1. Elise Butkiewicz MD, John Nevins DO, Elfie Wegner ANP-BC, CDE Overlook Family Medicine Residency, Atlantic Health System, Summit, NJ

2.  PCMH shows promise in reducing cost, improving quality of care and increasing patient satisfaction-the IHI Triple Aim  PCPCC 2014 analysis: PCMH model significantly impacts cost of care, ED and hospital visits, increases preventive services, improves population health 1  MGMA 2011 PCMH study: 70% interested in becoming a PCMH, 20% recognized, Family Med highest level of interest, one year to complete 2  Barriers: resistance/change fatigue, cost, staffing, time 1.Nielsen, M. Olayiwola, J.N., Grundy, P., Grumbach, K. (ed.) Shaljian, M. The Patient-Centered Medical Home's Impact on Cost & Quality: An Annual Update of the Evidence, 2012-2013. Patient-Centered Primary Care Collaborative (2014). 2.MGMA. The Patient Centered Medical Home Guidelines: A Tool to Compare National Programs. Medical Group Management Association. 2011.

3.  Describe the four national PCMH programs, and compare and contrast two of them, Joint Commission and NCQA.  Provide a self-assessment tool for attendees to quickly assess their practice for Joint Commission PCMH.  Describe our journey in reviewing recognition tools, satisfying the requirements, educating staff and residents and undergoing the site visit process required for Joint Commission.  Describe our experience applying for NCQA in 2009 vs. Joint Commission PCMH in 2014.  Stimulate group discussion based on audience experience with the PCMH process.

4.  Having a personal physician/provider in a team based practice  Having a whole person orientation  Providing coordinated and/or integrated care  Focusing on Quality and Safety  Providing Enhanced Access Joint Principles of the Patient-Centered Medical Home Published on Patient Centered Primary Care Collaborative (http://www.pcpcc.net).February 2007http://www.pcpcc.net).February

5. A Comparison of the National Patient-Centered Medical Home Accreditation and Recognition Programs David N. Gans, MSHA, FACMPE, Senior Fellow Industry Affairs, Medical Group Management Association Englewood, Colo. January 30, 2014

6.  Incorporate the joint principles of the PCMH  Address the complete scope of primary care services  Ensure the incorporation of patient- and family-centered care emphasizing engagement of patients, their families and their caregiver  Engage multiple stakeholders in the development and implementation of the program.  Align standards, elements, characteristics and/or measures with meaningful use requirements. A Comparison of the National Patient-Centered Medical Home Accreditation and Recognition Programs David N. Gans, MSHA, FACMPE, Senior Fellow Industry Affairs, Medical Group Management Association Englewood, Colo. January 30, 2014

7.  Identify essential (core to being a medical home practice) standards, elements and characteristics.  Address the core concept of continuous improvement that is central to the PCMH model.  Allow for innovative ideas.  Care coordination within the medical neighborhood.  Clearly identify PCMH recognition or accreditation requirements for training programs.  Ensure transparency in program structure and scoring.  Apply reasonable documentation/data collection requirements. Conduct comprehensive evaluation of the program’s effectiveness and implement improvements over time.  Implement field-tested improvements for all populations and markets over time. A Comparison of the National Patient-Centered Medical Home Accreditation and Recognition Programs David N. Gans, MSHA, FACMPE, Senior Fellow Industry Affairs, Medical Group Management Association Englewood, Colo. January 30, 2014

8. http://www.jointcommission.org/assets/1/6/compare_tjc_pcmh_ncqa_pcmh.pdf

9.  More specific expectations for care team roles/training  Patient has electronic access to health information, appointments, test results, refills  Use of EHR  Additional & minimum performance measures (i.e.)  50% care transitions have medication reconciliation  Set goals & act on minimum of 3 preventive/chronic measures  80% pts with current problem list  Identification of high-risk/complex patients http://www.jointcommission.org/assets/1/6/compare_tjc_pcmh_ncqa_pcmh.pdf

