Quality Improvement and Medical Home Models: Lessons Learned on the Transformation Journey

1. Quality Improvement and Medical Home Models: Lessons Learned on the Transformation Journey Pattie Bondurant Beacon Program Director HealthBridge

2. What Does the OLD View of Quality Improvement Look Like without HIT or an HIE? • Quality Improvement and breakthrough performance in any area of an organization is a significant accomplishment that has had little to do with culture change and automation to help sustain change • Historically- a manual process on the already busy and over-extended staff • Difficult to sustain and often a more perplexing challenge remains: how to spread the success to other facilities, practices or departments. • Changes are small, difficult to continue to improve without data and a method to manage the data to drive change

3. A 2011 View of HIT - HIE - QI • HIT and HIEs focus on the supporting role in ongoing improvements to the quality of patient care as a fundamental property of the health care system. • Harness HIT and HIEs to support and inform health care improvement • promoting safety • reducing errors • providing clinical decision support tools for clinicians • improving continuity of care • contribute to the quality of patient care by electronically tracking process and outcome measures

4. Aim of Health Care Transformation in 2011Wed HIT – HIE – QIFuel Health Care Transformation AIM: Move physician groups toward full practice transformation & meaningful use Provider Universe Tomorrow HIGH Provider Universe Today Engagement LOW LEVEL 1 LEVEL 2 LEVEL 3 BASIC QUALITY IMPROVEMENT AGGRESSIVE QI PATIENT CENTERED MEDICAL HOME BASIC TECHNOLOGY MEANINGFUL USE 4

5. Greater Cincinnati Beacon CollaborationAn Overview Support is provided under cooperative agreement 90BC0016-01 from the Office of the National Coordinator for Health IT, US Dept. of Health and Human Services.

6. The Concept of the Beacon Community-a transformed Health Care Community

7. ONC Beacon Community Program • Goal: Provide funding to communities to strengthen health IT infrastructure and exchange capabilities and achieve measurable improvements in health care quality, safety, efficiency, and population health. • Funding: $13.75 million award to Cincinnati • Awarded: Sept 1, 2010 • Length of Initiative: 30 month initiative .

8. Beacon Community Programs

9. Two Demonstration Projects Pediatric Asthma – led by Cincinnati Children’s Adult Chronic Disease – led by Health Improvement Collaborative & Greater Cincinnati Health Council Six (6) Health IT & Exchange Enhancements Led and implemented by HealthBridge ER-Inpatient Alerts, Disease Registry, Summary Record Exchange, REL Data, Core Infrastructure Rigorous Evaluation and Performance Measurement Performedby UC, CCHMC Evidence of improvement to drive payment reform Greater Cincinnati Beacon Collaboration

10. The GCBC Team

11. Beacon and Beyond- Primary Care Transformation What Needs to Happen? Break down information silos to improve flow of data to providers across to inform decision making Enhance Access to care and continuity of care Track and Coordinate Care Measure and Improve Performance

12. Primary Care TransformationPatient-Centered Medical Home • The American Academy of Pediatrics (AAP) introduced the medical home concept in 1967, referring to a central location for archiving a child’s medical record. • In its 2002 policy statement, AAP expanded the concept to refer to primary care that emphasizes timely access to medical services, enhanced communication between patients and their health care team, coordination and continuity of care, and an intensive focus on quality and safety.    

13. Primary Care TransformationPatient-Centered Medical Home • In 2007, a set of guiding principles describing the characteristics of a practice-based care model was issued by four physician membership organizations representing over 300,000 physicians.  • The authoring organizations are:  • American Academy of Family Physicians • American College of Physicians • American Osteopathic Association • American Academy of Pediatrics The clinicians represented by these organizations provide the majority of primary care in the United States.

14. The PCMH 2011 program’s six standards align with the core components of transforming primary care. • PCMH 1: Enhance Access and Continuity • PCMH 2: Identify and Manage Patient Populations • PCMH 3: Plan and Manage Care • PCMH 4: Provide Self-Care and Community Support • PCMH 5: Track and Coordinate Care • PCMH 6: Measure and Improve Performance

15. Practice Transformation-what does that look like from the practice’s perspective? “Our work with asthma is just the beginning of managing all the practice patients with complex medical problems. As each patient sees a specialist or has contact with another health care provider, regardless of the location or institution, that information could then be sent to the medical home and …captured for surveillance, management, pay for performance, and quality improvement efforts. This can be done with minimal staff requirements and a high level of sustainability in an electronic environment. Scott Callahan, M.D., PediatricianChildren’s Health Care, Batesville INBeacon Community Physician

16. Practice Transformation-what does that look like from the practice’s perspective? “PCMH-It has forced me to stop and look at everything we do and make me be more mindful of every process. The PCMH model forces you to look at everything….as a physician my sense is that having gone through this process it has taken some of the fear of me being accountable for everything and put processes in place that give me assurance of a system to support the day to day pieces of running a daily practice. I have some assurance that things are not slipping through the cracks. The PCMC process has created a few efficiencies in our daily flow and we are still working on our journey of culture change. “ “Bridges to Excellence D5 measurements at baseline were at 9% compliance and we are now at 54% compliance with our current D5 measures. “

17. Thank you! Pattie Bondurant MN, RN Beacon Program Director HealthBridge pbondurant@healthbridge.org