1. DECEMBER 4, 2009 10:00 AM TO 12:00 PM (EST) PRESENTATION BY GWEN LAURY RN, CCHC LOUISIANA PRIMARY CARE ASSOCIATION Understanding Louisiana Medical Home System of Care

2. Medical Home System of Care Louisiana Revised Statues of 1950. R.S. 46:978-979, Reform Healthcare for Medicaid Recipients and low-income uninsured. R.S. 39:100.51, Establish Health Care Redesign as a special treasury fund. “Health Care Reform Act 2007.”

3. “Health Care Reform Act” Improve health care outcomes in Louisiana by developing and implementing a health care delivery system that provides a continuum of evidence – based quality driven health care services. Health care delivery system is known as, Louisiana Home First and consist of Medical Home System of Care.

4. Medical Home System of Care A health care delivery system is define as the primary care that is accessible, continuous, comprehensive, and family centered, coordinated, companionate and culturally effective. A partnership between the primary care provider (PCP) and the beneficiary (patient/family) to assure that all medical and non medical needs of the patient are met. PCP will personally guide and coordinate and facilitate Preventative and Primary Care that improves the patients outcomes in the most cost-efficient manner.

5. Medical Home System of Care Coordinate and Provide Access to evidence base health care services; Convenient and Comprehensive to Primary Care. Access to appropriate Specialty Care and Inpatient Services. Quality Driven and Cost-Effective Health Care. Strong and Effective Medical Management. Patient and Provider Accountability. Prioritize Local Access to the continuum of Health Care Services.

6. Chronic Care Disease Model The Center for Health Studies Organizes the care of a population of patients with chronic diseases Organizes the care of a population of patients with chronic diseases Addresses a mix of effective interventions to improve office performance Addresses a mix of effective interventions to improve office performance Care becomes proactive rather than reactive, where there are missed opportunities to improve overall care and/or meet care goals Care becomes proactive rather than reactive, where there are missed opportunities to improve overall care and/or meet care goals

7. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional and Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization Care Model

8. Clinical Information System: Registry A registry defines your total population of patients – know who your patients are.  Provide reminders for care that is due at the time of the visit and remind the provider who is due for a visit.  Provides feedback for providers and patients.  Identify relevant patient subgroups and provide proactive care. (Those that are in need of better management)  Facilitate individual patient care planning through the registry.

9. Decision Support Embed evidence-based guidelines which describe stepped-care into daily clinical practice. Integrate specialist expertise into primary care. Defines what the standard of care is. Inform patients about guidelines pertinent to their care.

10. Delivery System Design  Define roles and delegate tasks amongst team members.  Use planned visits to support evidence-based care.  Integration of standing orders.  Build “effective” case management functionality into practice  Assure continuity by the primary care team.  Assure regular follow-up.

11. Self- Management: An Essential Shift in Chronic Care Disease Management Putting the patient back into the center of their care  Between 95-99% of chronic care illness care is delivered by the patient who has the illness.  Noncompliance can be defined as the doctor and the patient working toward different goals.  Acknowledges their place on the health care team.  A team is a group of people that work together to achieve a common purpose and are mutually accountable to each other.  Share responsibility for the ultimate outcome.  The work could not be accomplished independently.

12. Health Care Organization Concepts (from BPHC)  Accepted part of the work of the organization.  Upper management visibly supports the work through dedicated time and resources  Part of the center’s annual goals  The board understands and supports the work.  Population based disease management is an expectation for all who work at the center.  Duties of staff are in job descriptions and evaluations.

13. What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo

14.  All FQHCs will participate in one or more of the health disparities collaborative. (HDC)  All FQHC are moving towards the implementation of EHR  Revise all healthcare forms within the FQHC to make sure they are capturing the Demographic and Clinical Data that is needed for the UDS report to HRSA How are the health centers playing a role?

15.  Clinician branch meeting with CHC providers for input quarterly  Onsite visit for technical assistance with HDC activities  LPCA assistance in marketing to provide community partnerships that will facilitate the medical home concept How is the initiative working in Louisiana – what is being done to ensure HRSA grantees are participating ?

16.  More Funding For Assistance With HIT  More Technical Assistance With Appropriate Reimbursements  Assistance With Recruiting And Retention Of Providers And Support Staff.  Assistance With Funding For New Access Points What assistance can HRSA provide ?

17. The following comparative analysis is based on the “medical home” recommendation made jointly by  American College Of Physicians  American Academy Of Family Physicians  American Academy Of Pediatrics  American Osteopathic Association Strategies on getting the State to recognize the health center as the model for this initiatives ;

18. Medical Home Concept Recommendations Louisiana’s Federally Qualified Health Centers (FQHCs) Personal physician provides first contact and continuous care. Louisiana’s FQHCs employ Primary Care Physicians, Physician Assistants, Nurse Midwives and/or Nurse Practitioners. Physician directed practice in which a personal doctor leads a team of providers. The majority of Louisiana’s FQHCs have implemented practice care models such as the Chronic Care Management Redesign Model that create medical care teams to direct and manage the clinical care of patients. Whole person orientation where the physician arranges for care for all stages of life. The majority of Louisiana’s FQHCs participates in the state’s managed care program that operates the same principles. Coordinated care across the health system.Most of Louisiana’s FQHCs have referral partnerships with their local hospitals and specialty providers. Quality, safety, with evidence-based medicine guiding decision making. The majority of Louisiana’s FQHCs are JACHO accredited. Enhance access to care through systems such as open scheduling and expanded hours. Louisiana’s FQHCs see walk-ins and have arrangements for care after normal business hours. N/AFTCA (Malpractice Immunity) Some providers are eligible based on their location Medicaid Prospective Payment System Reimbursement. N/AFQHCs provide Dental and Mental Healthcare. N/ALimited grant dollars to assist with the uninsured. Why Louisiana’s FQHCs are the Best Active Model for a Medical Home System of Care

19. Challenges and Opportunities  Stronger clinical workforce  Funding for health center capital projects.  Increased timely access to medical specialist  Decrease health disparities  Decrease in inappropriate use of hospital ER  Joint partnerships with LSU and other State Healthcare Entities to improve quality outcomes

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