10.  Patient Rights, including making decisions regarding managing his/her care  Educating patients about their right to obtain care from other PCCs, seek second opinion, seek specialty care  Identify & incorporate health literacy needs  Interdisciplinary team acts on recommendations from referrals  Competency of Primary Care Clinician & Team  Responsibility of PCC for team function http://www.jointcommission.org/assets/1/6/compare_tjc_pcmh_ncqa_pcmh.pdf

12.  Patient centered care  Comprehensive care  Coordinated care  Superb access to care  A systems-based approach to quality and safety http://www.jointcommission.org/assets/1/6/PCMH_what_you_need_to_know_NEW.pdf

13.  PCMH Self Assessment Tool: readiness tool, resident teaching tool  Prepublication Standards-Revisions to the Ambulatory Care PCMH Requirements: road map to change  Hospital Quality Team  Joint Commission PCMH consultant

14.  Weekly meetings  Multidisciplinary team for 2 offices: nursing, office and billing coordinators, office manager, 2 medical directors, NP, PharmD, behaviorist  Work distributed, deadlines  PCMH binder for each site

15.  Welcome packet: Mission, Vision, Rights and Responsibilities, Access, Patient Care Contract (in English and Spanish)  Learning Needs Assessment  Care plan--Goals template—Brief Action Planning (BAP)  Team structure: Orange/Blue, Teams of 3  Patient centered policy: personal physician, whole-person orientation, health literacy/translation services, coordinated care, group visits, patient advisory groups, HIT, patient portal, Accountable Care and Population Health  Community resources references and bulletin board  EBM: “guideline corner”  Patient Safety: Quality Safety Case Review  CQI; tracking: AAFP GO Diabetes/Adolescent vaccine grants, pain, falls, med list, lab call backs, hand hygiene, date-time-sign, patient satisfaction

16.  Quality Management meetings: multidisciplinary, both offices, monthly  Team of 3 meetings: bi-monthly  Quality Safety Case Review: multi-disciplinary, bi-monthly  Ambulatory Joint Commission meeting: monthly  Frequent email updates; transparency

17.  One dedicated reviewer  Full day  Ambulatory site and PCMH review (option for PCMH only)  Interviews staff, providers, residents, patients  Reviews policies, CQI, team structures, EMR records  Observes office flow, procedures in action  On Site Recommendations: Patient Care Contract Spanish translation

18.  Horizon Pilot Project NJAFP  One contact person as resource through NJAFP  Bi-weekly Webinars  Level 1 recognition for two practices  Paper charting (NO EMR!)  Limited leadership team: Medical Director, Office manager, NP representing both practices  Limited buy-in from office staff and MD’s, no regularly scheduled meetings with all stakeholders  Two separate applications  Very labor intensive- involved screen shots, developing reporting logs and spread sheets to demonstrate process requirements  Overall perception by office staff as additional work burden

19.  EMR  Strong leadership team - two Medical Directors  Weekly structured meetings- representation of whole office: Practice Manager, Office Coordinator, Nursing Coordinator, Billing Coordinator, Behaviorist, Clinical Pharmacist and NP  Presented PCMH goals, reviewed and received feedback on work flow process at office wide management meetings.  Information disseminated to office and medical staff by Nursing Coordinator, Office Coordinator and Chief Residents at their meetings  Scheduled site evaluation as opposed to an electronic application process

20.  Increased reimbursement:$5/pmpm from QualCare  Hospital recognition  Institutional resource  Hospital Foundation grants  Marketing opportunity  Community recognition  Morale booster/ Energized office staff

21. http://www.jointcommission.org/accreditation/pchi.aspx

22.  Elise.Butkiewicz@atlantichealth.org Elise.Butkiewicz@atlantichealth.org  John.Nevins@atlantichealth.org John.Nevins@atlantichealth.org  Elfie.Wegner@atlantichealth.org Elfie.Wegner@atlantichealth.org  http://www.jointcommission.org/accreditation/pchi.aspx http://www.jointcommission.org/accreditation/pchi.aspxResources