1. Inter-disciplinary nature of primary care and the medical home model: The role of nursing Ann Ritter, Esquire Director, Health Center Development and Policy National Nursing Centers Consortium Nancy L. Rothman, EdD, RN, Independence Foundation Professor of Urban Community Nursing Temple University Tine Hansen Turton, MGA, JD Executive Director National Nursing Centers Consortium National Nursing Centers Consortium

2. Presenter Disclosures Ann Ritter, Esquire Director, Health Center Development and Policy Ann Ritter, Esquire Director, Health Center Development and Policy National Nursing Centers Consortium National Nursing Centers Consortium The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose

3. Medical Home Concept Introduced in 1967, by American Academy of Pediatrics Introduced in 1967, by American Academy of Pediatrics As a model for children with special needs As a model for children with special needs Comprehensive Comprehensive Continuous Continuous Coordinated Coordinated Family-centered Family-centered

4. Meeting chronic, developmental and psychosocial service needs in an integrated primary care model, emphasizing the importance of: family, community, culture, access to care, wellness, patient self- management of chronic disease in an integrated primary care model, emphasizing the importance of: family, community, culture, access to care, wellness, patient self- management of chronic disease

5. A medical home requires A multi- disciplinary team A multi- disciplinary team To provide care that is both To provide care that is both Holistic Comprehensive

6. As the term “medical home” developed… Described in language suggesting it should be implemented PRIMARILY or EXCLUSIVELY by PHYSICIANS Described in language suggesting it should be implemented PRIMARILY or EXCLUSIVELY by PHYSICIANS

7. Medicare Demonstration Project Provides additional primary care dollars to support chronic care management efforts, but only for physician providers Provides additional primary care dollars to support chronic care management efforts, but only for physician providers

8. Role of nursing in “medical home” PA Governor’s Chronic Care Initiative PA Governor’s Chronic Care Initiative Included Certified Registered Nurse Practitioner led Primary Care Practices Included Certified Registered Nurse Practitioner led Primary Care Practices Emphasized importance of care mangers – an RN role Emphasized importance of care mangers – an RN role

9. PA Governor’s Chronic Care Initiative 1) A pay for performance program 1) A pay for performance program 2) Included 8 CRNP- led primary care practices out of 32 primary care practices selected in SE PA – where program was initiated in 2008 2) Included 8 CRNP- led primary care practices out of 32 primary care practices selected in SE PA – where program was initiated in 2008 4) Required achieving NCQA recognition as a patient-centered medical home 4) Required achieving NCQA recognition as a patient-centered medical home 5) Use of Wagner’s Chronic Care Model 5) Use of Wagner’s Chronic Care Model 6) Meeting IPIP Goals Diabetes for adults & Asthma for children 6) Meeting IPIP Goals Diabetes for adults & Asthma for children

10. NCQA Recognition for a Patient-Centered Medical Home Initially reviewed the nurse led practices for the PA Governor’s Chronic Care Initiative Initially reviewed the nurse led practices for the PA Governor’s Chronic Care Initiative Reported outcome of review, but noted they did not recognize nurse-led practices

11. NCQA Recognition for a Patient-Centered Medical Home “Effective October 22, 2010, NCQA will recognize nurse-led primary care practices as patient-centered medical homes in states that permit advanced practice nurses to lead practices.” “Effective October 22, 2010, NCQA will recognize nurse-led primary care practices as patient-centered medical homes in states that permit advanced practice nurses to lead practices.”

12. Policy Role of the National Nursing Centers Consortium State and federal recognition of nurse-led primary care practices State and federal recognition of nurse-led primary care practices

13. Policy Success of the National Nursing Centers Consortium Achieved inclusion of nurse-led practices in Affordable Care Act, which may have helped NCQA in making their decision to include nurse-led practices Achieved inclusion of nurse-led practices in Affordable Care Act, which may have helped NCQA in making their decision to include nurse-led practices

14. Remaining agenda NNCC and Patient-Centered Medical Home Access for all to patient- centered medical homes is only possible including nurse-led practices Access for all to patient- centered medical homes is only possible including nurse-led practices Ensuring nurse-led medical homes recognize the inter- disciplinary nature of primary care and the medical home Ensuring nurse-led medical homes recognize the inter- disciplinary nature of primary care and the medical home Medicare Demonstration Project, allows reimbursement to support providers beyond physicians Medicare Demonstration Project, allows reimbursement to support providers beyond physicians