Southeast Texas Medical Associates, LLP James L. Holly, M.D. Southeast Texas Medical Associates, LLP

Medical Home - 2009, 2010, 2011 Medical Home Miscellaneous Articles
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Patient-centered Medical Home SETMA's COGNOS Project October 29, 2009
Addresses the relationship between SETMA’s COGNOS P:roject (IBM’s BI software) and PC-MH.

Reporting of Health Care Provider Performance January 28, 2010
Addresses the place of Public Reporting of Provider Performance by Provider Name as a key part of PC-MH. COGNOS is discussed and quality metrics are introduced.

Medical Home: Questions About Our Journey April 8, 2010
A summation of a national publication About SETMA and Medical Home. It addresses the history of our Growth as a Medical Home and the keys to our success.

PC-MH: The Power of Data in Designing the future of healthcare May 20, 2010
Demonstration of business analytics in the practice of Medical Home and Population Medicine

SETMA and the National Quality Forum November 11, 2010
A Review of SETMA’s relationship with NQF and the September 2010 Transitions of Care Conference held in Washington, DC. SETMA’s Experience with Care Transitions

Re-Evaluating the Value of Members of the Healthcare Team October 21, 2010
Addresses the need for changing the Perception and the function of members of the healthcare team In the PC-MH. Concepts such as “harmonics” and “disruptive Innovation” with “precision medicine” are also addressed.

A Review of 2010 and a Projection for 2011 December 30, 2010
A review of 2010 and a projection of what SETMA hoped to accomplish in 2011

Concierge Medicine and the Future of Healthcare January 27, 2011
Contrasts the new phenomenon of “concierge medicine” with Medical Home and shows why The similarities are only superficial.

Pilgrimage to a Patient-Centered Medical Home February 17, 2011
An article about SETMA’s journey to being a patient centered medical home.

Patient-Centered Medical Home - Care Coordination and Coordinated Care January 20, 2011
Discusses the concepts of Care Coordination and Coordinated Care. It discusses the traditional “care coordination” by physicians and Identifies seven deficiencies in that process. More details of the “baton” are given.

Reducing Preventable Readmissions to the Hospital March 31, 2011
Shows the relationship of PC-MH’s Care Transitions with the national effort to decrease preventable readmissions to the hospital.

Patient-Centered Medical Home and Care Transitions: Part I April 21, 2011

Two-part series on Care Transitions in the Medical Home. This part focuses on the four domains of the future of healthcare

  • The Substance -- Evidenced-based medicine and comprehensive health promotion
  • The Method -- Electronic Patient Management
  • The Organization -- Patient-centered Medical Home
  • The Funding -- Capitation with payment for quality outcomes

Patient-Centered Medical Home and Care Transitions: Part II April 28, 2011
Part II focuses upon the eight options when a patient is discharged from the hospital. It gives details about the “baton” which is the vehicle of transitions of care and Also discusses SETMA’s hospital follow-up call which is made by the Department Of Care Coordination

SETMA: Practices in the Spotlight Medical Home and Diabetes Care April 7, 2011
Summary of April, 2011 Patient-Centered Primary Care Collaborative (PC-PCC) Meeting and Dr. Holly’s presentation. SETMA is one of the ten Medical Home recognized for excellence in the treatment of Diabetes in the Medical Home Setting

Over-diagnosis - THE Problem? May 19, 2011
Response to the assertion that the Solution to healthcare reform is to change the standards For diagnosing a disease. If the standard is higher, fewer People will be sick, it is argued. While PC-MH wants to lower the cost of care, I argue that the solution is not found in changing the definition of disease.

Can More Care Provide Less Health?  May 14, 2009
A review of the Dartmouth/Atlas study on quality of care and patient satisfaction in the light of healthcare reform legislation

Care Transitions: The Heart of Patient-Centered Medical Home May 24, 2011
This presentation addresses SETMA’s 14-year development of the functions which allows us to do effective transitions of care. This is a brief summary of a presentation of the same title which has been given at multiple sites in 2011.