Overview PCMH Learning Community

Dec 6, 2011Mazhar Shaik, Chief Clinical OfficerLynda Meade, Program Manager

Agenda

• Why We are Doing it? How We are Doing it? What Does the PCMH Initiative Entail?

• Goals and Aspirations of This Collaborative

• Features, Benefits and Value Proposition

• Approach, Structure and Requirements

• Tools and Resources • Q&A (MPCA/PCDC)

Why MPCA is Initiating the PCMH Learning Community?

Prioritization Grid of Health Center Areas of Need (Operations)

MPCA is responding to our stakeholders’ needs.

Preferred Methods of Learning

Again, MPCA is responding to stakeholders’ needs and preferences.

How Are We Doing It?

We are executing the PCMH initiative in partnership with a national expert agency.

MPCA identified the national expert agency on PCMH through an evaluation process:

National Pool Finalists Winner

NCQA TransforMed PCDC

JACHO PCDC

AAAHC

TransforMed

PCDC

- Interview - Presentations- Proposal Evaluation - Reference Check

What Does the PCMH Program Entail? Goals and Aspirations:

This 12-month program, entitled the “PCMH Learning Community” will equip Health Centers with knowledge, tools, resources and one-on-one consultations to successfully:

• Compile an NCQA PPC PCMH survey submission with the goal of ‐obtaining PCMH recognition at a level appropriate for the organization

• Collect and organize data for required Stage 1 MU objectives with the goal of attesting

• Identify future areas for improvement that fully embody the principles behind PCMH and MU concepts

PCMH Learning Community Road Map

Understand

• The Regulations• The Objectives • The Measures• The Collaborative

Assess• PCMH Readiness• MU Readiness• The Gaps• The Organization

Decide

• Medicaid/Medicare• Level 1,2,3• 2011, 2012• The Collaborative

Map

• Join the Collaborative • Redesign• Collect and Organize• Attest and recognize

Features of This Collaborative

• Builds a learning community – brings together organizations committed to making improvements in care delivery

• Uses evidence-based best practices as framework for designing improvement at individual sites/practices

• Is an action-learning approach – you learn and do and learn…

• Change is specific, measureable and directly related to an improvement outcome

• Uses teams (in partnership with leaders) to learn, test and lead implementation of change improvement

• Builds in sustainability at all points• Coaching and technical assistance support (e.g., coaching

calls, webinars, on-site and virtual site visits)• Increases the degree of improvement achieved

Strengths of Learning Community

1. Cost-effective/scalability (leverage experts)

2. Activity (real world) focused

3. Leads to actionable work plan

4. Peer networking

5. High participant accountability

6. Action period reinforces learning

7. Supports self-paced learning

8. Allows for wider organizational participation

Benefits

Timeline flexibility/resource availability

One effort, two results (PCMH/MU)

Content value

Not a cookie cutter approach - we meet you where you are

CHC expertise

Build capability - preparing for future stages of PCMH and MU

Benefits …

MPCA has high knowledge of CHCs, has established working relationships with CHCs

MPCA is a trusted partner of Michigan CHCs

PCDC trusted consultant to the Primary Care Community

PCDC reputation with collaborative assistance for over 400 locations

MPCA/PCDC have the capacity and capability to do this work

Dollar savings $20,000 - $25, 000 per CHC

PCDC: A Learning Community Partner

December 6, 2011Peter Cucchiara, BSMIS ,MBA, Managing DirectorDeborah Johnson Ingram, Sr. Program Manager

PCDC Background

Manual

Funded by New York Community TrustReleased 11/09 “Comprehensive “How To”10,000 Downloads

Presentations

At more than 20 conferences, forums, webinarsSeveral 1-2 day training sessionsFocus on rationale, standards and process

PCMH/MUCollab.

Partnered with CHCANYS (NY PCA)12 CHC in Wave 1; Planning Wave 2Focus on achieving two results in one effort

TechnicalAssistance

Redesign FaciliationProject Management CoachingConsulting toward HH recognition and MU certification

A Sample of Significant PCDC Activities

PCMH/MU CHCANYS/PCDC Collaborative• Access CHC• Basics/Promesa Systems Inc• Bronx Lebanon Hospital • Brooklyn Plaza Medical Center• Charles B. Wang CHC• East Harlem Council for Human Servics Inc. • Joseph P. Addabbo FHC• Morris Heights Health Center• Pediatrics 2000• Settlement Health• Soundview Healthcare Network

PCMH Assessment/Facilitation Services• Bassett Healthcare Network• Lutheran Family Health Center• Maimonides Medical Center – ICL• Montefiore Community Pediatrics Program• Montefiore Medical Group• St. Barnabas Ambulatory Care Clinics• Stepping Stone Pediatrics• Bedford Stuyvesant FHC (Emblem)• Primary Medical Care – PC (Emblem) • SL Quality Care DTC (Emblem)• Fort Drum Region Health Planning Org.

