THE EVER EVOLVING PATIENT CENTERED MEDICAL HOMEKathy Willis, MD
Jay Besse
WHAT IS THE PCMH?
Medical Home is not a place, but rather a theory and model for providing comprehensive primary care.
It creates and encourages partnerships between health care providers/teams and individual patients—and sometimes the patient’s significant others.
LSU HISTORY
HERE
NCQA PPC-PCMHJOINT PRINCIPLES
Personal physician Physician directed medical practice
Team of individuals who collectively take responsibility for ongoing care
Whole person orientation Personal physician takes responsibility for all
the patient’s health care needs
NCQA PPC-PCMHSTANDARDS
Standard
1. Access and Communication
2. Patient Tracking & Registry Functions
3. Care Management
4. Patient Self-Management Support
5. Electronic Prescribing
6. Test Tracking
7. Referral Tracking
8. Performance Reporting and Improvement
9. Advanced Electronic Communications
CONTINUING THE LSU MEDICAL HOME
Accountable Care Organization agreement Representatives from our partners will work
with us Important that a consistent concept is
maintained across the LSU Medical Home locations
CONTINUING THE LSU MEDICAL HOME
Same patients Same providers Same staff Same program Same dedication
WHAT DO WE NEED TO DO NOW?
Address the challenges to meeting the NCQA requirements
Formalizing the requirements of the LSU Medical Home
Identify and adapt to system changes
DEFINING THE LSU MEDICAL HOME STANDARDS
Two Perspectives Providers
What do we expect from the patients? What things should we are providers do to improve the
patients experience? What do we expect from our staff in the Medical
Home? Patients
What should a patient expect as a member of the LSU Medical Home?
Comprehensive Multi-Domain Flexible
LSU MEDICAL HOME MEASUREMENT DOMAINS
ACCESS PROCESS SCREENING & PREVENTION OUTCOMES PERCEPTION & SATISFACTION
DOMAIN 1: ACCESS
Appointment Show Rate Median Days to Appointment Referrals * Telephone Follow-up * Assessing Electronic Access to patient
records *
* In Development
DOMAIN 2: PROCESS
Documentation Blood Pressure Weight Height Smoking Status
Primary Care/Medical Home Verification Verify patient-provider relationship
Medication Reconciliation
47117734
3894
6931
6906
68164662 41654
.65
.7
.75
.8
.85
.9
.95
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200901 through 201301
documentation: PP, fraction with blood pressure documenteddenom: MHCD patients in qrt
DOMAIN 3: SCREENING & PREVENTION Cancer Screening
Breast – Mammogram in past 2 years, age 40-75 Cervical – PAP test in past 3 years, age 21-65 Prostate – PSA or PSA education in the past 2 years, age 50-75 Colorectal – Colonoscopy in past 10 yrs, Flex Sig in past 5 years, or
FOBT in past year Tobacco Cessation Depression Screening Lipid Assessment
Lipid Profile in the past 2 years Lipid Profile in the past 3 years
Routine Flu Immunization Current flu shot
Pneumococcal Vaccination Pneumovax administered ever
Abdominal Aortic Aneurysm (AAA) Screening *
* In Development
DOMAIN 4: OUTCOMES
Blood Pressure Control Last BP > 140/90 mmHg Sustained BP > 140/90 mmHg
Lipid Management Most recent LDL < 100 Composite Lipid management
LDL <130, HDL>50, Trig <200
Smoking Quit Rate
5654
9449
4939
9435
7088 8574
6626
51765
.2
.25
.3
.35
.4
.45
.5
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200901 through 201301AWARD criterion = 0.27, see line on graph
wellness: Last BP > 140/90, Total [R]denom: MedHmCD sustained 6/12
DOMAIN 5: PERCEPTIONS & SATISFACTION
Pre-Visit Medical Home Perceptions
Post-Visit Medical Home Satisfaction
PATIENT PERCEPTIONS
Focuses on capturing patient responses to domain related questions
Multiple Versions Constant
Refinement Will identify areas
for focus by the Medical Home
PERCEPTION RESULTS
3. Short wait to see doc
2. Easy to get appt
4. Helps me reach goals
1. Clinic communication
5. Follows up with test results
12. Easy to get care when needed
11. Friendly and helpful
7. Teaches me about health
10. Gets screenings done
8. Educates about meds
9. Assesses affordability
14. Overall satisfaction
6. Staff concerned with quality
15. Willing to recommend
13. Overall quality rating
3.3
3.4
3.5
3.6
3.7
3.8
3.9 4
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9 5
Response Levels
Showing Highest and Lowest Clinic LevelsSurvey Results
Line connects overall system levels. Dots are LAK_NEW CLINIC valuesGraph includes data from quarter 201104 to 201202Samplesize in range (103;117) - average : 110
PATIENT SATISFACTION
Will align with Medical Home domains Focused on quick feedback to improve the
patient experience Will validate if improvements made through
improved patient perceptions have improved patient satisfaction
WHY MEASURE THE MEDICAL HOME?
The Medical Home is fluid and requires constant review and refinement. There is no one model that fits the patient population, therefore, measurement helps to identify areas for improvement and action.
GOALS FOR THE LSU MEDICAL HOME
Continued measure development through data dissemination
Identify areas for improvement Participation in Medical Home-related
improvement projects*
LSU ICON - MEDICAL HOME INTEREST GROUP
Identifying areas of improvement to assist with meeting or exceeding the defined NCQA standards
Assist with the refinement of the currently identified measure set
THANKS TO THE MH STANDARDS SUBCOMMITTEE
Kathy Willis, MD Karen Applewhite, RN Tena Turnage, RN Pam Wright, RN Jay Besse Kris Like, RN Julie Nevers, RN Mary K Blackburn, RN
THANKS