7Medical Neighborhood Foundation PCMH – Patient Centered Medical HomePCSP – Patient Centered Specialty PracticeACO – Accountable Care OrganizationMedical NeighborhoodACOPCSPPCMH
8Today vs. Tomorrow Today vs. Tomorrow My patients are those who make appointments to see meOur patients are everyone in our patient populationA patient’s chief complaint or reason for the visit determines careWe systematically assess all our patient’s health needs to plan careCare is determined by today’s problem and available timeCare is determined by a proactive plan to meet patient needsPatients are responsible for coordinating their own careCare is standardized according to evidence-based guidelinesI know I deliver high quality care because I am well trainedA prepared team of professionals coordinates all of the patient’s careAcute care needs met through next available visit and walk-insWe continuously measure our quality and make rapid changes to improve our performanceIt’s up to the patient to tell us what happened to themWe track test results and referrals, and follow-up, including ED visits and hospitalizationsOperations center on meeting the doctor’s needsA multidisciplinary team works together and has defined roles and responsibilitiesSource: The University of Oklahoma-Tulsa (revised)
9PCMH Primary Care Providers Recognition programs NCQA 2011Standards Includes Stage 1 Meaningful Use Requirements
10PCMH Numbers Started with 38 in 2008 Over 6,000 medical practices Almost 30K clinicians49 States~15% of all primary care practicesSource: The Commonwealth FundSource: Market Watch, Business Wire, 2013
20The Effort Continues Aetna and WellSpan form ACO (10/11/13) River Health applies for MSSP (8/30/13)Memorial Hermann Physician Network and BCBS of Tx (9/18/13)Rutgers and Robert Wood Johnson Medical School form ACO (10/16/13)More than 300 Physicians Join Brown & Toland’s ACO with Cigna (10/15/13)
27Healthcare Organization The SubcomponentsBusinessShared GovernanceLegal, Policy & ComplianceOperationsFinancePopulation ManagementRisk ManagementPerformance ReportingHealthcare OrganizationBusinessTechnicalClinicalClinicalStaff Assessment, Engagement & EducationPopulation ManagementEvidenced-Based Care ManagementCare CoordinationCare TransitionsCare PlanningClinical WorkflowPatient EngagementQuality MeasuresPerformance AnalysisQuality ImprovementPCMH Practice/ RecognitionTechnicalIT InfrastructureClinical Systems & ToolsRegulationsData AnalyticsReporting RequirementsACO ConnectivityPatient ConnectivityHealth Information Exchange
28Organize, Prioritize & Strategize Initiate stakeholder outreach and educationEstablish a separate entity with authority and accountabilityConduct organizational assessments, improve deficiencies, and obtain recognitionImprove medical managementIdentify technology requirements and implement systemsEstablish performance evaluation, reporting, and improvement processDevelop a strategic plan and execute!