Posts Tagged ‘Patient-Centered Medical Home’

Healthcare Update Week in Review: Medical Homes for Teens, Healthcare Spending Slow

April 29th, 2013 by Cheryl Miller

A majority of mental health issues emerge in adolescence, with 14 being the most prominent age, according to a new study from UCSF’s Department of Pediatrics.

It’s a frightening statistic; at a time when kids are dealing with real life situations (grades, peer pressure, pimples) they also have to struggle with less tangible conditions, like anxiety, depression, even learning disorders.

Yet, despite the widely known prevalence of this, nearly half of today’s adolescents lack a medical home, which could provide them with the appropriate treatment, researchers say. The medical home’s comprehensive, team-based care could be the best way to help teens and families through this scary time. More on how this healthcare model can be effective inside this issue.

Assessing the effectiveness of team-based care delivery methods is also the subject of a new study published in Population Health Management.

Researchers from George Washington University, Virginia Commonwealth University, and Carilion Family Medicine conducted case studies of small primary care practices to assess three team-based care models and to see if they can improve primary care delivery and patient outcomes. Improving patient care, practice workflows, and patient and physician satisfaction, researchers say, are competencies that have become expected of physicians as the healthcare landscape evolves.

The art of appreciative inquiry, a health coaching tool that is becoming more accepted in the medical community, can also help improve patient care and satisfaction. While all coaching tools are used to help inspire and engage people, appreciative inquiry is particularly effective because it builds on a person’s strengths instead of weaknesses, says Dennis Richling, MD, chief medical and wellness officer for HealthFitness. Too often attention goes into fixing what’s broken instead; by tapping into what’s already positive, the person is empowered to continue to make positive changes.

Fixing the nation’s economy is key to the record slow growth in health spending in recent years, say analysts in a new Kaiser Family Foundation report.

Based on statistical modeling and analysis by health cost experts at the Foundation and Altarum Institute’s Center for Sustainable Health Spending, studies find that the economy is responsible for 77 percent of the slowdown in health spending, a category encompassing what individuals, employers and governments collectively spend. The remaining 23 percent results from changes in the healthcare system, including higher deductibles and other cost-sharing that dampen patients’ use of services, as well as various forms of managed care and delivery system changes.

Though the recession will likely continue to dampen health spending growth over the next couple of years, the study projects that expected economic growth will drive up health spending in years ahead, gradually adding 3.5 percentage points to the annual growth rate by 2019. This would push the annual growth rate in health spending back over 7 percent, which is much closer to historical averages.

And lastly, current methods for estimating the costs and savings of federal health legislation also need to be fixed, because they are missing billions of dollars in potential long-term returns from effective obesity prevention policies, according to a new study released by the Campaign to End Obesity.

Changing the way cost estimates are created would give policymakers a clearer picture of costs and savings, the report concludes.

Infographic: Why the Patient-Centered Medical Home Works

March 29th, 2013 by Patricia Donovan

The five key features of the medical home model — patient-centered, comprehensive, coordinated, accessible, committed to quality and safety — are included in this infographic from the Patient-Centered Primary Care Collaborative (PCPCC). It includes definitions for each of these features, sample strategies used by health professionals, employers, and payors, and their collective impact on the health system.

patient-centered medical home

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You may also be interested in this related resource: 2012 Healthcare Benchmarks: The Patient-Centered Medical Home.

Infographic: Patient-Centered Medical Home Functions, Attributes

February 25th, 2013 by Melanie Matthews

A new infographic from Greenway Medical Technologies answers some key questions about the medical home and its impact on the health care system, including private sector support, a breakdown of reimbursement models used, and much more.

Functions, Attributes of a PCMH

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You may also be interested in this related resource: New Models in the Patient-Centered Medical Home: Incentives, Infrastructure and IT to Support Accountable Care.

Infographic: Spotlight on Embedded Case Management

January 28th, 2013 by Jackie Lyons

Case managers working inside patient-centered medical homes and accountable care organizations are taking on larger roles in primary care. About half of healthcare organizations embed or co-locate case managers at points of care, according to a new market research by HIN.

