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Patient Centered Medical Home - PowerPoint Presentation

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Patient Centered Medical Home - PPT Presentation

ACHA May 2018 Joseph Campos II PhD University of Hawaii at Manoa PCMH The services provided by an accreditable Medical Home are patientcentered physician or nurse practitionerdirected comprehensive accessible continuous and organized to meet the needs of the individual patients ID: 778581

health care patient medical care health medical patient pcmh patients physician workers access referrals patient

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Slide1

Patient Centered Medical Home

ACHA May 2018

Joseph Campos II, Ph.D.

University of Hawaii at

Manoa

Slide2

PCMHThe services provided by an accreditable Medical Home are patient-centered, physician- or nurse practitioner-directed, comprehensive, accessible, continuous, and organized to meet the needs of the individual patients served.

Slide3

Joint Principles of PCMHThe American Academy of Family PhysiciansThe American Academy of PediatricsThe American College of PhysiciansThe American Osteopathic Association

Slide4

Details of Joint Principles of PCMHPersonal physician: Patients have an ongoing relationship with a personal physician. First contact, continuous, and comprehensive care.Physician directed medical practice:

Personal physician leads a team of individuals at the practice level.

Collective responsibility for the ongoing care of patients.

Slide5

Details of Joint Principles of PCMH - continuedWhole-person orientation:Medical home provides for all the patient’s healthcare needs or appropriately arranges care with other qualified professionals.Care for all stages of life: acute care, chronic care, preventive services, and end-of-life care.

Care is coordinated and/or integrated:

Coordination of care across the healthcare system and patient’s community.

Care is facilitated by information technology, health information exchange, use of interpreters, etc.

Slide6

Details of Joint Principles of PCMH - continuedQuality and Safety:Quality and safety improvement are hallmarks of the medical home.Specific activities include but are not limited to evidence-based decision making, individualized care plans, collection and reporting of quality improvement data, use of information technology, and voluntary certification of practices as medical homes.

Slide7

Details of Joint Principles of PCMH - continuedEnhanced Access:Patients can easily access healthcare via their medical home.Specific improvements include open access scheduling, expanded hours, and enhanced phone or e-mail communication.

Payment:

Increased payments support the added level of service and value provided to patients who receive care from a medical home.

Slide8

Patients today are savvy consumers of health care and have higher expectations.

Communication

Access

Convenience

Coordination

Responsiveness

Slide9

PCMHThe foundation of a Medical Home is the relationship between the patient, his/her family, as appropriate, and the Medical Home. Within the patient-centered Medical Home, patients are empowered to be responsible for their own health care.

Slide10

PCMHAn approach to providing comprehensive, patient centered, and coordinated primary care for health center patients.HHS Priority Recognition Goal

Goal: 25% of grantees recognized by 9/30/2013

Goal: 13% of grantees recognized by 12/31/2012

Many entities across the U.S. are embracing the PCMH model:

Private Payers: Blue Cross Blue Shield, United Health Care, etc.

This is a great opportunity for all members of the health community, including social workers and mental health

practioners

, to influence the quality of and access to health care.

Slide11

Some things to consider before you can transitionUnderstand what procedures and standards a primary care practice must follow in order to obtain recognition. The practice must provide documentation of the practice’s guidelines for implementation.

Slide12

Guidelines for implementationEnhance access and continuityIdentify and manage patient populationsPlan and manage careProvide self-care support and community Resources

Track and coordinate care Measure and improve performance

Slide13

PCMH – 5 Components Patient/primary care provider relationshipAccessibility to care

Comprehensiveness of care

Continuity of care

Quality

Slide14

Behavioral Health as a Core Service

Accessibility to care - At least 50% better access to MH care if offered in primary care.

Cultural fit of college health for the college student

Behavioral Health Providers can free up PCPs and provide expert care.

Care management is more efficient and specialized

Slide15

PCMH – A: RelationshipCommunication, Understanding and CollaborationPatient can identify his/her physician and patient care team members.

Patients are fully empowered to participate in decisions involving their health care.

The patients are provided with information and explanation regarding the Medical Home approach to care.

Social workers and mental-health

practioners

can play an integral part in helping patients decipher and digest the information provided.

The physician explains information in a manner that is easy to understand.

Social workers and mental-health

practioners

can help physicians understand how to communicate ideas in an easy to understand manner.

Slide16

PCMH – A: Relationship Cont.Communication, Understanding and CollaborationThe physician listens carefully to the patient and, when appropriate, the patient’s personal caregiver(s).

The physician speaks to the patient about health problems and concerns.

The physician provides easy-to-understand instructions about taking care of health concerns.

The physician knows important facts about the patient’s health history.

Slide17

PCMH – A: Relationship Cont.Communication, Understanding and CollaborationThe physician inquires as to the patient’s concerns, worries, and stressors.

The physician inquires as to the patient’s mental health status (

e.g., sad, empty, or depressed).

Provides services within a team framework, and that “team” provider concept has been conveyed to the patient.

The family is included, as appropriate, in patient care decisions, treatment, and education.

The Medical Home treats its patients with cultural sensitivity.

Slide18

Recap on RelationshipThe social worker and mental health practioner are in a unique position to be able to help both the provider and patient in ensuring that information is clear and concise; helping providers understand stessors; and helping providers understand cultural issues that may impact a patient’s health.

Slide19

PCMH – B: AccessibilitySocial workers and mental health workers may play a key role in services that are provided on 24/7 basis.Patients are provided information about how to obtain medical care at any time, 24/7.

The Medical Home ensures on-call coverage (pre-arranged access to a clinician) when the clinic is not open

.

Electronic data management is continually assessed as a tool for facilitating the above-mentioned Standards.

