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
Governance Board Governance Board Responsibilities Governance Board Leadership Training The SETMA Team and The SETMA Culture SETMA's Mission, Vision and Goals: Patient Safety and Quality Care Harassment, Neglect, Abuse, Exploitation - Role of HCAHPS & CAHPS Healthcare Provider Standards Providers Responsibility Medication Refills, Reconciliation and Maintenance Provider and Leadership Use of Data and Analytics Commitment To All Patients -- Ethnic Disparities Kaizen - Board Creates Culture of Safety and Quality SETMA's Policy and Practice for Advanced Directives SETMA's Policy on Completion of Medical Records Care Guidelines : Improve processes to evaluate and treat Integrated patient safety program (Sentinel Events) Effectively Manages all programs, services or sites Provides Patients with information about Primary-care Medical Home Organization-wide Planning to Maintain Focus on safety and quality Organization-wide Planning to Maintain Focus on safety and quality SETMA's Performance Quality & Safety Judged by CMS SETMA's Performance Quality & Safety Judged by CMS SETMA Awarded by HIMSS for Quality and Safety 2011 John M. Eisenberg Patient Safety and Quality Awards Application Healthcare Quality Award 2012 Principles of Quality and Metrics Principles Contacting SETMA & Secure Texting PC-MH Mission, Vision, Goal, Access, End-of-Life Communications and Public Reporting Change Existing Processes to Improve Performance Team Members Focused on Safety and Quality	Your Life Your Health View Articles by Subject Aging Well Behavioral Health Cardiovascular Disease Risk Care Coordination Care Transitions Children's Health COGNOS Project Diabetes Exercise Healthcare Reform:Public Policy HIPAA & Security Labor Day Less Initiative Medical Home Medical Records Men's Health Mental Health Nutraceuticals Nutrition Smoking Cessation Thanksgiving Weight Management Women's Health All Articles	Public Reporting Public Reports by Year (2009-2017) Public Reports by Type Fall Risk, Pain, Functional, Wellness, Stress Assessment Fall Risk, Pain, Functional, Wellness, Stress Assessment for 2011 AND 2012 Core Measures: SETMA & Baptist Hospital Core Measures for January to December 2011 PQRS Diabetes Measures - Blood Pressure Diabetes Measures - Glyco and LDL Diabetes Measures - Nephropathy Screening, Foot Exam, and Eye Exam Preventive Measures - Screening (BMI, Colorectal Cancer, Mammography, Osteoporosis) Preventive Measures - Influenza, Pneumococcal, Urinary Incontinence Preventive Measures - Tobacco Use NQF Care for Older Adults Comprehensive CHF Care Diabetes Measures Diabetes Measures - Blood Pressure Control Diabetes Measures - Glyco and LDL Diabetes Measures - Smoking Cessation Female Measures General Health Measures Medication Measures Persistent Medications Medication Measures Pediatric Measures HEDIS (NCQA) Effectiveness of Acute Care Effectiveness of Chronic Care - Clinic/Hospital Effectiveness of Chronic Care - Clinic Only Effectiveness of Chronic Care - Diabetes (Smoking Cessation) Effectiveness of Chronic Care - Diabetes (Glyco and LDL) Effectiveness of Chronic Care - Diabetes (Blood Pressure Control) Effectiveness of Preventive Care Effectiveness of Preventive Care - Older Adults Effectiveness of Chronic Care - Diabetes Measures Effectiveness of Chronic Care - Persistent Medications (MPM) NCQA Diabetes Recognition Program Audit LESS Initiative PCPI PCPI Hypertension PCPI Diabetes PCPI Chronic Stable Angina PCPI Care Transitions PCPI CHF PCPI Weight Management PCPI CKD Stages IV V SETMA Lipid Audit Lipids Treatment Audit Tutorial Lipids Tutorial AQA COGNOS Project SETMA Audit for CKD Stages I III Patient Satisfaction Survey	Accreditations/Awards Achievements which have Advanced SETMA: The Time-line, Philosophy and Principles which Underlie that Advancement Awards	Diabetes Center of Excellence Education Diabetes Order Referral Form Seven Stations 2011 Advances in Diabetes Diabetes Tutorial Diabetes Prevention
EPM Tools Association of Medication and Diagnosis Automated Team Function Behavioral Health Adult Weight Management Tutorial Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Behavioral Health in SETMA's Patient-Centered Medical Home Model of Care Depression Tutorial Fall Risk Tutorial Health Insurance Portability and Accountability Act (HIPAA) Privacy Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive LESS Initiative Tutorial Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Pain Management Tutorial Reduction of Antipsychotic Medications Toolkit Smoking Cessation Tutorial Stratifying End-of-Life Risk for Hospice Services Tutorial Chronic Conditions Tutorial Chronic Renal Disease Management Tool Tutorial Calculating the Stages of Renal Disease Proteinuria Disease Management Tools Acute Coronary Syndrome Tutorial Adult Weight Management Tutorial Angina Tutorial Cardiometabolic Risk Syndrome Tutorial Chronic Renal Disease Tutorial Congestive Heart Failure Tutorial Diabetes Tutorial Hypertension Tutorial Lipids Tutorial Lipid Quality Audit Tutorial Primary Pulmonary Hypertension Tutorial Framingham Cardiovascular Risk Cardiometabolic Risk Assessment Framingham Heart Study Risk Calculators Tutorial Frederickson Classification of Dyslipidemia LDL Level Lipid Disease Management Risk Assessment General principles about ICD-9 Codes and HCC/RxHCC Codes Charge Posting Tutorial Coding to Ensure Accurate Health Risk Scoring E & M Codes Tutorial HCC & RxHCC Risk HCC/RxHCC Risk Tutorial ICD-9 Code Training Manual Hepatitis Screening Hospital Based Tools Hospital Care Summary and Post Hospital Plan of Care and Treatment Plan Tutorial Admission Orders Tutorial Daily Progress Notes Tutorial Care Transition Data Set from PCPI Tutorial Using The Clinic and Hospital Follow-up Call Templates Respiratory Failure Tutorial Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Tutorial for SETMA's Internal HCAHPS Survey Master GP Suite of Templates Master GP Suite of Templates Tutorial Medical Home Support Materials Department of Care Coordination, Director of Care Coordination and Care Coordination Referral Template Electronic Tickler File Electronic Tickler File Tutorial Follow-up Calls Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Medical Home Coordination Review Tutorial Medical Home Plan of Care and Treatment Plan Medical Home Transtheoretical Model Assessment Stages of Change Tutorial Patient-Centered Medical Home Annual Questionnaires Patient-Centered Medical Home: SETMA's Medical Home Coordination Review (MHCR) Tutorial Patient Document for Coordination of Care Transitions of Care Management Coding (TCM Code) Tutorial Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial Nursing Home Depression Tutorial Fall Risk Tutorial Hydration Assessment Tutorial Nursing Home Guidelines for Care Tutorial Nursing Home Principal Suite of Templates Nutrition Assessment Tutorial Reduction of Antipsychotic Medications Toolkit Skin Care Tutorial Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds Preventive Health Tools Adult Weight Management Tutorial CHF Exercise Tutorial Diabetic Exercise Tutorial Diabetes Prevention Tutorial Exercise Prescription Tutorial Hypertension Prevention Tutorial Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Initial Preventive Physical Exam & Annual Wellness Visit Tutorial LESS Initiative Tutorial Progression to Type 2 Diabetes Smoking Cessation Tutorial Progression to Type 2 Diabetes Quality Metrics ACO and Medicare Advantage Stars HEDIS: NCQA, History, Quality, Safety, STARS, ACO ACO Quality Measures Performance Tool ACO Quality Measures Performance Tool Tutorial STARs - 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 - One form of Care Coordination HCAHPS - Hospital Consumer Assessment Of Healthcare Providers and Systems CAHPS - Consumer Assessment of Health Care Provider and Systems Teaching Tool for PC-MH Course – Patient Care Activation, Engagement, Shared-Decision Making Display & Explanation of PC-MH Tools SETMA's Medical Home Pilgrimage Concierge Medicine not Medical Home Medical Neighborhood Security & HIPPA Referrals Patient Web Portal Health Information Exchange Medication Reconciliation The Automated Team Coordination of Care Medical Home Description & Standards AAAHC Joint Commission NCQA Planetree URAC NCQA Interview February 14, 2014	Facebook	Letters

