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It’s the Systems! L. Gregory Pawlson MD, MPH Executive Vice President NCQA

Core Presentation. It’s the Systems! L. Gregory Pawlson MD, MPH Executive Vice President NCQA. Why Focus on Systems? . IOM reports: “ To Err is Human” and “Crossing the Quality Chasm”

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It’s the Systems! L. Gregory Pawlson MD, MPH Executive Vice President NCQA

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  1. Core Presentation It’s the Systems! L. Gregory Pawlson MD, MPH Executive Vice President NCQA

  2. Why Focus on Systems? • IOM reports: “To Err is Human” and “Crossing the Quality Chasm” • both reports provided substantial evidence on critical importance of systems (including evidence from other areas (aviation) • Evidence from a few RCT’s (measurement benchmarking and feedback) and studies with reasonable experimental design that systems appear to positively influence quality and efficiency • Research showing variance on process outcome measures explained more by site/group than individual clinician • Studies of Shortell, Wagner, Roblin and others on importance of structure and organization

  3. Focus on systems allows change from “blaming” individual clinicians for mistakes and shortfalls to actions related to improving systems to facilitate clinician success

  4. Wagner Model for Effective Prevention and Chronic Illness Care

  5. Moving from models to practice • Provide additional evidence of linkages between use of systems using structural measures, and both quality and efficiency process-outcome measures • Development of reliable and valid tools for evaluating systems presence to use for both research and implementing practice change • Create structural measures that are directly actionable and are free from major bias and confounds at physician office practice “microsystems” level • Sample size • Attribution • Need for risk adjustment • Link adoption and use of systems to payment

  6. Overlap in Content of PPC-PCMH-CCM Delivery System Design Patient Centered Medical Home ClinicalInformationSystems P P C DecisionSupport Self-ManagementSupport Community Support Wagner Chronic CareModel What’s Included?(Infrastructure) How Much Used?(Extent) What Functions?(Implementation) Evidenceand Scoring(Verification)

  7. Implementing and Evaluating PCMH Educational Support Office Systems Decision Support Information Technology Delivery System Design Patient Support Individual Clinician-Staff Attitudes, behaviors and proficiencies Inputs Patient Centered Ongoing Care Output MOC (Boards) Practice Evaluation Programs Evaluation Programs Tools Patient Experience of Care Measures (CG-CAHPS) Clinical Process & Outcome Measures (inc overuse, resource use) (Recognition programs and/or group/plan data) Office Systems Assessment (PPC)

  8. Linkage of PCMH to Reimbursement for “ongoing” care Payment per patient per month (or per year) for level of “Patient Centered Medical Homeness” Pay for Performance- Clinical and Patient Experience Fee Schedule for Visits/Procedures

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