Slide 1 LPHI Regional Care Collaborative June 17, 2014 PCMH and Sustainability Alan Mitchell Primary Care Development Corp.

Slide 2 Today’s Presentation Patient Centered Medical Home: Concepts Recognition vs. Transformation – Project planning – Building sustainability into the process NCQA PCMH: 2008 vs vs Common Challenges with PCMH – Care management, care coordination – HIT Cost Benefit Analysis of PCMH – Payer and other incentives – Calculating cost

Slide 3 PCMH Concepts Approach to primary care focused on patient – Access – Population Management – Care Management – Self-management – Care tracking and coordination – Quality Improvement NCQA, Joint Commission, URAC, others – NCQA 2008, 2011, 2014 Some state incentives, but not a gov’t program

Slide 4 Recognition vs. Transformation Recognition: Successful evaluation of submission Transformation: Operating as a true medical home Rush to recognition may sacrifice transformation and sustainability

Slide 5 Critical Success Factors Recognition Good documentation Understanding of the standards Transform/optimize with a focus on “must pass” elements Resources to gather and submit documentation HIT Transformation Commitment to change Shared effort across the practice HIT Sustainability plan Resources: People, time, money

Slide 6 Sustainability Build it in from the beginning: – What are we doing? – Who’s in charge of it? Who’s going to do it? – When? How often? – How much does it cost? – What incentives do we have for doing it? – How will we monitor success? – How to integrate into existing structure? To be sustainable… PCMH is not “extra work.” It’s the way your practice operates. Plan

Slide 7 Common Challenges Access and Communication – Cost of answering service or on-call provider – Same days: Watch our for usage, double-booking, advance scheduling – Electronic communication: portals, secure messaging Patient Lists – Costs of contacting patients – How often are lists run? Evidence-based guidelines – Training; Keep materials up to date

Slide 8 Common Challenges Care Management – Care Teams: can be self-sustaining Self-Management – Training; Patient materials available Quality Improvement – Who’s checking the reports, how often? Do providers know? Managing Change – Communication – Accountability and buy-in

Slide 9 Cost Benefit Analysis How much does it cost to do it? – Time spent x FTE x Wage – Visit volume Incentives – Payers: per visit or pmpm payments – PQRS / eRx / Meaningful Use – New care management codes – Make sure you’re getting paid what you’ve earned How much would it cost if you didn’t do it? Opportunity cost? Reputational enhancements and risks (patient experience)

Slide 10 Next Steps What’s the current status? Do you have a plan to sustain? – People, tasks, someone in charge Do you know your costs? Do you know your incentives? Calculate – PCDC’s sustainability tool Begin planning for PCMH 2014 or next iteration