Thinking about adding a case manager to a primary care team? Assembling case manager criteria and finding the right practice are just a few steps that should be taken before embedding a case manager. This new infographic from the Healthcare Intelligence Network outlines top sites for ECMs, tools, protocols and workflows and typical duties of ECMs, drawing from responses from our 2012 Trends in Embedded Case Management survey.

Among the data points presented in this infographic are:

  • Top care sites for ECMs, such as primary care practices and clinics;
  • Ten steps to take before embedding a case manager;
  • Top ECM protocols, such as teaching patients to self-manage their health; and
  • Typical duties of an ECM, including medication management and reducing readmissions.

We invite you to embed this infographic on your own Web site using the code that appears beneath it. Also, share it via your social media channels. A deeper dive into the latest trends in case management is reflected in 2012 Healthcare Benchmarks: Embedded Case Management.

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Q&A: Integrated Health Coaching Brightens Total Healthcare Picture of Population

November 21st, 2012 by Jessica Fornarotto

To determine the coachee’s values, the health coach listens to achieve empathy and understanding, which demands that they have a sense of an individual value, says Kelly Merriman, vice president of service delivery at HealthFitness.

Prior to their presentations during a September webinar on Integrated Health Coaching: The Next Generation in Health Behavior Change Management, Merriman and Dr. Dennis Richling, chief medical and wellness officer at HealthFitness, discussed HealthFitness’ transition to a population health management focus, why HealthFitness’ coaches target the chronic disease population and a new coaching tool called appreciative inquiry.

HIN: How has HealthFitness’ shift from a disease management to a population health management focus meshed with the industry’s post-reform models of care, for instance the patient-centered medical home (PCMH) and the accountable care organization (ACO)?

(Dr. Dennis Richling): HealthFitness has had a population health management focus for many years and we see that many of the same principals that we use in our approach are included in ACOs and in medical home models.

Recently, we took a new look at disease management, which traditionally has been a stand-alone service, largely focused on patient self-care issues separate from lifestyle coaching interventions. In our new model, health behaviors across the entire risk continuum are dealt with in a person-centric way, rather than a disease-centered approach. That of course aligns with some of the principles of the post-reform models of care, like the medical home, and even to some degree with ACOs, which are attempting to be responsible for the total healthcare picture of a population.

HIN: In your company’s three-tiered coaching across the continuum approach, where do most of the coaching candidates fall?

(Dr. Dennis Richling): In every population you find different numbers, but in a typical employer, we see that the greatest opportunity for coaching is in those individuals who have behaviors that can lead to chronic disease. A good example of an ideal candidate for our coaching program is a 40-year-old manager working 50 hours a week. His blood pressure isn’t high, his cholesterol is slightly elevated and he’s a little overweight. He doesn’t exercise regularly and while he tries to watch his fats, he isn’t eating the most healthy diet because he hasn’t figured out how to balance his work schedule and his family life, and being 40. He’s also at risk for chronic disease. If he adopts more healthy behaviors, he can avoid developing a chronic disease.

Then there are those who already have a chronic disease like diabetes or coronary artery disease. This is about 10-20 percent of a population, depending on the population we’re looking at. Instead of putting all of them into nurse coaching, like traditional disease management, we determine through claims and a short assessment if the disease is well managed. In our experience, about three-quarters of those with chronic disease are taking their medicines and managing their diseases relatively well, though, they still need help with the underlying lifestyle issues that led to the chronic disease.

Those individuals are matched with an advanced practice coach (APC) who understands their underlying chronic disease issues, but will work with them to achieve goals that they want to work on, like losing weight or exercising regularly. By far the smallest group is those with the newly diagnosed or uncontrolled chronic disease. We match them with nurse coaches who can most effectively work with their self-management approaches, with making sure that they follow their medication and care plans that the physicians have prescribed.

HIN: In tailoring a coaching program to the individual, how does a coach determine the coachee’s values?

