Posts Tagged ‘patient-centered medical neighborhood’

4 Goals for Furthering Care Coordination in the Medical Neighborhood

August 28th, 2014 by Cheryl Miller

With the advent of the medical neighborhood, care coordination is no longer the sole domain of the primary care practice (PCP), but a responsibility shared among all providers that touch the patient. But how to formalize co-management of patients by PCPs and specialists — in a way that both assures efficient delivery of high-quality healthcare and addresses the ‘pain points’ of each provider group? Here, Robert Krebbs, director of payment innovation at WellPoint, Inc., discusses the four goals for furthering care coordination in the medical neighborhood.

The care compact isn’t intended to solve all the world’s problems. We know it’s not going to make care coordination perfect, but it’s a starting point. Just like the PCMH provides a foundation for the medical neighborhood, the care compacts provide a foundation for care coordination between practices. It’s an essential starting point to further care coordination expectations across the medical neighborhood.

First, with the care compact, we’re helping the pilot practices by identifying the PCPs they can collaborate with to put care compacts in place. We’re playing connector for these two practices.

Second, we’re assessing the current care coordination capabilities of the specialist practices in the pilot and looking at where they’re starting from in terms of care coordination.

Third, we’re watching them customize the care compact and monitoring how they adapt it to their practice needs so we can come up with a stronger template at the end of this pilot than we started with that guides this last point.

Finally, we’re going to disseminate best practices throughout the process to all participants in the pilot. Everyone will benefit from the hard work of each participating practice.

Excerpted from Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination.

5 Attributes of Medical Home Neighborhoods, Where Practitioners Unite for Patient Care

December 5th, 2013 by Cheryl Miller

“The healthcare world is changing in ways that many of us have never seen in our lifetime with the possible exception of Medicare,” says Dr. Terry McGeeney, director of BDC Advisors, a veteran of the healthcare system for 30 years.

It has moved away from system fragmentation, patient disenfranchisement, technophobia and fee-for-service (FFS) to system coordination, patient-centeredness, tech savviness and fee-for-value reimbursement, where bundled payments and accountable care are the reality, Dr. McGeeney says.

Ultimately, the patient-centered medical neighborhood (PCMN), or network of physicians collaborating and coordinating care per the patient-centered medical home (PCMH) model, will be a partnership among practitioners, patients and their families that ensures and respects the decisions of the patients, says Dr. McGeeney during Medical Home Neighborhoods: Uplinking Specialists To Create Integrated Systems of Care, a November 20th webinar now available for replay. Dr. McGeeney examined the trend toward medical neighborhoods and effective strategies for building out the neighborhood.

Bridging the gap between physician and provider-speak and hospital-speak, and identifying and engaging specialists in the medical neighborhood are key, Dr. McGeeney continues. Transitioning a clinically integrated entity to a high-functioning medical neighborhood is a real opportunity and challenge.

What are the key attributes of a highly functioning medical neighborhood?

  • A clear agreement on a delineation of roles of the neighbors in the system. Many successful neighborhoods are establishing letters of agreement or understanding on who is going to do what.
  • Sharing clinical information needed for effective decision-making, reducing duplication and waste in the system, as supported by appropriate health information technology (IT).
  • Continuity of medical care when patients transition between settings, particularly important in the post-acute space, and the move toward risk and episodic bundled payments. The transition from clinic to the emergency room (ER) is also critical.
  • Focusing on patients’ preferences, whether it’s to the primary care clinic or through a dedicated care coordinator, with the PCMH playing a key role. Strong community linkages, including both clinical and non-clinical services, including pharmacy, behavioral health, etc.

The top ways for practices to build capacity, Dr. McGeeney says, is to do a workflow analysis, and add capacity when appropriate, ensuring all are empowered.

As with all new healthcare models, there will be challenges, says Dr. McGeeney, among them PCP buy-in, leadership; communication at multiple levels; unaligned incentives, technology updates, and a difficult transformation.

And perhaps the biggest risk to the PCMH and PCMN model is the lack of patient engagement needed to leverage patient choice, Dr. McGeeney adds.

Choosing the ideal specialists is a good way to start — specialists that possess good communication skills, strong reputations and high value.

But as with any neighborhood, the whole is often greater than the sum of its parts, and assuring specialists that this new model will result in improved quality, cost reductions, the reduction of duplicated, unnecessary work and a better life/work balance is key.

And not everyone will be invited into the neighborhood, Dr. McGeeney cautions: there will be winners and losers. “The reality is there’s a number of hospital beds in this country to contract. Some providers may be left out of networks and thereby left out of the potential to share in savings. Proper positioning in this new environment is critical.”