PCMH/MU Training/Educational Sessions for PCAs• Alabama Primary Health Care Association• Alaska Primary Care Association, Inc.• Bi-State Primary Care Association (Vermont & New Hampshire)• California Primary Care Association (120 Centers)• Community Health Care Association of the Dakotas• Michigan PCA• Wisconsin Primary Health Care Association (April 2011)• CTPCA• OKPCA• SCPCA

PCDC Partners with PCA’s

10%

94%

% of NYS Practices PCDC Assisted with PCMH Recognition as of 12/2011

PCDC

NYS

75

739

3.0%

97.0%

% of U.S. Practices PCDC Assisted with PCMH Recognition as of 10/2011

PCDC

USA

Value Proposition Considerations

Average Cost of Two Day Conference $3,000

Average Cost EMR 2 day education $1,500

Average Cost for HIT 2 day education $1,500

NCQA PCMH Training 1 ½ day $1,000

Plus Travel Expenses $3,000

Total Range $4500 - $6000

PCMH MU Collaborative

4 Learning Sessions (4 days)12 WebinarsWeekly T/A Coaching for PCCWeekly T/A Coaching for PCAOther:WebinarsWebinettesSharepointToolsResources

Total Price for 12 month package $5,000

Value Proposition Considerations

What Comes With your HRSA 35K

Going it alone yields:

• A link to tools and resources from NCQA

• The challenge to stretch your 35K to gain NCQA submission/recognition– Hire a private consultant (>

$30,000.00) not including in kind cost

– Send staff to NCQA training (1.5 day training w/ travel and hotel >$1700.00) not including in kind cost

Joining the MPCA collaborative yields:

• 12 months of direct/ indirect consultant services from industry experts

• Guided process to getting a submission completed in projected time frame

• Projections of ROI (inclusive of in-kind costs*)

Value Proposition Considerations

Medicaid FFS10,000 Medicaid FFS visits/yearLevel 1: 10,000 * $ 5.50 = $ 55,000/yearLevel 2: 10,000 * $11.25 = $112,500/yearLevel 3: 10,000 * $16.75 = $167,500/year

Medicaid Managed Care (PMPM)3,000 Medicaid Managed Care patientsLevel 1: 3,000 * $2 * 12 months = $ 72,000/yearLevel 2: 3,000 * $4 * 12 months = $144,000/yearLevel 3: 3,000 * $6 * 12 months = $216,000/year

• Practice with 10 providers that sees 10,000 Medicaid managed care patients per year and achieves level 3 PCMH and MU Stage 1 by 2011 could generate by 2015 a total of:

– MU

• $63,750/EP/five years X 10 MDs = $ 630,750– PCMH

• L3: 10k pts X $6/Pt/yr = $720,000/year X 5yrs = $3,600,000 Projected 5 Year Total = $4,230,750

PCDC Approach

Guiding Principles

12

Map – see the pathbefore we walk it

Balance – test/principles

Measure twice cut once

Three work strands as one

Decision Catalogue

Teams & Collaboration

Focuses on system design as source of resultsRedesign of specific system elements fordesired results and outcomes

Client needs through use of a targeted, results- and outcomes-focused assessment (combination of data, interviews, observations and organizational strategic goals)

data and observations key opportunities for change

Develop an implementation plan focused on redesign for high impact results and sustainable changes

Integrated Approach

Understanding

SynthesizeIdentify

Implementation

supports implementation to enable effective, sustainable changes in operations and results.

