Meaningful Use and the Capabilities of HIE to Support the Needs of a PCMH

1. David N. Gans, MSHA, FACMPE Vice President Innovation and Research Medical Group Management Association July 29, 2011 Meaningful Use and the Capabilities of HIE to Support the Needs of a PCMH Hawaii Health Information Exchange Beacon Grantees Meeting Honolulu, Hawaii

2. About MGMA Our mission…To continually improve the performance of medical group practice professionals and the organizations they represent MGMA has • 23,500 members… • Who manage and lead 13,700 organizations • With 280,000 physicians • Providing about 40% of U.S. physician services

3. What is a Patient Centered Medical Home (PCMH)?

4. What Is a Patient Centered Medical Home (PCMH)? • A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. • The PCMH is an approach to providing comprehensive primary care for children, youth and adults. • The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. • “A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.” -- American Academy of Pediatrics

5. Joint Principals of the PCMH • Personal physician providing first contact, continuous and comprehensive care • Physician directed medical team • Whole person orientation with the personal physician responsible for providing for all the patient’s health care needs • Care is coordinated across all elements of the health care system including subspecialty care, hospitals, home health, nursing homes and the patient’s community • Care is facilitated by registries, information technology, and exchange of health information

6. Joint Principals of the PCMH (Continued) • Quality and safety are hallmarks of the medical home • Evidence-based medicine and clinical decision-support tools guide decision making • Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement • Patients actively participate in decision-making • Enhanced access to care is available through open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff • Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home

7. What Changes When a Primary Care Practice becomes a PCMH • An EHR is used not only for its medical record capabilities but also as a quality tool and to schedule preventive services for individual patients • Patient registries are used to evaluate and improve the health status of patient populations • Advanced scheduling and asynchronous care become normal • Group visits and self management support are common • Care delivery evolves from “practice-work “ to “teamwork”

8. Voluntary Recognition as a PCMH To demonstrate that a practice is a PCMH, it undergoes voluntary recognition by an appropriate non-governmental entity to demonstrate that it has the capability to provide patient centered services consistent with the medical home model Recognizing Bodies • National Committee for Quality Assurance (NCQA) • Accreditation Association for Ambulatory Health Care (AAAHC) • The Joint Commission • URAC

9. PCMH Approach to Delivering Health Care Today’s Care Medical Home Care My patients are those who make appointments to see me Our patients are those who are registered in our medical home Care is determined by today’s problem and time available today Care is determined by a proactive plan to meet health needs, with or without visits Care varies by scheduled time and memory or skill of the doctor Care is standardized according to evidence-based guidelines I know I deliver high quality care because I’m well trained We measure our quality and make rapid changes to improve it Patients are responsible for coordinating their own care A prepared team of professionals coordinates all patients’ care It’s up to the patient to tell us what happened to them We track tests and consultations, and follow-up after ED and hospital Clinic operations center on meeting the doctor’s needs Aninterdisciplinary team works at the top of our licenses to serve patients Source: Adapted with permission from F. Daniel Duffy, MD, MACP, Senior Associate Dean for Academics, University of Oklahoma School of Community Medicine

10. Qualifying as a PCMH Under the NCQA standards, a practice must demonstrate proficiency in six standards: • Enhance access and continuity • Identify and manage patient populations • Plan and manage care • Provide self-care and community resources • Track and coordinate care • Measure and improve performance The AAAHC and proposed Joint Commission and URAC requirements are similar Source: National Committee for Quality Assurance, Standards for PCMH 2011

11. MGMA 2011 Patient-Centered Medical Home (PCMH) Study Results

12. Study Methodology Study Goals: To identify the challenges and barriers that medical groups encounter or anticipate will encounter in becoming a PCMH To provide information to MGMA members and others on the experiences of practices that have attained PCMH recognition. To identify how primary care practices deliver care Online electronic questionnaire distributed by direct e-mail to MGMA members and customers Data collected 25 March – 29 April 2011 341 medical organization responded prior to data cut-off Responses represented information for practices with 5,790 primary care physicians and 1,996nonphysician providers

13. Responses by Organization Type

14. Motivation to Become a PCMH

15. PCMH Status

16. Change in Patient Satisfaction As a Result of Achieving PCMH Status

17. Practice Processes for Accredited or Recognized PCMHs

18. Practice Processes for Those Transforming to Become a PCMH

19. Practice Processes for Those Interested in Becoming a PCMH

20. Top 5 Challenges of Accredited and Recognized PCMHs Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.

21. Top 5 Challenges of Practices Transforming to Become a PCMH Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.

22. Top 5 Challenges of Practices Interested in Becoming a PCMH Note: Based on a 5 point scale where 1=No challenge at all, 2=Low challenge, 3=Moderate challenge, 4=Considerable challenge, and 5=Extreme challenge. Challenge percentages represent considerable or extreme challenge.

23. Metrics in Place to Monitor Patients’ Use of Health Services

24. Comparing PCMH Requirements to the Meaningful Use Standards

25. Defining "Meaningful Use” "Meaningful Use" is described in the American Recovery and Reinvestment Act (ARRA) as: • Use of a "certified" EHR with e-prescribing capability as determined appropriate by the Secretary of HHS • The ability to report on clinical quality measures as specified by the secretary • The use of EHR technology that allows electronic exchange of patient health information • CMS and the Office of the National Coordinator for Health Information Technology (ONC) have developed comprehensive regulations outlining the complete definition of "meaningful use" and "certification."

26. Percent of EHR Systems with the Features Required to Meet Core Meaningful Use Criteria Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

27. Percent of EHR Systems with the Features Required to Meet Core Meaningful Use Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

28. Discussion on How the Meaningful Use Criteria Will Facilitate the PCMH Transformation

29. Are There Any Questions? David N. Gans, MSHA, FACMPE Vice President, Innovation and Research Medical Group Management Association 104 Inverness Terrace East, Englewood, CO 80112 Phone: (303) 799-1111, ext. 1270 E-mail: dng@mgma.com • Name, credentials • Organization • Date