(Kelly Merriman): We call it ‘listening until you don’t exist.’ Most people listen to get information or because they enjoy the process of exchanging perspectives. Our coaches listen to achieve empathy and understanding, which demands that they have a sense of an individual value. For example, Michelle is 46 years old and is significantly overweight. And because of her weight, she’s a pre-diabetic. She told her coach that she was ready to make a change. She knew her weight wasn’t only impacting her health, but also her self-esteem. Michelle’s coach listened and learned that she took pride in being a pillar of support for family and friends, that ‘never let them see you sweat’ mentality, which meant she was holding in her fears of being overwhelmed at times.

Imagine if a coach reflected back thoughtfully and said, “I’m hearing, Michelle, that you take pride in caring for others, that you value being competent and having others rely on you for support. And sometimes when things get to be a little too much, you overlook your own health.” Once a coach finds those values, they’ve got something to work with to promote hope and inspiration. It’s what we call motivation.

HIN: Could you provide some details on appreciative inquiry and perhaps describe a scenario in which a coach might employ this tool?

(Kelly Merriman): All too often when people want to change a behavior, they tend to focus on all the negatives. All the attention goes to focusing on what’s broken. That focus can hold a participant back from achieving their goal. Our coaches use appreciative inquiry to focus on the participant’s strengths instead. The appreciative inquiry approach deliberately seeks to discover that person’s exceptionality, through their unique gifts, strengths and qualities. We listen with intent to appreciate who they are during the early coaching interactions and then envision how they want their life to be.

Appreciative inquiry has low resistance as an approach to change because it builds upon the person’s positive core, the things that they already have going for them. It assumes that tapping into their positive experiences and strengths are useful in discovering their intrinsic motivation to change and development. This immediately shows the coach and the participant that they have faith in the ability to make a positive change.

As an example, let’s look at Michelle again. We want to appreciate what she’s got going for her and use that to help her to envision what her future may be. Michelle is overweight, pre-diabetic and feeling overwhelmed. Her coach learned that she’s committed to her health, takes pride in being a pillar of support for her family and friends and is organized and creative. Instead of focusing immediately on fixing what’s broken, that she eats too much between meals and doesn’t exercise enough, her coach focuses on envisioning Michelle’s idea of health, one that honors her strengths and her values. In this case, Michelle’s vision of health may be using her creativity and strengths of purpose to take care of her own self as well as the people she loves. She’ll make healthy choices, will see the results, and have the freedom to live the life she wants.

Q&A: Florida Blue Applies PCMH Principle of Increased Access

October 24th, 2012 by Jessica Fornarotto

Providing six hours per week of after-hours coverage is a requirement of the Florida Blue patient-centered medical home (PCMH) so that members have complete access to their physicians no matter what time of day, says Barbara Haasis, R.N., CCRN, senior clinical lead of quality reward and recognition programs at Florida Blue.

During an interview prior to her presentation for a May 10, 2012 webinar on “The Patient-Centered Medical Home: Lessons from a Statewide Rollout”, Haasis discusses requirements for their PCMH pilot, the role of a nurse educator in the PCMH to disease management and future plans for embedding case managers in their practices.

HIN: Your organization is several months into a statewide rollout of a PCMH pilot with more than 1600 primary care providers participating. We realize it’s too early to discuss any hard outcomes, but one requirement for the practices that are participating in the pilot is the availability of at least six hours per week of after-hours coverage. Why did Florida Blue make that a requirement for participation in the medical home pilot?

(Barbara Haasis): Florida Blue chose to add that because we are following, by the letter, the principles of a PCMH, as described by organizations such as the American Academy of Family Physicians. And one of the principles is increased access. In today’s society, where almost everybody is a working adult, and our program is for commercial members under 65 only, we wanted to make sure that our members could see their physicians either before work, after work, or on the weekends, if it was not a medical emergency.

HIN: Are any Florida Blue case managers currently working inside participating practices, or are there any future plans to embed health plan case managers in the practices?

(Barbara Haasis): At this point, our case managers are still inside of Blue Cross Blue Shield. We have expedited the process of referring a patient to our case managers, and we are looking at doing a pilot with one of our vendors that works with chronic diseases, wellness education, etc. That is still in the discussion phase, though.

We’re planning to put together a small pilot of about four or five practices and to put a nurse in the office who is not a case manager but a practice coordinator. One of the roles of this nurse would be to identify patients to move into Blue Cross case management or one of our disease or wellness programs.

