Rural Health Webinar:Strengthening Health Systems in Resource-limited Settings

R.W. Watkins, MD, MPH, FAAFPInstitute for Emerging Issues (IEI) at NC State Universityand Duke University9 April 2014

What is the Multi-Payer Demo?

The purpose of the Multi-Payer Advanced Primary Care Practice “demonstration project” (MAPCP) is:

To evaluate the effectiveness of the Patient Centered Medical Home (PCMH) model, when supported by both public (Medicaid and Medicare) and private payers (Blue Cross Blue Shield, and State Health Plan)

To utilize care management for these other payer sources

What is the Multi-Payer Demo?

NC is one of 8 states that was awarded an MAPCP demo

7 rural counties across NC were chosen to participate in the demo: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga

Patient-Centered Medical Home

The PCMH is a model of primary care re-design intended to improve the quality and efficiency of primary care delivery

What we have… What we need!!

Atul Gawande, MD

Benefits of the PCMH Model

Quality – Outcomes for seven medical home demonstrations Fewer ER visits (15%-50%) Fewer hospital admissions (6-24%) Lower mortality rates Better preventive service delivery Better chronic disease care Higher patient satisfaction

Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013, January 2014

Benefits of the PCMH Model

Efficiency – Cost Lower total costs of care - (6.5-22%) Shorter patient wait times Less staff burnout/turnover (10% Vs. 30%) Higher staff satisfaction/productivity

Source: Neilson, M, et al. The Medical Home's Impact on Cost & Quality, An Annual Update of the Evidence, 2012-2013, January 2014

This is a No-Brainer! Right?

So Why Aren’t Practices RUNNING to implement PCMH for themselves?!?1. Time

2. Resources

3. Consultants are expensive

4. Fear

a) Gov’t interference

b) Loss of control/independence

c) Change

How Do You Get All This Done?

ASU Practicum in Primary Care

ASU College of Health Science, School of Healthcare Management

Watkins. Journal of Medical Practice Management,Sept/Oct 2012, Vol 28:2, pp. 134-6.

Creation of Partnership with Appalachian State UniversityPARTNERSHIP: Recruit ASU students from School of Health Care

Management Develop curriculum, syllabus, website, core

documents Create new practicum course with internship

opportunity Teach students about PCMH, Provider Portal, Care

management process Send students out to practices to assist in attaining

PCMH certification, BQPP cert and QI initiatives

ASU Practicum in Primary Care

Fall of 2011 – 5 students Spring 2012 – 9 students – BSBSNC

Foundation Grant Obtained Summer 2012 internship – 8 students Fall 2012 – 14 students Spring 2013 – 15 students Fall 2013 – 16 students Spring 2014 – 15 students

ASU Practicum in Primary Care

Developed curriculum, core documents, website https://sites.google.com/site/pcmhprac/

Program Growth

ASU School of Health Care Management has made the “Practicum in Primary Care” a CORE curriculum class

Students willing to spend 2 semesters with us get full credit for their internship (300 hours)

“Keeping the Medical Home Fires Burning” is a new initiative where practices that have been recognized work with students on QI projects

Program Growth

Remote Learning Initiative Students work with practices within 3 hours of Boone MOVI (secure) web-hosting Face-to-face visits every 3 weeks or so

CCNC’s PCMH Efforts

Beginning of MP ProjectBeginning of

MP Project

Rural Health Webinar:Strengthening Health Systems in Resource-limited Settings

R.W. Watkins, MD, MPH, FAAFPInstitute for Emerging Issues (IEI) at NC State Universityand Duke University9 April 2014