO ENABLING A PATIENT-CENTERED MEDICAL HOME Peter Basch, MD, MACP

5:45 p.m. – 7:15 p.m. EXHIBIT HALL GRAND OPENING

SATURDAY, OCTOBER 8, 2016

7:00 a.m. – 8:00 a.m. Complimentary Breakfast in Exhibit Hall

Breakfast with NCQA President Margaret O’Kane for PCMH CCEs


8:10 a.m. – 9:10 a.m. DATA AND INFORMATION-DRIVEN TRANSFORMATION Shannon Nielson, MHSA, PCMH CCE

AN INTERDISCIPLINARY COLLABORATIVE: PEDIATRICIANS, INTERNISTS, AND FAMILY MEDICINE IMPROVING PATIENT-CENTERED CARE Jill Patton, DO

THE NUTS AND BOLTS OF PATIENT-CENTERED MEDICAL HOME CONTENT EXPERT CERTIFICATION EXAM PREPARATION Shauna Brown, MSL, Nicole Harmon, MBA, PCMH CCE, Cari Miller, MSM, PCMH CCE, and Peggy A. Reineking, MS, MBA, PCMH CCE


9:20 a.m. – 10:20 a.m. EXAMINING THE IMPACT OF HEALTH IT ON CARE INTEGRATION: ACHIEVING WHOLE-PERSON CARE Regina Neal, MPH, MS, PCMH CCE

USING PANEL STRATIFICATION IN THE MEDICAL HOME Lucy Loomis, MD

EVALUATING YOUR TRANSFORMATIVE TEAM’S APTITUDE TO ADVANCE Emilie Buscaj, MPH, PCMH CCE


12


10:30 a.m. – 11:30 a.m. INDUSTRY-SUPPORTED SYMPOSIA11:40 a.m. – 12:40 p.m. ORAL ABSTRACT PRESENTATIONS Paul Klintworth, MSPM, HIT

12:40 p.m. – 1:55 p.m. LUNCH IN THE EXHIBIT HALLWORKSHOPS (Select 1 of 3)

2:10 p.m. – 3:10 p.m. CO-MANAGEMENT AGREEMENTS: WHAT ARE THESE AND WHERE DO I BEGIN? Cari Miller, MSM, PCMH CCE

UTILIZING THE ELECTRONIC HEALTH RECORD TO ACHIEVE AND MAINTAIN PCMH RECOGNITION AND ALIGN WITH OTHER CONTINUOUS QUALITY IMPROVEMENT PROGRAMS Monaco Briggs, MBA and Lori Francis, BS, PCMH CCE

HOW TO BUILD AN INTERDISCIPLINARY TRANSFORMATION TEAM AND THE IMPORTANCE OF INCLUDING PATIENTS AND COMMUNITY PARTNERS Randall Messier, MT, MSA, PCMH CCE

WORKSHOPS (Select 1 of 3)3:20 p.m. – 4:20 p.m. DEC CO-MANAGEMENT MODEL PROVIDES PATIENT-CENTERED BEHAVIORAL CRISIS CARE Nicole Bauer, MA

QUALITY FIRST: A VIRGINIA SAFETY NET CLINIC COLLABORATIVE’S JOURNEY TO PATIENT-CENTERED TRANSFORMATION Caitlin Feller, MPP, PCMH CCE, Sally Graham, RN-C, ANP, Cynthia Newbille, PhD, and Peter Prizzio, MEd

THE FUNDAMENTALS OF STRUCTURING AND ADVANCING A TEAM-BASED ENVIRONMENT Michael

Attanasio, DO and Megan Santanna, MA

4:30 p.m. – 5:30 p.m. FEATURED SESSION

REDESIGNING THE PCMH RECOGNITION PROGRAM Michael S. Barr, MD, MBA, FACP

5:45 p.m. – 7:15 p.m. EXHIBIT HALL RECEPTION

SUNDAY, OCTOBER 9, 20167:00 a.m. – 7:15 a.m. Breakfast

7:25 a.m. – 8:25 a.m.STRATEGIES FOR SUCCESSFUL INTEGRATION OF BEHAVIORAL HEALTH INTO THE PRIMARY CARE PRACTICE: FOCUS ON MAJOR DEPRESSIVE DISORDER Alexander Blount, EdD

WORKSHOPS (Select 1 of 3)8:35 a.m. – 9:35 a.m. TRI-NAVIGATIONAL COMMUNITY CARE COORDINATION: THE INTERSECTION OF BEHAVIORAL

HEALTH, PUBLIC HEALTH AND CLINICS IN THE PCMH Aaron McHone, MBA

DEVELOPING SUSTAINABLE BEHAVIORAL HEALTH INTEGRATION INTO THE PCMH Dan Fishbein, PhD

HEALTH INFORMATION EXCHANGES: INCREASING QUALITY REPORTING IN THE MEDICAL NEIGHBORHOOD Nadine Robin

WORKSHOPS (Select 1 of 3)9:45 a.m. – 10:45 a.m. PATIENT-CENTERED MEDICAL HOME: NAVIGATING THROUGH RECOGNITION AND REWARDS

Allison LaValley, MBA

COMPLEX CARE MEDICAL HOME: CAPTURING THE PATIENT VOICE James Tan, MD, MHP, MBA, CPE

REACHING YOUR HIGH-NEED PATIENTS THROUGH TEAM-BASED CARE: CHALLENGES AND SOLUTIONS Karla Silverman, RN, CNM, MS

WORKSHOPS (Select 1 of 2)10:55 a.m. – 11:55 a.m. ADDRESSING THE NEEDS OF PATIENTS WITHIN THE PCMH: OPTIMIZING CARE OF PATIENTS WITH

DIABETES Industry-Supported Symposium

THE ROLE OF SOCIAL WORK IN THE NEW HEALTHCARE ENVIRONMENT OF PCMH INFUSED WITH TECHNOLOGY Audrey Whetsell, MA, PCMH CCE

ARE YOU MANAGING YOUR PCMH DATA, OR ARE THEY MANAGING YOU? Chris Espersen, MSPH

12:00 p.m. – 12:25 p.m. Box LunchWORKSHOPS (Select 1 of 3)

12:35 p.m. – 1:35 p.m. STREAMLINING FOR SUSTAINABILITY: LEVERAGING EXISTING WORKFLOWS FOR POST-RECOGNITION SUCCESS Saad H. Howard, MBA/MHA, PCMH CCE and Janice Magno, MPA, PCMH CCE

TRANSFORMING OLDER ADULT HEALTH AND HEALTHCARE THROUGH A “MEDICAL NEIGHBORHOOD” BASED ON COMMUNITY ASSETS Jessica Grabowski, AM, LCSW

INSIDE TIPS TO TACKLING THE FINANCE BARRIER Jennifer Ternay, MBA, CPA, PCMH CCE

WORKSHOPS (Select 1 of 3)1:45 p.m. – 2:45 p.m. GETTING STARTED IN YOUR NEIGHBORHOOD: PILOTING COMMUNITY HEALTH TEAMS THROUGH A

MULTI-PAYER APPROACH Susanne Campbell, RN, MS, PCMH CCE

BUILDING A TRANSFORMATIVE TEAM: CREATE YOUR MEDICAL HOME OR NEIGHBORHOOD Sari Miettinen, MD, FAAP, NCQA PCMH CCE

A PUBLIC HOSPITAL ACADEMIC MEDICAL CENTER PCMH JOURNEY Charles North, MD, MS

2:55 p.m. – 3:55 p.m.PRACTICAL POLICY: WHAT THE LATEST UPDATES REALLY MEAN FOR THE PCMH Michael S. Barr, MD, MBA, MACP, Paul Cotton, and Shari Erickson, MPH

3:55 p.m. – 4:10 p.m. CONFERENCE SUMMARY AND CONCLUDING REMARKS


13

Hotel & Registration Information

Official Conference Hotel:

Hilton Chicago720 South Michigan AvenueChicago, IL 60605T: +1-312-922-4400F: +1-312-294-6891

©20

16 H

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Hot

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& R

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Special Conference Rate: $269

The deadline to reserve a room at the discounted rate is September 2, 2016. Be sure to book your room early – due to the high attendance anticipated, availability is limited.

To reserve your room, visit www.PCMHcongress.com and go to the Hotel/Travel section. Be sure to reference PCMH.

New for 2016!Maximum Value Package

PCMH Congress has introduced a Maximum Value Package, which includes registration for the full conference, syllabus, and access to PCMH Congress On-Demand—recordings of the educational sessions that you can listen to after the conference or share with colleagues. Be sure to select MVP to receive the most value for your PCMH Congress investment!

MVP

EDUCATION ACCREDITATION INFORMATION

INTENDED LEARNERS

This conference is designed for professionals devoted to transforming care through the medical home model of care, including clinicians, allied health professionals, practice administrators, quality managers, and consultants.

LEARNING OBJECTIVES

After attending the PCMH Congress 2016 meeting, participants should be able to:

• Incorporate strategies to optimize comprehensive quality improvement within the PCMH and the Medical Neighborhood

• Discuss the various roles within the medical neighborhood and their impact on patient care, including PCMHs, PCSPs, and ACOs

• Describe the impact that PCMH-recognized practices have made on patient and population health outcomes

ACTIVITY OVERVIEW

The interactive educational conference will occur at The Hilton Chicago, Chicago, Illinois on October 7-9, 2016. A question-and-answer session with the faculty will follow each presentation.

To be eligible for documentation of credit, participants must attend the full activity and submit a completed evaluation form. Participants who complete the evaluation online at PCMHCongress.com within 4 weeks of the live meeting will immediately receive documentation of credit.

HARDWARE/SOFTWARE REQUIREMENTS

The evaluation is accessible after the activity via a PC (Windows 2000/XP/Vista/7) or Mac (Mac OS 10.x or later) computer with current versions of the following browsers: Internet Explorer, Mozilla Firefox, Google Chrome, or Safari. A PDF reader is required for print publications. Please direct technical questions to [email protected].

ACCREDITATION

In support of improving patient care, the National Committee for Quality Assurance (NCQA) is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE) and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for the healthcare team.

NCQA designates this live activity for a maximum of 21 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This continuing nursing education activity awards 21 contact hours.

Each of these activities is approved for 1 contact hour (.01 CEU) of continuing pharmacy education: (0850-0000-16-002-L04-P, 0850-0000-16-003-L04-P, 0850-0000-16-004-L04-P, 0850-0000-16-005-L04-P, 0850-0000-16-006-L04-P, 0850-0000-16-007-L04-P, 0850-0000-16-008-L04-P, 0850-0000-16-009-L02-P, 0850-0000-16-010-L04-P, 0850-0000-16-011-L04-P, 0850-0000-16-012-L04-P, 0850-0000-16-013-L04-P, 0850-0000-16-014-L04-P, 0850-0000-16-015-L04-P, 0850-0000-16-016-L04-P, 0850-0000-16-017-L04-P, 0850-0000-16-018-L04-P, 0850-0000-16-019-L04-P, 0850-0000-16-020-L04-P, 0850-0000-16-021-L04-P, 0850-0000-16-022-L04-P, 0850-0000-16-023-L04-P, 0850-0000-16-024-L04-P, 0850-0000-16-025-L04-P, 0850-0000-16-026-L04-P, 0850-0000-16-027-L04-P, 0850-0000-16-028-L04-P, 0850-0000-16-029-L04-P, 0850-0000-16-030-L04-P, 0850-0000-16-031-L04-P, 0850-0000-16-032-L04-P, 0850-0000-16-033-L04-P, 0850-0000-16-034-L04-P, 0850-0000-16-035-L04-P, 0850-0000-16-036-L04-P, 0850-0000-16-037-L04-P, 0850-0000-16-038-L04-P, 0850-0000-16-039-L04-P, 0850-0000-16-040-L04-P, 0850-0000-16-041-L04-P, 0850-0000-16-042-L04-P, 0850-0000-16-043-L04-P, 0850-0000-16-044-L04-P, 0850-0000-16-045-L04-P, 0850-0000-16-046-L04-P, 0850-0000-16-047-L04-P, 0850-0000-16-048-L04-P, 0850-0000-16-049-L04-P).

Activities will provide up to 15 hours of maintenance of certification credit for PCMH CCEs.

ADA STATEMENT

NACCME and NCQA comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in this educational activity is in need of accommodations, please call 609-371-1137.

CANCELLATION POLICY

Cancellation requests postmarked by Sunday, July 31, 2016 will be honored in the form of a full refund, minus a $100 processing fee. No refunds will be issued after August 1, 2016. If you do not cancel or do not attend, you are still responsible for full payment. There are no exceptions to these policies. Payments made may not be applied toward tuition for future PCMH Congress conferences, or other meetings or products offered by NACCME or NCQA.

