TRANSFORMING THE FAMILY PRACTICE

INTO THE PATIENT’S MEDICAL HOME

Annual Scientific Assembly Banff 2017

“ARE WE THERE YET?”

MOE, Grace, BPT, MSc, PCMH-CCE BAILEY, Allan L., MD, CCFP

Faculty/Presenter Disclosure:Faculty/Presenters:

Grace Moe, BPT, MSc, PCMH-CCE• Executive Director, Strategic Planning & Special Projects

Westview PCN/Westview Physician Collaborative• Project Director, WPC Community Teaching Site

FM-Westview, FM Residency Program, Department of FM, U of A

Allan L. Bailey, MD, CCFPFamily Physician, Westgrove Clinic, Spruce Grove

Director, Innovation, Research & Evaluation, Westview PCN/Westview Physician Collaborative

Site Director, Family Medicine – Westview, FM Residency ProgramClinical Professor, Department of Family Medicine, U of A

• no conflict of interest to disclose•no relationships with any commercial interests•no grants/research support from any agency

Diffusion of Innovation

Hype Cycle

Patient-Centered Medical Home Assessment (PCMH-A)

• developed by the US-Safety Net Medical Home Initiative 1

• modified only to reflect a publicly funded health system

_____________________________________________________________________________

1Safety Net Medical Home Initiative.

The Patient-Centered Medical Home Assessment Version 3.1.

The MacColl Center for Health Care Innovation at Group Health Research Institute and Qualis Health; Seattle, WA

May 2013.

What Does It Mean?

Score Level D C B APoints in scale 1 2 3 4 5 6 7 8 9 10 11 12

Interpretation reflect absent or minimal implementation of the key change addressed by the item.

suggest that the first stage of implementing a key change may be in place, but thatimportant fundamentalchanges have yet to be made.

typically seen when the basic elements of the key change have been implemented, although the practice still has significant opportunities to make progress with regard to one or more important aspects of the key change.

most or all of the critical aspect of the key change addressed by the item are well established in the practice.

PCMH-A ResultsClinic 5

2014 - 2015 - 2016

9.0 8.8 9.19.7

8.8

6.2

8.0

6.1

8.2

9.3 9.29.8 9.6 9.6

7.9

9.28.6

9.39.8

9.2

10.49.7 9.8

8.89.4

8.79.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Sco

re

Clinic 5 2014 Clinic 5 2015 Clinic 5 2016

PCMH-A ResultsClinic 5

Interpretation

• “top performer”/early adopter?

• ANOVA year-to-year (statistically significant):• Patient-centeredness • Care Coordination • PCMH-A Overall

• Post-hoc Fisher’s Least Significant Difference:

• Patient-centeredness (2014 – 2016 only)

• Care Coordination (NOT 2015-2016)

• PCMH-A Overall (NOT 2015-2016)

PCMH-A ResultsPCN Wide

2014 - 2015 - 2016

8.1 8.08.5

9.9

8.6

7.38.1

7.48.28.2 8.2 8.5

9.1 9.1

7.88.6 8.5 8.58.5 8.2

8.79.3 9.0 8.7 8.8 8.7 8.7

0

2

4

6

8

10

12

Sco

re

PCN Average 2014 PCN Average 2015 PCN Average 2016

PCMH-A ResultsPCN Wide

Interpretation

• ANOVA year-to-year (statistically significant):• Patient-centeredness • Care Coordination • NO significant difference in PCMH-A Overall

• Post-hoc Fisher’s Least Significant Difference:

• Patient-centeredness (2015-2016 but NOT 2014 –2015)

• Care Coordination (2014-2015 but NOT 2015 - 2016)

• PCMH-A Overall (NO significant difference)

PCMH –A Overall Score

2014

2014 2015 2016

C1 1 8 7

C2 4 5 4

C3 5 15 11

C5 7 18 13

C6 3 17 18

C10 1 7 10

Number of Respondents

PCMH –A Overall Score

2015

2014 2015 2016

C1 1 8 7

C2 4 5 4

C3 5 15 11

C5 7 18 13

C6 3 17 18

C10 1 7 10

Number of Respondents

PCMH –A Overall Score

2016

Number of Respondents

2014 2015 2016

C1 1 8 7

C2 4 5 4

C3 5 15 11

C5 7 18 13

C6 3 17 18

C10 1 7 10

PCMH-A Overall Score 2014 - 2016

Clinic 5 PCN-Wide (n=6 FP clinics)

Per Capita Funding for “TEAM”and

PCN-Wide PCMH-A Scores 2014 – 2016

13.49

38.8737.78

40.69

46.69

56.92

59.86

51.44

54.81

49.55

8.24 8.60 8.73

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Per Capita CICP $ PCMH-A Score

Per Capita Funding for “TEAM”)and

TEAM (FTE):MD Ratio

Per Capita CICP $ PCMH-A Score2007 13.492008 38.872009 37.782010 40.692011 46.692012 56.922013 59.862014 51.44 8.242015 54.81 8.602016 49.55 8.73

Year TEAM:MD Ratio2007 0.26

2008

2009

2010 0.35

2011

2012

2013 1.06

2014

2015

2016 1.22

Conclusions

• Are we there yet? NO, not even for the “early adopters” – at best a B+.

• There can be wide variance of performance between clinics even within a single PCN.

• Not all key aspects of performance improve at the same rate.

• Are the “early adopters” “plateauing” – WHY?

• The PCMH-A tool may be useful if used over time: is it something we should encourage for the “early and late majority”?