Situation: Payment reform is driving the need to improve quality, with much emphasis placed on practices becoming patient centered medical homes. PCMH has been shown to improve quality, affordability and patient satisfaction. http://www.pcpcc.net/evaluation-evidence
Background: There is evidence that the learning collaborative approach is a best practice to working together to improve patient care. The Iowa PCA and participating FQHC members have invested in the learning collaborative approach over the last two years. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869409/
Assessment: While 4 Iowa FQHCs have achieved recognition as of February 28, 2013, 2 submitted for recognition, others continue to work toward recognition for PCMH. However, we know that transforming practices into a PCMH does not end at recognition. Rather, this process takes years to accomplish and the work is never done. Additionally, recertification is required every three years and NCQA will issue new standards in 2014. http://www.clinical-innovation.com/topics/clinical-practice/health-affairs-medical-home-transition-can-take-3-5-years
Recommendation: Iowa PCA and participating FQHCs embark on the third year of the Medical Home Learning Collaborative. The PCA, with expert consultation as needed, will provide technical assistance to centers to improve outcomes and continue work of full practice transformation. Without active leadership engagement the transformational work typically worsens as transformation requires bold steady leadership for success. Monthly reports will be provided to health center leadership summarizing participation and technical assistance provided to teams and the progress of the learning collaborative as a whole with a goal of ensuring health center leadership takes a proactive role to make Year 3 the year of the leader creating a results driven organization. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869425/
Year 3 Medical Home Learning Collaborative
- Building enduring PCMH
- Data driven performance improvement and provision of care
- Focus on intent of the PCMH standards
- Maximizing participation
- Leadership call â€“ kick off meeting
- Quarterly reports to ED/CEO
- Face to face in June and December
- Peer to peer Calls
- Monthly coaching calls (may be more frequent if practice desires)
- Friday updates
- Data reporting: PCMH-A, Self-Assessment, and Clinical Data and other tools and assessments as areas of improvement are identified.
- Two site visits per center (may be more frequent if practice desires)
NCQA Specific Support:
Health centers recognized at Level 3 NCQA PCMH. The focus will be on transformation and developing specific areas of need. (4 centers) (1 Center pending level 3)
- NCQA developing areas (these areas may be more difficult in 2014)
- Educating the patient on medical home
- Deeper understanding of the intent of the PCMH factors (beginning with the must pass elements)
- Community health home (behavioral and dental integration)
Health centers not yet recognized or recognized at Level 1 or 2. (7 Centers, 1 Center pending level 2)
- These centers will move into first cohort when recognized at a level 3 NCQA PCMH.
- Technical Assistance with understanding:
- the factors of NCQA PCMH
- policy, process and workflow feedback
- well as documentation review
- Coaching calls more frequent than one per month to provide resources, tools and models to assist with PCMH work.
Tips on How to Use Your PCA PCMH Coach
Nagykaldi and colleagues concluded (through a literature review of 23 studies) that practices using practice facilitators increased the delivery rates of preventive services and also improved relationships and communication between providers, assisted clinicians with chronic disease management, provided professional education, and facilitated system-level improvements. http://annfammed.org/content/10/1/63.full
Coaches can serve as:
Facilitators who help practices achieve their improvement goals.
- Conveners who bring groups of staff members together to work through an issue.
- Agenda setters and task masters who help practices prioritize their change activities and keep them on track.
- Skill builders who train practices in quality improvement processes and assist them in developing proficiency in the techniques used in the Chronic Care Model.
- Knowledge brokers who know about external resources and tools and save practices from engaging in extensive searches for information or reinventing the wheel.
- Sounding boards who give practices a reality check and provide feedback.
- Problem-solvers who can help practices identify and surmount a stumbling block.
- Change agents who promote adoption of specific evidence-based practices.
Leadership Tips for Success
Leadership is a must to encourage staff to participate in the Medical Home Learning Community:
- Provide staff time to implement changes
- Facilitate staff involvement
- Encourage and empower staff
- Get to know and work with coach
Links to tools to support leaders as they support their staff to transforms as a medical home: