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Copyright 2011. Medical Group Management Association. All rights reserved. 1
Meaningful Use and the Capabilities of HIE to Support the Needs of a PCMH
Hawaii Health Information ExchangeBeacon Grantees Meeting
Honolulu, Hawaii
David N. Gans, MSHA, FACMPEVice President Innovation and ResearchMedical Group Management Association
July 29, 2011
Copyright 2011. Medical Group Management Association. All rights reserved. 2
About MGMA
Our mission…To continually improve the performance of medical group practice professionals and the organizations they represent
MGMA has• 23,500 members…• Who manage and lead 13,700 organizations• With 280,000 physicians• Providing about 40% of U.S. physician services
Copyright 2011. Medical Group Management Association. All rights reserved. 3
What is a Patient Centered Medical Home (PCMH)?
Copyright 2011. Medical Group Management Association. All rights reserved. 4
What Is a Patient Centered Medical Home (PCMH)?• A medical home is not a building, house, or hospital, but rather an
approach to providing comprehensive primary care. • The PCMH is an approach to providing comprehensive primary care
for children, youth and adults. • The PCMH is a health care setting that facilitates partnerships
between individual patients, and their personal physicians, and when appropriate, the patient’s family.
• “A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” -- American Academy of Pediatrics
Copyright 2011. Medical Group Management Association. All rights reserved. 5
1. Personal physician providing first contact, continuous and comprehensive care
2. Physician directed medical team3. Whole person orientation with the personal physician responsible for
providing for all the patient’s health care needs4. Care is coordinated across all elements of the health care system
including subspecialty care, hospitals, home health, nursing homes and the patient’s community
5. Care is facilitated by registries, information technology, and exchange of health information
Joint Principals of the PCMH
Copyright 2011. Medical Group Management Association. All rights reserved. 6
6. Quality and safety are hallmarks of the medical home– Evidence-based medicine and clinical decision-support tools guide
decision making– Physicians in the practice accept accountability for continuous
quality improvement through voluntary engagement in performance measurement and improvement
– Patients actively participate in decision-making7. Enhanced access to care is available through open scheduling,
expanded hours and new options for communication between patients, their personal physician, and practice staff
8. Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home
Joint Principals of the PCMH (Continued)
Copyright 2011. Medical Group Management Association. All rights reserved. 7
What Changes When a Primary Care Practice becomes a PCMH• An EHR is used not only for its medical record capabilities but also as
a quality tool and to schedule preventive services for individual patients
• Patient registries are used to evaluate and improve the health status of patient populations
• Advanced scheduling and asynchronous care become normal• Group visits and self management support are common• Care delivery evolves from “practice-work “ to “teamwork”
Copyright 2011. Medical Group Management Association. All rights reserved. 8
Voluntary Recognition as a PCMH
To demonstrate that a practice is a PCMH, it undergoes voluntary recognition by an appropriate non-governmental entity to demonstrate that it has the capability to provide patient centered services consistent with the medical home model
Recognizing Bodies• National Committee for Quality Assurance (NCQA)• Accreditation Association for Ambulatory Health Care (AAAHC)• The Joint Commission• URAC
Copyright 2011. Medical Group Management Association. All rights reserved. 9
Today’s Care Medical Home Care
Our patients are those who are registered in our medical home
Care is determined by today’s problem and time available today
Care is determined by a proactive plan to meet health needs, with or without visits
Care varies by scheduled time and memory or skill of the doctor
Care is standardized according to evidence-based guidelines
Patients are responsible for coordinating their own care
A prepared team of professionals coordinates all patients’ care
I know I deliver high quality care because I’m well trained
We measure our quality and make rapid changes to improve it
It’s up to the patient to tell us what happened to them
We track tests and consultations, and follow-up after ED and hospital
Clinic operations center on meeting the doctor’s needs
An interdisciplinary team works at the top of our licenses to serve patients
My patients are those who make appointments to see me
PCMH Approach to Delivering Health Care
Source: Adapted with permission from F. Daniel Duffy, MD, MACP, Senior Associate Dean for Academics, University of Oklahoma School of Community Medicine
Copyright 2011. Medical Group Management Association. All rights reserved. 10
