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	James L. Holly, M.D.

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Medical Home - PC-MH Patient Engagement & Alternative Payment Models

This link is to the slide deck which was presented to SETMA’s providers at our monthly half-day training session February 18, 2014. Patient Engagement & Primary Care Physician: The Quest for the Holy Grail - A Patient-Centered Strategy for Engaging Patients. The full article can be read at: Patient Engagement & The Primary Care Physician: The Quest for the Holy Grail The two-hour session was one of the most “engaging” sessions we have had in our monthly training sessions. The discussion was vigorous and all of SETMA’s providers felt that this was a significant step toward our understanding and practicing of the dynamic of the PC-MH. Mr. Wilkins’ article’s subtitle is “A Patient-Centered Strategy for Engaging Patients.” I would recommend this article to any and all who is interested in going beyond the structure of PC-MH and understanding its dynamic and spirit as well. It is straight forward, thorough and practical.

This session was one in a series of very helpful studies of the “Patient-Centered Conversation.” The following link is to a publication of the FAMILY PRACTICE MANAGEMENT www.aafp.org/fpm March 2008 Ronald M. Epstein, MD, Larry Mauksch, MEd, Jennifer Carroll, MD, MPH, and Carlos Roberto Jaen, MD, PhD. SETMA providers studied this in August, 2013 and it was extremely helpful to us: http://jameslhollymd.com/Presentations/What-is-patient-centered-communication. Our patient encounters have changed significantly since then. (Note: Dr. Jaen is the Dr. & Mrs. James L. Holly Distinguished Professor of Patient-Centered Medical Home at the University of Texas Health Science Center in San Antonio and he is also the Chair of the Department of Family and Community Medicine in the School of Medicine.)

In August, 2013, SETMA provider’s studied the February 14, 2013 Health Affairs article on Patient Engagement:
http://jameslhollymd.com/Presentations/SETMA-8-20-13-Provider-Training-Health-Affairs-2-14-13-Patient-Engagement.

As a part of SETMA’s PC-MH Externship for senior medical students and for primary care residents in post graduate training, the following was produced and studied. SETMA.com | Medical Home | Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making, This tool was prepared as a plan of care and treatment plan for a real patient without any identifying information

SETMA continues to study PC-MH and we continue to learn. Today, February 19th, the Governance Board, Executive Management team and other key leadership of SETMA has an 8-hour strategic planning session scheduled which will focus on our immediate and long-view future, a great deal of which has to do with PC-MH and our preparation for the Alternative Payment Models being proposed. I believe that SETMA is well positioned to meet the challenges of the future:

The March, 2013, Commonwealth Fund white paper entitled, “Paying for Value: Replacing Medicare’s Sustainable Growth Rate Formula with Incentives to Improve Care,.” supports that judgment. SETMA providers reviewed this document in our April, 2013 Provider training session. That review showed that SETMA is currently doing everything that the Commonwealth Fund paper recommended for the future of healthcare payment. (See: Provider Payment Reform: Incentives to Improve Care)
The U.S. House Ways & Means & Senate Finance Committee Staff’s October 30, 2013 Discussion entitled, “Draft Sustainable Growth Rate Repeal & Medicare Physician Payment Reform” also supports that judgment. SETMA studied this draft in our November 19, 2013 Provider Training session. That can be reviewed at: Discussion Draft: Sustainable Growth Rate Repeal & Medicare Physician Payment Reform.

Payment Models Pro and Con including Payment for Value

The following is a summary of our structural and formal advances in PC-MH:

The National Committee for Quality Assurance (NCQA -- http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx) and has received the highest designation, Tier III, for 2010-2013 and 2013-2016.
Medical Home News - Spreading Medical Home Concepts Beyond Primary Care
The Accreditation Association of Ambulatory Health Care ((AAAHC -- http://www.aaahc.org/accreditation/primary-care-medical-home/) and has received the highest designation by AAAHC for 2010-2011, 2011-2014.
Medical Home News - Keep Calm and Become a Medical Home
URAC (Known only as URAC -- https://www.urac.org/accreditation-and-measurement/accreditation-programs/all-programs/patient-centered-medical-home-achievement/) and has received the highest designation as PCMH Certification with Electronic Health Records (2014-2017). Both AAAHC and URAC included multiple-day, on-site visits.
Medical Home News - The URAC PCMH Practice Achievement Program
March 3-5, 2014, SETMA will be surveyed by the Joint Commission for ambulatory care and patient-centered medical home -- http://www.jointcommission.org/accreditation/pchi.aspx.
Medical Home News - The Joint Commission Primary Care Medical Home Certification Program

If we are successful in the Joint Commission survey, SETMA will be the only practice in the United States and for that matter in the world which will simultaneously possess recognition and/or accreditation by all four organizations which evaluate practices for medical home. Even with this remarkable achievement, we continue to learn about medical home and about how to serve our patients better with this remarkable method of healthcare delivery.

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