JamesLHollyMD.com

	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
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A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - 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Letters - 4 PC-MH certifications. Completed in 12 months and one week, July, 2013 to July, 2014

In the past 12 months SETMA has completed certification or re certification from all four organizations which offer PC-MH recognition. The following lists the name of the organization, the description of the accreditation, whether this is an initial accreditation or a reaccreditation, the duration of the accreditation by year, the date of the most recent accreditation.

- NCQA -- Medical Home recertification, recertification, (2010-2016),  July 2013
- URAC -- Medical Home & Ambulatory Care, initial certification (2014-2017,  February, 2014
- Joint Commission -- Medical Home and Ambulatory Care, initial certification (2014-2017),  March, 2014
- AAAHC -- Medical Home & Ambulatory Care, second recertification, (2010-2017),  July 2014

In the last six years, SETMA has earned the distinction

Of becoming the only practice in America to achieve Accreditation from all four agencies
Of becoming the only practice to achieve accreditation or reaccreditation of all four in a 53-week period.
Of having an accreditation surveyor say: "you have a wealth of information in your EMR which is awesome. SETMA has an excellent understanding and implementation of the concept of medical home which is I in my experience superior to anyone else in the USA. I have never seen a hospital care summary and post hospital care plan like SETMA's in my life. Your patient information and education documents are complete and easy to read. I have not seen any thing like this even in ____."
Of developing an Accreditation Team, which while fulfilling other patient-care responsibilities continually reviews the changing accreditation standards of each agency, making sure that SETMA not only maintains fulfillment of the standards under which we were accredited, but that even before our next accreditation survey, that we have Incorporated the newer and higher standards into our system.
Of having SETMA's Accreditation Team participate in accreditation education meetings, together continually expanding and deepening SETMA's knowledge and understanding of the process and requirements medical home.
Of having monthly provider, education meetings for continually improving patient safety and quality.
That while we are learning, we also are challenging these agencies to improve the content and deployment of their accreditation processes making them more relevant to real practice improvement.

With two years, July, 2016, before we cycle through this process again, SETMA will now focus on our becoming a true medical home, strengthening our infrastructure and practice of PC-MH.

Our goal is that by our 2019-2020 cycle of reaccreditation -- with ten years of practice as a medical home -- that our fulfillment of the ideals of medical home will be automatic and that it will bring great value to our patients, our providers, our practice, our profession and our community.

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

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