Providers - James L. Holly, M.D.

Chief Executive Officer

Adjunct Professor
Family and Community Medicine
School of Medicine
UT Health Science Center
San Antonio

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

Curriculum Vitae

A Brief Bio

Ted Carpenter, Letter of Transmittal

Provider's Responsibility

Publications

Teamwork

Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award University of Texas Health Science Center San Antonio School of Medicine
James L. Holly, M.D., receives 2012 Distinguished Alumni Award from School of Medicine
Auditorium named for HSC alumnus James Holly, M.D. -- The major auditorium at The University of Texas Health Science Center in San Antonio (750 seats, 400 annual meetings held in the auditorium) named the Dr and Mrs. James L. Holly Auditorium due to a multi-million dollar gift from one of Dr. Holly’s patients - May, 2011
May 8, 2015, Golden Jubilee of Northwestern State University Class of 1965 and Presentation of The Carolyn Bellue Holly Distinguished Professor of Teaching and Learning Endowment: and the Marie Cobb Bellue Scholarship for Teaching and Learning Endowment, and the Irene Woodruff Holly Scholarship for Health Education Endowment -- Carolyn Bellue Holly Distinguished Professorship Endowment for 50th wedding anniversary
Northwestern State University 2016 inductees into Long Purple Line News Press Release Long Purple Line -- Dr. Holly named Distinguished Alumnus, 2016.