Slide20

PCMH – C: Comprehensiveness of CareIf the Medical Home limits the population served, those limitations are disclosed to prospective patients.The Medical Home scope of service includes, but is not limited to:

a. Preventive care including surveillance, anticipatory medical and oral health care guidance, and age-appropriate screening.

b. Wellness care including healthy lifestyle issues such as appropriate sleep, stress relief, weight management, healthy diet, oral care, and others, as appropriate.

c. Health risk appraisal and health risk assessment and discussions.

d. Acute illness and injury care.

e. Chronic illness management.

f. End-of-life care.

Social workers and metal health workers play an integral role in a-F

Slide21

PCMH – C: Comprehensiveness of Care Cont.Patient education and self-management resources are provided.Knowledge of community resources that support the patient’s (and family’s, as appropriate) needs are known by the Medical Home.

Social workers and mental health workers can provide invaluable insight to community resources that affect accessibility to comprehensive care.

The community’s service limitations are known and alternate sources are coordinated by the Medical Home.

Referrals are appropriate to the patient’s needs; when referrals occur, the Medical Home collaborates with the specialist.

Slide22

PCMH – D: Continuity of CareA significant number (more than 50%) of the Medical Home visits of any patient are with the same physician/physician team.Referrals for services (external to the Medical Home) are documented in the clinical record.

Consultations are recorded in the clinical record.

Referrals are disease- or procedure-specific.

Slide23

PCMH – D: Continuity of Care Cont.The results of a patient referral are recorded in the clinical record; follow-up procedures exist, and the results of the referral are appropriately reported to the Medical Home as they are made available.

Follow-up appointments are documented in the clinical record.

Critical referrals, critical consultations, and critical diagnostic studies are tracked, and appropriate follow-up is made when the results are not received within a timely manner.

Transition of care (e.g., pediatric to adult or adult to geriatric) is proactively planned, coordinated, and documented in the clinical record when indicated or when appropriate.

Electronic data management is continually assessed as a tool for facilitating the above-mentioned Standards, including consultations, referrals, and lab results.

Slide24

PCMH – E: Quality of CarePatient care is directed by a physician, nurse practitioner, or physician assistant.The Medical Home incorporates evidence-based guidelines and performance measures in delivering clinical services.

The Medical Home periodically assesses its use of evidence-based guidelines and performance measures to ensure that they are current and being used effectively and appropriately.

Slide25

PCMH – E: Quality of Care Cont.Supervision of patient care by the Medical Home, as evidenced by: a. Appropriate and timely diagnosis based on findings of the current history and physical examination.

b. Medication review and update including prescription, over-the-counter, and diet supplements, and if indicated, use of recreational drugs and substances.

c. Appropriate ordering of diagnostic tests.

d. Absence of clinically unnecessary diagnostic or therapeutic procedures.

e. Appropriate management of patient referrals (avoidance of unnecessary referrals).

Social workers and mental health providers can help facilitate referrals.

Slide26

Lets delve in a bit deeper with some things to consider as you look to move to a PCMHPromoting Physician Buy-In: Change can be scary and physicians have hectic schedules. However, their participation and contribution to PCMH is pivotal in a successful transformation

Training and Reimbursement Schedule

: If your college health center participates in third party billing, there can

be substantial

changes to the way you code and bill. This will require training.

Slide27

Team-Based Care: PCMH model introduces team-based care to primary care practices. Team-based care requires staff to address patient treatment decisions collectively.Best practices suggest that pre-visit meetings occur. Pre-visit huddles improve decision-making and care for patients. **S. L. Hughes, F. M. Weaver, A. Giobbie-Hurder et al.,

“Effectiveness of team-managed home-based primary care: a randomized multicenter trial,”

Journal of the American Medical Association

, vol. 284, no. 22, pp. 2877–2885, 2000.

Slide28

Changing the way Students view their college health clinic.Each student has their own unique circumstanceIn-state students in close proximityIn-state students from distant locationsNational out-of-state studentsInternational studentsHow do we change their experiences and concept of primary provider.

What about insurance carriers that require in-network PCPs?

Slide29

Changing the college health clinic and business office culture.Not only do medical providers need to adjust their approach, but front office and business office staff need to be informed of their role in the PCMH model.

Slide30

Patient Culture“i-gen” patients value being part of the process and communication with their healthcare provider.AccessibilityUnderstanding their potential reaction to change.With informational outreach patients understand the PCMH model is to improve their quality of, and participation in, life.

Educating

patients regarding their

health and ensuring they have the

knowledge necessary to

improve it.

Slide31

Front Office and Business office roles in PCMH:Ensuring greater access and increased communication. Develop more responsibility in decision-making skills, that require additional training on the PCMH principles.new workflow processes in the officeincreasingly integrated responsibilities to patients and staff.

Slide32

Patient ExperienceIt is important that patients understand that the ultimate goal of PCMH is to improve their quality of life and participate in achieving this objective. PCMH focuses not only on the manner in which care is administered, but also educating patients regarding their health and ensuring they have the knowledge necessary to improve it.

Patient Education is important to change their understanding of their role in their own care.

Slide33

Care CoordinationPCMHs are tasked with improving care coordination and documenting patient engagement in self-management. This can be done by creating a care manager or care coordinator position. The care coordinator performs tasks that may have previously delivered inconsistently such as patient follow-ups and patient

Slide34

Staff Allocation and Clinical SpacePrimary care practices need to build collaborative relationships with other professionals, such as social workers, nutritionists, and health educators, to provide needed services.This can easily be facilitated in the college health environment.

Facilities may need to be renovated to accommodate changes. If a practice employs a care coordinator, they must be provided with space to communicate with patients in private