Qualifying as a PCMH
Under the NCQA standards, a practice must demonstrate proficiency in six standards:1. Enhance access and continuity2. Identify and manage patient populations3. Plan and manage care4. Provide self-care and community resources5. Track and coordinate care6. Measure and improve performance
The AAAHC and proposed Joint Commission and URAC requirements are similar
Source: National Committee for Quality Assurance, Standards for PCMH 2011
Copyright 2011. Medical Group Management Association. All rights reserved. 11
MGMA 2011 Patient-Centered Medical Home (PCMH) Study Results
Copyright 2011. Medical Group Management Association. All rights reserved. 12
Study Methodology
• Study Goals:– To identify the challenges and barriers that medical groups encounter
or anticipate will encounter in becoming a PCMH– To provide information to MGMA members and others on the
experiences of practices that have attained PCMH recognition.– To identify how primary care practices deliver care
• Online electronic questionnaire distributed by direct e-mail to MGMA members and customers
• Data collected 25 March – 29 April 2011• 341 medical organization responded prior to data cut-off• Responses represented information for practices with 5,790 primary care
physicians and 1,996 nonphysician providers
Copyright 2011. Medical Group Management Association. All rights reserved. 13
Responses by Organization Type
Physician-owned medical practice
Hospital-owned or integrated delivery system (IDS)-owned medical practice
Federally qualified health center, community health center or similar practice
Other
0% 20% 40% 60% 80% 100%
54%
22%
15%
9%
45%
39%
4%
12%
63%
21%
6%
9%
Interested in becoming a PCMH
Transforming to become a PCMH
Accredited or rec-ognized PCMHs
Copyright 2011. Medical Group Management Association. All rights reserved. 14
Motivation to Become a PCMH
The opportunity to improve the health of our patients
To provide patient-focused care
PCMH is the future of primary care
The opportunity to increase practice revenue
To be on board with the priorities of the National Strategy for Quality Improvement in Healthcare
It is mandated by our parent organization
0% 20% 40% 60% 80% 100%
88%
87%
80%
63%
35%
8%
Copyright 2011. Medical Group Management Association. All rights reserved. 15
PCMH Status
Interested in becoming a PCMH
Transforming to become a PCMH
Accredited or recognized PCMHs
Don't know PCMH status
Not interested in becoming a PCMH
0% 20% 40% 60% 80% 100%
41%
27%
21%
6%
5%
Copyright 2011. Medical Group Management Association. All rights reserved. 16
Change in Patient Satisfaction As a Result of Achieving PCMH Status
Considerable increase
Mild increase
No change
Mild decrease
Considerable decrease
Do not conduct patient satisfaction surveys
0% 20% 40% 60% 80% 100%
17%
40%
37%
0%
0%
6%
Copyright 2011. Medical Group Management Association. All rights reserved. 17
Practice Processes for Accredited or Recognized PCMHs
Assigns each patient to a primary care clinician
Exchanges clinical information electronically with pharmacies
Involves patients and family members in shared decision making about their care
Maintains chronic disease registries
Addresses patients' mental health issues and refers them to appropriate agencies
Uses chronic disease registries to conduct population management
Develops and documents self-management care plans prepared in collaboration with patients
Exchanges clinical information electronically with hospitals
Develops care plans for high-risk patients
Exchanges clinical information electronically with referral physicians
Has multidisciplinary care teams collaborating with a primary care clinician
Has a care coordinator managing high-risk patients
0% 20% 40% 60% 80% 100%
95%
88%
83%
81%
75%
71%
67%
59%
59%
58%
51%
44%
0%
10%
17%
14%
24%
17%
31%
31%
37%
39%
36%
37%
5%
2%
0%
5%
2%
12%
2%
10%
3%
3%
14%
19%
Does not provide cur-rently or does not in-tend to provide
Intends to provide within the next 12 months
Currently provide
Copyright 2011. Medical Group Management Association. All rights reserved. 18
Practice Processes for Those Transforming to Become a PCMH
Assigns each patient to a primary care clinician
Exchanges clinical information electronically with pharmacies
Involves patients and family members in shared decision making about their care
Maintains chronic disease registries
Addresses patients' mental health issues and refers them to appropriate agencies
Uses chronic disease registries to conduct population management
Develops and documents self-management care plans prepared in collaboration with patients
Exchanges clinical information electronically with hospitals
Develops care plans for high-risk patients
Exchanges clinical information electronically with referral physicians
Has multidisciplinary care teams collaborating with a primary care clinician
Has a care coordinator managing high-risk patients
0% 20% 40% 60% 80% 100%
85%
78%
63%
43%
69%
27%
23%
41%
36%
36%
30%
21%
12%
18%
33%
52%
24%
56%
68%
50%
57%
54%
56%
62%
4%
4%
4%
5%
6%
17%
9%
9%
7%
10%
14%
18%
Does not provide cur-rently or does not in-tend to provide
