PCMH-Neighbor Concept Builds on Patient-Centered Medical Home Momentum

Specialists working day to day with primary care medical homes will move more easily into the role of patient-centered medical home neighbor (PCMH-N) than those who have not, notes Robert Krebbs, WellPoint’s director of payment innovation. WellPoint recently launched a medical neighborhood pilot for three specialties with clear care coordination alignment opportunities with primary care medical homes.

The neighborhood model requires education on the part of specialists and patients who have not been part of integrated delivery systems so they can better benefit from the new patient-centered medical world, Krebbs explains in this audio interview.

Robert Krebbs shared the key components of WellPoint’s Enhanced Personal Health Care for specialty care program during a May 15, 2014 webinar, Care Compacts: Forming the Foundation of Care Teams with PCPs and Specialists, a 45-minute program sponsored by The Healthcare Intelligence Network.


Length: 4:31 minutes

BCBSM Specialists Warm to Outcomes from Care Coordination Collaborations

Although initally challenging, the engagement of specialists in Blue Cross Blue Shield of Michigan’s medical home program generated several outstanding primary care-specialist collaborations that improved care coordination and reduced unnecessary utilization and spend related to difficult-to-manage patients, notes Donna Saxton, field team manager for BCBSM’s value partnerships program.

A pioneer since 2005 in the development of outcomes-based measures to evaluate patient care, BCBSM based its standards on the Chronic Care Model. Today, the payor acts as a resource for other medical home recognition and accreditation efforts.

Donna Saxton share details from its PCMH designation requirements and the system of rewards and incentives that has produced results for the plan, the PCMH practices and its members during an April 30, 2014 webinar, Generating Medical Home Savings and Quality Improvements Through Outcome-Based Measures, a 45-minute program sponsored by The Healthcare Intelligence Network, now available for replay.


Length: 4:31 minutes

Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care

If payment inequities can be addressed, communication and technology tools in place in large physician multispecialty groups make them ideal candidates for a medical neighborhood, suggests Terry McGeeney, MD, MBA, director of BDC Advisors. Dr. McGeeney, who spent 13 years of his practice career in a large multispecialty group, has also seen some FQHCs and managed Medicaid programs that do a good job of linking community and social supports required in medical neighborhoods.

As for engaging patients in this emerging integrated care delivery system, try explaining the medical neighborhood’s value proposition for them, he suggests. Patients already get why the integrated approach is good for physicians and insurance companies but need to hear why they should buy in to team care, patient portals and other aspects of centralized care coordination.

Dr. McGeeney shared his expertise in developing medical home neighborhoods during a November 20, 2013 webinar, Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care.


Length: 6:16 minutes

Healthcare Trends & Forecasts in 2014: Expect Surge in Commercial ACOs to Continue

Despite the migration of some Pioneer ACOs to CMS’s Medicare Shared Savings Program (MSSP), expect the surge in commercial accountable care organizations to continue in 2014, predicts Steven Valentine, president, The Camden Group. In this audio interview, Valentine suggests improvements to patient handoffs, an area in which ACOs have disappointed, in Valentine’s view, as well as expectations for the other much-modeled care delivery platform, the patient-centered medical home (PCMH).

In both the ACO and the PCMH, Valentine anticipates specialists will be critical parts of the solution, especially when it comes to emerging payment models, quality and performance.

Steven Valentine and Catherine Sreckovich, managing director, healthcare, Navigant, provided a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014 during an October 30, 2013 webinar, Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.


Length: 8:13 minutes

Aligning Value-Based Reimbursement with Physician Practice Transformation

In its quest to transform 70 to 80 percent of its physician practices to a patient-centered medical home (PCMH) over the next three years, WellPoint has adopted a “meet the practices where they are” philosophy, reports Julie Schilz, director of care delivery transformation for WellPoint. Each practice is at a different place in the transformation effort and requires specialized supports, she adds.

Smoothing the transformation rollout is the simultaneous participation of 500 WellPoint practices in CMS’s Comprehensive Primary Care (CPC) program, whose goals dovetail with key PCMH principles — as though WellPoint had another partner in its transformation initiative, Schilz notes.