HIN: Could you describe the duties of the nurse educators in the medical home pilot, especially as they relate to patients with any of the pilot’s five focus health conditions, which are diabetes, COPD, coronary artery disease, asthma, and CHF?

(Barbara Haasis): Right now we have three nurse educators. They are each assigned to a specific practice so that they can establish a relationship with that practice. Part of the scorecards that we give to our physicians on a quarterly basis includes metrics that measure whether or not our diabetics have received their preventive screenings and their chronic disease management.

If a practice is having an issue with a specific disease entity, the nurses can offer them some suggestions on how they may be able to improve compliance. If there are issues with cost, we may be able to work on that with our case managers. The nurses have a relationship with the practice. Where the practice is having an issue with the patient, they can call their nurse educator and get assistance that way. They’re also aware of the external opportunities, such as the American Diabetes Association, that our practices can refer their patients to.

Infographic: Primary Care for the 21st Century

October 8th, 2012 by Melanie Matthews

Primary care in the United States is moving toward a new, team model of care centered around the patient and led by the primary care physician.

The aim of this model of care, the patient-centered medical home, is to increase the quality and cost-effectiveness of care. Learn more about the structure of this model of care, why it’s needed and what the healthcare system will need to support this model of care.

Primary Care in the 21st Century

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Physician Endorsement Helps ‘Sell’ Medical Home Model to Patients

August 28th, 2012 by Patricia Donovan
medical home patient

Recorded Webinar: Patient Engagement in the Medical Home

Nothing will engage patients and health plan members in the medical home model more than a ringing testimonial from the individual’s own physician, advises Horizon Blue Cross Blue Shield of New Jersey. That’s one of the lessons the payor has learned as it shops its patient-centered medical home (PCMH) model around its member population.

“The endorsement of a physician is key in this model,” explains Jay Driggers, Horizon’s director of consumer experience and engagement. “An insurance company isn’t going be able to [engage members] all on its own. If a PCP says this is a good program, and I want you to be a part of it, then typically patients will agree, and will want to be a part of it as well.”

A danger of leaving providers out of this messaging is that patients may sense a downgrading in their level of care, Driggers warned during a recent webinar on Patient Engagement in the Medical Home: A Continuum Approach.

Other key words and phrases with which to pepper conversations about the medical home: “coordinated comprehensive care” and “increased access.” “These issues are really prominent in the patient’s mind, in the consumer’s mind. They love the idea of somebody helping them, not have to repeat themselves, or working with their specialists to obtain all of their health records.”

Horizon has invested a lot of time and resources to research and test consumers’ perceptions of the medical home. The verdict? Awareness and understanding of the model is low, but interest is strong.

To maximize the transformative effect of the medical home, accountable care organizations (ACO) and episodes of care (also known as bundled payments), Horizon created a wholly owned subsidiary called Horizon Healthcare Innovations (HHI). To achieve its mission of creating “an effective, efficient and affordable healthcare system,” HHI decided to take a closer look not only at physician behavior, but also at the behavior of patients and health plan members. The consumer engagement team is charged with identifying tools to engage patients and encourage behavior change.

HHI has crafted a broader view of engagement as a four-part continuum: awareness, understanding, action (behavior change) and outcome. Of its seven key consumer engagement objectives, HHI ranks “becoming knowledgeable on care models and benefits” at the top, and employs a variety of strategies, including behavioral economics and the Patient Activation Measure (PAM) model, to segment consumers by need and motivation.

Tempted to employ technologies like smartphone apps and telemonitoring to communicate with and engage the population? Don’t assume everyone’s ready and willing to use them, advises Driggers. “Mobile health is not yet a silver bullet,” he said. “If you’re a senior citizen who doesn’t even really use a cell phone, I shouldn’t expect that you’re going be able to manage your diabetes using a smartphone app.”

Among the five key components of Horizon’s medical home model are a population care coordinator to manage the care of high-risk patients and close care gaps, as well as a playbook and learning network of best practices.