Current Academic Appointments:

Adjunct Professor
Department Family and Community Medicine
School of Medicine
University of Texas Health Science Center
San Antonio, Texas

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

Curriculum Vitae

Academic

Northwestern State University - Undergraduate
Bachelor of Arts - History and Philosophy
1961 to 1965

Baylor University - Graduate School and Pre-Med
Master of Arts - History (course work completed)
1966 to 1969

University of Texas Health Science Center School of Medicine, San Antonio, Texas
Doctor of Medicine
1969 to 1973

2012 Distinguished Alumnus
School of Medicine
University of Texas Health Science Center San Antonio

2016 Distinguished Alumnus
Long Purple Line
Northwestern State University Endowments

2017 Aesculapian Laureate Society,
UT Health San Antonio Long School of Medicine

Graduate Medical Education

Internal Medicine Internship
1973 to 1974

Medical School Activities

Founder Health Careers Program for Minority Students
Director of Program
1969 to 1971

Organization of Student Representatives, Association of American Medical Colleges
Founding Chair
1970-1972

AAMC Executive Committee
Voting Member
1970 to 1971, 1971 to 1972

AAMC/AMA Accreditation Site Visit Cornell Medical College, New York City
Voting Member 1972

Medical School Activities Post Graduation

President of Alumni Association for four years (2006-2010) during which alumni support of the school financially was increased geometrically.
Endowed the Dr. and Mrs. James L. Holly Distinguished Chair in Patient-Centered Medical Home in an interdisciplinary setting between Nursing, Pediatrics, Family Practice and Internal Medicine at the University Health Center San Antonio School of Medicine. March, 2011
Endowed the Distinguished Lectureship on Patient-Centered Medical Home at the University of Texas Health Science Center San Antonio School of Medicine. Named the W.E. Bellue and William R. Holly, Sr. Distinguished Lectureship. - June, 2011
Endowed the Primary Care Institute at UT Health Science Center San Antonio with a $50,000 initial contribution - March, 2012
Endowed a scholarship for senior family practice resident to attend an informatics conference annually at Texas A&M School of Medicine - 2009
President Council, University of Texas Health Science Center San Antonio - multiple years
Chancellors Council, University of Texas System, Austin, Texas - multiple years
The University of Texas Health Science Center at San Antonio Development Board

Professional Activity

Emergency Medicine
Beaumont, Texas
1974 to 1976

Solo Practitioner
Beaumont, Texas
1976-1995

Southeast Texas Medical Associates, LLP (SETMA, LLP)
Beaumont, Texas
Founder and Chief Executive Officer
1995 to Present

Professional Positions Held

President, Golden Triangle Physicians Alliance (GTPA) and Independent Practice Association (IPA) of 250 Physicians - 1997 to Present
Chairman of the Board, GTPA - 1997 to Present
Medical Director, GTPA - October, 1997 to Present
Hospitalist, GTPA - 1997 to Present
Founding Board Member of Select Care of Texas, a Federally Qualified Physician Health Organization (PHO) - 1998 to 2009
Member of HIMSS Patient Safety and Quality Outcomes Committee, 2011
Member of National Quality Forum and invited participant in the 2010 Workshop on Care Transitions
HIMSS, Innovation Committee, June 30, 2012 - June 20, 2014.

Professional Achievements in Leading SETMA

National Committee for Quality Assurance (NCQA) Tier III Medical Home
NCQA Diabetes Recognition Program for all clinics
Association for Ambulatory Healthcare (AAAHC) accreditation for Medical Home
AAAHC accreditation for Ambulatory Care
Joint Commission Accreditation Medical Home, Ambulatory Care and Reference Laboratory
Diabetes Center of Excellence Affiliation
Agency for Healthcare Research and Quality HHS Accepted SETMA’s LESS Initiative for its Innovations Program
All SETMA Providers Successfully Completed Joslin Program and Designated as Certified Joslin Primary Care Providers
Office of National Coordinator, Health Information Technology, HHS through the Rand Corporation designated SETMA as one of 30 Exemplary Practices in Clinical Decision Support
SETMA awarded Gartner Business Intelligence Semi-Finalist for excellence in BI
SETMA award Innovator of the Year, February, 2011, by Healthcare Informatics Magazine
eHealth Initiative Innovator of Year award, January 2012

Time Line on Patient Safety Developments at SETMA

1998 - March 30, 1998, SETMA purchased NextGen Electronic Health Record and NextGen Enterprise Practice Management System.
1999 - January 26, 1999, first patients seen at SETMA on EHR. As of January 29, 1999, all patients seen at SETMA were seen with EHR and have been since.
1999 - Defining the value of EHR for the future of healthcare, “ More Than a Transcription Service: Reorganizing the Practice of Medicine With Computerized Patient Records (CPR).” May, 1999.
1999 - SETMA morphed from EHR to electronic patient management - “More than a Transcription Service Revolutionizing the Practice of Medicine And Meeting the Challenge of Managed Care With Electronic Medical Records (EMR) which Evolves into Electronic Patient Management,” October 1, 1999.
1999 - Began developing disease managements tools for diabetes, hypertension, lipids, CHF, Renal Disease, Cardiopulmonary Risk Syndrome and numerous others.

All of SETMA’s Electronic Patient Management Tools were written by Dr. Holly and are posted on SETMA’s website. They are offered for use by any healthcare provider without cost. See below for more detail: