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John Magee, MD, FAAP CHOP Care Network Chestnut Hill The Children’s Hospital of Philadelphia 1.

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Presentation on theme: "John Magee, MD, FAAP CHOP Care Network Chestnut Hill The Children’s Hospital of Philadelphia 1."— Presentation transcript:

1 John Magee, MD, FAAP CHOP Care Network Chestnut Hill The Children’s Hospital of Philadelphia 1

2 2 CHOP Care Network Chestnut Hill Approximately 12,000 active patients in the practice – approximately 36,000 annual visits Race (50% African American, 40 % Caucasian, 10% other) Insurers (30 % HMO traditional, 20% Medicaid HMO, 50 % traditional insurer - PPO or self insurance) Demographics (70% urban, 30% suburban) – NW Philadelphia 6 MD’s and 3 PNP’s - approximately 8 clinical FTE’s Hospital owned practice (last 6 years – independent previous 60 years) Disclaimer ……….. a general pediatrician

3 Preventive Services Improvement Project Overview Mission: To improve health supervision care of children birth to age 3 as outlined by Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3 rd edition. Overall goal and your charge: This project is designed to answer: Can Bright Futures be easily implemented, birth to 3, in a busy clinical setting? 3

4 The Goal … Implementation 4

5 Definition  Bright Futures is a set of principles, strategies, and tools that are theory-based, evidence-driven, and systems-oriented that can be used to improve the health and well-being of all children.  The centerpiece of Bright Futures is a comprehensive set of health supervision guidelines Focus on Clinical Care Guidelines 5

6 Definition  NCQA’s Patient-Centered Medical Home (PCMH) Is a program for improving primary care. In a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams and coordinating and tracking care over time. Focus on Clinical Care Systems 6

7 7 Believe you will need both Clinical Care Systems and Clinical Guidelines Systems are critical to support, maintain, and monitor actualization of the Clinical Guidelines The Clinical guidelines are the targets the Systems reach for Working hard alone will not be enough without the Clinical Systems to support your efforts …… JM’s opinion. The integration of the Bright Futures program with the NCQA process

8 National Committee for Quality Assurance (NCQA) and the PPC-PCMH program  NCQA developed a set of standards and a 3-tiered recognition process (Physician Practice Connections – Patient-Centered Medical Home (PPC- PCMH) program) to assess the extent to which medical practices are functioning as medical home  Obtaining recognition via the PPC-PCMH programs requires providing adequate documentation to show evidence that specific processes and policies are in place  Recognition is offered at three levels: ◦ Level 1 – basic ◦ Level 2 – intermediate ◦ Level 3 – advanced 8

9 2007 NCQA’s Levels of PCMH Recognition A Brief Overview  LEVEL 1: Describes a basic PCMH and requires practices to use paper‐based clinical systems and electronic administrative systems [e.g., practice management system (PMS)]. Learning to document processes comprehensively and systematically may be a challenge but most offices should be able to achieve level 1 certification.  LEVEL 2: Requires practices to use some electronic systems (e.g., registries or an EMR) to plan, manage, and coordinate care, and to document services.  LEVEL 3: Indicates a technologically‐ and administratively‐advanced health care office with the ability to communicate electronically to other entities (patients, hospitals, labs, other social service and healthcare organizations). While Level 3 sites are not required to have fully implemented e‐prescribing and bi‐directional lab interfaces, Level 3 sites use EMRs as standard technology for care planning and practice management, and benefit from the allocation of ongoing resources (including permanent staff positions) to quality improvement. 9

10 Core concepts and process examined by NCQA PPC-PCMH recognition program JM’s opinion  Focus on care that is coordinated and integrated throughout the practice – team vs. clinician centric  Focus on electronic tools that enhance care  Focus on measured outcomes and written policies  Focus on delivery of care to sub-populations within the practice with high risk or chronic conditions  Focus on data mining and population analysis concepts  Focus on evidence based standards embedded within office workflow  Focus on continuous quality and safety efforts across the practice  Focus on enhanced access and methods of access 10

11 Rationale for Obtaining NCQA /PPC-PCMH Recognition  Processes aligns with implementing Bright Futures quality goals  Tool to facilitate the transformation of systems in your practice into a true Patient Centered Medical Home  PCMH has been found to be associated with ◦ improvement in quality ◦ improvement in equity ◦ improvement in staff/provider satisfaction 11

12 Rationale for Obtaining NCQA /PPC-PCMH Recognition  Aligns with changes in reimbursement being considered in many regions that are likely to favor NCQA-recognized practices – greater focus on measured outcome, process and quality measures  Has the potential to attract new business as well as help maintain or strengthen your status as a recognized leader among your peers  Has the potential to reduce overall health care costs 12

13 Overview of 2007 NCQA/PPC-PCMH Recognition Program  9 standards, 7 of which contain “must-pass” elements  30 elements, 10 of which are “must-pass”  Each element contains a series of factors which generate points upon which your final score will be based  Minimum of 50% of available points required for a “must pass” element 13


15 Overview of 2011 NCQA/PPC-PCMH Recognition Program  6 standards, all of which contain “must-pass” elements  27 elements, 6 of which are “must-pass”  Each element contains a series of factors which generate points upon which your final score will be based  Minimum of 50% of available points required for a “must pass” element  A much higher bar then 2007 program – slightly more sensitive to the realities of pediatric practice 15

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18 Approach & Timelines  Assess your practices current PCMH‐related activities/characteristics/status  Conduct a gap analysis, and develop an action plan that responds to identified strengths and challenges  Identify a project team (my suggestion 3-5 individuals) ◦ Individual(s) viewed as practice leader(s) ◦ Individual(s) that understands clinical operations of practice ◦ Individual(s) that understands business and clerical operations of practice ◦ Individual with appropriate computer skills (need to collect and store documents in electronic form, need to format data, need to upload data)  Implement your plan in a systematic manner, incorporating steps such as documenting existing policies and procedures gathering evidence to support them, and developing new policies and processes as needed 18

19 Approach &Timelines  Articulate your goals as you perform the work ◦ Provide an overview of your timeline for obtaining recognition (e.g., 6 - 9 months – will vary dramatically by practice) as well as key milestones to achieve along the way ◦ Be as specific as possible, including what will be accomplished, by when, and by who ◦ Describe your approach for achieving your goal (e.g., “We will develop a PCMH project team with representation from …. you define. Team members will be allocated …. defined # …. hours of protected time weekly to meet and to carry out project-related work.”) ◦ Make sure to specify and allocate dedicated resources (e.g., staff, time, technology) it will take to achieve milestones and goals.  Submit your survey to NCQA using the web‐based Interactive Survey Tool ◦ Recommend free web-based NCQA course “How to Use the Web-based Interactive Survey System (ISS) Tool Physician Practice Connections®- Patient Centered Medical Home” 19

20 What will it take? 3 year assessment versus transformation of your practice? “Snapshot versus a real-time movie”  It is likely that obtaining PCMH recognition will have significant implications for your practice ◦ Describe the implications you anticipate for the practice to ensure everyone is on the same page  It will require dedicated resources (particularly staff time), and may require purchasing new systems, shifting priorities, and even hiring consultants to help the practice make necessary changes ◦ Be as specific as possible, particularly when discussing potential costs and the need for additional resources. 20

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22 22 Why it was done? We seemed to be much busier, but our patients where not necessarily healthier Care was often poorly coordinated within the office Care was not always aligned with “best practices” Communication with specialists was even less coordinated Our clinicians and staff seemed to be working more and enjoying it less The integration of the Bright Futures program with the NCQA process

23 23 Why it was done? Patient and staff complaints seemed to be more frequent Studies and labs that our office had already performed where often duplicated by a specialist or hospital because of poor exchange of patient specific information Our office was often unaware when a patient was seen in the ER Our office was often unaware when a patient was hospitalized The integration of the Bright Futures program with the NCQA process

24 24 The integration of the Bright Futures program with the NCQA process Results of our interventions: Patient satisfaction appears to have increased Staff satisfaction is clearly improved Clinician satisfaction is improved Clinical management is more in line with best practice guidelines Improved operational workflow and efficiencies – responsible parties clearly defined and provided with appropriate tools Improved workflow has facilitated fiscal well being of the site

25 25 The integration of the Bright Futures program with the NCQA process Critical to develop leadership team with carved out time and appropriate economic support Most of the what’s do to … are well established and can generalize Most of the how’s... are not as well scripted and will need to be more customized to each individual site Human component is the most difficult component to change Requires major changes in the culture of the practice and its staff Is more of a concept not a defined product Requires additional time and resources at the start … but over time can save time and resources Would not turn back … is a better way of providing care and doing business

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27 27 General resources National Center for Medical Home Implementation Center for Medical Home Improvement The American College of Physicians html National Initiative for Children’s Healthcare Quality (NICHQ) Medical Home Chapter Champions Program on Asthma

28 28 Email alerts, listserv, and general information The Commonwealth Fund The Institute for Healthcare Improvement (IHI) National Initiative for Children’s Healthcare Quality (NICHQ)

29 The End Questions 29

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