TrainingCoaching

Our Traditional Approach

Knowledge & SkillsTrusted ColleagueProtected Time

The MessagesThe Audience

The Team

Decisions

Communications

Detailed Assessments

Outlining Plan, Resources, TimelineManaging the Plan and by the PlanMaking the Adjustments

Workplan

Assessing Scope & CapacityGetting Organizational Backing

Assessments – evaluating readiness/capabilityDefining gapsOptimization

Work Area Considerations

100% of MU is incorporated into PCMH but

Only 44% of PCMH is met by MU andYou only get 1 must pass element out of 6

When choosing 6 MU clinical measures …align them with the 3 diagnostic conditions you selected for PCMH and your UDS clinical measures

PCMH/MU Overlap Summary

MU objectives fall in All 6 standards 12 of the 27 elements 34 of the 149 factors

In several cases, multiple PCMH factors relate to 1 MU objectiveE.g., MU C8 incorporates 5 PCMH factors

1

2

3

Structure

IPre-Work

AssessmentGap

AnalysisWorkplan

IITraining

Four Full Day Sessions

IIIVirtual

Training12 Training

Sessions

IVRemote T/A

Weekly 1 Hour Sessions for Primary Care

Centers

VRemote T/A

Weekly 1 Hour

Sessions forPCA Staff

Learning

Events

Activity

Periods

Learn & Do

Trade School Model

Phase 1: Pre- Work (October December 2011-January 2011) The first phase of the project called “pre-work” will place strong emphasis on completing assessments of each of the 18 practices. Using several of PCDC’s tools from its 2009 publication Obtaining Patient-Centered Medical Home: A How-To Manual, and other tools. Practices will conduct comprehensive practice profiles and self-assessments to provide understanding of their operational and technological capacity as it relates to the four clinical interventions. PCDC will analyze the data from these assessments and earlier data, as well as conduct an on-site visit to each practice, to produce gap analyses and generalized project work plans. This phase will include a number of webinars and virtual meetings to orient practices to the goals of the collaborative and to use assessment and profile tools effectively. This pre-work phase takes a blended approach of using site visits and virtual coaching to establish and reinforce the coach/practice relationship.

Objectives Topics/Activities Tools/Resources Recommended Delivery Methods

Introduction and overview of the Learning Collaborative model and curriculum.

Identify and evaluate each practice’s operational and technological strengths and gaps related to the four clinical interventions

Identify change/process management steps that need to be taken in order to ensure successful adoption of performance improvement practices

Leadership Orientation (PCDC/ Practice Team Leaders)

Completing “practice profile” Selecting a team

Kickoff (PCDC/ Practice Teams) Introduction to CCBC four clinical interventions Preliminary exploration of goals and measures Organizational Impact Review

Pre-Training Introduction to PCDC’s PCMH 2011 Self-

Assessment Tool On-Site Visits (PCDC Coach)

Review results and deliver feedback of practice profile and self-assessment

Identify practice goals and units of measure for CCBC clinical quality measures

Design general project workplan (to be expanded and customized in Learning Session 1)

Additional activities (for each site): Collect baseline data and assess practice

capabilities Assess ability to collect data, run reports, use

registries and current care management capabilities

Identify current staff/clinical team member composition

Collect and review any prior assessment data Evaluate level of technical assistance required

1. PCDC Practice Profile:

a. PCDC PCMH 2011 Self-Assessment: focus on standards directly related to the four interventions (e.g. Standard 2 Element D “using data for Population Management)

b. Depth of PCMH review c. Post-recognition dashboard

2. Team Selection Grid 3. Team Selection Toolkit 4. EMR Assessment Tool to identify

Clinical Decision Support, Health Information Exchange, e-prescribing and reporting capabilities

Webinars – pre training Site Visits Recorded Webinars and Webinettes Conference calls Virtual weekly meetings with PCDC

coaches via Webex, conference call, video conference, etc.

Case Studies Simulations

Estimated T/A time allocation: 5 hours per practice, per week

Tools and Resources

1 – Pre Work Tools

2 – Webinars & Webinettes

3 - Reference

Team Chart and Team Development TemplatePCMH Assessment, Gap Analysis Template Workplan Development TemplateCommunications Campaign Outline

Beginning your Team JourneyWebinettes for Every StandardMeaningful Use/PCMH FAQ

Manuals – PCMH, CDSSMU/PCMH Vendor GuideVendor Inquiry

Sample Resource Inventory

Discussion

Peter Cucchiara BSMIS, MBAManaging DirectorPerformance Improvement

22 Cortlandt St.New York, NY 10007212-437-3921pcucchiara@pcdc.org

Deborah Johnson IngramSenior Program Manager

22 Cortlandt St.New York, NY 10007212-437-3935Djingram@pcdc.org

Questions?More information and to access

information, resources and tools:

www.mpca.net/PCMH

Mazhar Shaik, Chief Clinical Officermshaik@mpca.net517.827.0487Lynda Meade, Program Managerlmeade@mpca.net517.827.0470