1. Rob Gaslin, Controller SAMC-Baker City Patient Centered Primary Care Home 02/18/2014

2. Baker City, Oregon SAHS Strategic Plan  Location – Frontier Designated  County Population – 16,210  Size – 3,068 sq miles  Interesting fact: Home to the largest pure gold nugget ever found

3. Saint Alphonsus Medical Center – Baker City SAHS Strategic Plan  Member of CHE/Trinity Health  Critical Access Hospital/RHC’s/Nursing Home  Owned Clinics EMR installed 7/2011 PCPCH certified 10/2012 and 6/2013  Under 2011 criteria  Reapplied for tier 3 status 2/14 under 2014 criteria

4. 2011 to 2014 Application  Baker Clinic certified as PCPCH tier 2 under 2011 criteria  Baker Clinic reapplied as PCPCH tier 3 under 2014 criteria  Valley Medical Clinic certified as PCPCH tier 3 under 2011 criteria  2014 criteria add significant number of standards Longer application More opportunities

5. Scoring  Tier 1: 30-60 points and all 10 must-pass measures  Tier 2: 65-125 points and all 10 must-pass measures  Tier 3: 130 or more points and all 10 must-pass measures

6. PCPCH Core Attributes SAHS Strategic Plan  #1 Access to Care A. In-Person Access B. After Hours Access C. Telephone & Electronic Access D. Same Day Access E. Electronic Access F. Prescription Refills

7. PCPCH Core Attributes, cont. SAHS Strategic Plan  #2 Accountability A. Performance & Clinical Quality B. Public Reporting C. Patient and Family Involvement in Quality Improvement D. Quality Improvement E. Ambulatory Sensitive Utilization

8. PCPCH Core Attributes, cont. SAHS Strategic Plan  #3 Comprehensive Whole Person Care A. Preventative Services B. Medical Services C. Mental Health, Substance Abuse, & Developmental Services D. Comprehensive Health Assessment & Intervention E. Preventive Services Reminders

9. PCPCH Core Attributes, cont. SAHS Strategic Plan  #4 Continuity A. Personal Clinician Assigned B. Personal Clinician Continuity C. Organization of Clinical Information D. Clinical Information Exchange E. Specialized Care Setting Transitions F. Planning for Continuity G. Medication Reconciliation

10. PCPCH Core Attributes, cont. SAHS Strategic Plan  #5 Coordination & Integration A. Population Data Management B. Electronic Health Record C. Complex Care Coordination D. Test & Result Tracking E. Referral & Specialty Care Coordination F. End of Life Planning

11. PCPCH Core Attributes, cont. SAHS Strategic Plan  #6 Person & Family Centered Care A. Language/Cultural Interpretation B. Education & Self-Management Support C. Experience of Care D. Communication of Rights, Roles and Responsibilities

12. External Resources  The EOCCO has fully embraced the PCPCH as the foundation or cornerstone of frontier health transformation. EOCCO has been very quick to remove barriers to proper, cost-effective care  Baker County Complex Care Continuum Hospital, Clinics, Sherriff, Police, Mental Health Next step – expand model for Medicaid

13. Incentive Payment  PCPCH Tier 2  PCPCH Tier 3  EOCCO & Providence Health Plan

14. Effects

15. Questions? Thank you!