PRIVACY POLICY

NACCME protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. NACCME and our joint sponsors will not release personally identifiable information to a third party without the individual’s consent, except such information as is required for reporting purposes to the appropriate accrediting agency. NACCME maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Copyright © 2016 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education.

Jointly provided by North American Center for Continuing Medical Education, LLC, an HMP Communications Holdings Company and the National Committee for Quality Assurance.

Group Registration DiscountsPCMH Congress is pleased to offer group registration rates for any organization planning to send at least two people from the same organization to the conference. Discounts are as follows:

2 – 5 attendees: SAVE $100 6 – 10 attendees: SAVE $200 11+ attendees: SAVE $300

To receive a group discount, call our registration line at 800-218-3185 or email [email protected]. Note: A group organizer/administrator may register all attendees in a group; however, they must be able to accurately provide all required information through the individual registration process for each person in their group.

Early Bird Early Regular Regular Advanced Onsite

On or Before 5/13/2016



On or Before 10/6/2016 10/7/16-10/9/16

Regular $999 $1,099 $1,199 $1,299 $1,499

MVP $1,199 $1,299 $1,399 $1,499 $1,699

Culinary Medicine Cooking ModulesModules are not included in the price

of CRS Spring base registration. The

additional cost is $175 for one (1) four-

hour module or $300 for two (2) four-

hour modules.

Disease Implications of Diet: An Intro-

duction to Culinary Medicine – Friday,

May 29 from 1:00 p.m.-4:00 p.m.

Hypertension and Nutrition: Low Sodium

Diets and Flavor Building – Friday, May

29 from 5:00 p.m.-8:00 p.m.

Lipids in Disease: The Impact of Dietary

Fats on Health – Saturday, May 30 from

6:00 p.m.-9:00 p.m.

Diabetes Mellitus: Carbohydrates and

Nutrition – Sunday, May 31 from 6:00

p.m.-9:00 p.m.

French Quarter Group Jogging Tour

I would like to participate in the

French Quarter Group Jogging Tour

on Sunday, May 31 at 6:00 a.m.

Complimentary with your CRS Spring

registration.

Syllabus Book ($35)

TOTAL DUE: ___________(Including registration)

PCMHCongressTM


Registration Form


15

PERSONAL INFO

First Name Middle Initial Last Name

Phone Number Email Address

Mailing Address

City State Zip Code Country

Company/Organization Name Position

Professional Category m MD/DO m NP/PA m MSN/BN/RN m Pharmacist

m Administrator m Other Allied m Industry m None

Are you an NCQA PCMH-Certified Content Expert? m Yes m No

Primary Specialty: m Primary Care m Family Medicine m Internal Medicine

m Other [write in]

What is your primary care setting? m Hospital m Office-based m N/A

m Other [write in]

Years in Practice: m Less than 5 m 6 to 10 m 11 to 20 m 21 to 30 m 31+

What is your current patient load per week?m 50 or fewer m 51 to 100 m 101 to 150 m 151 or more

In what state are you licensed to practice? [write in]

NPI # [write in – 10 characters]

If you are a non-prescriber and do not have an NPI #, please leave it blank.

METHOD OF PAYMENT: m Visa m MasterCard m AMEX m Discover m Check*

* Make checks payable to HMP Communications. All checks must be drawn on a U.S. bank in U.S. funds. Mail to HMP Communications, 70 E. Swedesford Road, Suite 100, Malvern, PA 19355.

Credit Card Number Expiration Date Security Code

Billing Address

City State Zip

Signature of Cardholder (Required)

FOUR WAYS TO REGISTER:

CALL: 800-218-3185

FAX: 610-560-0502

VISIT: www.PCMHcongress.com/register

MAIL: HMP Communications

70 E. Swedesford Road, Suite 100

Malvern, PA 19355

Early Bird Early Regular Regular Advanced Onsite




On or Before 10/6/2016 10/7/16-10/9/16

Regular $999 $1,099 $1,199 $1,299 $1,499

MVP $1,199 $1,299 $1,399 $1,499 $1,699

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October 7-9, 2016Chicago Hilton - Chicago, IL

The conference for members of the medical neighborhood

Register early for the lowest rates!

Use code PCMHSAVE50 to save $50 on your registration.* *Expires 6/30/16

Developed by

Follow us on: facebook.com/NCQA.orgTwitter @NCQA#pcmhcongress

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