HHI’s efforts have increased awareness, interest and overall engagement in the medical home, but Driggers said HHI is not stopping there. “A ‘one and done’ approach doesn’t work. It takes repetitive, constant work to raise awareness. And interest rises with frequent contact.”

Video: 2012 Medical Home Starts Linked to Surge in Patient Satisfaction

August 9th, 2012 by Patricia Donovan

In a week when both Blue Cross Blue Shield of Michigan and CDPHP have considerably amped up their medical home game, a new video from the Healthcare Intelligence Network (HIN) documents a rise in patient satisfaction resulting from the construction of more medical homes.

In response to HIN’s sixth annual survey on the patient-centered medical home (PCMH) model, 52 percent of healthcare organizations who took the survey said they have established medical homes for their populations. This year’s survey results also reflected the highest levels of patient satisfaction to date in the survey’s six-year history, with 82 percent reporting a rise in patient satisfaction that they link to PCMH processes.

With patients at the center of the medical home care model, monitoring their satisfaction levels along with their health helps to paint a complete picture of PCMH success.

Earlier this week, Blue Cross Blue Shield of Michigan designated another 994 practices as medical homes, making it the country’s largest PCMH effort of its kind for the fourth consecutive year.

At the end of last month, CDPHP effectively doubled its medical home initiative when it added 70 practices to its Enhanced Primary Care effort.

Narrated by HIN COO and Executive VP Melanie Matthews, HIN’s sixth annual PCMH analysis delves into ACO activity planned by responding medical homes, health IT, PCMH team members, patient education and engagement strategies, and much more. Florida Blue’s Barbara Haasis also shares some details on the payor’s statewide rollout of a medical home program.

If you prefer to read an executive summary of the survey results, download it here. A more detailed analysis is available in the HIN bookstore.

Rollout of Florida Blue Medical Home Exercise in Quality, Innovation

May 30th, 2012 by Patricia Donovan

Don’t rely on technology, and don’t expect busy doctors to take on added administrative tasks. Those are just two lessons that have shaped Florida Blue’s programs to improve the quality of primary care over the last eight years.

And while Florida Blue’s name may be new, its mandate to identify and close critical gaps in patient care is longstanding.

The organization formerly known as Blue Cross Blue Shield of Florida (Florida BCBS) has had a quality-focused program to recognize excellence in primary care since 2004, explained Barbara Haasis, RN, CCRN, Florida Blue’s senior clinical lead, quality reward and recognition programs in a recent webinar on The Patient-Centered Medical Home: Lessons from a Statewide Rollout.

In 2004, Florida BCBS rolled out Recognizing Physician Excellence (RPE), its first statewide pay-for-performance (PFP) quality program for more 4,000 primary care physicians.

Seven years later, when the Florida payor decided results from the RPE program had topped out, it shifted direction to a patient-centered medical home (PCMH) approach, which reflected both industry trends and requests from employer groups.

In parallel with RPE, it piloted its PCMH program with a small number of practices in 2010, focusing on patients with diabetes and hypertension. The practices in the pilot were offered a registry to record patient data, but the expectation that electronic health record (EHR) data could be dropped into the registry was not met. Neither were busy physicians willing to complete the patient information forms themselves.

Based on lessons learned in the pilot, Florida Blue opted not to require any type of e-connectivity or EHR when it rolled out the program statewide in 2011, aligning instead with the e-connectivity standards of national programs such as the NCQA medical home recognition program.

However, mandates to utilize e-prescribing and to provide at least six hours of after-hours coverage are included in the program’s eligibility requirements.

Today there are more than 1,800 physicians in the program covering 25 counties; well over half a million Florida Blue members see a physician participating in the PCMH.

Florida Blue issues quarterly scorecards to its PCMH physicians that contain the results of their quality metrics in six key ares as well as feedback on their total cost of care. Overall, Florida Blue finds that physicians participating in the medical home program are more efficient in their total cost of care and have better quality outcomes than those who have never participated in a quality program before.

Nurse educators and medical field directors from Florida Blue support the physicians in the delivery of patient-centered care. Ms. Haasis said Florida Blue will also add four practice transformation coordinators to assist practices in the transition to the medical home model of care.