Intends to provide within the next 12 months
Currently provide
Copyright 2011. Medical Group Management Association. All rights reserved. 19
Practice Processes for Those Interested in Becoming a PCMH
Assigns each patient to a primary care clinician
Exchanges clinical information electronically with pharmacies
Involves patients and family members in shared decision making about their care
Maintains chronic disease registries
Addresses patients' mental health issues and refers them to appropriate agencies
Uses chronic disease registries to conduct population management
Develops and documents self-management care plans prepared in collaboration with patients
Exchanges clinical information electronically with hospitals
Develops care plans for high-risk patients
Exchanges clinical information electronically with referral physicians
Has multidisciplinary care teams collaborating with a primary care clinician
Has a care coordinator managing high-risk patients
0% 20% 40% 60% 80% 100%
78%
67%
68%
32%
73%
18%
26%
33%
28%
35%
17%
8%
13%
28%
20%
46%
21%
53%
51%
48%
53%
48%
44%
50%
9%
6%
13%
23%
7%
29%
23%
18%
19%
18%
40%
42%
Does not provide cur-rently or does not in-tend to provide
Intends to provide within the next 12 months
Currently provide
Copyright 2011. Medical Group Management Association. All rights reserved. 20
Top 5 Challenges of Accredited and Recognized PCMHs
Establishing care coordination agreements with refer-ral physicians
Financing the transformation to PCMH
Coordinating care for high-risk patients
Modifying or adopting an EHR system to support PCMH related functions
Projecting financial effects (practice revenue, costs, etc.) of the transformation to PCMH
0% 20% 40% 60% 80% 100%
51%
43%
38%
38%
36%
Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.
Copyright 2011. Medical Group Management Association. All rights reserved. 21
Top 5 Challenges of Practices Transforming to Become a PCMH
Revising clinical workflow
Contracting with health plans
Projecting financial effects (practice revenue, costs, etc.) of the transformation to PCMH
Establishing care coordination agreements with referral physicians
Financing the transformation to PCMH
0% 20% 40% 60% 80% 100%
51%
48%
48%
45%
41%
Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.
Copyright 2011. Medical Group Management Association. All rights reserved. 22
Top 5 Challenges of Practices Interested in Becoming a PCMH
Financing the transformation to PCMH
Projecting financial effects (practice revenue, costs, etc.) of the transformation to PCMH
Establishing care coordination agreements with referral physicians
Contracting with health plans
Obtaining physician buy-in
0% 20% 40% 60% 80% 100%
64%
60%
59%
57%
52%
Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.
Copyright 2011. Medical Group Management Association. All rights reserved. 23
Metrics in Place to Monitor Patients’ Use of Health Services
Process and outcome measures for chronic disease management
Process and outcome measures for prevention measures
Referral to specialists rates
Emergency room visit rates
Hospital admission rates
Hospital readmission rates
Home care use rates
0% 20% 40% 60% 80% 100%
73%
66%
63%
61%
58%
52%
32%
51%
42%
44%
47%
55%
47%
21%
28%
30%
31%
20%
28%
23%
11%
Interested in becoming a PCMH
Transforming to become a PCMH
Accredited or recognized PCMHs
Copyright 2011. Medical Group Management Association. All rights reserved. 24
Comparing PCMH Requirements to the Meaningful Use Standards
Copyright 2011. Medical Group Management Association. All rights reserved. 25
Defining "Meaningful Use”
"Meaningful Use" is described in the American Recovery and Reinvestment Act (ARRA) as:1.Use of a "certified" EHR with e-prescribing capability as determined appropriate by the Secretary of HHS 2.The ability to report on clinical quality measures as specified by the secretary 3.The use of EHR technology that allows electronic exchange of patient health information 4.CMS and the Office of the National Coordinator for Health Information Technology (ONC) have developed comprehensive regulations outlining the complete definition of "meaningful use" and "certification."
Copyright 2011. Medical Group Management Association. All rights reserved. 26
Percent of EHR Systems with the Features Required to Meet Core Meaningful Use Criteria
Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data
Copyright 2011. Medical Group Management Association. All rights reserved. 27
Percent of EHR Systems with the Features Required to Meet Core Meaningful Use
Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data
Copyright 2011. Medical Group Management Association. All rights reserved. 28
Discussion on How the Meaningful Use Criteria Will Facilitate the PCMH Transformation
Copyright 2011. Medical Group Management Association. All rights reserved. 29
Name, credentialsOrganizationDate
David N. Gans, MSHA, FACMPEVice President, Innovation and ResearchMedical Group Management Association104 Inverness Terrace East, Englewood, CO 80112 Phone: (303) 799-1111, ext. 1270E-mail: [email protected]
Are There Any Questions?