Just as important as practice support is transparency with health plan members, Schilz adds, especially when it comes to explaining the concept of the medical home neighborhood — where care coordination is a collaboration between primary care and the specialist.

Ms. Schilz shared the key features of WellPoint’s transformation initiative, including results from its pilot program that have led to a system-wide rollout, during an October 24, 2013 webinar, Aligning Value-Based Reimbursement with Physician Practice Transformation.


Length: 5:29 minutes

Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community

There’s education, there’s experience, and then there’s the ‘right stuff’ — the indefinable personality traits that earmark an individual as a change agent, collaborator and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA’s requirements for the RN case managers it hires for its advanced patient-centered medical homes.

Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview.

While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center’s Comprehensive Primary Care (CPC) initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from healthcare reform.

Ms. Watson shared how TIPA has successfully embedded case managers in an open, multi-payor community during an October 9, 2013 webinar, Improving Population Health with Embedded Case Managers in an Open, Multi-Payor Community.


Length: 8:36 minutes

Motivational Interviewing by Ochsner Health Coaches Drives Results in 4 Key Areas

When health coaches employ motivational interviewing during patient encounters, expect upticks in medication adherence, weight loss, HbA1c levels and overall engagement, notes Alicia Vail, RN health coach for Ochsner Health System. Ochsner’s eight health coaches focus on patients with diabetes, hypertension and obesity who have come to their attention by way of physician referrals, health screenings and pre-chart reviews.

In this podcast, Ms. Vail describes how Ochsner Health System incorporates health coaches in its clinic structure and describes the benefits that result from the coaching intervention.

Alicia Vail and Bill Appelgate, executive director of the Iowa Chronic Care Consortium, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, Health Coaching’s Value in Accountable Care and Medical Homes.


Length: 3:59 minutes

Health Coaching’s Value in Accountable Care and Medical Homes

Primary care and the patient-centered medical home offer a great opportunity for health coaches to become allies with patients in improvement of their health, notes William Appelgate, executive director of the Iowa Chronic Care Consortium. Individuals with the highest health risks should be given priority, but those on the cusp of a serious health event also merit coaching assistance, he says. For providers new to the coaching conversation, Appelgate shares three benefits of incorporating health coaches in the care process — including the upping of their ‘outcomes game.’

Bill Appelgate and Alicia Vail, RN health coach for Ochsner Health System, shared how an evidence-based health coaching focus drives returns in a value-based payment delivery system during a June 19, 2013 webinar, Health Coaching’s Value in Accountable Care and Medical Homes.


Length: 8:35 minutes

Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach

Although the healthcare industry is well-acquainted with the patient-centered medical home, the model is still quite new and novel to patients, notes, Jay Driggers, director of consumer engagement at Horizon Blue Cross Blue Shield of New Jersey. In this interview, Driggers describes what’s at stake when moving from a reactive provider model to a proactive model.

Drigger presented during Patient Engagement in the Patient-Centered Medical Home: A Continuum Approach, a 45-minute webinar on August 22, 2012, during he described some of Horizon BCBS’s novel consumer engagement tactics that involve everything from smartphone apps to telemonitoring.


Length: 2:51 minutes

The Patient-Centered Medical Home: Lessons from a Statewide Rollout

Nurse educators provide essential support to physician practices in Florida Blue’s rollout of a statewide patient-centered medical home, explains Barbara Haasis, RN, CCRN, senior clinical lead for Florida Blue’s quality reward and recognition programs. They help practices meet key disease metrics within Florida Blue’s performance scorecards, and can direct providers to both internal and external resources to help them resolve patient issues. Ms. Hassis also explains why providing after-hours access is a prerequisite for practices in the medical home program as well as the case manager’s contribution to this program.

Barbara Haasis presented during The Patient-Centered Medical Home: Lessons from a Statewide Rollout, a 45-minute webinar on May 10, 2012, during which she shared how the health plan transitioned from the Recognizing Physician Excellence (RPE) program to a medical home model.

 
Length: 5:12 minutes